My thanks to “J”, a certified nurses aide (CNA) who works at a nursing home in central Indiana, for sharing the following thoughts about her experience as it relates to the problem of understaffing and other issues of concern (like a lack of adequate training for CNAs, etc.). Her identity is not being revealed in order to protect her from retaliation from management (although if “Stuart R.” reads this, he might be paranoid enough to fire every CNA who works in his chain of nursing homes who’s first name starts with “J”.  Wait, what if “J” were actually a male?)  🙂

I’m a new CNA. I don’t feel that I received adequate training in school or upon hiring. I’m feeling shattered and overwhelmed. I’ve just landed my first-ever CNA job (at an Indiana nursing home). I found out during training that I love the residents and the very nature of this work. My teacher predicted I would fall in love. And I did.

I love my residents. I understand they probably ran circles around me when they were my age. Unlike them, I don’t know how to make apple pie from scratch, stay married to the same person for 50 years, raise eight cloth-diapered children, harvest 10 acres each of corn and wheat, or milk six cows and collect the eggs from 2 dozen hens before sunrise and then butcher, pluck, and fry one of these aforementioned hens for Sunday dinner! I’m fond of them, I care about them and I respect them.

My facility pays exceptionally well (to make up for being chronically understaffed, perhaps?). I’m inexperienced and slow and flying by the seat of my pants. I’m honestly doing the best I can and still I don’t feel I’m doing right by any of them and I don’t know what to do about it. My assignment for the past two shifts has been 29 residents, the majority of whom I haven’t had time to become familiar with. This boils down to roughly 15 minutes of individual care per resident spread out over eight hours. Two minutes per resident is shaved off due to reasons that could have been avoided by a little forethought on the part of those in authority. Stupid reasons, such as having to chase down rubber gloves, wipes, clean linens and briefs, or read 20 charts because I’m in charge of the health and safety of people I know nothing about and any uninformed decision or action on my part has the potential to kill someone.

A few of the 29 residents I care for are pretty self-sufficient, while the rest of them require and DESERVE way more than the remaining 13 minutes of hands-on care. These are people’s mothers and fathers. They could be my parents. The quality of care I have time to give each resident is inadequate, and certainly far below that which I would expect if they were my own parents. I feel like they’re being neglected. Neglected by me, despite that I don’t have an idle moment and usually end up working off the clock.

When I finally fall asleep after I get home, I have nightmares. I don’t believe that even the most experienced and proficient of aides can provide *adequate* care to that many residents singlehandedly. I’m probably going to get fired for not charting. Because I can’t bring myself to ignore a call light and humiliate one of my beloved residents into soiling herself so that I can go make a note that someone else “eliminated” and how much and whether or not it was in a brief or in the toilet, while someone is begging *right now* to be taken to the toilet to eliminate like the adult that she is.

So there’s this nurse who is counted among THE PEOPLE WHO ARE OFFICIALLY CARING FOR YOUR MOM OR DAD. Because she’s there at the same time as I am, the facility gets to count her as someone who is providing hands-on care. Except all she does is administer medications.  She’s “above” doing what she can to make sure your mother isn’t having her skin digested by the enzymes in her diarrhea. She can see that I’m already up to my elbows in seven different cases of diarrhea, yet she’ll sit and chitchat with the other nurse about what’s on sale at K-Mart and still see fit to remind me about all these other call lights that are on, rather than step up herself and care for a resident who is suffering from the caustic germs that’s eating the skin off his nether regions.

I just wanted to propose the possibility that for every aide you encounter who seems jaded and apathetic, there’s another one who wishes she had a button to stop time and make sure absolutely everyone’s every need is met, so that she could go home and rest easy feeling that her best was good enough by her own standards. I don’t know who to hate more, myself for not knowing how not to fail my residents, or the greedy powers that be at the facility for failing all of us. There’s a very high turnover rate for CNAs. I had to become one to understand why.

Please know that it breaks my heart to see you or your mom or your dad suffer and I will do everything in my power to prevent that, but that my power is very, very limited. Please understand that I have to feed my kids and this is the only way I know how to do it. Please keep in mind that the people with the least authority and power are most likely the ones who are the most emotionally invested in your mom’s or dad’s happiness and well-being.

Anyway, I just wanted you to know how much a lot of us care and how much some of us are up against.

May God richly bless every loving, hard working CNA like “J”!  May God give them the strength (physically and otherwise) to provide excellent care like “J” obviously provides to her residents.  May God provide nurses (unlike the one referred to in “J”‘s comments) who will conscientiously lend a hand to her hard working CNAs (instead of talking on their cell phones at work, or talking about the latest sale at K-Mart, etc.).

My opinion is that, in a more perfect (nursing home) world, CNAs would be paid better, be allowed to be involved in the care planning of their residents (something few facilities currently allow) and be treated with much more respect by the nurses they work with.