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 The MOM & POP nursing homes have met their demise & have been replaced by the large corporations.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!

dtill in Massachusetts said: 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.

I work in a small nursing home in Mass. 4 aids 1 1/2 nurses per shift we get nothing from knowone no thank yous, no nothing!

chris in Brockton, Massachusetts said: I work in a small nursing home in Mass. 4 aids 1 1/2 nurses per shift we get nothing from knowone no thank yous, no nothing!

Hi Chris,
I want to thank you right now for all of the hard work that you all do there. I know first hand what its like to be an aide and its real hard work.I think that sometimes when I am feeling like I am not getting any appriciation for my hard work, I look to the residents that I am caring for to get my satisfaction. When I walk into a room and the resident smiles cause they are happy to see ME, that is what makes it all better for me. Keep up the good work that I know you do!!!!
Georgia

I took a CNA course at a LTC facility. A week long course followed by two weeks of skills training. The skills training amounted to working for the facility for free for two weeks and the staff signing off on my skills whether seen or not. I continued for another month waiting on the state to test me - working for minimum wage training on the job with my peers. They were over worked - had no time and I was taught their short cuts.

The short cuts were necessary to complete the assigned tasks in a shift. Short cuts normally amount to lifting patients by yourself even though protocols and paperwork say two person lift - or even mechanical lifts. The aides know who they can lift by themselves to save a few seconds. Every LTC facility knows that the aides are using these short cuts in order to get things done. Admin has a dont look, dont tell policy. As long as work is getting done, they dont care how the aide gets it done. It is only when someone gets hurt that they stand up and posticate about the rules. And then have another inservice about the proper way to lift - whatever.

And I believe with all my heart that you have aides that are reading the paper when you walk by - shame on you for not firing that person right now. Somewhere you have an aide doing double duty and taking dangerous short cuts because the paper reader is on the payroll and not doing their share of the work.

Another thing I found most interesting of all as a new CNA - it is the CNA that makes the least amount of money in the nursing staff and yet they spend the most of their personal money to provide items of comfort to the residents. The CNA brings in lotions, shampoo, conditioner and other little items that make the resident more comfortable and the LTC facility a little more liveable. They physically hug the residents, hold their hands when they cry and are there for them.

Than you for saying that so beautifuly!!!! That is exactly right. I have been an aide for 21 years and you are teh very first person I have heard say it wxactly right. Wow. I was just shocked reading it. Why is it like that? Can I please quote you if I ever need to? It would be a great pleasure to be able to use your comment. Thank you again for representing the CNA's point of view so to the point ans truthful!!

We are about to open a small nursing home in a small country town in northeast Georgia and looking for an administrator with experience if anyone knows anyone that would like to apply for the job. It will be between six and twelve months before we get construction done and open. We are starting out with 30 to 40 beds so we are small and going to focus more on the residents.

hrental in Clarkesville, Georgia said: We are about to open a small nursing home in a small country town in northeast Georgia and looking for an administrator with experience if anyone knows anyone that would like to apply for the job. It will be between six and twelve months before we get construction done and open. We are starting out with 30 to 40 beds so we are small and going to focus more on the residents.

hrental: I am an experienced NHA licensed in Iowa and am looking to relocate to Georgia from Iowa, and the time frame of 6-12 months works perfectly for me. Could you please send more information on this opportunity or a link to the application/process of application?

nha in Waterloo, Iowa said: hrental: I am an experienced NHA licensed in Iowa and am looking to relocate to Georgia from Iowa, and the time frame of 6-12 months works perfectly for me. Could you please send more information on this opportunity or a link to the application/process of application?

Hi, I am out of town right now plus we are just in the process of finding property for this venture. We would be interested in talking with you in the next couple weeks. Just curious why Georgia, how long have you been a NHA and how much experience do you have? Just a little quick history. Would it be an option for us to call you in the next couple weeks as well as aplication. I will be talking with my partner in the morning and the realtor at the end of the week. Thanks for your interest.

It would probably be easier to contact me through my personal email address at ericolson7@hotmail.com. I hope to hear from you.

I've been administrator of eight facilities, from 30 beds to 350 beds. The CNA is the backbone of the facility. That being said, I am forced by the economics of LTC to rely on the lowest paid people to do the best possible job. That's not an equation that generally works. At each facility there has always been a core of long-term licensed and un-licensed staff, who show up and try to do the best they can with limited resources. Then there is the group of people that rotate in and out on a constant basis. Twenty-five cents more an hour is a lure when the the wages are low.

At the administrators level its completely about census and case mix. The corporate office is on the phone three times a day wanting to know what the Medi-care census is, what Medi-care admissions are expected and what my action plan is to get a higher quality case mix (higher paying) Medi-care admissions. IT IS COMPLETELY DISGUSTING.

If you have any delusions that you are going to be an administrator and help people, let me disabuse you of that notion. It is all about money for the corporations.

If you want to help people, go to medical school. Be the dog, not the tail. The corporations will do nothing but make you wag your tail to please them.

what is the average medicaid usually pays for a long term care patient on a monthly basis? what is the overall net profit margin at your present facility?

Well my problem in the LTC field is the lack of opportunities for new NHA. I have been in LTC for 10+ years and have my license however no one is willing to take a chance on a new NHA. I have the education and experience but no one is even willing to interview me. I hit road block after road block. I joke that there is an "administrators bus" with the same NHAs that travel around the area and these are the same people who get the jobs, however most of these people are in their jobs for a few months to a year. How about giving someone else a chance? The field is frustrating enough. How does someone get their foot in the door? Everyone at some point in their lives had to have someone give them a chance as well.

hrental in Cleveland, Georgia said: what is the average medicaid usually pays for a long term care patient on a monthly basis? what is the overall net profit margin at your present facility?

My last facility was a 59 bed, locked unit. Medi-Cal only (That's Medicaid in California). No Medi-Care money. Medi-Cal paid $125.00 per patient. I kept the facility 95-100% full. (Thats why psych is good, unlimited patients)

So, the equation is 125x59x30= $221, 250.00

That amount of money has to pay for all the facility bills every month and it's not enough, so the corporate office starts not paying vendors and we go down the burn and change the vendor route.

Profit is very slim if any at all. I may make a profit, but it goes away after the corporate office takes it's "management fee".

I don't think I ever get "real" financials. The numbers have been greatly massaged at the corporate level.

At $221000 a month there should be a hefty profit. I would guess at least $20000 a month net profit. Corporate could be covering up the profit. Of course I do not know all your expenses.

Looking for SNF Administrator position in north Atlanta area. I have my Georgia license. Moved from Texas to be closer to family. Very good track record established with 15+ years experience as an Administrator. Most of my experience has been with the heavy-hitters (HCR/Manor Care, Life Care Centers of America, Sava). I've also had some experience in assisted living. Love my residents, families and staff. I'm itching to get back into a building.

I'd appreciate any suggestions about reputable companies that may be hiring and/or recruiters who might be helpful.

Looking for SNF Administrator opportunity in North Atlanta area. I recently moved from Texas to be closer to family.
Established very good track record in Dallas/Fort Worth area with 15+ years experience; mostly with HCR/ManorCare, Life Care Centers of America. Love my residents/families/staff. My feet are itching to get back into a building.

I'd appreciate any suggestions you can offer regarding reputable companies that may be hiring and/or recruiters who know this business.

Atlanta, Georgia with Georgia license in Gainesville, Georgia said: Looking for SNF Administrator opportunity in North Atlanta area. I recently moved from Texas to be closer to family.
Established very good track record in Dallas/Fort Worth area with 15+ years experience; mostly with HCR/ManorCare, Life Care Centers of America. Love my residents/families/staff. My feet are itching to get back into a building.

I'd appreciate any suggestions you can offer regarding reputable companies that may be hiring and/or recruiters who know this business.

I'm a recruiter and I specialize in LTC placements. Send me an email with your contact information, along with a copy of your resume, I may have something of interest. Thanks! cbosca@riogrp.com

This career path is so difficult to get your foot in the door. I have tried everything I can think of. Degrees, resumes, networking, contacts, etc... no replies. I really want to be an NHA but no one is willing to take a chance on new fresh ideas. I'm a motiviated worker, does anyone have any job openings as an NHA or ANHA in the northeastern PA region?