Stories from the Night Shift

  Living in a facility is an emotional toll in itself. Losing all privacy, the comfort of your own home, and the support of your family can push people into a bad place mentally. To add to the pressure, strangers enter your room everyday, and overwhelm you with information you may not understand. They wake you up at 6am to take your vital signs, and they control when and what you get to eat. Oftentimes, residents in long-term care facilities need some sort of other emotional support. In fact, nighttime is when all the emotions come to the surface, because that is the loneliest time of day. Constant overthinking leads to restlessness, so many patients are awake at night simply pondering. Family and friends eventually stop visiting, and the person that residents rely on ends up being the CNA. Let’s take a second to appreciate this privilege. Someone, who doesn’t know anything about you, trusts you enough to confide their deepest emotions in you, and they blindly trust you to respect ...

  Take it from me, working as a CNA has never been and will never be easy. I was a junior in high school, working 6pm to 6am on Friday night, going to a Speech and Debate tournament all day on Saturday, and then going back to work on Sunday night, only to clock out and drive straight to school Monday morning. I was working on my research paper at 3am while all my call lights were off, and doing homework assignments during my 4am lunch break. And worst of all, I am the sleepiest person you will ever encounter. Prior to working as a night CNA, I had never pulled an all-nighter. You will never catch me staying up late doing schoolwork, or waking up early to go to the gym. Sleep is (was) non-negotiable for me.  I had a patient who asked me how old I was, and I told him I was 16 years old in high school. He said, “Wow, that’s badass.” At that moment, I felt proud of myself. I was the badass 16 year old CNA who was juggling it all so well. From school to work to home to my other job...

  CNAs spend arguably the most amount of one-on-one time with patients, especially in the long-term care facility setting. For that reason, nurses rely on CNAs to serve as a liaison between patients and themselves, so that any reports of changes in condition reach the nurse, and aren’t lost in translation. That is why it is important that CNAs are vigilant of any changes in patient condition and behavior. I talked about nonverbal patients in a prior post. Those patients cannot verbalize to the CNA or nurse what issues they are having, and since the CNA is closer to the patient, the CNA has to take matters into their own hands and recognize the smaller signs of discomfort.  For example, a patient who is normally alert suddenly does not recognize their family members. This could be a sign of delirium. Delirium can indicate a urinary tract infection, a bad reaction to medication, or even onset of dementia. Another example is a patient that stops talking and refuses to get out of ...

  I know we’ve covered the importance of being empathetic to patients, especially during deep emotional conversations or during life-changing moments for them. But what about the day-to-day interactions that seem insignificant? When you walk into a patient’s room, what do you say to them? How do you introduce yourself? Patients see a different CNA every 12 hours, so how do you distinguish yourself from them in a way that makes the patient comfortable?  If there’s one thing I learned from entering a patient’s room, it is to always knock. What we fail to recognize is that we are, essentially, in someone’s home. If you were in someone else’s house, would you not knock before you enter their room? Not knocking is an incredible invasion of privacy, if you think about it. Just because their bedroom is now at a long-term care facility rather than their own home doesn’t mean that they lose the right to feel human. After knocking, you should always address the patient using their last ...

  It sounds impossible, right? Trying to care for someone who cannot verbalize what they need from you. In today’s day and age, we have become used to always receiving instructions. People tell us what they need from us, and we act and deliver results. We receive texts and emails with direct requests, fully spelled out for us, without any thinking needed on our parts. Our managers at work call us with any new tasks, or when they need us to pick up a shift. As a CNA, about 20-30% of my patients either did not speak a language I spoke or did not speak at all. I was left with the impossible task of trying to read their mind.  I’m joking, of course. Most people don’t realize that when one sense fails, the other four strengthen. Similarly, when one is no longer about to speak, they find other ways to convey their needs. The burden is almost never on the CNA to figure out what the patient wants, because they will find some way to tell us what they need. Some patients will point to o...

  Normal food or pureed food? Water or juice? Bed raised or lowered? Positioned supine or lateral? Lights on or off? Every decision matters as a CNA, and every small detail can significantly impact the patient’s experience in a facility. For example, if you give a patient with swallowing difficulties or a compromised digestive system a plate of normal food, their odds of choking skyrocket. If a patient is pre-diabetic and you give them juice, you put them at risk of hyperglycemia. If a patient has a habit of moving around in their bed or cannot support their own weight and you raise their bed, they will suffer an injury far worse if they fall. If a patient has respiratory difficulties and you position them supine, breathing becomes much more of a struggle for them. If a patient has a tendency to develop migraines and you leave their lights on, their condition could worsen and make them more irritable.  I know everyone talks about how important empathy is in patient care, but n...