Nursing Assistant Central

I wrote the following essay in 2001 to offer some insight to new CNA's on some of the issues patients deal with on a daily basis. A lot of the following text is the result of countless conversations with my patients over the years, combined with common sense and empathy. As a Nursing Assistant, in the midst of your hectic work day, always make it a point to stop and consider the patient's perspective. If you do this daily, you will develop increased patience, compassion and a desire to provide exceptional care while maintaining your patients' dignity.

"Come on! Time to get up! You don't want to be late for breakfast!" The voice, like a bugle, interrupted my sleep while the curtains were thrown back, blinding me with a brilliant sunrise.

Another day. I squinted, trying to see the clock. Six? Am I actually being dragged out of bed at six in the morning, again?

I heard the water running in the bathroom and then watched as the Nursing Assistant rummaged through my closet, looking for an outfit. I silently hoped that she would choose pants that didn't fit too snugly, and prayed she would dress me in a long-sleeved shirt and sweater. The temperatures in this place can reach arctic levels!

I heard a scream coming from the far corner of the room, followed by what sounded like a slap. My roomate was at it, again. She was severely demented and had no control over her combative behavior. She routinely gave the staff a run for their money during care. She screamed, pinched, slapped, kicked and once she even got a grip on someone's hair. That was a time to remember! It took two nurses and an CNA to release her hold!

How life had changed for me, over the last month or so. I had a stroke not long ago. The doctors didn't think I'd live. I showed them, though! I came to live here unwillingly, but don't we all? I never dreamed this is how my life would end. I was supposed to be healthy and active for at least another ten years! My husband and I had planned our 'Golden Years' many years ago. We had been saving every penny we could, in hopes of securing a comfortable retirement. Our hopes were dashed, however, when my husband died unexpectedly five years ago.

The money we had so carefully stashed away is now dwindling. From what I understand, the rent in this place is pretty steep! Apparantly, Medicare will not cover my expenses until I am fresh out of funds. My house was sold and the money will go to this new home of mine. I wonder if the staff here realizes that my hard earned money is paying their salaries? Oh, well, no matter. The staff I have encountered so far have made my experience as pleasant as possible, considering the circumstances.

The stroke left me paralyzed on the left side of my body. I am unable to walk, or even stand. I require assitance for every aspect of my life, even going to the bathroom! The powerlessness that I felt in the beginning was compounded by the humiliation I felt at having my personal space and privacy so completely stripped away. I have always been a very independent woman, and in the beginning, I didn't take too kindly to having to depend on others for my very existence.

Because of the stroke, I have trouble speaking, as well. Most of the staff have been very patient and helpful, trying their best to anticipate my needs and listening carefully when I do try to speak. For the most part, I remain silent. I have no family to come and visit with me, so chatting with and listening to the CNA's share stories with me about their lives is such a welcome and much needed part of my day. They often will ask me questions about my life and my feelings that only require a 'yes' or 'no' answer. I am grateful for the communication. It can be so lonely here.

The Nursing Assistant approaches my bed with an outfit in hand. She leaves for a minute and comes back with a basin of water. The blankets are pulled off of me and I am hit with a rush of cold air. Not all CNA's take the time to cover me with a bath blanket while they help me get washed up, so I'm chilly through the entire bed bath some mornings.

On this morning, I feel the bed beneath me with my good hand. Wet, again. Of all the effects of the stroke, incontinence is the one I've had the hardest time dealing with. I cringe when one of the CNA's calls my undergarment a 'diaper'. It is simply degrading, despite the fact that, well, that's what it is.

I am given a bed bath and dressed, all while laying in bed. I try my best to help my caregiver, following their instructions to grab the siderail as I turn. We make small talk, actually a one-sided conversation, until they announce they're going to find someone to help lift me into my wheelchair.

The wheelchair is another thing I have had a hard time getting used to. With one arm, it is impossible to push myself along. Consequently, wherever I am placed, there I stay, until I am moved again. The wheelchair is relatively comfortable, however, after an hour or so, it starts to feel like my hips are being squeezed together and my bottom becomes numb. I try to shuffle myself in the chair, however, this usually causes me to slide to one side and I am even more uncomfortable! Aside from the discomfort, sometimes I am placed beside a noisy resident who drives me crazy! She makes loud meaningless noises all day. I know she can't help it, the poor thing, but honestly, I can't take more than five minutes of it! I am always afraid to ask to be moved, because I don't want to appear cold and uncaring. I also don't want the CNA's to think I am petty, or a pain in the neck. They are always so busy.

As I lay in bed waiting for the CNA to return with her partner, I am being verbally assaulted by the woman in the next bed, who swears this is her house and I am an intruder. She threatens to call the police and I half hope she does...we could use a little excitement around here! Apparently, the girl who started care on her this morning got slapped one time too many, and went off to start on someone else first.

The Nursing Assistants come into the room arguing this morning. It seems they are both running behind today and tension is reigning on the floor. Someone must have called in sick, again. It seems the floor runs short more often than not. I can always tell by the expressions the staff are wearing whether they are short staffed or not.When they are short, they do what I've heard called the 'CNA shuffle', which is a walk that almost borders on a run. When they are short, the call lights are like a symphony and they never stop for a minute. It seems, when they are short, everyone is in a bad mood. It makes me feel like a burden.

I am lifted into my wheelchair on the count of three. It has only been a month, and I am still not used to the feeling of being gripped and lifted by two girls half my size. I try not to show my fear, but I must admit, the thought of landing on the floor terrifies me.

I am wheeled to the dining room and placed at my table. Now, I just sit and wait. I watch the people around me and try to imagine what they were like before they were sick. I laugh to myself as the phrase "What are you in for?" crosses my mind. At times, I do feel imprisoned.

For safety reasons, I am not allowed to leave and even if I could, where would I go? I have no home, no family, no car...I don't even have a pocketbook anymore! (I have no money, so what's the point?) Sometimes, we are brought out to the balcony or the courtyard for fresh air. Since they have been working short staffed so often, however, that is a special treat.

The smell of toast and bacon brings me back to reality. Meals are something I don't look forward to anymore. My stroke has impaired my ability to chew and swallow properly, so the doctor decided to put me on a ground diet. Everything I eat has to be put through a blender first. The appearance of the food is not very appetizing. The consistency is even worse. I often find myself craving a nice piece of steak, or even a solid piece of chicken. The taste of the food is bland. I have been told the kitchen prepares the food with no salt, to accomodate those residents on a low salt diet. I pray that whoever serves me my meals has the insight to sprinkle a little salt on the plate!

Since I have swallowing difficulty, my liquids have something added to them that thickens the consistency. Mine is only thickened to a nectar consistency. There are people at the table with me who need to be spoon fed their liquids, they are so thick. Imagine, I ever took gulping water for granted! Somehow, thickened water just isn't the same.

After breakfast, it's time for activities! This is a high point of my day. They always seem to come up with new ways to entertain. My favorites are Bingo and reminiscing. I love to listen to people talk about the good old days...so many memories! I also love the musical entertainment! Once, we had a group of young children, Irish step dancers. We all loved that! They danced around the entire room! Sometimes, a person will bring in an animal or two. Babies and animals seem to be a big hit!

Activities are the highlight of my day, but I feel sorry for some of the other residents, the disruptive ones, who are banned from activities. Sometimes, it's because another resident complained about them. Other times, it's because the activities staff feel they are too disruptive to the group. Either way, I feel they are being left out.

Bathroom time, now there's the low point of my day! It is a constant reminder of my incontinence and my inability to get onto the toilet on my own. I can only hope I get used to the daily ritual.

The rest of my day progresses pretty much the same as the beginning, with the exception of getting into bed instead of out! Sometimes, when they are short staffed, I have to wait longer then I'd like to be put to bed. I like to get to bed early, because six o'clock in the morning comes too fast!

As I lay here and listen to the defiant one in the next bed, I wonder to myself why she hasn't caught on to the routine yet. I listen as the Nursing Assistant tries to reassure her for the ten thousandth time that everything is ok.

It has only been a month for me, and I am not here willingly. I have come up against tremendous changes and I have weathered them. Some of my problems, I am still working out. I would, of course, rather be home in my own bed, with my own life, not dependent on anyone but myself.

"We're all done! Give me a hug", I hear the CNA say to my roomate. Surprisingly, she complied. I smiled to myself and settled under the covers.

Yes, everything's going to be alright.

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