Certified Nursing Assistants

Today, Fiona, my boss who's an OT, and I went to do an in service for a pt who was referred by nursing for transfer training using a sit-to-stand lift.  This patient uses a Hoyer lift for transfers, meaning he is completely dependent in the transfer.  In attendance were maybe five or six CNAs (certified nursing assistants) (in the Philippines, we refer to them as caregivers) to check out the transfer technique.  After showing them how to do it, we were greeted by a straightforward response from them:  Transferring the pt through the sit-to-stand lift is cumbersome, inefficient and very time consuming.  It is not plausible, they claim, to use it on him cause it will just take too much time and there also would be a safety concern when they try to use it.

I understand what they are getting to.  They have to see many patients at a time and using the technique that we just taught is gonna take a lot more time that using a Hoyer.  In a way, I feel for them.  CNAs do the dirty job that the nurses don't do.  They are at the bottom of the pt care hierarchy: an RN is usually the unit manager and then you have the LPNs (licensed practical nurses) and then you have the CNAs.  The CNAs literally do the dirty job: clean up the pt, bathe the pt, dress the pt, change soiled clothes, feed the pt, get pt up and back in bed when needed.  They also get a measly pay, maybe several dollars more per hour than minimum wage.  What they do is physically taxing and I would not wonder why they would entertain thoughts of using the Hoyer on my patient right now because it is faster and convenient.  However, I also would want my pt to get better and that means I need him to have more active participation during the transfer which the Hoyer could not offer.

It is disappointing and sad when sometimes patients tell me that they have clicked on the nurse's call bell cause they need to go to the bathroom and nobody shows up until thirty or forty-five minutes later.  By then, they have already soiled themselves or have slid down on their wheelchairs from exhaustion.  Because of repeated instances, some of them no longer use the call bell and instead attempt to transfer themselves to the bathroom which eventually leads to falls and fractures.  They put the blame on the hapless and helpless CNAs.   Yes, like in every profession, there are good ones and bad ones.  But then again, maybe one or two CNAs are assigned for maybe up to ten beds at one time.  It is possible that while a patient turned the call bell on, the assigned CNA was helping another patient in the bathroom too.  But still they get the blame if they don't get out there and assist as soon as possible.  

It is a sad reality.  But we cannot always give the best care we want for our patients.  And, though, I would still insist on recommending the use of the sit-to-stand machine for toilet transfers with that particular patient, for now I would take time and appreciate the CNAs who were present there today.  At least they told us face front: We're not sure if we are gonna use it often with him, but let us at least try.  So for now, here is a hats off to my seldom recognized teammates in health care: the certified nursing assistants.