The Sound of the Monitor: Lessons from the Night Shift

 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 that the CNA is the first link in the chain of care: we are the first responders to a patient’s immediate needs, and if the solution to their need or problem is outside of our scope of practice, we will refer them to someone of a higher authority or level of training. 

I never realized how important call lights were until I began working. In training, we learned a phrase called “LOCCS”. It is a memory aid to help us remember what we need to check before leaving a patient’s room after helping them. LOCCS stands for lowering the bed (to prevent any potential fall risk), opening the privacy curtain, comfortable positioning of the patient, call light within the patient’s reach, and sanitizing your hands and your workspace. My teachers never placed much emphasis on that second “C”, but the call light being in reach of the patient is fundamental to delivering proper care. There exist a plethora of reasons why a patient may be unable to use other means of communication to ask us for help - reasons we may never have considered before until we encounter them on shift. A patient may be nonverbal, may not speak English, may be paralyzed, or may have a neurodegenerative disease, among other possibilities. All of these situations would prevent a patient from asking CNAs and nurses for help, whether in an emergent situation, such as a fall, or in a non-emergent situation, such as not being able to use the bathroom without physical support. We always place the call light in the patient’s hand, clip it to their gown, or clip it to their pillow. This makes the highest quality of care fully accessible to the patient. In my opinion, the most important step in patient care is keeping that call light in reach of the patient. It truly is the only thing that can connect you to your patient when you are not actively in their room with them. 

Another sound you hear during the night shift is the sounds of other medical equipment. I vividly remember the first deaf patient I ever had, with his hearing aids constantly making this faint, high-pitched, ringing sound. I thought this sound was normal, until I searched it up and found that it actually means there is an issue with the hearing aid. The sound could be caused by earwax buildup, improper fit, the volume being too high, or a damaged part in the device. I also remember the first patient I had with a nasal cannula hooked up to this big black box, whose purpose I did not know at the time. I later learned it is called an oxygen concentrator, and I noticed it makes a sound that reminds me of waves crashing on a beach. The mind of a CNA learns to recognize these different sounds and adjust their care based on them. Within just one month of working at the facility, my response to each sound began to feel like a reflex. Call light? Get up and go. Bathroom call light? Get up and run. Hearing the waves on the beach crash? Remind myself to clean their nasal cannula every shift. Vital sign monitor beeping? Call the nurse. Care becomes a second nature, like something you are not trained to do, but rather conditioned to do. That is when I recognized the importance of sound. Sound is what bridges the attention of the CNA with the needs of the patient. Sound tells the CNAs how they need to adjust their care from patient to patient. Most importantly, sound is a constant reminder that we are doing something right. By showing up everyday, no matter how taxing, the sounds of the monitors keeping our patients healthy tell us that it is all worth it in the end.