The diary of a nursing assistant, part 2

I realize that I have only been a nursing assistant for a little over three years, but I am at a facility that assists the NH Red Cross in training new nursing assistants. So, I am frequently reminded of my first experiences as a N.A. Many of the students will ask me for advice and one of the instructors told me I should write it down someday. I guess today is someday. I do have to say that the Red Cross, I feel, has one of the best courses in NH to take. But, it is still very hard for the instructors to prepare new N.A.'s for the “reality” of the career they chose.

So, I guess I should just start with some things that scared me the first day on the job. It was being alone with a resident. During my course I was teamed up with another student, so my experiences with the residents were on the same level with my team buddy. It did not take me long to realize that after you leave your course, graduate and in NH pass the NH State exam you are on your own. Yes, facilities have you precept or buddy up with a veteran N.A. in a brief on the job training, it is still scary. One piece of advice I have to give all new N.A.'s is that your not going to kill them. You will find your way of doing the job and it probably will not be the same as any one else. This is fine. As long as you follow your facilities' rules and regulations, do not forget the state in which you live rules and regulations you will be fine.

Depending on your state and facility that you work, there will be a wonderful opportunity to learn more than your course could ever teach you. For instance, I live in NH where we need to not only be certified, but licensed as well. Because of this licensing it opens more opportunities for me. You can learn to do C.B.G.'s, bladder scans, sterile dressings, oxygen therapy, restorative programs and after two years you can train to be a M.N.A. (an N.A. that can give medications). There are many, many more opportunities available, but I just named a few.

When getting your first resident assignment, all you need to remember is that every one needs to be clean, they need their teeth, hearing aids and etc. Treat your resident as if they were your family member. After you get that into your mind and feel comfortable, it is all down hill. I treat my residents as if they would someday be my N.A. The other thing is treat their personal possessions the same. You would not like to be robbed, do not rob them. You do not want to be yelled at, do not yell at them. You would not like to be mistreated, do not do it to them. You would not like to see your favorite clothes balled up and thrown on the floor.

Make sure their room is kept clean, stuff off the floor and everything they need is in easy reach. When you do not anticipate their needs then they may become a fall risk. One other thing, the most important, is if you do not know how your resident ambulates – ask. I ask when I get assigned to a resident that I am not familiar with. Find out where the facilities O.T. and P.T. memo's are kept. Read the residents treatment book. Make sure you are thinking about your residents during your shift, not what party you are going to go to this weekend when you have off.

After you complete your first day, you will not want to go back. Trust me everyone feels that way. Basically, the first month you are a N.A. you will think you made a mistake. You will ask yourself what you were thinking when you spent the money to do this, the veteran N.A.'s hate you, the residents hate you, the nurses hate you. Trust me, they do not. They are trying to get to used to you being slow. Being slow is how you are going to be for a few months. Try and time yourself every morning after the first week. Try and not cut corners in your care, but set a personal goal for every day. For instance, it took you an hour to do this resident. The veteran N.A. told you it takes her a half an hour. You freak out. Do not freak out. You are new and you are still reciting the steps in your head. Just try to cut the time down five minutes each day. Maybe you are chatting too much because you are nervous. Maybe you are not getting your supplies together fast enough or forgetting some and need to stop. That is okay. I would say in about six months if you try and cut down your time each day you will have that resident up in a half an hour just like the veterans.

Please take the advice of veteran N.A.'s and your nurses. They really want you to succeed. It costs money to train new N.A.'s. It is not cost effective to want you to fail. Do not take to heart if veteran N.A.'s does not seem friendly at first or seem to sound annoyed when you ask them questions. It is not you. In many, many cases it is that the other N.A.'s have put themselves on a schedule (which you will also, given a little time) and every minute counts or maybe they are trying to get back to a resident for many reasons and you do not know.

Listen and get to your nursing meetings on time when she/he schedules it. Crucial information is passed from one shift to another in these meetings. A resident can change from shift to shift either good or bad. There is also 'sundowning' that occurs in the later shifts. You need to know that information. It will help you anticipate your residents' needs. Do not think that you know everything just because you just took the course. Let me tell you, not to be mean, but you know nothing. Your training really begins the first step you take on your floor with your first encounter with a resident, nurse or N.A.

A personal piece of advice. Keep your personal life separate from work. Your residents, fellow team members or staff do not really want to know. Especially, your residents. The residents worry about us in every type of weather. They worry if their N.A. is going to get them up on time, who their N.A. is today and if they are going to have a good or bad day. The last thing you want them to do is worry about your boyfriend leaving you, your kid with a cold or that bill you can not pay. You can get close to your residents and you will. It is our human nature. But, I caution you to keep your private life – private. You can tell them your getting married, that you have children, that they are in soccer, stuff like that – good things that make them feel safe to talk to you or things that will make them smile.

Sharing a piece of yourself in a good way closes the gap between you and your residents. They will feel that you have their best interests at heart, that you are no longer a stranger, that you can be trusted, it will also give them something in common with you. In turn they will tell you when something is bothering them, that they feel sick or in pain. Keeping yourself totally shut off with cause them to view you as untrustworthy and a stranger. I had one resident that swore the first week I worked at a facility that I was a spy working for the government to take her rights away. It was not until I found out she was a mother of three boys that I had something to talk to her about. I asked about her children and told her that I, too, had three boys. After that first awful week, it was so much better. She trusted me and we grew to care for each other. She got to the point that she wanted me 24/7. That is a wonderful compliment.

Now it is time for some more reality. If you did not pick it up in clinical, then let me tell you now. Making a bed is different in reality. Depending on the needs of your resident, the mattress will not be what you had in class. Many mattresses are hard to get the sheets just right and the blankets just right. When making the bed for your resident, if she/he is still in reasonable mind, ask them if they have a particular way. If not, when you are done, look at it. Would it be the way you would want visitors to see it? There are many times that you will use two top sheets along with a bottom sheet. Some residents have their own comforters and some will use the facilities. Some will have tons of pillows, others will not have any (believe it or not). Just keep that in mind. Much of what you learned to pass the course will not apply.

A real issue I have is when a N.A.'s does not look at their residents safety. If you are going to use equipment that you have only used either during your course or never – ASK! Ask for assistance when using equipment. The last thing you want to do is injure your resident or yourself. Your career will definitely become short.

Another thing is catheter care. Do not place bags on the floor. I do not care if a towel is under it or not. Please place them in a decorative bag or in some kind of bag that makes them discreet. Then hang it towards the feet of the bed or safely attach under the wheelchair if the wheelchair is in use. If you drop the bag to the floor you can trip over it causing it to be pulled out of the resident. They will not forgive you for that. Trust me! Do not drop the bag to the floor - it is a dirty floor. You are increasing the bacteria on the bag. This can assist in causing a UTI. Residents with Foley's already have an increase chance of getting a UTI. You could also partially pull the Foley out in some cases by dropping it to the floor. This becomes uncomfortable for the resident. It can cause the Foley to leak. This will cause the resident to be incontinent and add to skin breakdown.

Another issue is leaving a nasal cannular on the floor. Do not drop the nasal cannular on the floor and leave it. This causes a safety issue on the residents and yourself to trip. It will also cause dirt and dust to get into the nasal area, then it is introduced into the resident's nose. YUCK! Roll up the hose and either place it in a draw string back for storage or tie it onto the condenser or oxygen tank.

I would like all people, N.A. in particular, watch your hand placement when helping a resident when transferring. Watch your thumb placement in particular. The elderly's skin is thin and brusing is inevitable. We should not increase bruising by pushing our thumbs into the residents hand, leg, foot, arm or any other place for that matter. Your thumb is very strong and you will always find a thumb print on just about all your residents. Think ahead! How do I avoid thumb prints? If the resident only needs a minimum assistant in transferring, I generally have them take a hold of my hand, I in turn just wrap my fingers around their hand, then I use the opposite arm to assist in getting up. This always prevents thumb prints on your  resident.

When using equipment, like the sit to stand machine, watch were the equipment rolls or comes in close proximity of your resident. Many residents will get bruising or skin tears when you are not careful around equipment. One other way to give a skin tear or bruise is when using a B.P. cuff (blood pressure cuff). When attaching the cuff, make sure you do not have any of their loose skin in the Velcro. They will thank you.

There is many more pieces of advice I can give you, but many would be directed towards my facility. But, I do want to leave you with this... enjoy your residents, learn from them, learn from other N.A.'s you come to trust, ask questions and take your facilities' training sessions whenever you can. Most of all, enjoy your rewarding career. I wish you well.