atomic_fungus (atomic_fungus) wrote,

#2546: Why don't you be a CNA again?

Short form: because it's a horrible, horrible job.

Long form:

At the interview I went to last month, one of the first things I was asked was about my work as a CNA in Cedar Rapids. "That's valuable!" The interviewer said.

No; no, it isn't. And it is not (as he contended) going to be more valuable later on.

Look: you run your ass off for eight hours a day; the only time you're not moving is when you're on break, and you have to move fast because you're responsible for the well-being of 10-20 people. You're the front-line of care; you bear all kinds of responsibility for everything. Despite that, you have no authority to do anything more involved than changing bed linens. 90% of your job is dealing with bodily wastes, some of which are laden with infectious organisms. For all of that, you are the lowest-paid person on the floor and you're disposable: you have little or no job security, and most of the time the place has more applications than it knows what to do with, and can hire three people to replace you within a week.

CNAs are cheap because you need only take a single eight-week course, and pass an exam, to become one. Most of the time, CNAs are people who are on their way to being LPNs or RNs; it really looks good on a resume when you're trying to get a job as an LPN or RN that you "got your chops" working as a CNA while you were in school. It's not too bad to spend a couple years as a CNA while you work on becoming an LPN; then you can work as an LPN while working on being an RN. Or if--like me--you had designs on becoming a radiological technician of one stripe or another, it's a way to pay the bills while you figure out WTF you're going to do and how you're going to accomplish it.

As a career--just being a CNA--it's an awful choice. It's incredibly stressful work; it's both physically and emotionally exhausting, too.

Everything has to be done fast. You have to be incredibly callous towards the very people you're there to help: it doesn't matter if moving that guy that way makes his still-healing hip hurt, because you don't have time to be gentle. (But if you injure him--not hard to do when he's in such a frail state--you're fired, and probably going to jail to boot.)

The threat of losing your job--and possible criminal prosecution--hangs over your head every minute you're actually working. You have to be really careful about everything you do, and everything you say, but you have to do everything as fast as possible. If you screw up--even if it's an honest mistake--you'd better pray to God that none of the patients gets injured because of your error, because the very best outcome you can expect in that case is only to lose your job. More likely you'll be summarily fired and never work as a CNA again; in some cases you can expect to be hauled away in a squad car.

The "criminal prosecution" aspect is always de-emphasized--if people were afraid to work as CNAs the medical industry would have to raise their pay--but it's a reality, and that's not improving as time goes on. Sure, it's rare for someone to make an honest mistake and get thrown in the pokey for it; usually only cases of egregious negligence get punished that way--but it's still possible.

If you're working under an RN who doesn't like you, she can get your ass fired just by complaining to the DON (director of nursing) about you often enough. The place I worked, there was one person who was always writing complaints to the DON about this person or that person; and she even bragged about getting some people fired.

Besides all that, then there's the problem of it being a sexist industry. If you're a guy working as a CNA, you can forget about "equal rights"; if a female patient says she doesn't want you performing procedures on her, that she wants a woman CNA, you have to stop and get a female CNA. (Male patients, of course, have to take whatever CNA comes to help.) It's a female-dominated industry and a man working in it has to bear whatever sexist bullshit comes his way; but if he's accused of sexual harassment--even falsely--he's still going to be in serious trouble.

The RN (or LPN) can shift blame for her mistakes onto you. RNs and LPNs are very difficult to find (unlike CNAs) and they're not disposable; if you get an unethical RN you may find yourself being fired for someone else's screw-up and--again--you're probably not going to work as a CNA again.

Most places are reasonable; a lot of them aren't going to make trouble for you because it can, in fact, end up making trouble for them if they're too harsh on CNAs. There was one place in Cedar Rapids which was always advertising for CNAs, because it was well-known in the long-term care community for being an unremediated shithole that used up CNAs. (I knew someone--the wife of a friend--who got in trouble there for trying to do her job too well.)


I came up with a "worst case" scenario:

Say you're a CNA working for a nursing home, and you work with one other CNA in a ward of 23 people. One of these people is a 73-year-old male cancer patient with a central line. He's got early Alzheimer's, so he's confused; usually he's all right but sometimes he gets a little loopy. The nurse on the ward that shift is an older RN who's very friendly with the DON, and she's been there for years. You've been a CNA there for a year.

One day, while you're working on getting everyone settled down after lunch, the man becomes agitated and complains about his central line. You talk to him and try to calm him down, but it doesn't work, and he starts trying to rip the thing out in his agitation. If he manages that, he could bleed to death, so you have to stop him.

You manage to calm him down and you ask the other CNA to get the RN. While you're waiting, the guy tries to get at the central line again and you stop him; this happens a couple of times before the RN comes. She comes in, sees the guy in a moderately calm state, and tells you he's fine, and to get on with your regular work. You tell her that the guy's still agitated and trying to tear the line out, and that either someone's got to watch him or he has to be restrained; the RN tells you he's fine and that you'd better get back to work, or else.

You can't restrain a patient without a doctor's orders; illegal restraint can send you to jail. The nurse has a certain amount of latitude, but the CNA has none whatsoever--and as a CNA you have no choice but to do what the nurse tells you. You get the guy into bed and go off to continue your rounds.

Fifteen minutes later the emergency call light is flashing; the guy's roommate is yelling about there being "blood all over the place" and when you come in you see that the guy is bleeding profusely from his chest and the central line is laying on the floor. You call 911 and inform the nurse.

Luckily, the guy is transported to the hospital and he lives, but the guy's kids pull him out of the nursing home talking "lawsuit".

Two days later, you're fired for "leaving an unstable patient". It's not "abandonment" (which will get you jailed) but you're told you should have known better than to leave a man who was trying to remove his central line! The fact that the nurse ordered you to--even if you bring it up--is ignored.

Alternate ending: You ignore the nurse's order to get back to work and continue to watch the guy, with your partner's blessing. The guy tries to pull out his central line five more times in the next hour, after which the RN comes in and asks you why you're still in here when she told you to get back to rounds?

Two days later, you're fired for insubordination.

Either way, you never work as a CNA again.

* * *

By the way: you think a guy wouldn't pull out his central line if he was confused and agitated? There was a guy at the nursing home where I worked--guys, I'm warning you, this is gonna suck to read--this guy pulled out a foley catheter with the retention bulb inflated.

He did this more than once.

Do you know how big the retention bulb on a typical foley catheter is? It's a bit less than an inch across; a nurse inflated a spoiled one to show me once. This guy pulled that damn thing out through his dick. It must've hurt like every level of hell at once, yet he did it. It probably blew out after he got it past the urethral sphincter, but it would still hurt like the fires of hell. There was a guy in another ward with a foley; if you merely gave it a slight tug the wrong way, he'd yelp. That's how much it hurts. (Believe me, I only moved his foley that way once. He was lucid, so he understood "that was a mistake" and "OMG I'm so sorry!" Also, he was a great guy.)

People who are confused and agitated can do some pretty fricking awful things to themselves; that's why they have to be in nursing homes in the first place.

* * *

Besides the fact that you walk 5+ miles per day and spend a lot of time lifting, moving, pushing, wiping, cleaning, cleaning, wiping-- Besides that, it's emotionally exhausting, too.

Look: most of them aren't there because they're going to get better. Lots of them die a few months after they arrive there. It's hard to know which is worse: the ones who die within months or the ones who don't.

And you can go whole weeks without seeing any relatives. I rarely saw people get visitors where I worked; if you have any sympathy or empathy in you at all, you can feel the lonliness those poor people live with.

There were one or two residents who had visitors all the time.

I'm not blaming the families--or not entirely, anyway--because it's hard to see your loved one sitting in a wheelchair, unable to recognize you or even feed himself. It freaks some people out to see a person disabled by nothing more than the infirmities of age. It's very easy to rationalize it: "She wouldn't recognize me anyway, so what's the point of going?"

But when you're the CNA working the ward, guess what? The confused ones still recognize you; they see you almost every day. Some of them ask for you by name, if they ever learn it; but if they don't they'll still treat you like family because you're familiar to them, even if they don't know where they saw you. (Being treated "like family" may include being slapped and yelled at, pinched and scratched, because the person really can't help himself. You learn not to take it personally, because it's not personal.) They may not know who you are, but they know who you are, kinda.

It sucks to be someone's kid and have the guy ask, "Who are you again?" but chances are the guy knows you're someone important to him; he just can't remember who. (So if you have loved ones in a hospital or nursing home, gut it up and start visiting them regularly. They desperately need your company; and I'm pretty sure you go to hell if you don't.)

* * *

Even something as simple as an aspirin is rife with trouble.

If a patient decides he wants an aspirin, as a CNA your only option is to say, "I'll go tell the nurse."

The nurse can then consult the patient's chart. If there is a doctor's order in the chart allowing the patient to have aspirin, the nurse may then give the patient aspirin, and the problem is over. If not:

1) The nurse tells the CNA, "He can't have asprin."

2) CNA tells patient, "Doctor says you can't have aspirin."

3) Patient says, "What the hell? It's just an aspirin! I want an aspirin!"

4) CNA repeats what the nurse said, and then takes his leave of the patient.

5) Patient rings for help: "I want an aspirin!"

6) CNA gets the nurse, who tells patient, "You can't have aspirin. I'll call your doctor to see if he'll let you have some."

7) Patient protests, "It's just an aspirin! You can buy it at the drug store!"

8) Nurse explains drug interaction precautions, blah blah blah, most of which the patient doesn't even listen to. Nurse and CNA leave the room again.

9) Call light goes on again: "I want an aspirin!"

10) CNA says, "The nurse has a call into the doctor."

...repeat until the guy falls asleep or the CNA's shift ends, whichever comes first.

This kind of thing happened to me all the time.

* * *

The job is full of too many "rock and hard place" decisions.

There's too much physical labor, too much responsibility, no concomitant power, for far too little pay, and there's no job security.

It's exhausting on every level.

So, that's why I don't want to be a CNA again: I just can't. I mean, I can--I'm physically capable of doing the job--but...I just can't. Really.

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