Prepare a presentation from attached chapter
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UNIT
TRANSITIONING FROM STUDENT TO EMPLOYEE5
23 Entering the Workforce
24 Enjoying Professional Success
5
Chapter 23 | Entering the Workforce | 373
After reading this chapter, you will have the information needed to:
■ Plan a job search. ■ Prepare a résumé, reference list and cover letter. ■ Describe the job application process. ■ Interview effectively. ■ Accept or decline a job offer. ■ Know what to expect during your fi rst few days on the job.
Goals
23 C H A P T E R
Entering the Workforce
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You are sitting at lunch with a few of your classmates talking about your classes. Suddenly your friend Jenny says, “Can you believe it? You know, in just about two months, we will all be working somewhere. That’s incredible. I don’t even know where to start.” As the discussion continues, your instructor Ms. Howard walks by. She overhears your conversation and sits down to join you. She says, “You know, with everything going on in our country today, the demand for well-trained, hard-working nurse assistants is very high. More people are living longer lives, many with chronic health conditions. Employers at health care facilities and agencies are looking to use staff members effectively to maximize efficiency while maintaining an excellent quality of care. You are a great group of students, and I think you are going to have lots of choices and opportunities once you are ready to enter the job market!”
PLANNING YOUR JOB SEARCH Once you graduate from your program and pass your state certifi cation test, you will start looking for a job. Most people start looking for a job without a plan, which can result in wasted time and a feeling of frustration. You can avoid this—and increase your chances of success— by making a plan. Being organized will help you make the most of your search and fi nd the job that is right for you.
Identifying the Right Job for You Your training qualifi es you to work in many different types of health care settings and with many different types of clients. Before beginning your job search, it is a good idea to think about what sort of job situation best suits your interests and lifestyle. Asking the following questions can help you identify job opportunities that will appeal to you:
■ In what type of setting do you want to work? For example, would you be more comfortable working in a facility or in a person’s home? Do you prefer the fast- paced environment of an acute care setting, such as a hospital or clinic, or would you like to have time to get to know the people in your care over a longer time?
■ Is there a particular type of client you enjoy caring for? For example, if you enjoy working with elderly people, then maybe a long-term care setting would
be most appealing to you. If you fi nd it satisfying to help people at the end of life, perhaps a hospice organization would be the right fi t.
■ Would you prefer to work the day, evening or night shift? Do you need to take a spouse’s or child’s schedule into consideration?
■ How will you get to work? If you plan to take public transportation to work, you will need to look for job opportunities in areas that are well-serviced by your desired mode of transportation.
Identifying Job Opportunities Many resources are available to help people who are looking for a job. One of the best resources is people you already know. Your instructors and the nurse assistants and nurses you worked with during your clinical training may know of job openings for nurse assistants. The Internet is also a very useful tool for looking for job. You can visit the websites of health care facilities and agencies in your area that interest you. Many websites list job opportunities and allow people to apply for them online. Websites such as CareerBuilder.com and Monster.com allow you to search for job opportunities and post your résumé so those who are interested in hiring can fi nd you. Websites such as LinkedIn.com allow you to promote your skills, network with other people and announce your availability. Newspaper ads are also a good source of information about employment opportunities.
You decide that if what Ms. Howard told you about the many opportunities for nurse assistants is true, you better start thinking about what job situation would best suit your needs and make you happiest. You think that the opportunity to work with lots of different clients of all ages would be exciting, and you like the idea of never knowing exactly what the day will bring. You also like the idea of working as part of a team and having co-workers and supervisors close by. You begin to think that maybe a hospital setting would be right for you. You will be driving to work, but you would like to spend no more than 20 minutes commuting each way.
What are the benefits of thinking about your ideal job situation in advance?
What will be your next steps in planning your job search?
Key Terms: résumé
reference list
job application
cover letter
job interview
pre-placement health evaluation
employee orientation
probationary period
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APPLYING FOR JOBS Once you identify job opportunities that interest you, you need to apply for those jobs. Many employers require you to submit a résumé, reference list and cover letter as part of your job application.
Preparing a Résumé A résumé is a document summarizing your contact information, education and previous experience (Figure 23-1). Your résumé should be limited to one page, if possible. Type your résumé using a plain, simple font, and print it out on plain white paper. Résumés usually have several standard parts:
■ Contact information. Place your contact information at the top of the page, either in the upper left corner or centered. Include your name, mailing address, e-mail address and phone number. When choosing an e-mail address, make sure that it is professional (for example, your fi rst initial and last name).
■ Objective. Provide a one-line description of your qualifi cations and the type of job you are seeking (for example, “To obtain a position as a certifi ed nurse assistant in an acute care setting”).
■ Education. List each school or training program that you attended, the dates you attended the program and the degree that you graduated with. Start with your most recent training and work backward to your high school education.
■ Employment. List the jobs that you held, starting with the most recent and working backward. Include your job title, the dates that you held the job, and a brief description of your duties and accomplishments. Remember that even if the jobs that you held in the past are not directly related to the type of job you are seeking now, you probably still gained experience and skills that are applicable to your current job search. For example, working as a cashier in a retail store demonstrates that you have experience providing customer service, a skill that is very applicable to working in health care.
■ Additional experience. If applicable, you can include a section listing additional experience that is relevant to the job that you are applying for. For example, if you have done volunteer work or community service, it would be appropriate to list those activities here. Similarly, if you are fl uent in another language, be sure to mention that on your résumé.
■ References. At the end of the résumé, indicate that “References are available on request.”
Some information is not appropriate to include on a résumé, including your age, your religion, your sexual orientation, whether you are married and whether you have children. This kind of personal information should have no bearing on whether a potential employer decides to hire you.
Preparing a Reference List A reference list is a document providing the contact information for three to fi ve people who know you well enough in a professional capacity to speak to a potential employer about your experience and suitability for a job. When you think about people to ask to be a reference for you, think about people who know fi rsthand what your strengths are and what you will bring to a job. Former supervisors, teachers, coaches and clergy members are people you may want to consider asking to serve as a reference for you. Before listing a person on your reference list, contact the person and ask whether he would be willing to serve as a reference for you. Make sure that you have complete contact information for the person, including the person’s full name, mailing address, e-mail address and telephone number. Type your reference list neatly, using the same font you used for your résumé, and print it out on a piece of plain white paper.
Submitting Job Applications Now that you have identifi ed jobs that you would like to apply for and prepared your résumé and reference list, it is time to start submitting applications. A job application is a form that employers use to collect basic information about you, such as your contact information, your employment history, your educational history, your additional experience and skills, the hours you are available to work and your references. Much of this information is the same as the information provided on your résumé and reference list, so having these documents on hand will make it much easier to complete the job application. Because a job application is considered a legal document, it is important to be honest and accurate when completing it.
Today, many employers have job candidates complete the job application form online. The online job application is then submitted electronically, along with a copy of your résumé and a cover letter. A cover letter is a brief letter to a potential employer that explains why you are interested in the job and organization. In addition, the cover letter is an
376 | | Nurse Assistant Training
Jacalyn Jacinto 123 South Street Big City, US 12345 (123) 456-7890 jjacinto@speedymail.com
Objective
A position as a certified nurse assistant in a long-term care facility
Education
Big City Chapter, American Red Cross September–October 2012 Big City, US Nurse Assistant Training CNA certification: November 2012
Community Junior College August–December 2010 Big City, US
Big City High School Graduated: June 2010 Big City, US High school diploma
Employment
Modern Style Clothing January 2011–August 2012
Sales Associate. Provided customer service on the floor. Operated cash register. Maintained and restocked merchandise.
Super Savings Supermarket June 2009–December 2010
Cashier. Provided customer service by scanning and bagging items for check out; operated cash register.
Additional Experience
Big City Chapter, American Red Cross October 2012 Big City, US CPR/AED for Professional Rescuers and Health Care Providers Red Cross certification: October 2012
Big City Food Bank Volunteer January 2012–present
Fluent in Spanish
References
References available on request.
Figure 23-1 Sample résumé for a nurse assistant.
Chapter 23 | Entering the Workforce | 377
Jacalyn Jacinto 123 South Street Big City, US 12345 November 3, 2012
Patricia Patterson, RN Director of Nursing Independence Village 3 Independence Way Big City, US 12345
Dear Ms. Patterson,
I am writing to express my interest in applying for the certified nurse assistant position I saw advertised on your company’s website. Last month, I completed the American Red Cross Nurse Assistant Training course, and I have passed the state certification exam.
During my clinical training at Springhill Manor Rehabilitation, I discovered that I really enjoy caring for older clients and helping them achieve their best possible level of functioning. I understand from looking at your website that Independence Village is known for providing quality restorative care, and I would really like to be part of your team!
Thank you for taking the time to review my résumé. I am available for an interview at your convenience, and I look forward to hearing from you soon.
Sincerely,
Jacalyn Jacinto
Figure 23-2 Sample cover letter.
opportunity for you to briefl y describe the qualifi cations and experience you have that make you an appropriate candidate for the job that you are applying for (Figure 23-2).
If you are applying for a job that was advertised in the newspaper, you will send your résumé and cover letter to the employer through the mail. If the employer is interested in interviewing you, you will be asked to fi ll out the job application when you arrive for your interview. Again, having copies of your résumé and references on hand will make it easier to complete this paperwork. Because you will be completing a paper form, be sure to write neatly.
You may also apply for jobs by going to facilities or agencies where you are interested in working and asking at the front desk if you may fi ll out an application and leave a résumé. The employer will keep your application and résumé on fi le and may call you if a suitable job opportunity opens up.
You identify openings for nurse assistants at three local hospitals and decide to apply. But first, you know that you need to get your résumé and reference list together and write cover letters to accompany your applications. Before deciding to become a nurse assistant, you held various part-time jobs, including driving a school bus and working as a server at a local restaurant.
What experience from your previous jobs would be valuable and applicable to your role as a nurse assistant? How would you describe this experience on your résumé?
What information will you gather to help you write a cover letter to accompany each application you submit? Why is it important to write a cover letter specific to each job that you are applying for?
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GOING ON JOB INTERVIEWS A job interview is a meeting between a job candidate and an employer that allows both parties to fi nd out more about each other. During the job interview, the employer will talk with you to learn more about you and your suitability for the job. You can also use the interview as a time to fi nd out more about the organization and the job.
Doing a little research before the interview can help you to feel more confi dent and prepared. Visit the organization’s website. Often, there is a great deal of information on the website about the company’s history, mission (that is, its statement of purpose), ownership and the services that it provides. Being knowledgeable about the organization and the job you are applying for demonstrates to the employer that you are serious about your job search and that you are genuinely interested in working for the organization.
Think about questions that you might be asked during the interview and how you will answer them. Examples of questions you may be asked include:
■ Why do you want to work as a nurse assistant? ■ What do you fi nd most satisfying about working as a
nurse assistant? ■ Why did you choose to apply for a job at our
organization? ■ What are your career goals for 5 years from now? ■ Tell me why you are the best candidate for this job. ■ Tell me about a time that you had a problem at work.
How did you solve it? ■ Describe your ideal work environment. ■ Why did you leave your last job?
Remember that the interview is also a chance for you to ask questions. Think about these questions in advance. Your goal is to get a better understanding of what would be expected of you as an employee and what the work environment will be like. Examples of questions you might ask include:
■ What do the nurse assistants who work here like best about working here?
■ May I talk with one of the nurse assistants who works here?
■ On average, how many people would I care for during a shift?
■ How does the organization support professional advancement for employees? For example, will I have the opportunity to receive ongoing training as part of my job?
■ May I have a copy of the job description? ■ How often are employee reviews conducted, and
what standards will I be held to?
Although you may be interested in learning more about what the organization can offer you in terms of pay, vacation time and health benefi ts, the interview is not the time to ask these questions. Save these questions for when you receive a job offer!
Before your interview, make sure that the clothes you intend to wear are clean, pressed and in good repair (Figure 23-3). Women should wear a blouse and dress slacks or a skirt, or a dress. Avoid clothing that is overly revealing, such as mini-skirts, tops with low-cut necklines and open-toed shoes. Men should wear a button-down shirt and tie and a pressed pair of khakis or dress slacks. Pay attention to grooming as well. You want to help the employer see you as a member of the staff and a representative of the organization, so the same guidelines you learned in Chapter 1 about maintaining a professional appearance apply here. Make sure that your hair and nails are neat, clean and trimmed. Avoid strong perfume or cologne. Any jewelry you choose to wear should be minimal.
Put together all the paperwork that you will need for your interview and have it organized and ready to go with you. The person who is interviewing you may request a hard copy of your résumé and reference list. Even if she does not ask for a copy of these documents, having them on hand will make it easier to complete the job application.
Figure 23-3 Help potential employers see you as a member of their staff by dressing neatly and professionally for the interview.
Chapter 23 | Entering the Workforce | 379
Also bring along the list of questions that you would like to ask the interviewer.
Plan your route to the interview and leave early enough so that you get there 10 to 15 minutes before you are expected. When you arrive at the interview, turn off your cell phone. You do not want a call to interrupt your interview. When you meet the person who will be interviewing you, remember that manners count. Employers need to know that you will treat your clients and their family members, as well as your co- workers and managers, with dignity and respect. A fi rm handshake is a great introduction. Although it is natural to be nervous, try to appear calm and at ease, and try to smile!
The interview usually begins with the interviewer asking you a few questions about yourself and why you are interested in the job. This is when your advance preparation will pay off! Answer questions honestly and to the best of your ability. Keep your answers brief and to the point. If you do not know the answer to a question, it is fi ne to say that you do not know. When you speak about past employers, always be as positive as possible, even if the experience was a negative one. If you were fi red from a previous job, be honest. It is better that the employer fi nd this out from you fi rsthand.
At the end of the interview, thank the interviewer for his time and ask when he expects to make a hiring decision. Within one day of your interview, send a written note by mail or email to the interviewer to thank him again for the opportunity to interview. In your note or email, express your interest in working for the organization and include a brief statement about why you fi nd the job appealing and think it is a good fi t for you (Figure 23-4). If the employer has narrowed the choice down to you and one other candidate, this follow-up email or card may make the difference. If
you do not hear back from the interviewer within the time frame he gave you at the end of the interview, it is appropriate to call and ask whether the job has been fi lled or whether you are still being considered for it. Calling shows initiative and demonstrates to the employer that you are genuinely interested in the job.
Your hard work and preparation paid off, and you have been asked to come in for two interviews.
What will you do to prepare for your interviews, and make a good impression on your potential employer?
RESPONDING TO A JOB OFFER Job offers are usually made over the telephone. Now is the time to ask about the pay and benefi ts offered by the company! It is all right to ask the person making the offer if you may have some time to think about the offer before accepting or declining it, but be sure to get back to the person within a day. You may be lucky enough to receive several job offers at once. This is where all of the thought that you have put into your job search and all of the information that you gathered will be very useful, because it will help you choose the job that fi ts you best.
In some cases, you may not receive a job offer. Take a little time to think about how you felt the interview went and whether you can do certain things better next time. And remember, each interview you do will add to your experience and will make you better at the next interview.
November 15, 2012
Dear Ms. Patterson,
Thank you so much for your time today and for considering me for the nurse assistant position.
I really enjoyed meeting you and learning more about Independence Village. I am very
interested in working for your organization, because I think it would be very satisfying to help
people achieve or maintain their highest level of functioning.
Sincerely,
Jacalyn Jacinto
Figure 23-4 Sample thank-you note.
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BECOMING A NEW EMPLOYEE
Pre-placement Health Evaluation After you receive and accept a job offer with an organization, you will be required to complete a pre-placement health evaluation to ensure that you are physically and emotionally capable of meeting the job requirements and to identify any accommodations that may need to be made so that you can perform the job competently and safely. As part of the pre-placement health evaluation, you will be required to complete several health screening tests, such as a physical examination, a tuberculosis (TB) screening test and a drug screening test, and to verify that necessary immunizations are up-to-date. The pre-placement health evaluation is done after a job offer is made because it is illegal for an employer to ask during the interview process about disabilities that may affect your ability to perform your duties. This is in accordance with the Americans with Disabilities Act and is done to prevent discrimination against people who may have disabilities but can perform the job (with or without accommodations). Depending on the results of the pre-placement health evaluation, however, employers do have the right to withdraw a job offer that has been made, if it is determined that reasonable accommodations cannot be made to allow you to perform the job competently and safely.
Orientation When you become a new employee of an organization, you will receive an employee orientation. During employee orientation, you will receive information about:
■ The benefi ts you are entitled to as an employee ■ Your employer’s expectations relative to your
job performance ■ Your employer’s policies and procedures related to
subjects such as attendance and dress code ■ Your employer’s emergency and disaster
response protocols
During orientation, you should be provided with a written job description and a written “policies and procedures” manual. Receiving this orientation to your new workplace, along with any related documentation, is one of your rights as an employee.
Probationary Period Some employers have a policy of considering the fi rst few months to 1 year of an employee’s employment with them to be a probationary period. During this time, the employer closely evaluates the job performance and potential of the employee. At the end of the probationary period (which usually lasts from 3 months
to 1 year), the employee’s supervisor completes a formal performance evaluation and discusses the employee’s job performance to date with the employee. Some employers may not offer employee benefi ts until the probationary period is over and the employee is found to be performing the job to expectations.
CHECK YOUR UNDERSTANDING
Questions for Review
1. Which document is used to summarize your education and employment history for a potential employer?
a. Cover letter b. Orientation document c. Résumé d. Reference list
2. Which of the following should NOT be included on a résumé?
a. Your email address b. Your telephone number c. Your marital status d. Your volunteer work
3. A job interview is your opportunity to:
a. Tell the employer your requirements related to salary, vacation and health benefi ts.
b. Find out as much as you can about the organization and what it would be like to work there.
c. Receive feedback on your job performance to date.
d. Receive feedback on your résumé.
4. Which of the following people would make a good professional reference for a person applying for a job as a nurse assistant?
a. A best friend b. A grandparent c. Your youth group leader d. All of the above
5. What is the goal when dressing for an interview?
a. To impress the interviewer with your fashion sense
b. To present a neat, clean, professional appearance
c. To give the interviewer insight into your personality
d. All of the above
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6. During a job interview, the employer’s goal is to:
a. Determine whether you are the best person for the job.
b. Make you nervous by asking you a series of questions.
c. Orient you to the organization’s policies and procedures.
d. Verify that the information that you provided on your résumé and application is accurate and correct.
7. What is the purpose of the pre-placement health evaluation?
a. To inform new employees of the organization’s procedures and policies
b. To discriminate against employees with health issues or disabilities
c. To ensure that employees are physically and emotionally capable of meeting the job requirements and to identify any accommodations that may need to be made so that the employee can perform the job competently
d. To make sure the employee is performing up to the employer’s standards before benefi ts are offered
Questions to Ask Yourself 1. Think about jobs that you have held (paid and unpaid)
to date. What skills or experiences from these jobs could apply to your practice as a nurse assistant? What other talents do you have that might serve you well when you are working as a nurse assistant?
2. Who could you ask to serve as a professional reference for you? What do you think the people you have selected as references would say about your professionalism, your work ethic and the personal qualities that will allow you to excel as a nurse assistant and an employee?
3. Think about the image you present to the public (for example, on social networking sites such as Facebook or Twitter, or through the message on your answering machine or cell phone). What impressions do you think a person who does not know you well would form about you by looking at your profi le on a social media site, or listening to the message on your answering machine or cell phone? Do you think that this impression may help or hurt your chances of being offered a job?
4. You want to make a good fi rst impression on a potential employer. What are some actions you can take?
5. What job situation would be most appealing to you? How will you go about organizing your job search?
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After reading this chapter, you will have the information needed to:
■ Describe the basic expectations employers have for those wishing to be employed as nurse assistants.
■ Describe the ways a nurse assistant can manage violence and harassment in the workplace.
■ Describe the interpersonal skills a nurse assistant can use to manage diffi cult situations at work and contribute to a healthy work environment.
■ Describe how to manage your time and prioritize your responsibilities. ■ Describe the importance of caring for yourself, as well as others. ■ Describe opportunities for career development and advancement for nurse assistants.
Goals
Enjoying Professional Success24
C H A P T E R
Chapter 24 | Enjoying Professional Success | 383
Key Terms: harassment
in-service training
assertive
prioritize
schedule
You have just arrived at Morningside Nursing Home after a crazy morning at home. Your 8-year-old daughter told you that she needed to pick out another outfit for school because her shirt didn’t match her pants. Then your 6-year-old son told you that he needed to bring in something for snack time at school today. And after all this, you realized that you needed to get gas in the car to get to work. As you enter the doorway at Morningside, you think to yourself, “I woke up feeling great about beginning my second month as a nurse assistant. I sure hope I can manage my day at work better than I’ve managed my time at home today. It’s a miracle that I’m even here!”
BASIC EXPECTATIONS FOR THOSE EMPLOYED AS NURSE ASSISTANTS
Adhering to Employer Policies The fi rst step to being successful in the workplace is to learn about and adhere to your employer’s policies. Although you will learn about your employer’s specifi c policies and procedures during your employee orientation, most employers have common basic expectations for employees. These include the following:
■ Show up on time and ready to work. ■ If you will not be at work, call your supervisor or the
designated person as soon as you know that you will not be coming in—at least 2 hours before your shift begins.
■ Take breaks only when assigned. Before going on break, ensure the safety of those in your care. Tell your supervisor where you are going and when you will be returning, and return by the agreed- upon time. When your shift is over, report to your supervisor before leaving the fl oor.
■ Clock in and out only on your time card. Do not clock in and out for anyone else.
■ Follow directions. If you do not understand something, ask for clarifi cation.
■ Complete tasks. If you are not able to complete something, tell your supervisor.
■ Document your actions. Remember: It is not done if it is not documented.
■ Be aware that certain actions are never tolerated in the workplace. Violence or the threat of violence, abuse, harassment, possession of weapons or illegal drugs, intoxication and theft are each considered grounds for immediate termination by most employers. Should you either witness or be subjected to any of these circumstances, report them immediately to your supervisor or human resources department and complete an incident report.
Keeping Your Certifi cation Up to Date Keeping your nurse assistant certifi cation up to date is also essential to keeping your job. Although each state has different renewal requirements, the following documents and information are most commonly needed to renew your certifi cation:
■ Proof of employment. To renew your certifi cation, you must show that you are working or have recently worked as a nurse assistant. If you allow your certifi cation to lapse, you will be required to take the training course and pass the certifi cation evaluation again in order to be recertifi ed.
■ Proof of completion of in-service requirements. OBRA (the Omnibus Budget Reconciliation Act of 1987) requires nurse assistants to complete at least 12 hours of in-service training each year. In-service training is additional training offered by your employer with the intent of keeping employees’ skills and knowledge up to date. During in-service training, you may be taught new skills or information, or receive refresher training in existing skills.
■ Renewal fee
■ Completed application
The application for certifi cation renewal, as well as directions on where to send the application and fee, can usually be found on the website of the organization that maintains the registry for nurse assistants in your state (for example, the state Board of Nursing).
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Time-management skills are important in the renewal process. You have to plan ahead to have your in- service hours completed, your renewal fee saved and your application completed and submitted before your certifi cation expires. Keeping your job means keeping your nurse assistant certifi cation.
DEALING WITH VIOLENCE AND HARASSMENT IN THE WORKPLACE The risk for experiencing violent or aggressive behavior while on the job is, unfortunately, a very real one for nurse assistants and other health care workers. Although less common, harassment by fellow employees can also occur on the job. Being able to manage these diffi cult situations appropriately is important for your health and happiness at work.
Violence in the Workplace As a nurse assistant, you may care for people who display violent or aggressive behavior toward you, such as hitting, kicking, slapping, spitting, biting or making verbal threats or offensive statements. Medication side effects and conditions such as dementia or mental illness can cause a person to act violently or aggressively. Although it is never acceptable for you to respond with violence or to cause harm to the person, it is also not expected that you must tolerate violence or abuse on the job.
The Occupational Safety and Health Administration (OSHA) recommends that employers establish violence- prevention programs. These programs provide training and establish protocols for preventing and responding to inappropriate conduct. The participation of all employees is important to ensure the success of the violence- prevention program.
As a nurse assistant, you can contribute to the success of a workplace violence-prevention program by taking the following measures:
■ Follow your employer’s policy for reporting incidents. Promptly report any incident of violence or aggression, and complete an incident report according to your employer’s policy.
■ Communicate with other members of the health care team. When caring for a person who displays violent or aggressive behavior, it is important to share your observations with the nurse about actions that can provoke this behavior, as well as actions that can reduce this behavior. The nurse can then include these strategies for reducing or responding to inappropriate behavior in the person’s care plan, so that all caregivers have access to them.
■ Attend violence-prevention training offered by your employer. Topics often include how to recognize warning signs (for example, behavioral changes or increasing anger) that could lead to a violent or abusive incident; how to manage an unsafe situation; and what procedures to follow should an incident occur.
■ Know ways of responding to another person’s anger or aggression (Box 24-1). Responding in these ways can help the situation from escalating out of control.
Harassment Harassment is ongoing behavior that causes signifi cant distress to another person. The behavior is done deliberately and repeatedly to frighten or distress the person. Harassment can be verbal or physical. You may fi nd yourself being harassed by a fellow employee. Actions such as making unwanted sexual advances or comments; making comments about a person’s gender, race, sexual orientation, culture, religious beliefs or other unique traits; or discriminating against a person
▼ Box 24-1 How to Respond to and Manage Another Person’s Anger or Aggressive Behavior
■ Seek causes for the behavior. For example, an undiagnosed infection or an injury can cause a person to respond with anger or aggression when you attempt to give care.
■ Do not take the person’s anger personally. ■ Avoid getting too close to the person or touching
the person. This may be threatening to the person and may make him or her angrier or more aggressive.
■ If someone is angry about what you are doing or responds with aggression, stop the task and give the person time to cool off.
■ Try distracting the person with another activity or change the topic and tone of the conversation to something pleasant.
■ Ask for help from a co-worker when you must provide care to a person who is known to behave in a violent or aggressive manner.
Chapter 24 | Enjoying Professional Success | 385
because of the person’s unique traits are all forms of harassment. If you feel that you are being harassed at work, you should bring the matter to the attention of your supervisor, the human resources department, or both.
CONTRIBUTING TO A POSITIVE WORK ENVIRONMENT Working in health care can be stressful. As a nurse assistant, you have a great deal of responsibility to provide safe, compassionate care. There will be multiple demands on your time, and it can be challenging to balance all of your responsibilities and make sure that everyone’s needs are met. In addition, health care is a people-focused profession. Where there are people, there are emotions. Especially in health care, these emotions can be very strong. If not managed well, they can lead to increased stress and burn-out.
A positive work environment is one where staff members support each other and feel supported. Every employee can contribute to a positive work environment. To succeed in the workplace and help contribute to a positive work environment, you must know how to manage stress and other strong emotions, such as anger. You must also have strong interpersonal skills, including skills related to resolving confl icts and advocating for yourself and others. Guidelines for contributing to a positive work environment are given in Box 24-2.
Managing Feelings of Anger Anger is a natural human response to stress. Anger is neither better nor worse than any other human emotion. Feelings of anger are often accompanied by physical symptoms, such as increased heart and respiratory rates, increased blood pressure and fl ushing of the cheeks. Some people burst into tears when they become angry. Although anger is a normal response in certain situations, it is important to know how to handle this strong emotion
appropriately. Managing anger is crucial to succeeding in your job (as well as in your personal life!).
In your job as a nurse assistant, you may have occasion to feel angry. Sometimes you may not be treated with the dignity and respect you deserve. A person in your care may say inappropriate things, hit you, or spit on you. It is important to look at why the person might be saying or doing these things. Often, these inappropriate behaviors are part of the disease process, and the person cannot help his or her behavior. Understanding this might help to reduce some of the anger you are feeling in response to the person’s behavior.
Co-workers may not treat you with the dignity and respect that you deserve, either. Some staff members may focus more on your job title than your contributions, and treat you in a dismissive or condescending way. Staff members who are stressed may also show negative behavior. Stress makes people less tolerant, and they can become angry more easily. Sometimes you will be the target of another person’s anger, even when you do not deserve to be.
The natural response when someone treats you badly or unfairly is to become angry. Unchecked anger may cause you to say or do something that you will regret. To prevent this from happening, take deep breaths, and try to regain control of your emotions. Think about reasons why the other person might be behaving in the way that is making you angry, and try to practice empathy. If necessary, remove yourself from the situation until you can regain control. (Of course, if the situation involves a person in your care, arrange for the person’s safety before leaving.)
Managing Confl ict Confl ict, or disagreements, can arise when two people have differing viewpoints. Health care is people-focused, and as a result, it can be emotionally charged. There are many opportunities for confl ict to arise. Confl icts may arise between two staff members, or between a staff member and a person in his or her care (or a family
Nurse Assistant DO’s and DON’ T sBox 24-2
Contributing to a Positive Work Environment DO support your co-workers. Be willing to pitch in to help others when needed.
DO use good communication skills to prevent misunderstandings from occurring and to resolve misunderstandings that do occur.
DO treat everyone courteously.
DO smile!
DON’T gossip. Gossip is usually negative and not factual, and it can distract you and others from the work you need to do. Avoiding gossip helps to keep stress and other unnecessary negative emotions out of your life.
DON’T call out absent from work unless you are really unable to attend because of illness or a family emergency. When one staff member is absent, others have to pick up that person’s workload for the shift.
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member of a person receiving care). Confl icts can also arise between two people receiving care.
No matter when it arises or who it involves, confl ict always has a negative impact in the workplace. It is always best to resolve confl ict as quickly as possible so that both parties have a more positive attitude about the future (Figure 24-1). It is also best to confront the source of the confl ict directly, but this does not mean attacking the other person. Even if a team member is rude to you, it is not appropriate for you to be rude in return. Rather, try saying something such as, “When you talk to me like that, it makes me feel bad, and it is diffi cult for me to want to work with you. I really don’t like feeling this way.” This statement expresses how the other person’s behavior affects you. It is nonthreatening, and it invites conversation, which can lead to settlement. The two of you can discuss what is not right and decide how you can work together to make the situation better for
both parties. Guidelines for resolving confl icts are given in Box 24-3.
Most confl ict can be resolved between the two parties involved. If you believe you have honestly tried, but failed, to resolve the confl ict, you should bring the problem to the attention of your supervisor. Because unresolved confl ict can be very disruptive to the workplace and it can affect the quality of care that is provided, it is very important to work together to fi nd a solution to the problem. And, once the confl ict is satisfactorily resolved, it is important for both parties to put the confl ict behind them and move on.
Practicing Assertive Communication The ability to be assertive is another important interpersonal skill to practice in the workplace. Being assertive means that you are able to make your needs and feelings known in a respectful way. An assertive person communicates his or her needs and feelings in a direct way, while still respecting the needs and feelings of others. This is different from an aggressive person, who communicates his or her needs and feelings directly, but without regard for the needs and feelings of others. An aggressive person comes across as threatening or a bully. An assertive person is also different from a passive or passive-aggressive person, who fails to communicate his or her needs and feelings at all, but instead becomes stressed, resentful or angry about the situation. Instead of facing the issue directly, a passive person internalizes his or her anger and dissatisfaction. A passive-aggressive person internalizes his or her anger and dissatisfaction and also may act out in inappropriate ways (for example, by making sarcastic comments).
Consider this situation: A co-worker asks if you can come help her in 15 minutes, because she needs help
Nurse Assistant DO’s and DON’ TsBox 24-3
Resolving Confl ict DO ask to speak with the person privately.
DON’T use accusatory language that assigns blame to the other person. Instead, take responsibility for your own emotional response to the situation. For example, instead of saying, “You should have known better!” say, “I’m concerned by what I saw you doing yesterday.”
DO allow the other person to express his or her feelings about the situation,
and try to understand the other person’s viewpoint.
DO ask the other person to work with you to fi nd a solution to the problem that meets everyone’s needs.
DO understand that sometimes in order to move beyond the confl ict, you may just have to “agree to disagree” about certain points.
DO apologize for any role you may have played in the confl ict.
DO seek help from a supervisor if it is impossible to resolve the confl ict on your own. Unresolved confl icts affect the quality of the work environment and the care that you provide, and therefore cannot be allowed to continue.
Figure 24-1 Resolving confl icts that arise is essential.
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getting a person in her care out of bed. It is near the end of your shift, and you really need to leave work on time today because you have to pick up your daughter at school. A passive response would be “Sure!” (while you become stressed and silently resent the fact that now you will be late to pick up your daughter). An aggressive response would be “No way! I told you earlier today that I had to leave on time today. Why don’t you ever listen to me?” This type of response does nothing to help your co-worker and, in addition, will probably make her feel bad. But an assertive response would be “My shift is over in 15 minutes, and I need to leave on time today to pick up my daughter at school. I can help you now, or maybe Mary is available to help you later.” The assertive response helps you to meet your needs, while also helping your co-worker to solve her problem.
When using assertive communication skills, what you say is as important as how you say it. Speak confi dently, but without aggression or blame. Maintain a pleasant facial expression. Acknowledge that you understand the situation and the other person’s point of view. Then, explain your point of view or position, using “I” statements. Finally, try to offer a suggestion for reaching a solution.
Being able to assert yourself helps to reduce stress, because it can help you to manage your time and your workload and prevent feelings of resentment and anger that can occur when you take on more responsibility than you can handle. Being assertive also helps you to gain the respect of others, because they see that you are direct about communicating your needs but also are understanding of their needs. Finally, the ability to speak up is important to protect yourself, those in your care and even your employer. For example, suppose another staff member asks you to do a procedure that you are not legally allowed to do. You may not be comfortable denying the person’s request, especially if the person is senior to you in the organization. However, to protect yourself, the person in your care and even your employer, it is important for you to speak up in a respectful manner and tell the person that you cannot do the task and explain why.
MANAGING TIME As you move from the role of student to employee, you move into areas of greater responsibility. You can make this transition smoothly if you know how to:
■ Plan your time, using critical thinking skills to assess situations.
■ Balance your scheduling needs and the needs of the people in your care.
■ Stay in control of your time.
Using Critical Thinking Skills to Manage Your Time The ability to think critically about situations and problems will help you in your everyday life and at work. Critical thinking is a fi ve-step process:
1. Identify the problem.
2. List alternatives to solve the problem.
3. List the pros and cons of each alternative solution.
4. Decide on the solution.
5. Evaluate: Is the problem solved?
When you think critically about a situation, you are able to see the impact various courses of action may have. For example, you are on your way to help Mrs. Symington transfer from bed to the bathroom when you see Mr. Shilling’s call light go on. You know that Mr. Shilling is impatient and will try to get out of bed without help, risking a fall. Mrs. Symington is less inclined to get out of bed without assistance, but she may have an episode of incontinence if she needs to wait too much longer. You look around and do not see anyone who is immediately available to help you. You decide to help Mr. Shilling fi rst, since the consequences of a fall could be potentially much worse than having to change Mrs. Symington’s clothing and linens. Applying critical thinking skills to this problem helped you determine the potential consequences of each course of action and make a decision.
Critical thinking skills also allow you to solve problems that may arise because each person in your care, and each situation, is unique. For example, you are a home health aide and Mr. Tripp, one of the clients in your care, has trouble standing at the sink to shave. It is not possible for Mr. Tripp to sit at the sink because there is nowhere for him to put his knees. You could shave Mr. Tripp in bed, or you could set him up with his shaving supplies at the kitchen table. You decide to set Mr. Tripp up to shave at the table, so that he can still maintain his independence. In this way, you used your critical thinking skills to determine the best solution to the problem.
Developing Time-Management Skills
Your personal life Time management is one of the most challenging tasks you face as a busy adult—particularly if you are a parent. It can be diffi cult to juggle job and family responsibilities, as well as time for yourself. Completing the time- management checklist in Box 24-4 can help you get an idea of where your current strengths and weaknesses are when it comes to time management.
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Good time-management skills are essential in helping you keep your job and reduce your stress levels. Here are some strategies you can use to help you manage your time effectively:
■ Plan ahead for each day. Prioritize (list in order of importance) the things you must accomplish each day. Allow a realistic amount of time to complete each item.
■ Have back-up plans in place (for example, for child care and transportation).
■ Always plan to report to work at least 15 minutes before your shift starts.
■ Make sure you have a reliable alarm clock. ■ Have a reliable form of transportation. ■ Keep a monthly calendar noting personal and
family activities and appointments. Record all activities and appointments and coordinate them with your work schedule.
■ Share household duties with your spouse and children.
■ Establish set times for daily activities such as homework, baths and bedtime.
■ Check your phone messages and write them down. Open mail daily.
■ Pay bills twice a month (for example, on the 1st and the 15th of each month).
■ Keep an ongoing grocery list, noting items that need to be replaced as they are used up, and shop once a week for the entire week.
Think back to your crazy morning. What time-management skills could you have used to make your morning easier?
Your work life The world of learning and the world of work are different. When you learn new ideas and skills in a training program, you learn to perform every step of a task—such as giving a complete bed bath—in a specifi c, uninterrupted way. By learning the ideal way to perform these skills, you master how to perform each step. However, in a real-life setting, the situations are
▼ Box 24-4 Time-Management Checklist Answer yes or no to each statement in this time-management checklist. Yes No
1. I get to work 15 minutes early so that I can plan my workday before it begins.
2. I know what I want to accomplish each
day.
3. I list tasks that need to be done each day and check them off as they are completed.
4. I take big jobs and break them into smaller
pieces.
5. I do not take too much time away from my
work by continually listing and planning.
6. I do the most diffi cult and least interesting
jobs fi rst thing in the morning.
7. I do not put off tasks; I do them now.
8. I avoid letting one day’s work carry over
to the next day.
9. I make full use of each day to complete
that day’s work.
10. I sometimes evaluate myself to fi nd out where I lose time.
11. People compliment me on my use of time.
12. I do not spend too much time on the phone.
13. I watch and learn from the people around me who always seem to be ahead of schedule.
14. I look for ways to use my time wisely each day.
15. I group tasks logically.
16. I listen carefully when someone gives me directions or other information.
17. I set deadlines and strive to meet them.
Now, look at the statements where you checked “yes.” These are areas where you are already practicing good time-management skills! Next, look at the statements where you checked “no.” These are areas that you will want to work on improving, to improve your time- management skills.
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not as ideal, nor are they as specifi c. You may need to modify the skills you have learned to meet the specifi c needs of each person in your care. In addition, you will be required to provide care for many more people at once.
In the real world, other people and situations infl uence how you use your time. For example, someone else makes decisions about how many people are in your care. How much time you spend caring for each person is also determined by factors outside your control, such as the person’s medical condition and level of mobility. Finally, unplanned events happen when you least expect them. For example, you may be giving a bed bath when the person you are bathing begins to vomit. You have to stop what you are doing and sit the person up or turn his head to the side. Then, once the person is no longer vomiting, you must make sure he is all right, report the situation to the nurse and decide what new actions to take. In addition, the person may have to be bathed again, and the linens may have to be changed. You must make new decisions based on each new situation. No matter what you decide, this bed bath will take longer than usual.
Box 24-5 describes a typical day in the life of Nora, a nurse assistant working in a nursing home. Reading about Nora’s day can help you to see some of the time-management challenges that arise during a typical day and effective ways of handling them. Learning to make the most of your time enables you to give people the best care possible.
Planning your day Every day on your new job, you have many tasks to complete and details to remember. So far, you have been learning specifi c skills. Now you have to know how to put them all together. You must create a schedule (a written plan that lists the time and order of several tasks) to guide you through the day. At fi rst, scheduling your time seems diffi cult. As you gain experience, it will become easier.
At the beginning of each shift, you fi nd out how many people are in your care and who they are. The nursing care plan and a verbal report from either the caregivers who worked on the previous shift or from your supervisor give you information about the kind of care that each
Text continues on page 394.
▼ Box 24-5 Nora’s Day In the following account of a typical day in the life of a nurse assistant, Nora Fuentes, you will see how a nurse assistant plans her day and controls her time, yet responds to the needs of the people in her care. If you try to stay organized and plan your day, as well as remain flexible and responsive to unexpected situations as they arise, you too can manage your time effectively. As you are reading about Nora’s day, remember the five principles of care—safety, privacy, dignity, communication and independence—and look for examples of how Nora practices these principles.
Planning the Day
Nora arrives for work promptly at 7 A.M. In morning report, Nora learns that she has fi ve residents in her care: Rachel Morgan, Victor Rivera, Jake Wilson, Shirley McDay and Rodney Britten.
Nora already knows four of these residents well, but Mr. Britten has been at the nursing home just a few days. She looks at the quick, abbreviated notes she has written during report and reads:
Rm. 121 R. Morgan, 45, MS (un-bed)
■ Can feed self (DR) ■ Help with: bed bath—dressing—bedpan—transfer to
w/c—ROM
■ Blurred vision—tires easily ■ *PT—1 P.M.
Rm. 114 V. Rivera, 78, stroke (un-bed)
■ Help with: bed bath—dressing—elec razor—urinal (7, 9, 11, 1)—feeding (DR)—transfer to w/c
■ L-sided weakness—*ROM in A.M. ■ *PT—1 P.M.
Rm. 120 J. Wilson, 79, diabetes (un-bed)
■ Can: dress—feed self (DR)—walk/cane—tub ■ Help with: dentures—elec razor ■ Sight—light perception—sensation: hands & feet ■ *PT—10:30 A.M. RecT—2 P.M. ■ *Urine S&A early A.M.—diabetic diet
Rm. 119 S. McDay, 55, Alzheimer’s (un-bed)
■ Can: feed self (DR)—OOB bathroom—walk with assist ■ Help with: tub—remind her to use the toilet—incont.
care—dressing ■ Wanders A.M. & P.M.—rummages and hoards
Rm. 124 R. Britten, 41, AIDS, wound isolation (oc-bed)
■ Help with: bed bath—soft foods and liquids—bedpan ■ Vomiting and diarrhea ■ *VS in A.M.
* Indicates that the task must be done at a particular time.
Continued on next page
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▼ Box 24-5 Nora’s Day Continued After reading the morning report, Nora creates a schedule for the day’s activities similar to the one shown here:
Rachel Morgan Victor Rivera Jake Wilson Shirley McDay Rodney Britten (Reverse Isolation)
7:00 A.M. Bedpan Urinal Urine S&A Tub 7:15
VS
Set up A.M. care, bed bath, help dress
Assist dentures/ shave
Tub 7:45 Help dress
A.M. care (gown/ gloves)
8:00 A.M. Rest Tray setup
Up to w/c to DR (need help)
Tray setup/assist feed
Assist walk to DR Assist walk to DR Assist feed Oc-bed
9:00 A.M. Un-bed Urinal Rest
DR—back A.M. care, help dress, ROM
DR—back DR—back
10:00 A.M. Rest in bed (need help)
Up to w/c (need help)
*10:30 PT Un-bed
Un-bed
ROM Un-bed
11:00 A.M. Rest Urinal Check incont. Check diarrhea
11:30 lunch
12:00 noon Up to w/c to DR (need help)
Tray setup Assist feed
Assist walk to DR Check incont. Assist walk to DR
Tray setup Assist feed Rest
1:00 P.M. *1:00 w/c DR to PT Urinal *1:00 PT DR—back DR—back Check diarrhea
2:00 P.M. Rest in bed (need help)
Rest in bed (need help) Wife visits
*2:00 RecT Check incont. VS
3:00 P.M. Report Charting
Urinal Check diarrhea Remove trash and linens (need help)
* Indicates that task is to be done at a specifi c time.
Nora looks over her schedule and notes that she needs help transferring Rachel Morgan and Victor Rivera into and out of bed. Nora decides to talk to her co-worker Arthur to see whether he might be able to help her. Arthur and Nora compare assignment sheets and realize that they are working in nearby rooms and that they both will need help with transferring their assigned residents, so they arrange to work together. They also realize that they have the same lunch break.
Following the Schedule
Nora’s fi rst stop is Room 121, where she offers Rachel Morgan the bedpan. “I’ll be back shortly to help you with
your bed bath and dressing,” Nora says before she leaves the room.
Nora’s next stop is Room 114. She offers Victor Rivera his urinal. Because Mr. Rivera has had a stroke and is on a bladder training program, he must be offered his urinal every 2 hours. “I’ll be back with your breakfast tray, Mr. Rivera,” Nora says. Nora washes her hands after exiting Mr. Rivera’s room.
She then heads to Room 120. Because Jake Wilson is diabetic, he has to have his urine checked for glucose and acetone daily. He knows the routine well, so he urinated once earlier in the morning and then again later to provide a sample.
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▼ Box 24-5 Nora’s Day Continued Nora thanks him before asking how his favorite football team did in the game last night.
“The Dolphins beat the Cardinals 34 to 10! You should have seen it!” Mr. Wilson says, his eyes sparkling. “I played some football myself when I was younger.”
Using standard precautions, Nora tests the urine for sugar and acetone and records the results, which she later reports to the nurse.
“How are my levels this morning?” asks Mr. Wilson.
Nora reassures Mr. Wilson that the test results are normal. She washes her hands and then walks with him to the tub room. While Nora helps Mr. Wilson with his dentures and shaving, they discuss his activities for the day.
“Today’s my session with the physical therapist,” he says. “I want to be on time for her.”
“Don’t worry, Mr. Wilson,” says Nora, as she walks him back to his room. “You’ll be there on time.” She then goes to Rachel Morgan’s room to set up her A.M. care.
“I think I can wash myself today, but it may take me awhile,” Mrs. Morgan says.
Nora smiles at her. “You just do what you can, Mrs. Morgan,” she says at the door, “and I’ll be back to help you fi nish your bed bath.”
Nora puts on a gown and gloves before going into Mr. Britten’s room to take his vital signs and provide A.M. care. Mr. Britten, who has AIDS, has developed a staph infection in an open wound on his arm and must remain in wound isolation until the infection is gone.
“Hello, Ms. Fuentes,” Mr. Britten says quietly. Nora greets Mr. Britten and begins wrapping the blood pressure cuff around his unaffected arm. She asks him about his partner’s upcoming trip to Australia.
A smile tugs at the corners of his mouth. “Owen leaves for Sydney today,” he says. “Would you believe I already miss him? He’ll be gone for 2 whole weeks.” Nora records Mr. Britten’s vital signs, which are normal.
“Maybe he’ll bring you a kangaroo,” she says.
“If he does, I’ll name it ‘Nora,’” he says with a grin.
Nora discards her gown and gloves and washes her hands before going to Room 119, where she greets Shirley McDay, who has Alzheimer’s disease.
“Hello, Mrs. McDay, I’m Ms. Fuentes, your nurse assistant. Today is Tuesday, it’s 7:45, and it’s time for your morning bath,” says Nora. After the bath, Nora helps Mrs. McDay get dressed.
“I think I’ll wear this outfi t today,” says Mrs. McDay, selecting a green blouse and an orange skirt from her closet. The blouse and skirt do not match, but Nora knows that green and orange are Mrs. McDay’s favorite colors.
Wanting to say something positive, Nora says, “That blouse looks so nice on you.” Mrs. McDay smiles shyly.
Then Nora returns to Mrs. Morgan’s room to help her fi nish her bed bath and get dressed. Because Mrs. Morgan tires easily, Nora helps her get comfortable in her bed so that she can rest before going to the dining room for breakfast.
Next, Nora puts on a gown and gloves and enters Mr. Britten’s room with his breakfast tray. She suggests that he start eating the breakfast himself while she helps the other residents to the dining room for breakfast. Nora assures him that she will come back to help him fi nish his breakfast.
Nora removes and discards the gown and gloves and washes her hands before enlisting Arthur’s help with getting Mrs. Morgan out of bed and into the wheelchair. As she pushes Mrs. Morgan to the dining room, she stops along the way and invites Jake Wilson and Shirley McDay to walk with her and Mrs. Morgan to the dining room.
After getting the three residents settled in the dining room, Nora takes a breakfast tray to Mr. Rivera who, until his condition worsened this week, had been eating regularly in the dining room. She helps him with his breakfast by placing her hand over his hand on the spoon. He has diffi culty chewing and swallowing, so it takes a long time to help him eat. “My wife is coming to visit me today,” says Mr. Rivera, dribbling oatmeal out of his mouth. “I can hardly wait.” Nora gently wipes his chin and discusses the visit with him.
Observing contact precautions when she returns to Mr. Britten’s room, Nora apologizes for taking so long. Much to her surprise, she fi nds that Mr. Britten has eaten all his breakfast by himself.
“I’m so tired, I just want to sleep now,” he says. Nora leaves Mr. Britten’s room. She removes and discards the gown and gloves and washes her hands.
While Mrs. Morgan eats breakfast in the dining room, Nora changes the linens on her bed. Then she goes into Mr. Rivera’s room and offers him the urinal.
“One of these days I’m going to be regular like a clock,” Mr. Rivera jokes. Nora helps him with his bed bath and helps him brush his teeth. While helping him dress, Nora encourages Mr. Rivera to fasten as many buttons as possible with his “good hand.”
“You did more buttons today than you did yesterday,” she says when he becomes tired. “You’re really making good progress.”
Continued on next page
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▼ Box 24-5 Nora’s Day Continued Mr. Rivera beams. When Mr. Rivera is dressed, Nora helps him slowly complete his range-of-motion exercises. Nora washes her hands after leaving the room.
On her way to the dining room, Nora smiles at Arthur, who is leading a resident back to her room. In the dining room, Nora greets Rachel Morgan and wheels her to the elevator.
“How was breakfast?” Nora asks.
“Today they had pancakes, which I just love,” says Mrs. Morgan. When they reach Room 121, Nora tells Mrs. Morgan that she will be right back with someone to help transfer her into her bed.
“All right, dear,” says Mrs. Morgan. Nora steps into the hall and sees Arthur carrying bed linens.
“Arthur, could you please help me transfer Mrs. Morgan into her bed?” she asks.
“Comin’ right up,” says Arthur. “Let me just put these linens down in Mr. Lightfoot’s room, and I’ll be right there.” After Mrs. Morgan is comfortably settled in bed, Nora heads back to the dining room, where Mr. Wilson and Mrs. McDay have fi nished breakfast. As the three near the elevator, Mr. Wilson mentions that he is going to visit a friend on the second fl oor. Nora glances quickly at her watch and reminds him about his physical therapy appointment.
“I’ll be back in time,” says Mr. Wilson. Nora walks Mrs. McDay back to her room.
“Is this my room?” Mrs. McDay asks as they near the supply closet.
“No, here we are,” Nora says at the door to Room 119. She encourages Mrs. McDay to sit in a chair while Nora changes the linens on her bed. After the bed is made, Mrs. McDay climbs onto the bedspread and reaches for a magazine.
Nora sighs as she walks to Mr. Britten’s room. She puts on a gown and gloves and enters the room. Mr. Britten is awake and is glad to see her. Nora gives him his bed bath, moving him as gently as possible to protect his fragile skin. She makes sure he is comfortable before leaving the room.
Getting Assistance
Nora heads toward Room 118 to see whether she can fi nd Arthur. He is in the room fi nishing Stephen Lightfoot’s personal care. Arthur is ready to move Mr. Lightfoot out of bed, and he needs Nora’s help.
“A rthur, I’ll help you move Mr. Lightfoot and change his bed if you will help me move Mr. Rivera and change his linens,” Nora says.
“You’ve got a deal,” says Arthur.
As Nora and Arthur lift Mr. Lightfoot into the bedside chair, he complains of extreme shortness of breath. First, Arthur
makes sure that Mr. Lightfoot’s oxygen tubes are not kinked anywhere. Then, so that Mr. Lightfoot doesn’t hear, he quietly consults with Nora to see whether she also noticed the blue color around his lips. Arthur decides to report Mr. Lightfoot’s condition to the nurse. He measures Mr. Lightfoot’s pulse and respirations and asks Nora to stay with him while he reports Mr. Lightfoot’s vital signs and change in color to the nurse.
After the nurse checks on Mr. Lightfoot, Nora and Arthur go to Mr. Rivera’s room. It is now about 10:15 A.M. They move him into his wheelchair and change his bed.
After leaving Mr. Rivera’s room, Nora passes Mr. Wilson in the hall on the way to his physical therapy appointment. She then goes directly to Room 121 to help Rachel Morgan with her range-of-motion exercises.
“Both of my arms are kind of stiff today,” says Mrs. Morgan, as they begin the exercises. Nora gently moves her wrists back and forth.
“We’ll do everything slowly,” she says, “and you tell me when to stop.”
After completing the exercises, Mrs. Morgan rests in her bed.
Adjusting the Schedule
At 11:00 A.M., Nora fi nishes changing the linens on Mr. Wilson’s bed when she remembers that it is time to offer Mr. Rivera the urinal again.
“Gosh, I’ve got to go check on Mr. Britten, too,” she thinks to herself as she rushes toward Mr. Rivera’s room.
Halfway down the hallway, Nora notices that Mrs. McDay’s call signal is on. “I’ll be right there,” she calls to Mrs. McDay. In her nervous state, Nora bumps into Arthur in the hall.
“Arthur,” she says, “I don’t know what to do fi rst! Mr. Rivera, Mrs. McDay and Mr. Britten all need my help at the same time!”
“Calm down, Nora,” says Arthur. “Let me see your schedule.”
Down the hallway, Mrs. McDay cries out for her mother.
“I’ll offer Mr. Rivera his urinal and then check on Mr. Britten while you take care of Mrs. McDay. Sounds like she really needs you,” says Arthur.
“I don’t know what I’d do without you!” Nora calls over her shoulder.
When Nora steps into Room 119, she sees that Mrs. McDay has wet the bed. Mrs. McDay rocks in her bed, scolding herself and picking at her bedspread. “I’m nothing but a baby! A baby!” she mutters under her breath.
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▼ Box 24-5 Nora’s Day Continued Nora sighs to herself as she helps Mrs. McDay out of bed, removes the wet linens and puts them in the hamper. As she helps Mrs. McDay wash and dress, she reassures her that the incontinence is not her fault and tells her that she doesn’t mind helping her clean up. She continues to comfort Mrs. McDay as she makes her bed.
After a few minutes, Mrs. McDay asks, “Can I go to the dayroom?”
After helping Mrs. McDay to the dayroom, Nora goes to Room 124 and changes Mr. Britten’s bed linens. She knows that he feels lonely in isolation and that he enjoys visiting with her while she provides care. However, Nora is scheduled for lunch at 11:30, and she is very hungry. She doesn’t know how she is going to make it.
Controlling Time
After heating her soup in the microwave, Nora joins Arthur at a table where he is sipping a cup of coffee. It is 11:40 A.M., and Nora has just 20 minutes to relax before she will have to begin taking residents to the dining room and helping with lunch.
“I always seem to be running late,” Nora says.
“Some days are like that,” Arthur agrees. Then he suggests that they review Nora’s schedule to see whether she could have made any changes.
Arthur looks over Nora’s schedule. “It seems to me that you have everything well organized,” he says. “But people aren’t like puzzle pieces, you know, that always fi t into place. They don’t always fi t into our plans.” Nora smiles.
“What do you do at home when things don’t work out as planned with your kids’ schedules?” Arthur asks.
Nora laughs and confesses that she tries to stay fl exible and roll with the punches. “Eventually everything works out, most of the time,” Nora says.
Arthur laughs. “That’s what they mean by experience being the best teacher,” he says. “It takes a while to learn how to balance the needs of each person with all the things that you have to get done. Do you think you could have done anything differently this morning?”
Nora thinks back on her morning. “I guess I could have checked on Mr. Britten before I did Mrs. Morgan’s range-of- motion exercises. But I didn’t know that Mrs. McDay would need me just when I had to offer Mr. Rivera his urinal. I was so worried that I would mess up his bladder training program. I can’t thank you enough for helping me today.”
When Nora fi nishes talking, Arthur asks her what she has accomplished that morning. As Nora begins to list the many things that she accomplished, she begins to relax, realizing
that she has successfully completed all her morning tasks. Feeling renewed, she goes back on the fl oor and helps everybody get lunch.
Focusing on Each Person
It is 12:30 P.M. when Nora brings Mr. Britten his lunch tray. Instead of hurrying out, she stops to talk for a few minutes. Mr. Britten tells her about how hard it is for him to be in the nursing home while his partner is traveling on business.
“I worry about him, and I would feel better if I were at home,” he says. “He’s the only friend and family I have.”
“Owen sounds like a very special person. I hope I get to meet him,” says Nora. She tells Mr. Britten that she will be back later to check on him.
Nora stops by Rachel Morgan’s and Victor Rivera’s rooms to make sure that they are ready for their physical therapy appointments at 1:00 P.M. She offers Mr. Rivera his urinal before leaving.
At 1:15, Nora fi nds Mrs. McDay sitting by the window in her room. Nora asks her whether she would like to talk for a while. Mrs. McDay looks up at Nora and yells, “I just want to be alone!” Then she begins to cry. Nora recognizes that the earlier incontinence has upset Mrs. McDay more than Nora realized.
Nora walks over to Mrs. McDay, sits next to her and speaks to her in a calm voice. After a while, Nora comments to Mrs. McDay that the brightly colored afghan spread across her lap is very pretty. Mrs. McDay smiles a little. “My sister made this afghan for me when I got married,” she tells Nora.
At a few minutes before 2:00 P.M., Nora stops in Room 120 to check on Mr. Wilson before his recreational therapy appointment. A physical therapy aide brings Mr. Rivera into his room and helps Nora move Mr. Rivera into his bed so that he can rest before his wife comes to visit. The physical therapy aide returns to the hall with Mrs. Morgan and again helps Nora as they transfer Mrs. Morgan out of the wheelchair and back into bed.
“Those physical therapy sessions always wear me out,” Mrs. Morgan says as Nora tucks the sheet around her shoulders. A few minutes later, Mrs. Morgan is fast asleep.
Nora’s shift is over at 3:00 P.M. Before leaving, Nora and Arthur go to Mr. Britten’s room. Nora checks his vital signs, and then she and Arthur double-bag and transfer his soiled linens and trash. After saying good-bye to everyone, Nora completes her charting and makes her report to the team for the next shift. She includes a description of Mrs. McDay’s catastrophic reaction in her report.
As she leaves the fl oor, Nora waves to Mr. Wilson, who is returning from recreation therapy. She smiles and feels very satisfi ed with herself.
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person needs or about changes to the existing care plan (Figure 24-2). You also learn about prescheduled activities or treatments. As you listen to the report, take notes, being careful to write down the following:
■ Daily tasks that have to be done at specifi c times, such as measuring vital signs, providing treatments, serving meals, and turning and positioning
■ Daily tasks that must be done but have no set time, such as bathing, dressing and mouth care
■ Special things that have to be done or considered that day for the people in your care, such as a appointments for physical therapy or a diagnostic test or procedure
■ Your assigned break and lunch times
After listing the tasks that you must do that day, think about the order in which to do things and write down a tentative schedule. Some tasks might involve important preparation steps. For example, you may have to schedule time to use the tub room before you can give a person a tub bath. Other tasks may require help from another co-worker or supervisor. When you make your schedule, be sure to think about these needs and include time for them in your schedule. Also think about what you know about each resident in your care. For example, you may have learned that Mrs. Wiggins, who has dementia, becomes agitated if she is rushed through her morning care or if her usual routine is changed. In addition, you know that when Mrs. Wiggins becomes agitated, it takes much longer to provide care for her. Take this knowledge into account when planning your schedule, by planning to follow Mrs. Wiggins’s routine as much as possible and allowing plenty of time for care so that she is not rushed.
After you fi nish your schedule, put a star next to each task that must be done at a specifi c time. Then prioritize the remaining tasks by marking the most important ones to remind you to do them fi rst, if possible. Now, when you look at your schedule, you know what must be done and when it must be done. Unscheduled events always occur. But when you know what must be done, it is easier to readjust your schedule.
Working in a health care setting is much like traveling by car. No matter how well you map out your trip, you are bound to make some detours along the way. Your schedule is like a road map that helps you fi nd an alternate route to your destination. Every day, no matter how well you plan things for yourself, people’s needs change—and so does your schedule. You may ask, “Why bother to make a schedule if I can never stick to it?” The answer is that the schedule is an important tool that reminds you of what you have to do, when you must do it and which things are most important for you to do. Often you will feel pressured to begin the day’s activities without planning, but it will save you time in the end if you take a few minutes to create a plan at the start.
During report, you learn that you will be caring for six residents today. Two of the residents, Mrs. Quillen and Mr. Short, require complete assistance with bathing, dressing and eating. Mr. Short is also scheduled for physical therapy at 10 a.m. Two other residents assigned to your care, Mr. Fernandez and Mrs. Lewis, also need help with personal care and ambulation. Mrs. Lewis has an appointment to have her hair cut after lunch. The fifth resident assigned to you, Mrs. Langdon, has Alzheimer’s disease and requires frequent supervision because she often is seen wandering and hoarding throughout the day. Your last assigned resident, Mr. James, has just been transferred to Morningside after having had a stroke that left him paralyzed on his left side. He is extremely weak and is allowed out of bed to the chair for short periods of time three times a day. The nurse from the previous shift tells you that Mr. James was up all night.
What tasks would you write down on your schedule for the day, and how would you prioritize them?
What issues would you need to consider when developing your schedule for the day to ensure that you are practicing the five principles of care (safety, privacy, dignity, communication and independence) with each of the people in your care?
Figure 24-2 During the change-of-shift report, you will receive updates and instructions that help you plan your day.
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Working as a team What do you do when you need additional time to meet the needs of a person in your care? How do you cope when an assignment is too risky for you to handle alone or too time-consuming for you to do your best job? What do you do when several people need your attention at once? These questions are diffi cult to answer, but in the real world these situations do happen.
Teamwork is essential in health care (Figure 24-3). It may be diffi cult to ask for help from co-workers who are just as busy as you are, but often two people can accomplish a task more quickly and more safely than one person can. Try to accommodate co-worker’s requests for help as much as your schedule allows. This fosters a spirit of teamwork and will make others more willing to help you when you need it.
When an assignment seems too risky to handle alone or too time-consuming for you to do a thorough job, it is important that you discuss this problem with your supervisor. Perhaps your supervisor does not realize how much time is required to meet the special needs of a certain person in your care, or perhaps you do not realize that another member of the team has just called out sick. Sharing information with your supervisor and other members of the health care team helps the health care team work well together so that everyone can enjoy a sense of satisfaction from a job well done.
Staying in control of your time You have just fi nished helping Mr. Wilson brush his hair and shave. You are ready to leave his room to attend to
the next thing on your schedule when he says, “Before you leave, could you do one quick favor for me?” You say that you would be happy to do something for him. Then he says, “Could you please make me a cup of tea and some toast? I’m hungry now, but I just couldn’t eat breakfast earlier. I don’t want to wait for an order to come up from the kitchen.”
You want to be able to do this special task for Mr. Wilson, but you think to yourself that his quick favor is not going to be quick at all. You know that this task may take 10 minutes of your time. What can you do now? What could you have done to anticipate this situation?
Sometimes, unplanned events can be handled by taking charge of your time from the beginning. When you fi rst go into Mr. Wilson’s room, check to see what has to be done and let him know how long you are going to be there this time. Also, let him know when you plan to come back. Before you start your tasks in Mr. Wilson’s room, ask him whether he thinks he might need anything special. If, at the beginning of your time with Mr. Wilson, he says he wants tea and toast, you can adjust the time that you spend on other planned tasks to include his special request. If you wait until the end of your time with Mr. Wilson to fi nd out that he has special needs, these last- minute requests may affect the rest of your schedule.
If you communicate your plans clearly to the person in your care, you may lessen the number of unplanned events during the day. What you say through verbal communication is just as important as what you say though nonverbal communication (such as your facial expressions or body language). The following tips will help you remember to communicate your message clearly and, in the end, may save time:
■ When you assist a person, even on a very busy day, try to be relaxed. Remember that the person in your care is your reason for being there. If you seem to be hurried and stressed, the person also may become stressed, which may require you to spend more time with her.
■ If touching is acceptable to the person, use touch to reassure and comfort the person while you provide care. Placing a hand on the person’s shoulder or holding his hand is calming and helps him know that you care. Showing the person that you care about him may help him feel more secure and help you spend your time more effi ciently and effectively.
■ When you help a person, take time to speak with him and really listen to what he has to say. Sometimes the simple act of stopping and listening to the person shows that you are available. This action can reduce his anxiety and perhaps even save you time in the long run.
■ Before you leave a person’s room, always ask if there is anything else the person needs before you
Figure 24-3 Teamwork is essential in a health care setting. Accommodate your co-workers’ requests for help as much as you can, and they should do the same for you.
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leave. This helps to improve effi ciency by allowing you to handle (or make arrangements for someone else to handle) the person’s requests before you leave, thereby minimizing interruptions later. This also leaves the person with the satisfaction of knowing that you are concerned about meeting her needs and want her to be comfortable.
Co-workers may also place demands on your time. While it is important to try and accommodate co-workers’ requests for help whenever possible, remember what you learned earlier about assertive communication. Review your schedule, and think about where you might be able to rearrange some of your responsibilities to help your co-worker. If you cannot shift some of your responsibilities without negatively impacting your schedule, then tell your co-worker you are not available to help and explain why. But try to offer another solution to the problem, such as suggesting someone else who might be able to help, or seeing how the two of you might be able to coordinate your schedules and work together to make sure both of you are able to complete your tasks for the day.
As you go through the day, your schedule seems to be working. You breathe a sigh of relief. So you proceed with your next task and decide to get Mr. James out of bed. As you enter his room, you notice that he is sleeping soundly. You know that you need to get him out of bed, but you also know that he didn’t sleep well the night before. You also know that you need to get Mrs. Lewis ready for her haircut appointment.
What would you do? What would be your priorities?
How would this situation affect your stress level?
CARING FOR YOURSELF While you are at work, you are dedicated to taking care of others. In your personal life, you may also be responsible for caring for others, such as children or your own aging parents. It can be hard to make sure your own needs are met, when you are so busy meeting the needs of others. However, in order to do your best for the others in your life, you must take care of yourself too.
Staying Physically Healthy Being a nurse assistant is very physically demanding work. Taking good care of your physical health gives you
more energy and helps to prevent work-related injuries. To maintain your physical health:
■ Get enough sleep. On average, most people need between 6 and 8 hours of sleep each night to function well. Sleep allows the body to rest and rejuvenate itself and recover from the physical and mental stresses of the day. When we do not get enough sleep, it makes it diffi cult to think clearly, and we lack energy and stamina. We are less able to tolerate emotional stress, and we are more likely to catch contagious illnesses, such as a cold or the fl u. Lack of sleep also puts a person at risk for health conditions, such as hypertension and weight gain.
■ Eat a healthy diet. In Chapter 14, you learned about tools you can use to plan a healthy diet, such as MyPlate.gov and nutrition labels on packaged foods. A healthy diet gives your body the nutrients it needs to function properly and helps to maintain a healthy body weight.
■ Incorporate exercise into your life. Find a physical activity (or activities) that you enjoy, and make a “date” with yourself to exercise several times a week. Try to mix up activities that get your heart pumping (“cardio”) with activities that strengthen your muscles (such as weight training) and increase fl exibility (such as yoga). Regular exercise helps to keep your heart, lungs and bones healthy and is essential for maintaining a healthy body weight. In addition, exercise is a great way to relieve mental and emotional stress.
■ Avoid habits that can harm your health. Habits such as smoking, excessive alcohol use or the inappropriate use of drugs (legal and illegal) can have a very negative impact on your health. If you smoke, or if you think that you might use alcohol or drugs excessively or inappropriately, take steps to break these habits. For example, share your concerns with your primary care provider, a clergy member or other trusted person in your life. Acknowledging the problem is the fi rst step in solving the problem and developing new, healthier habits.
■ Practice preventive health care. See your primary care provider at least once a year. Routine physical examinations and screening tests can help to detect health problems early, before they become more diffi cult to treat or cause permanent harm to your body. Also see your dentist twice a year for routine teeth cleaning and a dental exam.
Staying Mentally Healthy As you have learned, working as a nurse assistant can be stressful. The multiple demands on your time, having
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to care for people who may not seem appreciative of your efforts and facing the loss of people in your care who you have grown close to are just some of the situations that can make your job emotionally stressful. To stay healthy, you must fi nd positive ways of managing this stress (Figure 24-4). Examples of positive ways to relieve stress include:
■ Engaging in prayer or meditation ■ Engaging in physical activity ■ Enjoying a hobby ■ Spending time with friends and other people you
enjoy being with
Although it can be diffi cult, it is important to make time for yourself to do what you enjoy doing. This time away from the pressures of work and family can help you to relax and recharge, so that you are better able to handle stressful situations when they do arise. If stress becomes too great and you fi nd that your usual methods of managing stress are not working, or if you fi nd yourself turning to unhealthy methods of managing
stress (such as drinking too much alcohol or using drugs inappropriately), talk to your supervisor. Many employers have stress management or employee assistance programs available to help employees manage the stress in their lives.
DEVELOPING YOUR CAREER
Lifelong Learning Now that you have completed this training course, you have learned the basic skills and techniques needed to become a certifi ed nursing assistant. However, your training does not end on the last day of class! Once on the job, you will have the chance to learn new skills, new methods of providing care and new reasons for doing things a certain way. It is crucial to keep up to date with new information and to incorporate this information into your practice as a nurse assistant. Make an effort to continuously increase your knowledge. Ask the nurse about new techniques or equipment that you see being used, or for more information about specifi c disorders that the people in your care may have. Become a member of professional organizations for nurse assistants, such as the National Network of Career Nursing Assistants and the National Association of Health Care Assistants (NAHCA), to stay on top of new developments that affect the profession. Learning is truly a lifelong endeavor.
Opportunities for Professional Growth Although many people enjoy long and fulfi lling careers as nurse assistants, training and working as a nurse assistant is excellent preparation for other careers in the health care fi eld as well. For example, you may decide that you want to go back to school to become a licensed practical/vocational nurse or a registered nurse. Or, maybe you will want to receive additional training to work in one of the emerging roles in health care. Because of changes in our health care system, new roles are emerging as employers seek ways to deliver quality care in a cost-effective, effi cient manner. Examples of some of these emerging roles include patient care technician (PCT) and medication aide:
■ Patient care technician (PCT). In addition to the basic skills needed to be a nurse assistant, PCT training may include training in more advanced nursing skills (such as checking blood-glucose levels and inserting or removing indwelling urinary catheters), skills related to drawing blood samples (phlebotomy), and
Figure 24-4 It is important to take time for yourself to do things that you enjoy doing. © iStockPhoto.com/MoMorad
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