Direct Care Professional Network – Page 4

You’re thinking about becoming a Certified Nursing Assistant. You’re excited and want more information about this career. Some questions you might have deserve answers, and here we will try to do that.

1) What is a CNA?
A Certified Nursing Assistant is a member of the health care team. Always working under the direction of a nurse (RN or LPN/LVN) the CNA provides hands on nursing care to patients, residents, clients and customers in a variety of health care settings. CNA’s typically provide assistance with bathing, dressing, eating, toileting and oral care to people who cannot do these tasks alone. Also, the CNA is often the person who gets the vital signs, weights and height measurements.

The CNA has a high school diploma or GED.

2) Why be a CNA?
If you’re looking at a career in nursing, being a CNA is a great way to really test yourself on this goal. Being a CNA exposes you to many members of the health care team: You get to see nurses, physical and occupational therapists, doctors, med techs and assistants in action. You’ll soon know whether you have what it takes to further yourself in nursing; perhaps you’ll decide to move to another field of work within health care.
If you’re looking for a quick job to pay bills for a few months becoming a CNA might not be the right choice for you. Going through the training is hard work; being charged with caring for sick people isn’t something to be taken with a grain of salt. You have to the will and desire to help people…you’ll need patience and compassion. You have to be committed to a physically demanding job, with little tolerance for poor work ethic.

Career CNA: You won’t get rich doing this for a living. But you will gather experiences not often found in any other career. You’ll have pride over many accomplishments and you’ll make friends with people you would otherwise never meet. Being a CNA is one of the few careers where one can say they truly give it all for little in return. On the downside, your body will pay you back in a bad way if you don’t take care of it. You’re apt to hurt your back. If you get sick, plan to be at work regardless- and plan on getting sick more often than other people get in other careers. As stated above, the pay is not going to be rewarding- but the other rewards are priceless.

CNA’s don’t earn a high salary. You should be very aware of this. Many of who have been doing this for a long time notice new aides coming into the field, who get disillusioned over the pay. We’re paid by the hour; that rate is dependent upon several factors which include how much experience one has; what region of the country one works in and where employment is at.

In general, CNA’s who work in long term care settings (nursing homes, assisted living) earn the least; those who work for staffing agencies and hospitals earn the most. Belonging to a union also has an impact upon pay. Overall, wages for aides range from 7.00/hr for a brand new CNA at an assisted living center, to $20.00/hr for a CNA with 20 plus yrs experience, working for an agency. Average wages are in the area of 1$0.00 to 12.00/hr in all settings. Like I said you’re not going to get wealthy doing this work.

3) Where can CNA’s work?
In any setting provided there is a nurse to oversee the CNA’s practice. This is very important to remember. Always, CNA’s work under the direction of a licensed nurse. Don’t let anyone tell you otherwise. This is per federal and state statute, and it’s to protect the public. Only a licensed nurse can delegate duties to CNA’s. Doctors and therapists cannot. Families cannot. CNA’s cannot delegate to CNA’s.

Always keep this in mind- legally a CNA cannot practice on their own. Many aides place ads in newspapers offering their services as a CNA. This is illegal in all states! It’s okay to offer care giving services. Its okay to use your experience as a CNA; but it’s never good to claim yourself a CNA who is providing the services. When you do this, you’re delegating. And breaking the law. Be careful with this.

CNA’s are found on the payrolls at:
Nursing Homes
Home Health Care Agencies
Assisted Living Facilities
Staffing Agencies
Hospitals
Hospices
Doctor Offices/Practice Groups
Day Care Centers and Schools
Medical Clinics
Urgent Care Centers
An interesting note on potential sources of employment: The role of the CNA is mandated by the Federal government for nursing homes only. Other health care settings are not required by law to hire CNA’s…this includes hospitals, assisted living facilities and doctor’s offices (although not common). While all of these places do hire CNA’s, for good reason, they don’t have to.

4) How does one become a CNA?
Once you’ve decided this is the work you want, set out to locate a training program. Many nursing homes offer the training; the Red Cross does classes too- contact your local chapter. Tech colleges are another source where training is offered. Some high schools also provide classes- but mostly for students and not others. More and more, small private for profit schools are popping up all over the country. Offering a variety of specialty training, a CNA program is often part of this.

Costs of training programs vary by region and by the source. College classes are the most expensive followed closely by these Medical Ed schools; the costs including books is around $1500.00. One thing to remember when choosing a program is to make sure it is approved by your State board of Nursing or whatever State agency is charged with approving curriculum. This is vital to know. It does no good to take a course that isn’t approved.

Another important thing to know: Stay away from online and correspondence courses for Nursing Assistants. While these are great for basic knowledge most of these are not approved by most states. People who suddenly find themselves taking care of an elderly parent benefit most from these courses- not those with a serious interest in this as a career. You need clinical hours- real, hands on training in order to perform this work. You don’t get this with the online/mail order courses.

5) What Can I Expect During Training?
Plan on anywhere from 3 weeks of full time classes and clinical hours, to 8 weeks part time. You can expect to be challenged. Your knowledge will increase a lot. Some of the topics typically covered in a CNA course include:
Patient/Resident Rights
The Roles and Responsibilities of the Health Care Team
Legal Issues for Nursing Staff pertaining to the CNA
Medical Terminology
Infection Control
Medical Unit Environment- Safety and Proper Body Mechanics
Emergencies: Some states require CPR to be a part of this
Communication Skills
Documentation Skills
Patient Care: Vital Signs, bathing, dressing, moving patients, feeding, oral care, grooming skills
Patient Room Upkeep
…among many other skills. Most CNA courses cover the typical requirements and education you will need to be successful working in nursing homes, acute and sub-acute care centers, perhaps some rehab and restorative nursing instruction is covered as well. You will learn about caring for adults, children and babies. Some of this will include caring for people who are dying, and, how to provide postmortem (after death) care. Most CNA courses do not cover all the skills required for employment at hospitals. Most of these places offer their own special orientation for this purpose.

You should expect to do a lot of reading, and take many quizzes to test your new knowledge. You should know that 100% of your attendance is very critical to your success in any CNA program. Clinical hours refer to the portion of your training that takes you into the actual heath care setting- usually the nursing home. Here, you will be given an assignment of residents (not more than one in most cases). You will be expected to use your newly learned skills to show your instructor you can apply them on real people.

6) What happens after my training is completed?
Your instructor will assist you with scheduling a Competency exam administered by your state. This exam is mandatory and you must pass it. It will test your knowledge and competency with skills. Once passed, you are certified. In some states, you don’t need to wait to work however…there is a federal ruling that allows nursing assistants to work while waiting to take their exams, for up to four months. Many places won’t allow you to do this, for legal reasons.

The Exam is done in two parts: A written portion and a clinical portion. The written test is usually not too difficult- and this web site offers sample questions for you to practice. The clinical part is a bit harder. You have to bring a friend with you in order to complete this portion. The friend will serve as your patient, whom you demonstrate to the examiner, your skills. Bring a gait belt with you for use during your clinical exam.

The important skills the examiner will watch for will include infection control (hand washing– gloves!), patient safety privacy and dignity. Remember to close the privacy curtain. Remember to identify yourself to your “patient”, and remember to identify the patient! You will be asked to perform several tasks- usually up to five skills, but no less than three skills. These might include a full or partial bed bath; offering a urinal or bedpan; a transfer into a wheelchair; a complete or partial set of vital signs; making an occupied bed…any skill you learned in your training is apt to chosen by the examiner. Be prepared but don’t sweat and lose sleep over this. Your training should provide you with the competence you need to pass the exam.

You will be told on the spot if you pass or fail. The examiner realizes you are nervous and will expect some jitters from you. Mistakes are not the end of it; if you realize you made a mistake ask if you can re-demonstrate. Often this is allowed. If you do fail, ask about re-scheduling another test. Each state has different rules about how often a test can be re done and whether both portions need to be re-done.

Next, please read the following posts about other important information you will need in order to effectively work as a CNA. This info will provide you with details about aspects of this work you must take seriously.

Being Professional
The Nursing Process and the CNA
Observation Skills for CNAs
Legal Issues for CNAs
Job Interview Dos and Donts
7 Habits of Highly Effective CNAs

Good luck! If you choose to be a CNA, you will be rewarded in many ways.

Professional Boundaries

In this article, I want to write about a concept that should be well understood by all DSP’s. Here, we’re going to discuss what can happen when we become overly attached to a client, or their family and the implications this has upon the home.

One of the better changes for some group Homes is consistent staffing. However, this staffing model has created some unintended consequences.

DSP’s develop long term relationships with those we are charged to care for. We grow to love them and will do all the little “extras” for them. Usually this doesn’t present a problem for anyone. But there are times when our relationships become unhealthy- for us, for the client, for the other clients we’re assigned to; to our peers and to the program we work for.

Over Attachment
In group homes, DSP’s can become too attached to a certain client, in different ways. The DSP will be very upset if they are not assigned to care for this client, or, will use their relationship with this client as an excuse for being exempted from floating to other units. The DSP might spend inordinate amounts of time with this client, and therefore shortchange the others assigned to him/her. The direct care staff will always cater to this clients’ every whim before all others. This client will have more needs than all others as well- and these “needs” will increase as times moves along.

Sometimes, the client develops a fondness for a direct care staff that isn’t healthy. The client becomes dependent upon the direct care staff’s presence to be happy. He or she refuses to allow other direct care staffs to work with him/her. Clients have “bad” days when their favorite direct care staff isn’t at work. I have seen clients who believe they are “in love” with their favorite direct care staffs, especially those with mild dementia. I’ve also seen direct care staffs who care for clients in short term rehab centers develop “crushes” on these clients. The age difference between client and direct care staff isn’t that far apart.

Other assigned clients are neglected. Often. Or, the needs of these clients are tended to by the DSP’s peers. This creates a problem for everyone. Resentment sets in and working relationships suffer.

Being Objective
One of the problems with this arrangement, as it’s often called, is when the direct care staff loses his or her ability to be objective. This is a serious concern. We must be able to truthfully report the conditions of our clients. This includes, but isn’t limited to, the clients progress or decline in all areas: Ability to speak, bath, dress, feed self, walk- are all very important. The DSP who is too close to certain clients isn’t able to accurately describe the client’s true abilities.

This effects the client directly: A client who cannot really dress herself can be assessed as being able to do so. This might end up in a care plan…and other direct care staffs who work with this poor client will get frustrated at THEIR ability to motivate this client. Families are told their loved one can still dress herself when in fact she cannot, and hasn’t been able to perform this task for a while.

We have professional boundaries
DSP’s are considered to be the professionals in the care giver-client relationship. A DSP is expected to maintain a therapeutic relationship and not anything else. We have the upper hand because of our knowledge and skills. We are responsible for the care we deliver. Within the ethical discussions on this subject, the care giver always has power over the client. Many times these relationships are for the benefit of the care giver and not the client.

When the care becomes intertwined with personal friendships and over-advocacy, it’s not healthy. What is OVER ADVOCACY? It’s when we demand clients be given care, therapies and attention they don’t truly need. This is often where over attachment to a client’s family starts. This is another whole problem- and the legal implications are high.

Ask yourself these questions. And be honest. If you can answer more than two of these with a YES, then YOU are crossing the professional boundaries. And setting yourself up for a lot of trouble.

* Have you ever spent off-duty time with a client/family?

* Do you keep secrets with clients/family?

* Do you become defensive when someone questions your interaction with a client/family?

* Have you ever given gifts to or received them from a client/family?

* Have you felt possessive of a client/family, thinking that only you could provide the care the client needs?

* Have you ever flirted with a client?

* Have you chosen sides with a client against his or her family and other staff?

If you find that you’re overly attached, how to manage that? It’s not easy. The first step is recognizing you have a problem. Then, it’s a matter of distancing yourself from the client. For some direct care staffs this is best done gradually. For others, a total cut off is appropriate. Many times, when the bosses see these problems, they’ll assign the direct care staff to another unit altogether, effectively ending the relationship. I don’t think this is a good way to do this.

A DSP can ask for a change with their assignment. Being open and honest about this will almost always result in getting the changes you seek. Part of being PROFESSIONAL means keeping staffing issues to yourself. The urge to tell the client, or the family, a change has taken place might be very high. It’s best to leave these discussions with the nurse. And, after the client and/or their family is informed, THEY will prod the DSP for information. Again, professional boundaries must take precedent over individual staff needs.

A note about being attached to client families.
It’s not as common as client-DSP friendships. But it’s much more dangerous. And, many times these relationships are initiated by the DSP.

Often times:
A family will block out all others in the home and depend upon the direct care staff for all communication. The direct care staff will be put into situations they are not trained and educated to handle. Every word the direct care staff speaks will be heard and recalled. If the direct care staff doesn’t have the right information, or misspeaks, a lot of trouble can arise, legally.

The direct care staff will become a spy, for the family. DSP’s are privy to some information that is private and confidential. The levels of care for other clients is an example. When we have over bearing families seeking information from direct care staffs who are all too willing to share, it creates huge management problems. It sets the stage for a turbulent relationship between the HOME and the family.
Some direct care staffs like to think families have some super power over a home. This is simply not true. Government regulation and oversight have “power”; as do legal standards.

Other direct care staffs will use the family in an effort to be assigned to the client they want. From my experience, these clients are almost always the ones who are considered “easy to do”– and the direct care staff is simply seeking a guarantee of being assigned to this client. There has been some evidence of direct care staffs seeking permanent assignment to certain clients in hopes of getting some monetary award. These situations are always unethical. The direct care staffs involved in this should be terminated from employment and barred from working as direct care staffs ever again. They are opportunists.

No matter whether a DSP is overly attached to a client or their family, it’s not usually healthy. Most times the only way to stop the problems associated with these relationships is to separate the direct care staff and client. Perhaps, consistent staffing would better serve all if the assignments changed every so often. A couple times a year and all direct care staffs would be required to change no matter what family requests are. We all want what is best for the clients. Sometimes though, in order to insure this is happening equally across the board, we have to make adjustments and changes.