For the CNA working in a state funded hospital for the mentally ill, it can be exceptionally rewarding and at the same time very dangerous work. The dynamics of working in a state hospital are different from any other medical facility the aide might find himself or herself working in. How do you admit new patients to your ward? What ward to you work? Who are the clients under your charge? What are the triggers that set them off? The safety team, what do they do? How do you restrain a resident without harm to them or yourself? How do you diffuse a potential volatile situation before it gets out of control? What is the role of the aide in these facilities?
The volatile and Suicidal patient: Depending on the ward of the mental health facility, the CNA’s job is slightly different from the aide working in the hospital or nursing home. Here the aide is more like a babysitter than a care provider. These are the very situations you need to look at as an aide, maybe you know something about a particular patient that can be dangerous, and you need to share these things with the people you work with. Every section of the Mental Health facility has its own set of rules and problems. A suicidal patient can and usually are put on a 1 & 1 schedule until their meds kick in or they no longer pose a threat to themselves. Here the aide is assigned to one person for up to 2 hours or longer, depending on the situation and staff numbers. The CNA’s sole responsibility for that time is keeping their charge safe. How do you do that? You take away all potential risks. Involve the patient in some kind of activity to distract them. Usually just sitting and talking with them or playing cards with them, will get both of you through the shift incident free. However, the aide cannot be diligent all of the time, someone somewhere is going to distract you giving your charge that opportunity to escape into someone room and steal socks or whatever they can get their hands on to harm themselves with. Remain calm, do not get frustrated with them, and keep them occupied as best you can with other activities that present very little to no opportunities to harm himself or herself or anyone else.
The Correctional Ward: This ward for the CNA can be very dangerous and is often fraught with combative patients that are looking at jail time. It can be terrifying at times. Remain calm; practice restraining moves all of the time, the aide who practices these techniques will save time and help his or her co-workers remain safe on the job. Get to know the residents, get to know your doctors and nurses, know the routine of the hall like the back of your hand, know your restraining holds and the numbers you may need to call for help. More often than not, there is more violence on the correctional ward then the entire hospital combined. Know the safety procedures and rules your life and the lives of your co-workers may depend on it.
Escorting a group of residents from one building to another has the potential to be unpredictable but for the most part usually goes off without incident. If you know you will be working on a ward where the residents have to be escorted to a dining hall or a recreation room, you should meet with your partner at the beginning of the shift and decide who will do what and when. If the plan is made in the very beginning, there will be fewer problems, during the transfer. Often an another aide will have to be called in to help with the transfers, as many facilities only allow a certain number of patients to one well trained CNA. Make sure you know who is assigned to help with the escort and what time they are expected to arrive. That way you can get your charges ready to go and be waiting at the door when the aide or aides come in. Always be vigilant and never let your guard down, know the steps you need to take during the transport. There are protocols and safety measures in place for the safety of each and every individual in the facility. Knowing these, will save time and make the shift smoother and safer for all involved.
There are many time saving tips that the CNA can employ in his or her place of employment, make a list of the ones you can think of, watch what the other more experienced aides do, choose the techniques that work for you and apply them on a daily basis. Know your rules and regulations, safety protocols, and procedures, make them second nature and always be aware and observant at all times.
Expert Contribution by Kimberly T. CNA EMT-B