When you are a CNA working in a nursing home you are run ragged. There is no time for anything. When you are a CNA working in a hospital, things get so crazy that you can easily forget which room you are supposed to be going to. However, if you are a home health CNA than your life is actually yours and your patients actually get the attention that they need! Of all the CNA jobs I have had, home health is hands down the easiest and most rewarding one, and here is why:

• When you do home health, it is just you and your patient. There is plenty of time to get things done properly and get to know your patient.
• Working away from a facility allows for much more flexibility as there are no bosses looking over your shoulder while you work.
• If you have an agreeable client you can work your hours around your needs. If your child has a doctor’s appointment during the time you are supposed to be at your patient’s home, you can arrange a different time with your patient so you can do for your child.
• The work is typically very light. The majority of home health patients do not really need as many hours as they are given. If you are scheduled to be with a patient for 3 hours each day, chances are that you will actually be doing work related duties for an hour or so. The rest of the time belongs to you and your patient.

For me, the most wonderful part of home health is the relationships you can develop. I have been with my patient for 3 years. While your employer will tell you that you are not supposed to become friends with your patients, this is totally impossible. You are spending one-on-one time with them every day so a relationship is bound to develop. You talk to each other about your family and friends and your hopes and dreams. You learn almost everything about your patient and them about you! My patient is like part of my family now. She comes to my children’s birthday parties and to holiday events. We talk and see each other even on my off hours. For a CNA who got into this field because they love people, this is the perfect type of job and that is what it was (and is) all about for me!

This article is part of a series of  articles that talk about how work is when you’re a certified nursing assistant. The article above and the thoughts expressed therein are those of the author, Tanya Glover who is a practicing CNA. 

The Social Butterfly- This is the patient who goes to every single “event” in the home. They do bingo, arts and crafts, dances, carnivals and church every Sunday morning. She always looks her best (or tries too) and her clothes are never washed in the facility. (She has them sent out with family because the home will “mess them up”) She is sweet with a winning personality – until you do ask how high when she says jump. You must beware the social butterfly because she can take you down quicker than the prom queen back in high school. Everyone knows her and the administration will not stand for her to be upset. This is not because they adore her, but because they have already had problems with her complaints in the past and they do not want her children back in the office demanding to know why mom is not being treated like the princess that she is.

The Social Butterfly is one of the nursing home patient personalities you'll have to deal with as a CNA

The Ladies Man- We all remember this guy from high school but never think we will meet him while working in a nursing home. This patient loves the attention of all the nurses and is not afraid to ask for it. (In fact, he assumes you want to spend your entire day with him!) When you are with him you no longer have a name; you are honey or sweetie pie or sugar. He will regale you with tales from his skirt chasing days and if you are not careful, grab a handful of your skirt as well! You can get angry with him but he simply withdraws, claiming that he really meant to touch your arm or pat your knee and all of a sudden he is confused and not up to talking anymore. He is generally harmless but trouble can ensue if this Casanova messes with the wrong nurse!

Miss Total Care of the Year- This is the patient that every CNA will fight over. (The equivalent to Miss Popularity back in high school)  He or she is total care and for the most part, cannot even move a muscle. Why do they all love her? Because she is cute! She is easy to take care of and she has family who comes in everyday to sit with her and praise the staff. They bring the nurses cookies and candy and even give them money at Christmas time! If the family falls in love with you, you are golden! They will request that you are their loved ones CNA for every shift that you work and you will then be part of the élite class of nurses. There are definite perks here!

The Grouch- This is the patient, who constantly sulks, complains about everything and thinks all the nurses are out to get him. (And not in the good way like with the Ladies Man!) If he gets lime jello on his lunch tray he complains that his favorite is cherry. If you make sure to bring him cherry the next day (out of the kindness of your heart because you know it is his “favorite”) he will gripe that he would rather have lime. You can never be gentle enough while caring for him and he will be quite vocal in letting you know how rough you are being. (Of course you are actually being just right!) He may actually like you but if you find out that he does, do not let it show. He will not admit that he likes anyone and if you challenge his Oscar the Grouch approach to life things will only get worse for you.

There are many more personality types out there but these seem to be the most dominant I have encountered in my years working at nursing homes. Keep this in mind when you enter a new facility and you will surely be able to pick out which patient is which!

This article is part of a series of  articles that talk about how work is when you’re a certified nursing assistant. The article above and the thoughts expressed therein are those of the author, Tanya Glover who is a practicing CNA. 

This CNA is Too Cold

When I first began working as a CNA at a nursing home, I saw some things that will remain in my memory for the rest of my life. The example that stands out the most deals with a total care patient who could only communicate through facial expressions. I was doing my orientation with a not so friendly aide who was constantly aggravated by the patients needs. We had just left Miss Total Cares room after cleaning up a large bowel movement. The aide did not talk to Miss Total Care the entire time she was cleaning her, she simply went through the motions (none too gently) and left. Less than 10 minutes later we were called back to the same room because Miss Total Care had another very large bowel movement. The minute we were in the room with the door closed, the aid began talking as if the patient was not only immobile, but deaf and dumb as well. She went on about how she cannot believe how much Miss Total Care “craps” and how she is sick of having to wipe her “butt”. This poor patient could only lay there as the aid flipped her around, cleaned her up (roughly) and cursed about how she could not believe she had to clean her up yet again. In case there is any confusion, this aid had no business caring for a dog let alone an aged woman who had zero control over her own body. (The aid was fired in short order…somebody reported her. *WINK WINK*)   Unfortunately I have seen this type of behavior a lot over the past 12 years and it makes me sick every time. ALWAYS report any negative or harmful behavior to your supervisor. You have to be a voice for your patients.

This CNA is Too Hot

Too hot or too cold? Which one are you?

Next you have an aide that cares so much that it hurts. This was me. My first six months at the nursing home put me in a major funk after we lost 12 patients. When I had a patient who was nearing death I would work an extra shift so I could spend as much time with them as I could before they left me. I would cry when it was over and go to the funerals. I could not get my work done in a timely manner because I couldn’t say no when someone asked me to stop and talk or give them a glass of water – whatever. I couldn’t say no when someone needed me. I had the heart to be there but not the emotional balance to be a productive employee. This is why I moved on to other nursing venues.

This CNA is Just Right

Finally, you have the aid who loves their patients. They do everything they can to provide quality care with just the right mixture of human emotion and love. This aid spoke to all her patients with respect and knew when she had to say no and get to the rest of her duties, even though she would come back later to see what she could do once her other work was complete. She was human so she did get aggravated sometimes but this was never shown on her face or heard in her voice. When one of her patients died, she mourned but did not let it ruin the work for her because she knew others needed her to do her job well. The bottom line is that this aide really cared and knew how to handle the emotions that come with caring. This is what I mean by a special person. There are not many like this. So many just view this as a job to be done and a paycheck to be collected. They do not look past the faces of those they care for and see that there was once vibrant life present behind those wrinkles and liver spots and this is what it takes to make a wonderful CNA. I do not have what it takes to do this job in a nursing home and that is why I left, but maybe you do have that something special that this job requires. If not, do not feel badly. Lots of aides cannot cut it in a nursing home environment.  There are lots of other areas they can focus on and if nursing is really what they love, they will be able to carve out their niche somewhere, and once they do, they will be much appreciated!

This article is the second of a series of  articles that talk about how work is when you’re a certified nursing assistant. The article above and the thoughts expressed therein are those of the author, Tanya Glover who is a practicing CNA. 

1.)  If you are first shift, your day will begin at 7am with you going through your patient list and waking folks up for breakfast. If you are lucky, you will be able to get one of your people up and ready before breakfast so you can mark them off your to do list.

2.)  Once you hand out the meal trays, feed your total care patients and take the trays back to the kitchen, you then have 2 ½ to 3 hours to have all of your patients washed, dressed and out of bed before it is time for lunch. When you go to school you are taught how to give a full bed bath and this is what you are supposedto do for each person. The fact is, this is an impossible feat. CNA’s will mark that they did a full bed bath, but in reality we are washing the sensitive areas and putting on some body spray. It sounds bad, but honestly there is no time to do it all right.

A CNA checking a resident's temperature

3.)  Once you get lunch done you have to check each patient again. You lay the ones down who usually nap in the afternoons and change the diapers of those who need to be changed. You take your vital signs and out the door you go-unless your replacement has not shown up on time. By law you are required to stay on post until another CNA arrives. If you do not you risk your license and many more nasty consequences.

So, there is your day. It was much easier to write out than it was to experience. Let me be very clear; this work schedule is totally possible to comfortably keep up with if you have a reasonable amount of patients, the key word being “reasonable”. While your supervisor may say that a patient load of 13 to 15 is reasonable, what they really mean is that it is reasonable for you. If they had to do it, it would no longer be so reasonable. The bottom line is that with this many people to care for, it is impossible to do it 100%. (The best facility I worked in had each CNA with 8 patients each. This was very doable and even enjoyable.) Personally, I took issue with the fact that I was unable to care for each patient the way I was taught, and this is why I no longer do nursing home work. However, if you want to give it a shot, keep in mind that you are just one person. You can only do so much and if you must cut corners to get your list of tasks complete, make sure you do not cut any important ones. Your best is all you can offer, and trust me when I tell you that there is not one CNA out there with a large patient load that does everything 100%. If at the end of the day all your patients have been fed, cleaned, and kept dry and smiling, you did your job better than most!

This article is the start of a series of  articles that talk about how work is when you’re a certified nursing assistant. The article above and the thoughts expressed therein are those of the author, Tanya Glover who is a practicing CNA. 

According to a report by the American Medical News, even a 2% cut in Medicare will result in the loss of 195,000 healthcare jobs by 2021. How do the Medicare cuts affect your future as a CNA?

Staffing Shortages

American nursing homes already suffer from staffing issues. Government studies have revealed that over half of the nation’s nursing homes do not have enough CNAs. These reports suggest that many patients in nursing homes receive substandard level of care due to the lack of nursing staff.

The following statistics reveal the amount of time that patients in long term care facilities currently receive throughout the day from nursing staff:

• Twelve minutes of care for registered nurses
• Forty-Five minutes of care for registered nurses and licensed practical nurses combined
• Two hours of care from CNAs

It’s easy to see that the cumulative total of 2.75 hours of staff time isn’t enough for these patients.

However, this statistic does reveal a glimmer of hope for CNA’s. It’s evident that CNA’s are on the front lines of patient care due to the fact that they spend the most time with the residents throughout the day. All long-term care facilities are in need of qualified CNA’s as part of their patient care plan.

Supply and Demand

 The job forecast for CNAs in nursing homes are definitely brighter than that of other skilled nursing staff. Nursing home administrators realize that CNAs offer the most bang for their buck due to factors such as:

• More time spent with patients
• Lower wages and other nursing staff
• Higher value for their wage
• Lower cost of training

Trained CNAs employed in nursing homes ultimately results in lower operating costs for the institution and therefore will increase the demand for CNAs.

Considerations

The demand for CNA’s may increase; however, it doesn’t mean that the clouds have cleared from this Medicare storm. According to the American Health Care Association, the nation’s Medicare costs will drastically undercut many institutions staffing efforts as well as reduce facility quality improvement programs.

The bottom line is that these cuts will result in a lower quality of healthcare and will affect the people who need it most – the patients.

Be prepared to invest some time and effort into writing a concise, compelling cover letter that allows your personality to show through. Put yourself for a moment in the shoes of the hiring manager. They have received an onslaught of dozens of resumes for this one position that they must fill. They need to weed through all of the applications they receive and try to pick the best person for the job.

Quick Tip: make sure you also check out our guide on how to write a compelling CNA resume.

Your job is to make the hiring manager’s job easier. Follow all of the directions in the job announcement to the letter. Just demonstrating that you are capable of following directions will separate you from those candidates that have sent in boilerplate letters and who did not follow the directions.

Here are five quick tips for preparing a CNA. resume cover letter:

 1. Always customize each cover letter

Find out the name of the hiring manager and address the letter to that person. Find out some interesting facts about the organization and mention them in your letter. The hiring manager wants to get the idea that you are applying for this particular job rather than any job you can get hired to do.

2. Use your cover letter to share who YOU are

Make your cover letter stand out from the stack of other resume cover letters that the hiring manager will be sifting through. Share how much you love working with babies, or the elderly, or whatever aspect of nursing you are passionate about. This is your opportunity to set yourself apart from the rest of the applicants.

3. Do not simply rewrite your resume in the form of a letter

Keep your cover letter fresh and unique. Remember your goal is to make the hiring manager want to pick up the phone and schedule an interview with you. Add relevant facts about your work history, education and experience.

4. Expand on how your experience matches the qualifications for the position

Pull all of the qualifications from the job announcement and write about how your education, skills and experience makes you a perfect match in every way.

5. Have someone objective review & proofread your cover letter

It’s challenging to proofread your own writing with 100% accuracy. Have a fresh set of eyes review your cover letter and point out any typos or areas that do not make sense.

*Bonus Tip: Work with a career counselor if your CNA training program provides one, or consider investing in hiring a career coach to help you refine your resume and cover letters, which you can then customize and refine for each specific job you apply for.

The health care field is a highly competitive one. Each year CNA training programs crank out hundreds of thousands of trainees. The job of your resume cover letter is to show how special you are, what a good fit you are for that specific job, and how the hiring manager would be foolish not to bring you in for an interview.

The medical community can sometimes be confusing to the general public; patients see a person in scrubs wearing a name tag with an acronym and are often unsure what the person does. To help shine some light on the differences between CNAs and MAs, let’s take a closer look at these two careers:

CNA Overview

CNAs work under the supervision of registered nurses and are on the frontline of patient care. On a daily basis, they perform tasks such as:

• Taking vital signs
• Bathing patients
• Grooming patients
• Helping patients walk
• Providing emotional care to patients
• Acting as liaison between patients and the nursing staff

MA Overview

MAs generally report directly to medical office managers, doctors and other health care practitioners. They typically work in a medical office setting or clinic and are responsible for duties such as:

• Updating patient’s medical records
• Completing insurance forms
• Arranging laboratory services for patients
• Scheduling hospital admissions for patients
• Scheduling patient appointments
• Handling bookkeeping
• Answering telephones

In clinical settings, MAs will sometimes also help take patient vital signs, obtain patient medical histories and are responsible for preparing exam room instruments and supplies.

Similarities

Both certified nursing assistants and medical assistants must work with the public. In this capacity, they need to act professional at all times. In a medical setting, they will be exposed to a wide variety of emotions such as fear, anger, sadness and apprehension daily.

CNAs and MAs are also subject to the following healthcare regulations:

• Joint Commission on Accreditation of Healthcare Organization (JCAHO)
• Health Insurance Accountability and Portability Act (HIPAA)
• Occupational Safety and Health Administration (OSHA)

Differences: Health Care Setting

Medical assistants are required to work in facilities where a doctor is present, such as a clinic or doctor’s office. Conversely, certified nursing assistants can work under the supervision of an RN or LPN. This allows them to work in many diverse settings to include:

• Nursing homes
• Community care facilities
• Long-term care facilities
• Hospitals
• Home healthcare settings

CNAs also have more freedom when it comes to patient care due to their certification. During the course of their career, CNAs have the opportunity to take on-going certification classes. This will afford them the opportunity to have additional responsibilities.

Differences: Training

Depending on the state’s requirements, CNAs undergo between 100 to 180 hours of training. The coursework includes class room training and hands-on clinical applications. At the conclusion of their training, prospective CNAs are required to successfully pass a CNA certification exam that tests the student’s competencies.

Medical assistants are trained in medical terminology, clinical and diagnostic procedures as well as typing, accounting and insurance processing. Training programs are regulated by the Accrediting Bureau of Health Education Schools.

Formal training for MAs is not always required; some medical assistants receive on-the-job training. MAs that begin their career this way will typically attend training sessions and work directly with an experienced medical assistant.

Earnings

The job forecast for CNAs and MAs is positive due to the increased need for healthcare workers in America. The lowest paid medical assistants earn approximately $20,000, while the highest-paid MAs make just over $30,000, notes the US Department of Labor.

A CNAs income ultimately depends on where they work. The highest-paid CNAs usually work in hospitals and nursing homes, while CNAs working as home-health aides are typically paid the least. The pay ranges from around $20,000 to just over $30,000 depending on location.

Due to the increased need for long-term care in America, the Department of Labor projects at 19% growth in employment opportunities for nurse’s aides through 2018.

What does this mean for you? This means that after training and passing the CNA exam, you stand a very strong chance of finding a job.

What to Expect

As a CNA, you will have direct patient contact daily. Your tasks may vary depending on what institution you work at; however, your typical duties will include helping patients eat, bathe and dress, as well as taking vital signs, helping patients to ambulate and reporting any change in the patient’s medical condition to other nursing staff.

Because patients need 24-hour care, you may be required to work a variety of different shifts. Most CNAs work full-time and as a new nurse’s aide you might have to work holidays and weekends, depending on the scheduling needs of your place of employment.

Where to Find Work

Nursing Homes/Community Care Facilities

Because Americans are living longer, the need for long-term care facilities, such as nursing homes is dramatically increasing. In fact, almost half of CNAs that are employed in America are working in some type of long-term care facility.

The multitude of opportunities to care for the elderly is valuable insurance for your future employment prospects, even in the midst of a troubled economy. Nursing homes are a great resource for CNAs that are looking to begin their careers in healthcare.

Many CNAs are also employed in community care facilities. These residential care facilities care for elderly patients and for people with special needs. The clinical setting is similar to nursing homes; however, these patients will typically require fewer needs than patients do in nursing homes.

Home Health Aide

Working as a CNA home health aide is another growing opportunity for CNAs. As a home health aide, you will be responsible for taking care of patients in their homes. Many home health aides will be responsible for a variety of patients at several different locations.

Working in this environment will require you to have a strong sense of independence. As the population in nursing homes increases, the home health aide path will continue to be an excellent career opportunity for CNAs.

Hospitals

CNAs employed in hospital settings will be exposed to a wide variety of assignments. As a CNA in a hospital, you will be responsible for several patients at the same time. A strong proficiency in multitasking is essential to be successful in this environment.

Another benefit to working in a hospital is that you may be exposed to several diverse specialties within the hospital. For example, a CNA working on a Medical/Surgical floor will observe different clinical procedures than a CNA employed on an Oncology or a Maternity unit.

CNA Wages

How much money you earn as a CNA will ultimately depend on a variety of factors such as the type of institution that you are employed at as well as in what part of the country you work. Since the cost of living varies in America, this will be factored into your pay.

Here are a few examples of typical hourly rates:

• Nursing homes -                   $10-$13
• Community care facilities -  $9-$12
• Hospitals -                             $11-$14
• Home health aides -              $8-$10

It’s up to you to be familiar with local, state and federal laws relevant to your scope of duty as a CNA. Failure to abide by these laws can result in a civil suit against you, possible loss of certification and in extreme cases may result in fines or imprisonment.

Now that I have your attention, let’s explore some basic guidelines that will help you stay out of the legal hot seat.

Patients Right to Privacy

In 1996, the Health Insurance Portability and Accountability Act was enacted to protect the confidentiality of patients. As a nursing assistant, you are responsible for safeguarding the privacy of patients. Medical issues should only be discussed with the patient’s doctor, nursing staff, other members of the medical team and close relatives.

Know Your Facility’s Policies

It’s essential that you perform your duties by following the correct procedures of your place of employment and within the scope of your training. If you are unsure about a certain policy or procedure, always check with your immediate supervisor.

Continuing Education

Keep up to date on continuing education requirements to provide the highest level of care to your patients. This will also allow you to stay informed about any new or changing medical procedure.

Legal Issues

In addition to the previously mentioned guidelines, there are a variety of legal terms that every CNA should be acquainted with. Be aware of the following legal issues and know how to avoid them during your career.

Malpractice

This involves negligent conduct that results in harm to the patient. Examples include practicing outside the scope of your duties, not providing care as previously trained and failing to follow your facility’s policies.

Negligence

This consists of the lack of reasonable care due to carelessness and often results in injury or harm to the patient. Negligence usually occurs when a CNA is in a hurry.

Types of Patient Abuse

There are four types of abuse that have been identified within the medical community. They consist of physical, sexual, psychological and verbal abuse.

Physical

Examples include hitting, kicking and roughhousing with patients. Another form of physical abuse involves providing the incorrect treatment to patients.

Sexual

This can involve any type of seductive or sexual harassing behavior directed toward the patient. Another form of sexual abuse is forcing a patient to do a sexual act against their will.

Psychological

This type of abuse includes patient intimidation through threats or any other harassing behavior that would cause emotional harm to the patient.

Verbal

This includes the inappropriate use of tone and language as well as any unpleasant gestures or names directed toward patients.

Property Rights

All patients have the right to have their personal items safeguarded during their stay in any healthcare facility. Theft of a patient’s property is nothing less than a crime.

Assault and Battery

Assault is defined as intentionally attempting to harm someone; battery involves actually committing the offense. In a medical environment, these terms don’t always involve attacking someone. Simply performing a treatment against the patient’s will could cause significant legal problems.

To avoid this situation, always inform patients of what treatment you plan to perform, and immediately stop if the patient refuses.

This is known as informed consent. Conversely, forcing the patient to do something against their will is defined as coercion. If the patient refuses treatment at any time, notify your supervising nurse.

False Imprisonment and Involuntary Seclusion

Patients have the right to come and go as they please. You must obtain proper authorization before restricting any movement. Additionally, the use of physical restraints must be specifically ordered by a doctor prior to being utilized on any patient.

When a patient is held against their will, it’s known as involuntary seclusion. Sometimes patients become unruly and can cause problems in common areas that are shared by other patients. Check with your supervisor before removing these patients.

Considerations

Your goal as a CNA is to provide the highest level of care to your patients. By following these guidelines and the proper legal standards, you are ensuring that you’re doing both you and your patients justice throughout your career.

The required hours vary by state. Some states may require 12 hours a year, while others set the standards at 24 hours. Check with your state’s nursing board regarding their CE requirements.

CE courses are offered through a variety of options such as: your current employer, local community colleges, your state’s nursing board and through numerous private vendors. When choosing a private company, make sure that they are accredited with your state.

The topics for CE courses are offered in subjects that are relevant to your duties as a CNA, such as:

• Current clinical methods
• Emotional support for the elderly and chronically ill
• Medical record documentation
• HIV/AIDS training
• Medical error prevention
• Communication with cognitively impaired patients
• Resident rights

This is just a small sample of some of the available courses for CNAs. Continuing education courses will help you maintain a high standard quality of care and can help keep you updated on current trends in healthcare.

Free Sources for CEs

Many members of the healthcare community pay fees to obtain CEs and simply consider it the cost of doing business; however, there are other options. If you know where to look, there are several low-cost and even free opportunities for continuing education. Before you read this you should read our previous article on free CNA inservices

Institution Education Departments

Many hospitals and nursing homes will develop CE courses through their education department. These CEs are usually free to employees. Check with your institution’s educational department to see what type of program they may offer.

Education Funds

Some employers make contributions to education funds. These funds frequently offer free continuing education courses for CNAs. An example available for CNAs who work in Los Angeles is the Service Employees International Union (SEIU) UHW-West & Joint Employer Education Fund. You must be employed by one of the companies affiliated with this union to qualify.

These free courses are specifically designed for CNAs. Examples of recent courses include a class on safe patient care and stress/end-of-life care. Each one of these courses provided eight contact hours.

Centers for Disease Control and Prevention

The U.S. Centers for Disease Control and Prevention’s (CDC) mission is to develop sound public health policies, promote healthy behavior as well as provide leadership and training. As part of this goal the CDC offers free continuing education for members of the medical community.

Courses in HIV education/treatment and other CEs are available on the website: http://www2a.cdc.gov/ce/availableactivities.asp. Take a look at the site to see if any available courses might fit your needs.

Armed Forces Service

If you are a working CNA and a member of the military on active duty for at least six months, some states will not require you to take in-service CEs that year. This exemption also applies to CNAs that are spouses of military members who were caused to be absent due to their spouse’s military duties. Check with your state’s board of nursing to see if you qualify.

Promotional Arrangements

Some companies, such as Johnson & Johnson as well as certain colleges will offer free CE courses. The majority of courses provide one hour; however, these units add up quickly. Here is a list of colleges that currently offer free courses:

• UCLA Health System
• Georgetown School of Nursing
• Kaplan University School of Nursing
• Walden University
• Chamberlain College of Nursing

To find out more information and to obtain a list of current Novell courses go to: http://ce.nurse.com/FreeCE.aspx. It’s up to you to investigate your options for free continuing education courses. These examples provide a starting point; check with the websites frequently for updated information.