The Trials & Tribulations of a NHA

Hi All;

I have been a LNHA for 3 years now. I suspect that like me, the majority of you chose this profession to make a difference in the lives of our Residents. I have been in the industry for almost 30 years and have worn many hats (SW, Surveyor and now LNHA). It seems to me that the current LTC environment is NOT conducive to quality patient care. The MOM & POP nursing homes have met their demise & have been replaced by the large corporations. Profits before people has become the norm. Sadly to say, I have become disillusioned with the current system as well as the poor work ethic of the line staff who call out at the drop of a hat & display an overblown sense of entitlement. ( i.e - won't work nights, week-ends or take call, only want to work 7 to 3, and won't accept assignments which are not to their liking). To add to the problems, corporate directives to shave expenses and increase profits have eroded the progress we have made since OBRA came into effect. I have seen many folks burn out and have their NHA licenses (and livelihood) put on the line due to all of the above. Also, I have had many sleepless nites worrying if the staff are going to show up or if staff will remember to implement care plans so that we can prevent another fall with injury (which I will have to report and be held accountable for.) Those folks who think they can enter this profession without any LTC experience are kidding themselves. They may be the darlings of corporate staff, but will not be able to hold their own when the state or federal surveyors come knocking. The system is clearly broken & I am not so sure it can be fixed. That's just my rant for the day about some of the minefields which NHAs must navigate on a continual basis.

Wow! Now I feel badly for my NHA. I have been CNA for twenty years. I can agree that the CNA"S do have their own thing going on. I do know the reason why. I hope that you want to hear it so that maybe you can help your own situation with your staff issues. Aides in general, feel that they have gone to classes to get a certificate that they have worked hard for and received. I for one feel very confidente in my skills as a CNA because I have worked strickly LTC of all of these years. A lot of the peoblems come from your front line staff feeling like the Administration is more intrested in the business part of the job as opposed to what the actual patients are doing. I think I can say that if the line staff felt that their Administrator cared about what type of a day they are having every day, and if they were really feeling lilke they were appreciated for a job well done, your staff would show up every day, knowing that they were going to see their Aministrator every day not to make sure that they are doing their job, but to see them, just saying thanks and good job. The relationship between line staffers and Administration should be there as far as respect for each other doing the jobs that they were hired for, but the ridgessness of Administrators with the attitude that, thats who they are and that they should be treated above every one else is the air that is given off and so staff tend not to be very comfortable giving ideas or even having a general conversation with the Adminestrators.All this makes staffers not want to be at work because we all know what type of a gruling day it can be. Some days ,you cant get yuorself to go because you have heard no appriciation in a long time and you cant handle the thought of every one wanting something from you for the next 8 hours of the day, and no thanks, again.Please try and go see your staff everyday and thank them and let me know what happends.

I am an Asst Administrator working in a union environment in a nursing home. I very much care about both the residents and staff, but I realize, I am not the norm. When I go around thanking staff for coming in, or for doing a double during a snow storm, they look at me in amazement. The administrator and I went around after survey to thank staff for a job well done. Again, they were amazed. Prior administration stayed in their ivory tower. I agree that it is very important to tell staff how important they are. They need to feel supported.

Even in doing this, I still see CNAs sitting around reading the paper while on duty. They don't even cringe when I walk by. No work ethic, it's unbelievable.

I just don't understand people who work in the nursing home field that don't like their jobs. GET OUT if you don't like it.

Thanks for sharing that with me.When I went to CNA school, belivve it or not, it was a 7 month course. I took it through the Red Cross. It was an excelentprogram. I think that now they push the CNA's into work after 3 weeks of training, and the girls are around 18 years old. I think that the whole section on compassion and dignity of the elderly is not being taught properly, and because most places start their aides out at over $10, its a job with benifits and decent income. I look forward to your next post.

Georgia said: Thanks for sharing that with me.When I went to CNA school, belivve it or not, it was a 7 month course. I took it through the Red Cross. It was an excelentprogram. I think that now they push the CNA's into work after 3 weeks of training, and the girls are around 18 years old. I think that the whole section on compassion and dignity of the elderly is not being taught properly, and because most places start their aides out at over $10, its a job with benifits and decent income. I look forward to your next post.

I have to wonder whether or not the CNAs know what they are getting into. When I used to interview volunteers, for example at a former job, before the interview, I would walk them around the NH and watch their faces, body language and reaction to the elderly. If they looked at all uncomfortable, I would ask if they really wanted to work in a nursing home. Do these future employees do any on the job training like nurses do clinicals, prior to graduation?

I live (and lead) by the rule that I would not ask or expect anyone to do anything which I would not do myself. I and the dept. heads have been visible on the nursing units throughout each day. We all answer call bells, and help transport residents. I have fed residents, helped to pass trays,stocked supplies for staff, served in the dining room and have hosted activities at night for residents & staff. We have bent over backwards to try to improve morale and teamwork and to let line staff know that what they do everyday is appreciated, and that we are all here to help each other. Dept. heads have complained that when they walk into residents' room to help out the C.N.A.s, the C.N.A.s leave the room and go on break- leaving them to do the work. We hosted monthly birthday parties for our staff where the facility pays for lunch (they can order take out of their choice) Last month, the C.N.A.s boycotted the birthday party because we would not buy them lobster. We have monthly raffles for line staff (gifts paid for by me or dept. heads., give out scratch tix for good attendance, gift cards for going above & beyond, an employee of the month award,and each month, every staff member also gets a ticket for a free lunch from the kitchen. It seems that no matter what is done it is not good enough. Words of thanks and praise haven't worked... Maybe I am just getting old... but I think the work ethic isn't what it used to be and the sense of entitlement is outrageous. Most of the C.N.As are great- however there are a toxic handful of staff who poison the environment and make life difficult for all. If anyone has any ideas on how to deal with these issues please pass them along. The renegades have run out any new staff we bring in, complain about anyone who tries to hold them accountable and have burned me out.

Hi Georgia;

C.N.A. courses in MA nursing homes or training schools generally run for 90 hours including classroom and labs and 24 hours of clinical experience. The C.N.A. courses at the Community Colleges run up to 6 weeks and exceed state requirements. I think you are right on when you say that we are putting C.N.A.s into the field with only minimal training and hands-on experience. Even though they have passed the written and clinical skills tests in order to be cerfified- they are not really prepared to handle the job. Perhaps if the clinical experience was longer - these training programs would be able to weed out the bad apples and could pump out better aides. Oh wait-- that would mean that they could demand better wages- and we all know that corporate America is not going to go for that. I think C.N.A.s are, in most places, overworked and grossly underpaid. The C.N.A. to patient ratios most homes are running also set up C.N.A.s for failure. I have seen nursing homes which expect C.N.A.s to provide care for up to 15 residents on the day and evening shifts. IMPOSSIBLE!! My C.N.A.s had 7 to 8 patients each on days, and evenings and still complained they were overworked. I know most homes don't staff that well.

I live by the same rule. I wouldnt ask them to do anything I wouldnt do myself and most of the staff int he facility I was at seen me do it. From passing medications to working as a cna to cleaning up rooms with housekeeping. I have always felt that it helps the comrodary if they see you do the jobs they do. Even thou the jobs we administrator have is a hectic one its never a good idea to not thank your line staff. remember they are your eyes and ears on the floors.

That is the same ratio that I work with now, and yes there are many homes that expect the aides to care for 15 ersidents each a shift. As far as CNA's go,if you dont tell them exactly what you want of them from the second that they walk in the door, they will do things their own way. The facility that I am at now is actually a Mennonite Community and the best place that I have worked as an aide. We are getting ready to implemet a real good mentor program which will give the mentors a say in whether they feel the person is qualified.I think that this will help, but tell me, why does it take so long to terminate an aide when it is ovious that they can not fullfill the job requierments?

If the aides are complaining about being overworked,and only have 7ersidents then you have some lazy aides that do not want to work at all and need to get the heck out of this business.lol.I worked at Manor Care for 15 years, and they had a program there that was called Circle of Care. It was like a refresher every year that actually helped the staff remember why the chose this type of job. I hsvent seen any other place use this program, but if you can get hold of it, i would sy that it would do a whole lot of good to implement that type of training. There is even a song that goes with it. it was great to go to every year. Its easy togo from home to home and get a job, and if you are not a great aide, they keep you just for the staffing.

I feel the same way about some of the things you said, but I feel that the survey process is part of why the nursing home industry is going down the crapper. The survey process is so adversarial that you think about covering yourself first and the patient second.

As for what you guys are talking about with the staff, you have to get rid of the bad ones, and the good ones will love you for it. You can always find a reason to fire someone, and if someone is a jerk, that makes it just that much easier.

I have read a majority of the post and agree to some degree on postions regarding the work ethic of STNAs. I started out as an aide was feed up with poor leardership and lack of team work so currently I am an AIT.

From an Aides's perspective, aides are fed up with the same mundane and routine way of care practices, lack of appreciation, and not involved in any key decisions regarding patient care of issues concerning their profession. Leaders must think outside of the box and create ways to empower your employees not only by assisting with STNA responsibilities. Aides also require respect and are not going to accept being treated like they are not valued. The aides are the heart of every nursing home and should feel that way. Another problem is the good stna's that sincerly care are usually the first to be terminated while the cancerous stay doing what they desire which ultimately affects the residents' quality of life, quality of care, and their rights.

It is also important to understand the current trends and cultures of all employees. A percentage of the Aides are single parents and have been forced to enter the workforce by the system because of a reduction or terminiation in benefits. A great deal of these single women are young and have not developed maturity or understand the meaning of strong work ethics. As leaders we must think outside of the box and create plans to empower employees. Aides need to be educated on how to balance the work and home life. There are a few aides who desire to pursue a higher education but it is almost impossible when you are a single parent and have lack support, just imagine not being able to accomplish a dream and just settling it is quite frustrating.

I also believe a contributor to most of our challenges in life is our country. We are at war against ourselves and dealing with divisions from the past, such as discrimination. Change began with leadership. The only hope we have is in our Creator!

I would like to also encourage Admins., not to give up in supporting and encouraging your staff. It is also important to create stress relieving techniques all staff can enjoy.

Satisfied staff means satisfied residents its the circle of life in the nursing home sphere. If your facility is not cohesive expect problems but as Admini we must always have a plan of action because we are ultimately responsible for the livehood of the facility.

Be postive and you will become a magentic force to attract other postive people. I also suggest developing a personality test when selecting employees that will uncover any demises. You can not heavily rely on references these days!

Let's get radical leaders!