Stories from the Night Shift

  I’m going to throw in some miscellaneous takeaways that I haven’t covered in other posts into this one. Now is my chance to throw as many cliches at you as possible, so stay wary. First, never be afraid to step out of your comfort zone, both as a CNA and in other aspects of your life. Humans were never meant to keep repeating things that don’t scare them. There is a reason we have adrenaline in our body. That adrenaline excites us, and it pushes us past our personal limits. Do things that scare you, even if it’s difficult, because after you do it once, it never seems scary again. Applying this to the CNA realm, if you’re asked to, take on a section you’ve never had before. Ask questions to charge nurses. Don’t be afraid to pick up that extra shift just because you’ve never worked on that floor. People will teach you what to do, and every step outside your normal boundaries is an opportunity to learn and grow.  Tying into stepping out of your comfort zone, never hesitate in s...

  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...

  I am a very flinchy person. I plug my ears when I hear a toilet flush, I jump when I drop an object and it makes a loud noise, and I scream whenever someone sneaks up from behind me. You can imagine, then, how difficult it was for me to adjust to the concept of working with dementia patients during a night shift.  About 80% of dementia patients in residential or hospital care settings experience “sundowning”. Sundowning is exactly what it sounds like: when the sun goes down, patients start to experience hallucinations, paranoia, anxiety, restlessness, and agitation. They start to pace around, talk to themselves, or become combative. A patient who was perfectly normal when the sun was out suddenly turns into an entirely different person as soon as the sun sets. While the exact cause for sundowning is unknown, a few factors may trigger these episodes. Fading daylight can create confusing shadows and increase anxiety, and changes in the brain can alter a patient’s sleep-wake cy...

  For honesty’s sake, I will not lie: I had no idea what a CNA did before I signed up for the class. I assumed I would be helping nurses directly, maybe by helping them retrieve medications or finish charting. I never expected the work that came with the job to be as hands-on as it is. It wasn’t until the second day of training that I heard the word “pericare” for the first time. For those of you who have never heard that term before, pericare refers to the process of washing and cleaning the genital and anal areas of your patients. That concept sounds incredibly foreign to someone who has never done pericare before, or never had pericare done on them. Most of what a CNA does on a shift is pericare. Bedridden patients cannot stand up to use the bathroom on their own, so they urinate and defecate in their briefs, and then CNAs go in, change the briefs, and clean up the patient. Similarly, paralyzed patients cannot move and turn so we can change their briefs, so two CNAs will go in i...

  Before I became a CNA, I used to hear the sounds of monitors and medical equipment as simple noise. Now, however, I hear them as warnings, I hear them as reassurance, and I hear them as a tool that helps me better recognize the needs of my patients. At night, when everything is quiet at most long-term care facilities, it is easy to recognize a change in sound. These sounds can be call lights, vital monitors, and even patients calling to you verbally for help. Sound is the means by which most communication between a patient and CNA occurs. When a call light gently beeps amidst the silence of a facility, the CNA assigned to that patient immediately gets up and tends to the patient’s needs. Most of the time, the patient needs help toileting, needs to be changed, needs a snack, or needs a glass of water. Other times, the patient will request to be repositioned, talk about a new onset of symptoms or pain, or ask for medications, a situation in which the CNA will call the nurse. Notice...