Wednesday, May 27, 2009

Loyalty, Compassion and a Good Constitution

In my mind, the three things that should be required for a CNA are loyalty, compassion, and a good constitution. If anyone can figure out a reliable way to test for these, let me know. Our work environments would improve greatly if everyone had these qualities.

I put loyalty first just because it's the most important to me. I don't mean loyal to your employer, I mean loyal to the residents. These folks live here year in and year out and just watch the help come and go and sometimes come back again. It must be hard for them to adjust to new people and personalities all the time. I have one resident who won't deal with new co-workers at all. They have dementia and seeing new faces puts them on the defensive. Now that I've been there for more than a year, while they don't know me, I think they recognize me. Most days they'll allow me to care for them and give them their medication. They'll smile and talk to me as best they can. If a new person tries to care for them, they get suspicious and refuse help, medication and anything else they can say "no" to.

Compassion is a no-brainer. No one wants to live in a Nursing Center. Sure, some of them become resigned to it, but none of them are really happy to be there. Being compassionate means comforting them and empathizing with them. This includes being kind even when they are angry, but being firm if you can't honor their requests. (I run into this a lot when a resident wants a pill that they don't have an order for. Sure, we have that pill in-house somewhere, but if they don't have an order for it, we can't give it.) It means offering alternatives when they can't have what they want. It means saying "What can I do for you?" instead of "What do you want?" when you enter their room. It means taking a moment after you've completed their care to see if there's anything else they need before rushing out the door. It means resisting the urge to put words in their mouths when they hesitate mid-sentence. The previously mentioned resident speaks in a word salad and gets angry when you try to correct them or fill in the blanks for them. I've learned to let them hunt for the word they want and try to figure out what they mean at the end of the sentence. Patience is a large part of compassion in this environment.

A good constitution is necessary because a lot of times we find ourselves working sick or injured. And we need to be willing to work, if possible, when we're ill or hurt. (Personally, my rule is that unless I'm vomiting, have diarrhea that can't be controlled with Immodium, or have a fever that can't be controlled with Tylenol, I'm working. And don't talk to me about spreading germs, we have gloves and masks and frankly, most of the time, we're contagious 24 hours before we even know we're sick, so we've already "shared the love" before we had to start taking Nyquil to sleep.) We need strong backs and strong hands because our residents need us to be their strength. We need to be able to smile and be kind even when our heads are pounding or our throats are sore. If I could infuse every cup of coffee or iced tea we drank with a +5 Constitution, I would.

Which brings me back to my initial question: How do we test for these qualities? Even if we had a test for them, would the people who had them even apply for the job? If a person doesn't have these qualities, can they be taught?


Patti said...

Work ethics. Everyone should have them, yet they are not taught in schools and CNA classes with any degree of seriousness. This lack of solid work ethic is common in all industries now a days, not just nursing homes and health care.

I don't think these things come natural to most people. I do think this stuff can be learned- but not via books and class time. It takes experience. Hands on experience where a person learns through example, trial and error, action and consequence.

Wisdom perhaps?

Loyalty as you describe it here is the place we all want to be...we want to stay loyal to our residents because we know they need us. The work environment does get in the way of it all, and we cannot disregard that. The poor pay, lack of benefits offered in more than half of America's nursing homes, the lack of good supervision and reward is a HUGE factor for those who do this work, but choose to leave individual facilities for others.

A dime more an hour might not seem like much, but to an aide it could be just enough to cover that electric bill or fill that tank of gas. Or pay the sitter.
Or buy the this work, by default it can be expected that high turnover will be common because there are no incentives and rewards for the performance of such HARD work.

My experiences tell me that people are not naturally compassionate when it comes to care giving to others. The younger a person is, the truer this becomes. There is a huge problem with disrespect for our elderly population. Not just from today's youth either- but other generations as well. I also see a lot of disrespect towards our residents from the very people charged with caring for them: nurses, aides, others.

I have seen nurses and aides treat their residents as though they were little children...and who disregard their rights as people using their "safety" as an excuse. Compassion should include allowing another human being to make their own choices, even if it isn't the right choice.

Compassion should include being an advocate for your residents. That means speaking up for them, defending them, making their case for them...and pushing others to do the same. Compassion doesn't mean we have to accept the way things are; we can become critical thinkers and ask, "WHY IS THIS SO?" or, "WHY NOT?"- and investigate further.

It does not mean forcing them to comply with our ideas and rules. We tend to forget our rules and ideas are for our convenience and nothing more. To try to say otherwise is silly. Empathy is a good trait to have. But I have known more than a few dozen handfuls of older people who have said empathy goes only so far when day in and day out, they are forced to endure things they really hate. Empathy does nothing to improve or change or better the environments these people live in. It is something to think about and it's not easy to do...being an agent of change is hard work but well worth it.

Constitution? When we're talking about attendance issues, this is a very gray area. Nursing is the worst profession when it comes to compassion among it's own! When someone is sick, with a bad cold or sinus infection, we rattle them to show up for work and wear a mask...think about that for a moment. Think about how that must make a resident/patient feel. We're supposed to be representing health. We don't when we have these expectations.

We can come to work with certain illnesses, but others we really need to be careful with- flus, stomach bugs and the like. It's not just the residents who are at risk- other staff as well.

I agree with the minor ailments and the simple things one can do to make them better. Pepto Bismol works wonders too!

A lot of attendance issues come with the overall dissatisfaction with the job. If one isn't overly content with their job, the slightest headache can be enough to keep them home. When an employee doesn't feel like they are part of a team, or is being treated well, will not give any more...the employee who feels respected and liked and all that, will give 110% and more.

K. Tree said...

I don't disagree with anything that you've said, Patti. I just try to rise above all this and take care of my Ladies (and Gentlemen, though these are fewer by far). I've said it before, this is not a job for someone who just wants to take home a paycheck. The reason they say this is a "calling" is because you don't get paid well, you don't get respected, but you strive to do good anyway. Lousy, but true.

I hope to be in this field long enough to one day see huge improvements in the way we do things. If I can stick it out until retirement age, I could be doing this for 25 years. I'd like to look back and say "Remember the bad old days when we got paid just above minimum wage, had no insurance and our charge nurses treated us like we were morons? It's so much better now."

Patti said...

I was being the devils advocate here, that's all. Trust me: Nothing irritates me MORE than people who call out for hangnails and when the weather is a habit. Nothing bothers me more than seeing a co worker dismiss a residents' concern or question; nothing bugs me more than those "What do you want NOW?" greetings in responding to a call bell. I call the "peer" on it every time it happens too.

I've gone to work with fever and headache and flu and pneumonia much to my residents' shock, but much to my bosses pleasure but with no **thanks***, and certainly no "You need to go see a doctor and stay at home!"...I've known aides who call out for a sore thumb, literally, and not just once but several times in a month...and nothing is said to them. At the same time an aide had a miscarriage AT WORK, and needed to go to the local hospital for the clean up of that. She was called at home the evening this happened and told she was EXPECTED to be at work the next day.

I don't earn a living wage doing this work. Far from it and I've been at it for 20 yrs now. New hires come in making MORE than I do because the starting wage has increased but the merit increases have not...

I show up for work in spite of all this nonsense. It is because of the residents and nothing else. If I were a single Mom I would not be able to afford to work as a CNA. Not at all.

Hopefully some day sooner than later we can both claim "those were the days"...but the days have not changed in my 20 yrs. If anything things have gotten worse because people have come to accept the current as the norm and are no longer trying to buck the system. Many see hope with the new President, but as of yet there are no indications he is interested in bringing any real change either.

Good thing some of us just like to do this...and always will. There are no tangible benefits to being a CNA.

So we have to make our own.

stinebean said...

I don't generally comment, but I'm leaving a note to say that I've been missing your words of wisdom with regard to the ltc field. Are you coming back to post again? I hope everything is ok.

K. Tree said...

Hey Stinebean,
Thanks for the note. Nothing's wrong except lack of an ISP. I really hope to be back online at the house by the end of July.