Tag Archives: certified nursing assistant

Time to Drop a Few. . .

Somehow, I’ve let myself tip the scales at > 250 lb.  Life happens. . .nursing school + working night shift = stress+boredom eating.  I can rationalize anything!  Oh, it’s Pi day (March 14, 3.14) – I’d better have some pie to celebrate.  I’ve been a good girl . . .time to have a venti machiatto coffee to celebrate me.  Unfortunately, there’s a bit too much of me to celebrate now, and I’m worried about immediate and down-the-line health consequences.

My “numbers” aren’t too bad right now. . .blood glucose in the mid-normal range, cholesterol numbers could use some work but I need some 12-hour fasting data (going to biometric screening after night shift when one has had both dinner and “lunch” probably skews the data).  The weight is too high, and the fact that my blood pressure readings immediately after a shift has systolic or diastolic (or both) consistently in the pre-hypertensive or hypertensive range is not a promising sign.

Yes, I take care of folks with CVA’s, folks who are bariatric (oh, the sad, sad skin issues. . .the burly bumpy pannus skin, the sores, just heartbreaking). . .that alone should motivate me.  But the thing that I read today, that gave me a target, was a flight nurse job posting.  I am years (or never) away from having the qualifications to do that job, but one thing really stood out – must be able to weigh in at a duty weight of 210 lb. or less (including gear).  Now, the gear probably weighs about 15-20 lb., because a helmet is involved, boots and a flight suit.  So that would put the target at 180 lb.

After kid #1, I weighed in at about 170 lb.  Then, I came up with the great idea of using Depo-Provera for birth control, and that’s when the weight gain started.  Add in 20+ years of working behind a desk, and up to about 215 lb. I went.  After a summer of working in long-term care, I got the numbers down to a consistent 220 lb., but then nursing school kicked in, and I’ve been sliding upward steadily.

So, graduation approaches. . .I’ve begun cutting portions, and eliminating the high-calorie coffees and the soda pop.  Once I have 3-4 days a week back, it’s time to start walking while the weather is nice.  Add more greens, whole grains and lean stuff.

I know the road ahead is long, but I have much to lose!  (Pun intended.)  I’ll probably never be at 120 lb. (my build just doesn’t work like that), but if I could reach a healthier weight, my heart, lungs, circulatory system, feet and back will be much happier.

I’ll keep you updated, internets, on my progress, good or bad. . .

 

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1:1 Patient Sitting Survival Tips

CNAs often are called upon to serve as patient sitters, particularly in the acute care setting. Sitters are an alternative to increased sedation and/or restraints for combative patients. Facility policy may dictate the use of a sitter (“safety companion”) if a patient has expressed suicidal ideation.

When dealing with an agitated, combative patient, using a soft voice, dimming lights, and providing a calm, restful setting can go a long way toward minimizing the amount of action going on. If a patient is fidgeting in the bed, but not actively trying to pull out their central line (that would be a BAD THING), peripheral IV, or fourth (ouch) Foley that day, heck, let’em fidget! If the patient is given some opportunity to get rid of excess energy through some, ah, bed mobility, chances are good they might be able to settle down and even get some rest.

Cloth tape may be your BFF for keeping leads, IVs and sat probes on/in your patient. You can use a square of cloth tape over tele leads to make them more likely to stay on, and if you have the pulse ox probe on a toe, use cloth tape to secure its cable to the top of the patient’s foot.

Distraction is another valid approach to use with the agitated patient. Try telling stories, singing or employing other entertaining methods to help the patient get his/her mind off being in the hospital.

What kinds of survival supplies will help you have a more enjoyable shift as a sitter (assuming you’re not spending an entire shift doing everything you can just to keep the patient in bed, that is)?

Here’s a list:

-book to read (can be a textbook)

-smartphone with Netflix – many programs are close-captioned so you can watch without waking your patient, or you can play Words with Friends (scrabble game), Facebpook, text, etc.

-snacks, bottled water

-cards/stationery so you can catch up on correspondence

-portable reading light (so you don’t wake your patient)

-cell phone charger

Happy sitting!

Post-mortem care – prep for the journey

CNAs, whether working in hospital or long-term care settings are called upon to assist with post-mortem care.  If you’re not clear on this going in, perhaps a different career choice would be best.  Just sayin’.

Yes, death gives darn near everyone the heebie-jeebies, yours truly included.  Everyone’s reaction to death and corpses is individual.  What can be standardized is a competent, professional response to the practical need to prepare the body for 1.  family to spend time with the departed and 2. need to get things settled/cleaned/straightened before rigor sets in.  We’ve certainly come a long way since the time of the Black Death.

In the hospital, the nurse may supervise this care, or it may be performed by a couple of CNAs working together.  A CNA may also perform this duty solo, but usually this doesn’t occur, for the practical reasons that positioning is more safely accomplished with two or more workers, and that post-mortem care does an emotional/spiritual number on even the most grizzled, seasoned health care worker. 

Sometimes, the nurse needs emotional support.  He or she has supported the patient through efforts to save his/her life, then through hospice or “comfort care” and then the dying process.  The nurse has to be supportive of family/loved ones as well, and their reactions to the dying process.  Last but not least, the nurse is responsible for final charting, finding out which funeral service the family would like used, dealing with belongings, and supervising/performing post-mortem care according to facility policy.

So, what’s our role as the CNA in all this?  There are three areas:  rules of behavior/etiquette, rules of gathering supplies, and rules of post-mortem care.

1.  Rules of behavior/etiquette:

  • Watch your mouth! It is said that hearing is the last sense to go.  So keep it proper!  Plus, many hospitals only have a curtain between you and family members lingering outside the room, other staff, management, and passers-by.
  • It’s not about you, it’s about the consumer!  (Best business advice ever, courtesy of Joe Dirt.)  Nobody wants to hear how you handled the death of someone in your family.  They are having their own experience, save the stories and advice for another time and location. So STFU.
  • Be discreet!  If the family will be coming back into the room post-mortem to spend time with their departed loved one, put the body bag in a drawer or cupboard.  Bag up extra non-needed medical wastes (catheters, lines, drips, etc.) and get’em out of the room.  Lower the lights so things don’t look so stark.
  • Be realistic about time frames.  Post-mortem care can take 15-30 minutes to accomplish with a team of two or more, depending on how much there is to remove/clean, and how much bleeding/oozing is going on.  Keep the family informed so they don’t freak out on you.

Rules of gathering supplies:

  • 10 mL syringe for removing Foley cath
  • 60 mL Luer-lock syringe for removing stool/fecal management system (excellent product video from Bard – select the removal procedure video)
  • plenty of chux
  • paper tape (less damaging to skin)
  • drain sponges/gauze (needed along with tape for securing holes where lines used to be)
  • surgical scissors (find in procedure cart as needed) – needed for removing sutures holding in PICC, central, art lines (these are too tight to get at with trauma shears, which have blunted leading tips)
  • body bag with tags (usually 3 – for body, outside of body bag and for belongings) – to use per facility protocol (LTC – usually the funeral service brings this item)
  • bags for belongings if not already taken by family – don’t forget to tag them
  • clean gown
  • clean bed linen
  • basin
  • soap
  • water
  • wash cloths/towels
  • comb
  • EMPTY garbage cans with plenty of liners (don’t forget the biohazard bags – you’re gonna need ’em) – it just plain sucks to start post-mortem care with every waste can in the room chock-full!
  • did I mention – plenty of chux? OK.

Rules of post-mortem care:

Hopefully you had a good CNA textbook that covered this topic and you read it during your CNA course.  If not, might be a good idea to review it before taking a new position.  I highly recommend the following article:  Post-Mortem Care

Remember to put a chux down under orifices (or is it orifi?) on the side you are rolling the body to, because drainage happens.  This one piece of advice will hopefully save you a few post-mortem linen changes.

Remember, this is the patient’s (and their family’s) last experience with your facility, so make it a professional one.

Squee! Cute Pediatric Accessories!

 

Puppydog Leads

  OMG!  So many adorable things to see in Pediatrics – besides the patients, of course.  And they have STICKERS!  So other than an embarrassing Dynamap moment (oh, I guess the button with the BIG person and the SMALL person allows changing the BP setting from adult to child) it was really great to experience the Pediatric unit at my hospital.  Darnit, though – missed my chance to wear Disney print scrubs.  Oh well. . .

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Hey, if that CNA gig doesn’t work out. . .

…perhaps you should consider working for Press Ganey.

In all seriousness, it’s nice to know that their Client Improvement Manager, Jackie Weaver, has a CNA background. 

If you haven’t considered the impact of PG scores on how acute health care is delivered, might be a good time to learn more.  Many hospitals use PG to gather statistics from patients on the perceived quality of their hospital stay/visit.  It’s interesting that many of the items measured relate to areas within nursing staff control, such as the time taken to have a call bell answered, for example.

You can download the WebEx presentation, “Improving Patient Flow: Improving Patient Satisfaction” here  (Includes a link for installing WebEx Player).

Since census drives staffing, which in turn drives the extent to which nursing staff are called off or placed on standby, it’s interesting to learn a bit about the factors that drive patient flow and thereby staffing.

The presentation takes about 47 minutes to run – just long enough to give yourself a good pedicure! (Just one great multitasking suggestion. . .)

 

The Brain Sheet

The CNA “brain sheet” serves two primary purposes:

  1. document care performed on your shift
  2. assist in providing a comprehensive report to your relief

If you’re a hospital CNA, you need a place to keep notes about your patient load – like who’s vented (on a ventilator) or not, who has a Foley, and other important things.  You can note which patients are due for baths/showers on your shift, what CBG’s are due on what frequency, and other useful details (who’s A&O, who has a PITA family, special/additional needs, how many staff needed for bed-to-chair or commode transfers or for turns, etc.).

Use color and/or highlighting to make important details stand out.  If your facility doesn’t provide a “brain sheet,” make your own format, including the following categories:

  1. patient’s room number
  2. code status
  3. nurse name and phone/pager number
  4. respiratory status (V=vent, T=trach, NC=nasal cannula and so on. . .)
  5. elimination status (F=Foley cath, U=urinal, BSC=bedside commode, BRP=bathroom privileges, etc.)
  6. capillary blood glucose (CBG) check information if that’s within your scope
  7. bath/linen change done or needed
  8. oral care schedule (vented or trached patients)
  9. turn schedule (dependent patients)
  10. notes for the next shift

If you get floated to another unit or floor suddenly, this is nice to have, as it can be handed off to the lucky person who gets your patients after you leave.

Being a Great Follower

Getting the shift off to a smooth start can make the difference between a “why, oh why didn’t I call in today” day and a decent work day/night.  Being organized and walking the unit briefly before shift change is key.  Hopefully your facility offers some overlap during shift change to facilitate this. 

Why should a CNA walk their unit before getting report?  Because nothing says “It’s my Friday and I’ll crap on the next shift if I want to” like a soiled utility room (that’s the “hopper room” to y’all from LTC) filled with bags of garbage and linen for YOU (lucky oncoming shift person) to take to the garbage/laundry chute, or if truly unlucky, the dumpster out back and/or the dirty laundry room.

If you can quickly identify what’s not done that should be, you might be able to guilt/bully/threaten collaborate with the offgoing shift to work together to fix deficiencies, rather than figuring out how to clean everything up yourself.  Or, if you’re blessed to be following a rockstar who never leaves you hanging, it’s a great time to exchange gossip compliment him/her on how great he/she is!  (Who doesn’t like to be appreciated?) Or, you might be able to help with an end-of-shift transfer or discharge (who schedules these, anyway?) to reduce your coworker’s stress level.

Bottom line – most of the time it’s up to you as the CNA to resolve challenges person-to-person.  If you think the oncoming charge nurse has time to help you resolve things, you’re probably dead-ass wrong, mi amigo!  So put on your big-girl (boy) scrubs and work to help the person you’re relieving end the shift right.

Oh great, another CNA/nursing student blog. . .

I’ve become somewhat addicted to reading nursing blogs.  There are many great ones out there, and I’ve posted some links for those of you who’d like to see some of my favorite reads.

However, there’s little on the interwebs for CNAs, whether working in LTC, home care or acute care (hospitals).  A quick Googling of the terms “CNA blog” will yield sites touting vocational-school programs, but little from actual CNAs.  Wouldn’t it be great, I mused, to have a blog that would allow sharing assistant-related lore, whether mine or from commenters.

So, in the interest of:  a) giving me something to do when I can’t sleep (which is pretty often, since I work NOC shift, b) providing a writing outlet since my nursing program is pretty much multiple-choice test-oriented and c) hopefully providing a positive addition to the body of CNA-related work knowledge out there – I am launching this blog.

Frankly, I don’t have the stick-to-it-iveness to spend a year cooking all of Julia Child’s recipes , or even spending a year watching the movie made about the blogger who spent a year cooking all of Julia Child’s recipes (are you freakin’ kidding me????) so don’t expect a lot.

And, since I’m a relative newcomer to the field, I’m not going to even pretend to be an authoritative resource on all things CNA.  There are many folks who’ve worked multiple years and decades more who can speak with much more gravitas about how to take care of sick and/or aged patients/residents.  I hope some of them come here to comment!

**So, here we are, almost 2 years later.  I’m now a new grad RN, learning the hospital ropes all over again.  This blog has had almost 7,000 views, which frankly is about 6,900 more views than I thought it would ever generate.

My chief struggle as a blogger has been finding my blog identity.  A blog is like a career, in that it develops as one stumbles along blindly; some blogs never get where they are going, because a destination is never identified.  A life without focus is unfocused, a donut with no hole – is a danish.   Seriously, though, I do think I’ve found it at last – a cooking blog with just a dash of healthcare worker whimsy.  So, dear readers, bon appetit and a tu sante!