Thursday, May 15, 2008

Training your CNAs

In the vast majority of nursing homes, CNAs are taught from the immensely popular How To Be a Nurse Assistant. Published by the American Healthcare Association, it is one of their best sellers (right after their reprint of the CMS State Operations Manual). Irregardless of how good the book is, nurse aides quickly find it to be useless in the real world. Despite all of the skills taught in the book, it doesn’t adequately cover the three things that the average CNA spends 90% of their time doing: skin care (turning, positioning, changing, bathing), providing assistance with eating, and dealing with psychosocial issues.

It is no secret that training programs for nurse aides are not only irrelevant to what really goes on, but are also of an inadequately short length. Whatever notion you may have to the contrary, the CNA is not an unskilled worker. Although some of the physical tasks probably would be considered menial, that is not the point here. As Lori Porter pointed out in her autobiographical Everything I Learned in Life...I Learned in Long Term Care, a nurse aide has the power to either promote a resident’s physical, mental, and psychosocial well-being, or completely destroy it and take that individual’s last shred of dignity away from them.

Either we forget (or simply have never realized) the enormous power we have entrusted to these folks – power that oftentimes goes unchecked. If we are to fulfill our legal obligations as nurses and/or administrators to maintain the health and welfare of our residents, it is simply incomprehensible to think that we would delegate this enormous task to unskilled workers. Thus we must transform the workforce, which can be achieved in one of two ways.

The first way is to change the way that CNA classes are conducted. Consider lengthening the course from two weeks to three weeks. The current practice is to have the students spend a week in class, then a week on the floor. What I suggest is that you combine class time with floor time. After three days or so in the classroom dealing with non-clinical topics, slowly introduce the students to the residents. Let them know what is going on with them from a medical and from a psychosocial standpoint so that they can truly see in action the conditions they are learning about. Have the students spend time on the floor during its busiest times, and then during the lulls have them to return to the classroom to talk about clinical issues. Don’t be limited by the textbook – allow the student’s minds to go above and beyond the norm. It seems that every nursing home wants well trained staff but they don’t want to put forth any effort to achieve that dream.

Although some corporate owners and administrators may balk at this approach, citing increased costs, it is actually a worthwhile investment. It is common knowledge that the vast majority of CNAs quit soon after being hired so it is prudent to keep a proverbial safety net under them for an extended period of time. With this paradigm in place, the students will have a supporting framework when things get rough. During the latter part of the second week or the early part of third would be an excellent time to begin peer mentoring.

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