Professional Etiquette for the Certified Nurse's Aide
Courtesy Goes Both Ways
In another article I wrote about courtesies that patients, residents, nursing staff and families should extend to certified nursing aides. Now I would like to address CNA's directly about appropriate workplace conduct.
Working as an aide is a hard job. On a daily basis you face grueling tasks, unpleasant sights, and difficult people. Reality is often different from the text book pictures of clean, happy, people being pushed in wheelchairs by smiling aides.
The truth is that you may lift thousands of pounds in the course of a day's work. You may be hit, yelled at, left with too much work when a co-worker vanishes, and splattered with a multitude of bodily fluids. Rather like parenting.
Like parenting, being an adult caregiver can be a very rewarding job. It takes a special type of person to be an aide. In my experience, there are two types of aides;
- Those who do the job because they have to
- Those who do the job because they love the people they care for.
You will find good and bad aides in both categories.
Regardless of your reason for choosing to be a nurse's aide or assistant, there are certain professional do's and don'ts you should follow when dealing with a patient, their families, your own superiors, and your fellow aides. These may take a little more effort on your behalf, but they can make life easier for everyone in the long run.
Before You Put On Your Scrubs
There are three important, perhaps life-saving, things to understand before you set foot on the floor:
Know the policies and your job description:
Know the policies of the company with whom you are employed. These go much deeper than what type of uniform you should wear. Some of these, unfortunately, may not even be in print. During your interview or orientation ask plenty of pertinent questions, and memorize the answers. Talk to other aides and your charge nurse about certain protocols if you aren't certain how to handle a situation. For instance, many patients and their families will try give aides a gift. The general opinion on this is that aides and nurses should not take personal gifts or payments for any services. However, different companies may have different methods of refusing gifts, or accepting gifts, depending on the type of gift and how it is given. Be safe rather than sorry.
Unless it is a dire emergency you should NEVER perform a task outside of your scope of practice. This means that if you are asked to a job that you weren't trained to do, or that is not in your job description, you should refuse. Even if it means angering your boss. Your certification and other's lives depend on your good judgement.
You may be trained and certified to perform a certain procedure, such as taking blood pressure readings. But if that is not in your job description for your employer then it can still get you into trouble if you are caught doing so.
Know your patients: They are more than numbers and schedules.
This is more of a necessity for nursing homes than hospitals, as hospital patients are usually only temporarily under your care. If you are a hospital aide, be sure to listen closely at change-of-shift to all the information provided by the previous aide about the patients. Don't accidentally make a patient more uncomfortable by jostling a wound when you run in to do a quick vital check.
In a nursing home, you will probably know your residents very well after working with them a short time, especially in a smaller facility. Even though you will be very busy, take time to learn more than just the information in a resident's chart.
This doesn't mean you need to know the names of all their grandchildren,( but if you have a good memory for this thing, it can help), but do know their personal likes and dislikes. What television channel do they like? Do they have a favorite outfit? Do they ike the window blinds a certain way? Memorize the particulars, and the residents will be happier and more cooperative.
Understand a variety of illnesses and behaviors:
You don't need to be a doctor to brush up on some medical facts about the persons under your care. Whereas you cannot give medical advice, you can understand some unusual behaviors better by familiarizing yourself with the symptoms.
Not every patient will be the same, but you can get a general idea of what is normal, and therefore normal for the individual. A lot of seemingly worrisome (and sometimes frightening) behaviors are very simple in nature once you understand their cause. Know the symptoms of dementia and alzheimers. It will help with your daily interaction to know that these patients have no control over their behavior patterns.
Now that you understand your employer, your residents, and their particular conditions, lets move on to the daily routine of an aide, and how you should comport yourself.
You will do more than hold their hands...
Aides do a variety of tasks. Depending on the facility aides may:
- Make beds
- Clean rooms
- Check vitals
- Shower or bathe residents
- Dress and groom residents
- Serve and feed meals
- Help with toileting
- Help with ambulation
- Provide certain nursing care under supervision of a nurse.
Rather than offer a detailed list of how a nursing assistant should behave while performing each task, I am going to break this up into four categories.
- Interactions with Residents and or Patients
- Interactions with Supervisors
- Interactions with Co-Workers
- Interactions with Families and Visitors
Know your residents as individuals, protect their dignity, and be someone they can trust.
CNA Survival Kit
Everyone loves their own customized survival kit, right? Make your own CNA survival kit with this list of things you should carry on your person, (love those big scrub pockets) or keep in a locker:
- Hand sanitizer
- Spare gait belt
- Spare gloves
- Spare scrub top
- Ink pens
- Hair bands
- Watch with a clip
- Lanyard or clip for keys/badge/or watch
- Candy for energy.
- Vicks salve (helps disguise odors)
- Ibuprofen or Tylenol for aches
- Emery board (you will break nails)
- Small notebook (use this to write down points to remember, patient info, important numbers or door codes, and tips and tricks you learn along the way)
- Spare salt and pepper, sugar, and jelly packs. This keeps you from having to make a long trek back to the kitchen.
- Water or soda in a spill-proof bottle
Provide Quality Care to Residents
- Knock at any door before entering, and announce who you are, and why you are there. Agitated, heavily drugged, or confused people may not remember where they are and why a stranger is in their room.
- When cleaning a room keep in mind the resident's personal preferences
- Make sure that private possessions are kept in their proper places.
- Don't use air freshener sprays unless the resident prefers.Some heavy fragrances can cause nausea in patients taking certain medications.Especially in combination with the heavy cleaners and disinfectants.
- Never speak badly of the resident or other residents during care, even if you think they can't hear or understand you.
- Respect their modesty. When showering or toileting/changing, don't make quips about smells,their bodies,or the process.
- No matter how much you personally dislike someone under your care, or a particular task, don't mention it. You can rant about it at home later.
- If you need help from another aide, don't make it a personal insult to the patient. "You are so heavy I need help moving you" is rude. Instead say, " I am going to get Tina's help so I don't hurt you."
- It is okay to let a demanding person know that you are busy, just be sure to see to their needs as soon as you can.
- Be careful how you explain yourself. If you are late to answer a call light, you can say "I'm sorry. I got here as soon as I could. Ms. Jones needed help." DO NOT say, " I couldn't get here sooner because MS. Jones has diarrhea and we had to clean up a huge mess."
- When assisting a patient with dressing, give them the choice of outfits. Many aides neglect this courtesy to save time. It is okay to offer confused a resident a choice between two outfits that are seasonally appropriate.
- When you go to the nurse's station to make a report, think before you speak. "Elizabeth is really making me mad today." isn't informative to the nurse, or considerate to the patient. Even if she is being difficult. Try " Elizabeth keeps calling me, but then tells me to go away. She doesn't seem like herself today." Remember, other residents, staff, and family are milling about and can overhear your words.
- Listen sympathetically when residents complain. If it is a genuine complaint, try to let your supervisor know or correct it yourself when possible.
- Do not go into a room pretending to provide patient care only to watch television or text on your phone.
- Provide privacy. Don't leave doors open when changing or bathing a person. Don't call in another aide to chat with you or laugh at the patient's situation. DO NOT take pictures! That is just WRONG.
- Be very careful of your watch or jewelry. I saw a lot of skin tears caused accidentally by metal watch bands and diamond rings. If you can't work around the jewelry, remove it and wear your watch on a clip.
- Wash your hands before and after providing care no matter how busy you are. You can spread infections to other patients and possibly back to yourself.
- Prevent accidents to the best of your ability. If you have access to the proper equipment, use it whenever necessary. I highly recommend any aide to own her own gait belt. Sometimes the belts provided get old and frayed. Keep your own in your locker.
- Pay attention. If an accident occurs you may have to help a nurse file an incident report. Try to note as many truthful details as possible. Don't cover for other people's neglect or deny your own.
- Be cheerful, but not condescending. Most of those under your care will be adults, and they won't appreciate being treated like children.
- Sssh! Try to avoid as many loud, startling noises as possible. Slamming doors, rattling trays, and loud shouts can be unnerving. Not to mention the clatter disturbs those who are resting.
- Don't play favorites.
- Don't give into the temptation to provide something that can hurt them. It is hard to resist their pleas, but you could do more harm than good by sneaking it to them.
CNA's and their charge nurses have to maintain a decent working relationship for the benefit of the residents.
Don't Neglect Your Safety!
- Avoid dangling jewelry
- Keep long hair pulled back
- Wear comfortable,safe shoes
- Practice proper lifting and moving techniques
- Follow contact precautions
- Know your emergency routines and escape routes
- Wear gloves
- Know when to ask for help
- Report sexual harassment
- Never do anything outside your job description
Nurse Supervisors and other Bosses
When you first start on the path to being a CNA, you will hear people say how you are 'one of the team' and how 'important and loved you are by the nurses'. There will be times when it will not feel that way.
Nurses come in all varieties from awesome to downright rotten. No matter how you feel about your supervisors though, keep your opinions professional while you are clocked in.
Nurses are not more important or less important to the team. It might not seem that way, but good nurses do just as much work as the aides during a day. Aides see a nurse seated behind the desk while the aides themselves are running up and down the hall answering lights.
She might stop them to give them new orders, or chastise them for not getting something done fast enough. That doesn't mean she is doing an easy job herself.
Be respectful to your supervisor. Unless there is a professional issue at hand, you shouldn't add to the drama by complaining about her constantly.
If you do notice that she is endangering patients or aides, or engaging in questionable behavior, by all means report her to her supervisor. Otherwise, simply heed some of the following advice:
Tips for a good relationship:
- Do your work as promptly and effectively as possible.
- Don't tell her every detail about what you are doing. Stick to what she needs to know. (she needs to know that Mr. Smith has a strange rash. She doesn't need to know that you changed Ms. Collin's sheets.)
- Chart honestly and legibly.
- Manage your tasks around hers. If she is checking a sick patient's BP, don't burst into the room with the meal tray. Apply yourself to another task until she is done.
- Try to get her help only when you can't do it yourself or the other aides are busy. She will come to respect you as being dependable and competent. Also, she will know that you are serious about needing help when you do ask.
- Don't gather with other aides and talk about her. She is outnumbered and will probably feel threatened. This can lead to retaliation.
- Don't talk her down to the patients.
- Don't talk her down to visitors.
- Don't try to buddy-up with the supervisor for the sole purpose of getting an easier assignment list.
Most importantly, don't tattle to your nurse unless it is about something important. You witness plenty of wrong behaviors from your fellow aides or other staff, but try to limit the amount of finger-pointing to severe infractions. (for example, if another aide is eating candy when she shouldn't be, this is a minor issue. However, if she is selling candy to a severely diabetic patient, this is an important issue.)
Staying on good terms with other CNA's helps everyone's job go smoothly.
Yes, the other aides are the only people that can commiserate with you about your job. This doesn't mean you should do it while working. Go to lunch together if possible, or meet up on a day off if you want to vent.
If you don't get along with another aide, keep it professional on the floor. Don't insult, belittle or harass another aide. Be kind to new aides. It might be annoying to have to explain things you already know to a trainee, but you will appreciate their assistance once they become fully trained. Whether or not they choose to make your life easier may depend on how you treat them on that first day.
Other tips for dealing with co-workers:
- Do not huddle in rooms to talk or watch television. Only as many people as are needed for a task should be in the room.
- When you are in the room caring for people, talk to them, not your co-worker.
- Don't stand in hallways laughing and joking with co-workers. People can misconstrue this as being directed at them personally. Do however talk in the hallways about anything important that needs to be done. Joke while you work, but not about residents.
- Watch each other's backs. If there is a combative patient, try to make sure no one goes in alone to provide care.
- Job swap when allowed. If Ms. Jones hates you, but loves Pam...offer to care for Pam's hall for the time it takes her to see to Ms. Jones. Residents will play favorites with their caregivers which can be very frustrating and lead to safety issues. Do what it takes to make things run smoothly.
- Monitor your co-workers as you go through your shift. Neglect, abuse,( verbal, physical, emotional, or sexual) and stealing need to be reported.
- Also watch for aides that do their job halfway. If you suspect that they are merely spraying the patients hair rather than providing the full shower or other such shortcut, report it to the person in charge.
- Again, limit the amount of co-worker reports to the most important issues. Leave the other stuff for residents, visitors or the nurses to notice when it is feasible.
Be courteous to different staff members. Don't deliberately leave messes for housekeeping. Be kind to the cooks too. If it weren't for them, cooking would be one more task on the CNA's list!
Family and other Visitors
If your resident is lucky, they are visited often by an assortment of friends and family. Whereas this is wonderful for them, it can be a trying experience for an aide. When it comes to these experiences, a little humor is involved.
Be sure that family members understand that you are an aide, not a nurse. Many people assume that anyone in a uniform is a nurse, and may harass you with issues that are out of your control. Tell them you are an aide, and offer to tell the nurse about their concerns.
Here are some common situations you may encounter, and how you should react.
These are the relatives that point out every wrinkled sheet and every speck of dust. Even if an aide has just been in the room to provide care, the first sign of an un-tucked corner or a need to toilet will send these family members running to the head nurse with complaints about lack of care.
Response: Unfortunately, the best you can do here is to apologize and try to fix the situation as soon as possible. If you are in the middle of a task (such as caring for another person) and can't leave, don't explain what the hold-up is, just tell them you have to finish your present tasks.
Family tend to think their resident is the only one that matters, and that aides are capable of being in several places at once. You can explain to your charge nurse later, if needed, why you couldn't answer the call immediately.
The Clueless Visitors:
Here we have the people that just "don't understand". These are the family that wander into any resident's room to use the toilet, sashay into the kitchen for a snack, and pass out candy to the residents regardless of restrictions. (any idea of the danger a lifesaver could pose to someone who is on a liquid diet due to choking issues?)
Response: Politely redirect them away from anything they aren't supposed to be doing, and let your nurse know immediately. Especially if they are doing something that can agitate others, create contamination, or possibly kill someone!
The Royal Family
These charmers are the type to burst into any facility with an entourage. They give the room the white glove test, then demand to "speak to someone in charge". They will usually call the aides "You there!", and throw around scary sounding phrases like "our lawyer". They also issue threats, and usually keep all the staff hustling and befuddled because you will never know what to expect.
As an aide, the best way to handle these visitors is by politely reminding them you are not the one in charge, then escorting them to those who are. Then make yourself scarce. Don't allow yourself to get so nervous you can't do your job. But don't slack when they are around either.
The Good Visitors
These are the people that appear unobtrusively and visit more than just their family. They know everyone's name, what they like, and how they feel. They may bring gifts for others, flowers for the nurse's desk, or volunteer time. Residents and patients will love them, and you may notice a calm atmosphere when they are around.
Be sure to thank them for their time if they volunteer. Keep them updated on anything new. (not gossip, just issues that might have unsettled their family member or other resident) Breathe a sigh of relief that they are there.
The Invisible Family
These are the relatives and friends that you never see. Of all the varieties, these are the worst. You will hear about their existence, and watch sadly as residents ask daily if there has been any word from any of them. Residents may try to call them, write to them, or even run away to see them, and will often have depressed moods when these family members don't appear.
Always be sympathetic and reassuring when someone gets upset over a lack of visitation. Help them make phone calls or write letters, even if you know it won't do any good.
Remember...if you work in a long-term care facility, then it is the resident's home. You should treat them as though you are a guest in their house. Be respectful of their privacy, personal likes and dislikes, illnesses, and possessions.
A CNA's job is not always easy or pleasant. Working as a team with the residents and other staff can make it easier on everyone. Being a nurse's assistant has great rewards though.
You will fall in love with your residents, and they will make you smile on some days and cry on others. No matter how difficult the actual work is when caring for them, the hardest thing you will ever experience is losing one. Appreciate them as people, and enjoy the memories you are making every day.