I come from a family of nurses and engineers, and while as a child I did not plan on working in health care, its only natural that I would find myself working in this field now. I have always had a love of the elderly and have been very empathetic, and wanted to be an activities director for a long time. When adulthood rolled around however, I compared wages and realized that I would be better of getting a CNA certification, since it was quicker, there was a higher need for good CNAs and I could really get a feel for if this was "right" for me.
What is a CNA? A CNA is a Certified Nursing Assistant (in Washington state, they are titled NACs, or Nursing Assistant- Certified in order to distinguish them from Certified Nurse Anesthetists). With my license I can take vitals, perform activities of daily living, help with toileting, and other intimate but necessary things. I am also certified to perform CPR and use a Defibrillator, however since most of the people I work with are DNRs (Do Not Resuscitate), it is unlikely that I will ever use this at my current job.
There are several places to learn how to be a CNA in Kitsap County, some facilities offer it for free, this college offers it as a program. I am very glad that I managed to find a free class, since I don't make an amazing amount of money and training can become quite expensive very quickly.
I started out on NOC shift, which is from 10 pm to 6 am. I was actually already on that kind of a sleep schedule since I have chronic insomnia, so it worked great for me and my body. Quickly I learned that the majority of my job would not be what I learned in my class though, it wouldn't be bed baths, or brushing teeth, or other random things, it would be changing diapers, or "attends".
I learned how to change a diaper, not in my CNA class, but on the floor after my clinicals. I felt largely unprepared since I was not doing any of the things I was taught on my shift, it was a bit of a "baptism by fire". I felt fairly comfortable with the process, but was slow after the first week, then I gradually began to speed it up and felt confident. Id say it took about 3 months to feel completely settled in to this job, but I think that may be the case anywhere really.
The routines on other shifts are all different, but most CNAs at my facility have not worked NOC shift and have no idea what it entails. On NOC shift, we change people usually 3 times a night, between 10-11:30, 1-2:30-and between 3:30 and 5. It usually takes at least 45 minutes a round, and even more time later in the shift.
Some other things we do include passing out hot chocolate to the residents that wake up and giving them a sandwich or some applesauce or yogurt if they are dysphagic. Sometimes people will snack and go back to sleep or watch some tv or netflix.
We also clean utility rooms, clean wheelchairs, do charting on residents and record their outputs for the nurses, so if they are not having a sufficient amount of bowel movements the nurse can give them something to help "move things along". Sometimes we still have a lot of free time, so its always a good idea to bring a book to read.
I have learned several things working this shift, but here are a few tips I have if you ever find yourself in a caregiving position, or are considering taking a job like this:
Focus! I have ADD and am absolutely awful at staying on task, its important to know how to focus without making the process too formulaic in your head and causing undue anxiety.
Don't get hit! If you are dealing with someone with dementia, this can be a confusing process for them and they might think you are molesting them. Its not fool proof by any means, but it is always a good idea to tell people that you are going to change them before you start pulling down their pants. How would you like it if someone you didn't know went in your room in the middle of the night and started undressing you and pushing you around?
If they are uncircumcised men, don't forget to retract the foreskin while cleaning them. I have seen some nasty infections because people forget to do it or are afraid of hurting the man. If you are gentle, it shouldn't hurt unless its already damaged. They will be in much more pain if they have an infection, trust me.
If they start swinging, do your best to speak soothingly and calm down them down. Don't be afraid of grabbing another person and having them help you, since your personal safety is what is most important. You can play Good Cop/Bad Cop or have them hold down the flailing appendages while you quickly (and gently) change someone. I had one resident who was refusing any and all changes and was extremely combative, it took 4 of us to change him. I wouldn't have bothered with him by myself since he was clearly dangerous, he already put one of my coworkers on light duty since while we were each holding a hand, he grabbed me and threw me against the wall, which jerked her and badly hurt her back. He later ended up having to be sent to a Geriatric Psychiatric ward where he passed away after trying to smother his roommate with a pillow and wrapping his hands around a nurses throat.
Don't be afraid to talk to the people! If they are awake at 4 in the morning, they probably don't mind a little conversation if you have the time. It makes them feel less awkward, and unfortunately they may not be getting as much social stimulation as they may like during the day. Also, its easier to sneak them candy this way, since no one is there ;) I would keep chocolate on me in case one resident wanted some, he had quite the sweet tooth.
Stuff a cloth in their crotch as you are rolling them, some people urinate forward and it will get EVERYWHERE. Also, be careful when pulling out an incontinent pad if you don't know the contents of the situation. I have been splattered with biohazard body fluids before and it was definitely a nasty experience, I threw those scrub pants away.
Make sure there are no wrinkles in the pad, and make sure their feet are floated if necessary to prevent sores. My facility actually has had very little episodes of bed sores seen among their residents, which is awesome (the few that did have them were usually hospice and were even more vulnerable than usual).
Do not pull hard on the diaper when you are taking the dirty one off of the resident. You can damage the skin and cause tears and abrasions. Make sure the diapers fit during all of this, it needs to be snug enough to hold in the fluids but loose enough to not cut into the skin.
Always put Protective Ointment on their bottoms after every incontinent episode, it keeps them fresh, protects them, and smells great!
If a resident has a history of accusations against staff, go in with another person, protect your license. Incident reports have to be filled out and it will be reported to the state, it will be subject to an investigation, even if it is completely ridiculous. For example, I had a resident accuse the kitchen staff of beating her up and shaving her head. While it was obviously not true since she had no bruises and all of her hair, there was still a pile of paperwork to do.
Do not treat the residents like children, they are adults. Be smart about how you talk to them, especially nicknames. I have one resident who has 1 nickname, but I call her grandma even though its not on her careplan because that is how she refers to herself to me ("Now remember, Grandma loves you very very much!"). I have one resident who was a psychiatrist and only wants to be called "Dr.____", I would not use "sweetie" with her since it is against her wishes and almost disrespectful.
Finally, be compassionate. Just because someone cannot verbalize their discomfort or distress does not mean you should be rude, cruel, or apathetic towards them. Nursing is incredibly demanding, emotionally, physically, and otherwise, but no-one deserves to be your punching bag.
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