Workplace Wednesday

Nursing Home

Oh, those stories! CNAs in a Nursing Home spend months, or even years, with the same residents. Not everyone has the skill set necessary to provide daily care for the same patients in a nursing home environment…but you do! Your unique combination of stability, caring personality and desire to get to know your patients while working in a team setting makes you a clear pick for the nursing home.

Overview

As a nursing home CNA, you will be caring for patients with long-term serious health conditions that are severe enough to require constant monitoring, nursing interventions and personal care. While these patients are very ill, they are mostly stable (their condition won’t change much) which creates a sense of routine in your daily interactions. Life in a nursing home tends to revolve around medications, treatments, meals and activities and a sense of easy rhythm exists, once you get to know your patients and their preferences.

Nursing Home CNAs work primarily with nurses and other CNAs. Doctors will occasionally do rounds in the facility and some facilities also offer physical therapy services. But overall, this setting will foster a small, close-knit team atmosphere with a fair amount of solo work time. Since you play well with others, but also work well independently, this is your a dream environment for you! An added bonus of providing long-term care for the same clients gives you the opportunity to get to know them in ways that other environments just can’t offer. So many stories, so little time!

“Nurturing is not complex. It is merely being tuned in to the thing or person before you and offering small gestures toward what it needs at that time."

Mary Anne Radmacher

Working in a nursing home brings very specific challenges, and great rewards. Read below for some specifics!

1. Pace

Healthcare in a Nursing Home is dominated by routine. Patients follow a very predictable schedule, with little variation. Getting the know the schedule, and the patient’s preferences, takes time. But, once mastered, that familiarity can offer a sense of security, a belonging to a purpose higher than yourself, that is unmatched in any other setting. There are a lot of patients to care for, and a lot of tasks to do, but taking the time for a smile, a kind word, an extra gesture of care can bring a bit of sunshine to both the patient and your own soul. Nursing homes put the “Care” in “Care-giver”.

You tend to thrive in an environment where you know what to expect and can perform your tasks with little interruption – but can access help when necessary. Routines are your safe-space. Spending lots of time with the same people is comforting to you and helping the most vulnerable people is in your blood. Compassion and protection are your superpowers.

2. Type of Patient

Patients that live in a Nursing Home need nursing care. They are have serious medical conditions (or sometimes injuries). Because they are so sick, they will need lots of help with activities of daily living (ADLs) as well. This is where CNAs come in! Nurses will perform nursing services (medications, monitoring, treatments, dressing changes, IV therapy, tube feedings, etc.) and CNAs will help with bathing, dressing, grooming, mobility, feeding, socialization, maintaining a clean environment, etc. We call these tasks “personal care”. Anything that you would normally do for yourself on a daily basis falls under personal care!

3. Number of Patients

Nursing Homes generally have a moderate patient assignment. Because the patients require NURSING care, there is usually a lot to do. But it is pretty easy to develop a routine, which makes the care go a lot quicker.

The number of patients you have will depend on what shift you are working and what department you are in. But, mostly, it will depend on what kind of help your patients need. Day shift will require more work with each patient, so fewer patients are assigned to each CNA. Night shift, when most patients are sleeping, means the CNA can care for more patients.

Overall, though, nursing home CNAs generally have more patients to work with than a CNA in a hospital. The care provided by CNAs will usually be centered on personal care tasks, rather than clinical skills. And, since the patients are pretty stable and long-term, it is easy to establish a routine.

4. Oversight and Supervision

While nurses and CNAs work as a team in a nursing home, they will perform their tasks independently of each other. CNAs that work in nursing homes need to have a certain amount of self-motivation and accountability. The nurses will be caring for a LOT of patients in a nursing home (way more than in a hospital). This means that they will be tied up with their own tasks, so won’t really have much time to monitor what their CNAs are doing. So, they rely on you to be ethical, motivated and willing to follow directions without their direct supervision.

Patients in this setting are ill but generally stable. Which means there is usually very little to report to the nurse regarding each patient, compared to more dynamic settings like hospitals. This setting will usually have less interaction between CNAs and nurses than hospitals or rehabs.

5. Length of Patient Interaction

Patients LIVE in a nursing home. That is why “HOME” is in the name. Staff members will get to know their patients really well, because they see the same patients day after day after day. CNAs that work in a nursing home need to be genuinely interested in their patient’s lives, because staff contact is often the only meaningful connection many of these patients will have.

6. Schedules and Shifts

Nursing Homes usually run on 8 hour shifts, which generally means you have to work 5 days a week. These settings are often understaffed, so overtime shifts are usually readily available for those who want to work more! Nights, weekends and holidays may be required (but usually on a rotating basis).

Schedules will vary depending on facility and department. Some will offer a set schedule that rarely varies, working the same days every week. Some will require more flexibility as the days you are scheduled will be different every week, based on scheduling needs.

Some nursing homes also have a short shift schedule, where they bring in an extra CNA just for busy hours (like getting patients up and dressed in the morning for breakfast or for shower days). These are usually shorter shifts (2-4 hours), but aren’t available at all nursing homes.

7. Pay and Benefits

Nursing homes generally offer some of the highest pay rates for CNAs, because they often have a difficult time hiring enough staff. It’s all about supply and demand!

Very few new CNAs want to work in a nursing home. They may think that it’s boring, or smelly or too hard. Many young CNAs don’t want to work with old people, thinking they can’t relate. Because of this, nursing homes have to work hard to hire enough staff to care for their patients. If they don’t have enough CNAs, they must use agency CNAs to fill in (substitute CNAs that don’t work for the facility). This is not a good practice because Nursing homes run best on a routine, and new people aren’t familiar with the patients or the routines, so things get missed.

Some nursing homes offer hiring bonuses, shift differentials (a few dollars more an hour for nights and weekends), extra shift bonuses when you agree to work an extra shift and other incentives that can really boost your paycheck.

An interesting side note is that Nursing Homes are the only workplace that legally REQUIRES all patient care staff to be certified. It is actually a law. So, while other settings can employ other types of caregivers (like PCAs, PCTs, Nurse Techs, etc.), in Nursing Homes they must be actual CNAs!

8. Learning New Skills

CNAs in a Nursing Home are usually focused on ADLs, because there are nurses on hand to handle all the higher level tasks. But, occasionally, you may have to learn how to do new skills in this setting. Training is generally provided informally (at the bedside, not in a classroom), when new skills are required.

9. Opportunity for Advancement

Nursing homes don’t generally offer a lot of opportunity for advancement. There may be an occasional opportunity to transition into scheduling, administration or activities, but the focus is on continuity of care here, not staff advancement. Some corporate nursing homes may offer tuition reimbursement (which means they will pay for your schooling!) or scholarships, but that is not as common as in other settings.

Summary

It pays to pick the right workplace…and your personality will have a huge impact on your overall success. Often, we have unrealistic expectations and the reality doesn’t live up to what we THOUGHT the work would be like. Knowing what to expect and making sure you have the skill set to perform well will go a long way to ensuring your success, no matter WHERE you decide to work in healthcare!