We Are The CNAs

I am a CNA in a nursing home.

I have not ALWAYS been a CNA in a nursing home, but right now I am. 

Okay, right NOW I'm at home sitting in front of my desk; that's because I have the day off. 

But guess what? 

I'm still focusing on my job. 

Last night I was up all hours researching, learning, educating myself about something that has been becoming an obvious issue for me and my work team, trying to figure out what has been going on with us and seeing if I could find some sort of reasonable solution that we can implement among ourselves. 

What I concluded is that we're all bat shit crazy and there's no hope for us. 

We are the ones who are caring for and about the elders and/or disabled in our society.  Every day, day in and day out. 

We are the ones who love them.  Every day, day in and day out. 

We love our people. 

We run our backsides off for eight hours at a stretch, up and down some damned long concrete hallways, doing our best to meet all the needs of these people that we love.  Our feet and legs take a beating.  Sometimes we sit on the floor while putting on or taking off someone's shoes, just for that brief moment of relief for our feet and legs. 

We lift, turn, bend, stoop ... hour after hour ... we get tired, physically tired.  We get worn out.

We listen to our people.  In the few minutes we have available to them while doing cares, we hear all kinds of things, and we listen.  In bits and pieces we learn the life stories of our people.  We probably know more about them than their families ever have.  We certainly know more about them than management or administration.

There are times when, out of the 40 or 50 people our team is responsible for, two or three (or four or five) of them will be more needy than all the rest put together.  We do our best to meet their needs, but it is a challenge.  There are only four of us working the floor most of the time, each pair in charge of 20-25 people, and we have to try to be everywhere at one time.  Obviously that's impossible.  Yet it's expected of us.   We're supposed to be able to handle the work load.  Mostly we do.  Somehow.

Certain times of our shift are more challenging than others. 

Just before mealtime, everyone seems to need to go to the bathroom at once.  That's just the way it is.  Nobody deliberately chooses inconvenient times to need the bathroom, but nevertheless that's the way it is.  And most assuredly nobody wants to hear, from the only person who can help them, that there are four or five people ahead of them on a wait list.  But with only two pairs of hands available and probably a dozen immediate needs for those hands, guess what.

After supper bedtimes begin.  A few people will go to bed very early; another few want to wait until close to the very end of our shift; most want us to put them to bed in between, within a span of maybe half an hour. 

When it takes an average of 15 minutes to do the cares required to put someone to bed properly, how many of those twelve to fifteen people are going to get to go to bed exactly when they want to, within that half hour time span?  With two of us available, maybe four of them.  Because, you see, we've also got to anwer all the other demands on our time while we're trying to get them tucked in:  call lights, toileting people, bed alarms, personal alarms, chair alarms, radio calls for assistance all interrupt what we're trying to do at any given moment.  Each person is important to us; each person believes in their heart of hearts that they are, or ought to be, MOST important every single solitary moment of every day, and we're supposed to respond accordingly.

Yet, somehow, we manage.  And, somehow, we love our people and they know that we love them and are caring for them and about them. 

If we have a few seconds between lights or alarms or radio calls, we pop in on someone dear to us.  Maybe it's someone who is bed-bound; maybe it's someone nearing end of life; maybe it's someone going through a rough patch who just needs to know someone cares ... it is always someone we care for and about, someone who needs us. 

Sometimes those few seconds are worth more than we have any way of realizing.  In a few seconds we can quickly reposition someone, fluff and flip their pillow, tell them we love them, and give their hand a squeeze.  For all we know, it may be the last time we see them. 

Then it's back to running on cement floors. 

Communication can be challenging. 

Sometimes (okay, fairly regularly) our people have cognitive difficulties as well as physical ones.  We go with them wherever they might be going, and don't even try to make sense of the fragmented sentences or words that don't go together; we just reply as best we can as though they were making perfect sense, reassuring them that whatever it is they're worrying about is being taken care of, whether it's buying a new tractor, feeding the chickens or gathering eggs, butchering a steer or hog, or locating their glasses or their teeth.  Quite frankly, it doesn't really matter much what we say as long as our body language and voices are reassuring; they'll immdiately forget and begin fretting all over again.  All we can hope to do is alleviate their distress momentarily - again and again and again and again ad infinitum ad nauseum. 

Everything we do uses up more time than we have available.

It also uses up more of our internal resources than we can afford. 

Caring for and about our people to the extent that we do is not just physically demanding; it's emotionally draining. 

You know what really makes me angry? 

When someone accuses us of whining about our work. 

Most of the time that happens when we make mention of the fact that several of our people have died in the last little while.  The other person will inevitably say something along these lines:  'Well, you know, it IS a nursing home.  Ummm ....  People go there to die, right?  You knew that before you went to work there!'

Well yeah, of course they're right.  And their intentions are good in that they're trying to get me to put it into perspective. 

However - when I've invested a considerable amount of time, energy, and emotion in caring for and about a person; when my strength has carried them (literally) as theirs failed them; when they have trusted me with their tears and fears, their laughter and joys - when all is said and done, that person has become dear to me and I have become dear to them in return. 

It is NOT just a simple matter of saying, 'They're in a better place, they're not in pain, they're with their loved ones, they're happy forever now, they wouldn't want me to be sad.' 

The fact of the matter is that THEY ARE DEAD. 

Over and over and over and over again, people we have become close to DIE. 

Their families grieve and that's the way it is.  Each person's family grieves for that person. 

What people don't seem to GET is that WE GRIEVE FOR ALL OF THEM. 

When a member of your family dies, you are entitled to grief, a period of time that varies from person to person but to which you are entitled for as long as it takes you to come to peace. 

It doesn't work that way for us. 

Over and over and over and over again, we have to stuff our feelings because we still have a job to do and we do not have time for grief. 

That's just the way it is. 

I ask you:  When we are already physically exhausted and emotionally drained, how much do we have left for coping with the unremitting grief, the pain of loss, that hits our belllies anew every time one of OUR loved ones dies?  Because never doubt for one instant that our people are most absolutely OUR loved ones.  Over and over and over and over again we take the emotional punches, absorb them as best we can, and get on with our work. 

The impacts to our psyches are not without consequence.  The effects are cumulative and permanent.  They don't go away just because we can't afford to let them show or interfere with what we have to do. 

As time passes it doesn't get any easier.  It gets steadily more difficult to carry our internal burden of grief and still maintain our professional and individual standards.  The load just keeps getting heavier and heavier as we go along. 

Still we love and care for/about our people.  That's who we are, it's what we do, and we do it quite very well thank you very much. 

We can stuff our grief, we can cope, we can get on with our work, we can do it all. 

We can put to use the self-help tools:  we can cognitively distance ourselves from the emotions; we can eat right, sleep enough, get plenty of exercise (really?  in OUR job? you gotta be kidding!  US get EXERCISE?); we can meditate and practice yoga; we can go to our 'happy place'; we can journal; we can vent to one another; we can create and attend support groups; we can educate ourselves and then implement plan after plan after plan for taking care of OUR SELVES. 

Sure we can do all that. 

On top of everything ELSE we do. 

Like we have time or energy left over to do any or all of the above. 

Get real. 

We are people our own selves, human beings.

We are not machines that, given proper maintenance and a stable power source, can go on and on and on 24/7/365. 

We are people and we do not GET proper maintenance or a stable power source. 

We have to provide our own, each for our own self and for one another as best we can. 

My trainer told me, 'Shiela, you had better figure out how to take care of YOURSELF because nobody else is going to do it.' 

Well, she was right. 

She was also wrong, because I happen to have been fortunate enough to land in a regular CNA work team that is indeed a team in the best sense of the word. 

We are sensitive to one another's needs; we are accepting of one another's foibles; we enjoy the heck out of one another's company; we recognize and understand our own and each other's strengths and weaknesses; we provide for one another the support and care that nobody else even seems to realize that we need.  We KNOW, each and all of us, that punch in the gut feeling when we find an empty bed that nobody bothered to tell us about ahead of time.  We KNOW the burden each and all of us carries, and we respect that in one another when nobody else notices or has a clue.  We do our best to help one another shoulder what we have to shoulder, even when our own strength is taxed to the max. 

As I say, I have been fortunate in my CNA team-mates.  I seriously appreciate them and hope to high heaven that they know how much.

We're struggling now, as individuals and as a team, with the load we're bearing. 

Physically challenging, emotionally debilitating, as our work is, we love it still, as we love our people. 

I have not managed to find much of anything, either within my own self or on the web, that might help us. 

I myself, personally, am feeling pretty vulnerable right now. 

I don't know how much more I'll be able to add to my load. 

We all need more down time - but it's far beyond our horizon. 

We all need more income - but it's far beyond our hope. 

We all need more of the support my team gives to one another despite the fact that we're all in the same boat - but nobody sees us or hears us. 

We all need extra pairs of hands, more help, during those awful times of guilt when we can NOT be in as many places as we need to be - but that ain't gonna happen. 

We all need regularity in our schedules so we know we'll have at least a little recovery time on a regular basis - but that is beyond our scope.  (Every other weekend off with all the days in between a chaotic hodgepodge just doesn't cut it)

We all need more time, more energy, more strength, more internal resources, more replenishment of all that we expend in doing what we do - but who cares?

We all need a two week paid vacation - you're not LAUGHING are you? 

Our needs are not being met; they aren't even noticed by anyone except us. 

We are the CNAs. 

We are the ones who are caring for and about the elders and/or disabled.

We are the ones who will love and take care of you when you need us. 

Do you REALLY want us to burn out?  It will no doubt happen just when you need us the most. 

Think about that. 

I have just spent hours of my DAY OFF, valuable hours I could have spent doing many other things, all of them more fun, writing about being a CNA. 

What's wrong with this picture? 

Compassion fatigue, burnout, stress, anxiety, physical exhaustion, emotional distress, cognitive dissonance (don't know what that is?  look it up), yada yada yada ... labels all. 

We do what we do and will continue to do what we do to the best of our ability.  Just bear in mind that, as that list of labels up there takes its toll, our best is getting harder and harder to achieve.