The purpose of this book is to inform readers about the role, responsibilities, and real life experiences of being a Certified Nurse's Aide. A CNA's job is often demanding, physically and mentally challenging and emotionally draining. It is a job that will present you with many challenges and obstacles. If you are seeking a job that will make you rich, being a CNA is not the job for you. However, if you have a genuine desire to help people when they are most in need, being a CNA could be the right fit for you.
As you read about my experiences as a Certified Nursing Assistant (CNA), you will see that I am not an author and this is no work of fiction. I simply want the public to gain an insight into the role and treatment of CNAs in nursing homes.
I immigrated to the United States in the early nineties. My port of entry was New York and I, like most immigrants, arrived with high hopes and aspirations of doing well, having heard that the American Dream was the reward for hard work and determination. My sister had sponsored my immigration to the States and after arriving I lived with her and her family for approximately one year. Although I was grateful to have a roof over my head, I soon realized that that was literally all I had. I had no friends, no job, very little money, and, I thought, no prospects. I soon found that many dreams falter along the way.
I arrived when workers were losing their jobs at an alarming rate, so what, I thought, were my chances as an immigrant of getting a worthwhile job? It had taken me approximately six years to complete the immigration process and now that I was finally here, nothing was happening the way I thought it would or in the time frame that I had imagined. I had been living in New York for several months and still had not found a job, not even a part-time one. I did various odd jobs for family members to help support myself, but it wasn’t enough. My self-esteem began to waiver and I soon became disillusioned. I even began to wonder if immigrating to the States had been the right move.
This new way of life was totally alien to me, as I had spent most of my working life in Europe, where I was used to working hard and enjoying a good standard of living. I was unaccustomed to being unemployed and relying on others. Reminiscing about my former life, the good old days and the family, friends and lifestyle that I had left behind, was not helping my situation, so I firmly resolved to remedy this as soon as possible. The bottom line was I needed a job, any job and fast.
I saw a television commercial about how to become a Certified Nursing Assistant (CNA). A CNAs primary role is to deliver high quality care to patients working under the direct supervision of a nurse and, according to the commercial, there was plenty of work caring for the elderly. Although I wouldn’t need a degree to become a CNA, I would need to earn a certificate and pass a competency exam. After the commercial ended, I weighed the pros and cons of becoming a CNA and, given my current situation, I decided to enroll in a course. After making some enquiries, I found that a course was offered at my local college. The course would cost $1,200 and would last about six weeks. The enrolment fee was a significant amount of money for me at the time, as I was not working and did not have a steady source of income. In addition, I would have to buy the course material. However, I thought the initial investment would pay dividends in the long run.
When I enrolled in the course, I was in my early fifties and was very apprehensive about my abilities. This was not helped when, on my first day, I saw that all the other students were very much younger than me. In fact, I was more than twice their age, as none of the other students on the course was older than twenty-five years old. Fortunately for me, all the other students were very friendly and treated me with a lot of respect.
The weeks on the course flew by. The main topics we covered included infection control, taking vital signs, delivering personal care to patients, communication skills and patients’ rights. One of the main roles of CNAs is to help patients with their daily living and basic needs. This involves helping patients, such as elderly residents in nursing homes, feed, bathe and dress themselves. CNAs also typically serve meals, make beds and keep rooms clean, which may involve emptying bedpans and changing soiled sheets.
Another aspect of a CNAs role involves recording a patient’s vital signs, such as taking their temperature or blood pressure, answering calls for help from patients and observing changes in a patient’s condition or behavior. Upon completing our coursework, I took the CNA certification, which included a multiple-choice exam and a manual skills test. I passed the test with flying colors. Thrilled at passing test on my first attempt, I immediately began looking for a job as a CNA.
I thought it would be easiest for me to join an employment agency, as the agency would do all the legwork in finding me a job, which proved to be the case. It was also essential that I get a job quickly so that I could get some hands on experience. Fortunately for me, I am a fast learner with a great attitude, so I was confident that I would learn the ropes of my new role in no time and, God willing, it would be a job that I would like and be good at. My first job with the agency was at a nursing home in New Jersey. I, along with six other CNAs, signed a contract to work in a nursing home for six weeks. The agency booked us all into a motel, which served as our accommodation for the duration of the assignment. Luckily for me, the facility paired me with a very nice lady who took me under her wing after learning this was my first job as a CNA. She told me that if I followed her lead I would be fine. The orientation lasted two days and went very well. I learned the job at a rapid rate. My daily routine consisted of changing diapers, toileting the residents, giving showers and generally providing care and assistance for them. After a short while, these tasks became second nature to me thanks, in part, to that lovely CNA. Her kindness and willingness to share her experience with me helped me a great deal. As a result, I was soon in my own element.
The agency also offered me a part-time job, which involved putting an elderly gentleman to bed at night and getting him washed and dressed in the morning. This part-time job only took two hours a day, so was easily manageable with my daytime job. Things were going very well with the facility and, as time progressed, I rapidly gained more and more experience. However, this all changed when I went to work one afternoon and was told to call the agency. The lady who answered the phone simply informed me that my services were no longer required by the nursing home. That was all I got. There was no further explanation or elaboration. To this day, I am oblivious as to what, if anything, I had done wrong. I had no choice but to leave the position and was back to square one with no job and left in limbo.
Thankfully for me, God is always on my side. A short time after I arrived back in New York, I received a call from the gentleman I had been caring for on a part-time basis. He asked me if I could care for him on a full-time basis as a live-in aide in New Jersey. This offer of employment could not have come at a better time. I was elated and beside myself with joy. The money was good and, in addition to my accommodation, my food would also be provided. I accepted his offer of employment on the spot and it turned out to be good venture for me, both professionally and personally, as that gentleman and I became good friends. He was a double amputee and I never heard him complain about his situation. Not once. I spent a total of nearly three years with this gentleman and even accompanied him and his family on a trip to Brussels. Over time he became seriously ill and he told me to look for another job. He also advised me to save my money and to buy a house as an investment for the future. He rapidly deteriorated after giving me that advice and died a few days later. I shed more than a few tears when he passed, I can tell you.
I did as the gentleman had suggested before he passed and got a CNA position in another nursing home, working on the 11–7 shift. At first I was doing 37.5 hours per week because I still had the other job caring for the gentleman. I worked both jobs until the gentleman died. At that point, I started to put in some much longer hours. It was also during this time that I bought a house with my wife. Things were going well and my future was looking bright.
Chapter 2
The Abused and the Abusers
During my training to become a CNA, I was taught from the onset that every person I ever came into contact with was to be treated with the utmost dignity and respect (and rightly so). I was also taught that as a CNA I must also always observe the rules and regulations of the facility for which I was employed. These rules, I learned, are fundamental to working in a care environment. In addition to these rules, I was told that CNAs do not have many rights. What? I thought to myself. How can that be? Let me explain. CNA’s do have certain rights. For example, CNAs have the right to a safe work environment with established safety procedures. The role a CNA, which often involves lifting, positioning and transferring patients, can be very physically demanding. CNAs also have the right not be verbally or physically abused by residents, patients, co-workers, or supervisors; the right not to be sexually harassed or discriminated against and the right to overtime pay. However, although CNAs have these rights, it is patently clear that in a nursing home environment, the residents have all the rights and, as a CNA, you had best never forget it.
As my career in the nursing home progressed, I soon began to realize that what I had been told was indeed true. I did not have any rights. All rights were reserved for the residents and the examples that I give throughout this book will clearly illustrate this.
From time to time I have read news articles about alleged abuse in nursing homes and watched television commercials asking whether you or a loved one has been a victim of nursing home or elder abuse. I would like to know where these nursing homes are located and what Health Authority would fail to take decisive action in the face of such allegations, as all nursing homes have working directives that must be adhered to. As a CNA you cannot force an alert resident to do anything that he/she does not want to do. However, the resident can refuse to do anything, even if it’s something basic, such as taking a shower. The idea that physical abuse of residents by nurses and CNAs is commonplace in nursing home is, in my opinion, beyond any sane person’s comprehension. A CNA is not going to harm a senile resident, as he/she is unaware of what is going on around them and alert residents are not going to tolerate any form of abuse or mistreatment in the first place. Are these critics stating fact or fiction? They should be taken to task and forced to prove these allegations. I will admit that there are some bad CNAs. By “bad” I mean that these CNAs don’t do their job properly or to the best of their ability, not that they abuse residents. In my experience, however, the good CNAs far out-number the bad ones.
I can attest to the fact that there are some very smart residents. For example, take the case of a resident who repeatedly hit an aide with her walking stick, whilst at the same time shouting for help. Two other aides had heard the yelling and ran to tell the supervisor what they had heard and what they thought was taking place. When confronted by the supervisor, the aide who had been hit by the resident with a walking stick tried to explain that she was the one who was being attacked by the resident, but no one believed her. That CNA was suspended and eventually terminated. Two weeks after the CNAs termination, the same resident who had attacked the CNA attacked the resident she shared her room with by hitting her with her walking stick and shouting for help at the same time. However, this time, someone approached the room and saw what was taking place and reported the incident. The irony is that the CNA, who had been terminated, was a truly compassionate person who cared deeply about her residents and who always went out of her way to make them feel at home.
There are a multitude of injustices that take place against CNAs, who are under constant duress. How absurd is it to say that no matter what a resident does or says they are always right? There were signs prominently displayed in the nursing home that I worked for that proclaimed: “See It, Report It!” Basically they wanted CNAs to spy on each other. But who cares when an alert resident tells a CNA to “take your fucking hands off me and go back to Africa,” or when they have to suffer the indignity of being spat at or being told, “If I had a gun I would shoot you?” To cap it all, this abuse of CNAs by residents is standard in most nursing homes. Although, I was briefed from the outset of my career as to what to expect when working in a nursing home, I never really got used to the abuse of CNAs by residents.
Nursing homes are essentially run by CNAs, as nurses rely on the CNAs to report everything to them. For instance, I once knew a CNA who was always in a hurry see if his residents were comfortable when he came on duty. This was especially true on the 11–7 shifts, when most residents are in bed. A routine check enables a CNA to see if everyone on his/her shift is okay and to report their findings to the nurse and/or supervisor.
Generally speaking, senile residents cause little or no problems, although you may occasionally get one or two senile residents who are in a combative state. In such cases, the CNA will need to get assistance from another aide. I recall a situation where a male resident went on a calling spree, putting on all of the call lights in his room. When I went to assist him, he said his room was too hot and asked if I could put the cool air on, which I did. Five minutes later the call light went on again, but this time the resident told me that his room was too cold and asked if I could turn the heat up. So I turned up the heat. This back and forth went on throughout the night. When I told the nurse what the resident was doing his reply was, “what do you want me to do about it?” I reminded him that he was the nurse in charge, but I might as well have been speaking to a brick wall as he did nothing about it.
On another occasion, the same resident asked for five blankets. When he got the blankets, he somehow managed to urinate on all of them. When his call light came on, I went to his assistance. When I entered the room, the resident told me that all of the blankets were wet and, with a smile on his face, stat...
