Certified Nursing Assistants, once trained, have various options for employment. Though many are employed in nursing homes caring for the elderly, there is as much of a demand for skilled CNA's in the hospital setting. While the duties of a CNA vary only slightly between the two, the working environment is the difference.
The role of CNA's in any setting is vital to both the patients, nurses and doctors. They provide the most direct care, and are often with the patient's more than the licensed nurses. In the hospital setting, they will care for patients of all ages, from children to the elderly. Although their duties may fluctuate depending upon the medical condition of the patient, there is one aspect of care that does not change, and that is providing compassionate care.
Hospital CNA's may work in a variety of departments. There are some who are employed in the emergency room, some who may work in a specialized department such as intensive care or progressive care, and some work in departments caring for those whose medical condition is less severe and who have been admitted due to fractures, viral or bacterial infections. CNA's work under the direction and instruction of an LPN or RN, and will provide their care based upon the individualized care plan of the patient. The care plan provides everything the CNA needs to know about the patient, including the reason for admission, how often vital signs need to be taken and what specific assistance the patient may require. Every detail of the patient's condition, and the care provided for them, is documented and reported directly to the nurse in charge. This information given by the CNA will assist the patient's nurse and doctor in determining the next course of treatment for the patient so that they may recover more quickly and return home in a timely manner.
When a CNA begins their shift in the hospital, they will be informed of the room numbers they have been assigned to, and then will go on "rounds" with the CNA they are relieving. This gives the oncoming CNA a heads up about the patient's current condition so that they are better prepared for the shift ahead. In addition, once the nurses for that shift have been given their report from the preceding shift, the nurse will meet with the CNA and give them a more in depth medical report, explaining to them what is needed for each patient they have been assigned to care for. Throughout their shift, the CNA will take vital signs periodically, recording them on a board provided by the nurse in charge. They will assist with toileting, either using a bedpan or by assisting the patient to the bathroom. Depending on the patient's condition, the CNA may need to stay with them to insure their safety. If a patient is diabetic, they may need to test their sugar levels at the start and end of their shift, and they will also be responsible for monitoring the meals that are provided for the diabetic. The CNA must always be aware of foods the patient can or cannot have in case of a mistake made by the kitchen when preparing their tray. If a CNA works in the morning, they will be responsible for preparing the patient for the day ahead, though in hospitals this task requires a little less work. Hospital patients generally require minimal assistance with hygiene, mainly needing their supplies set up for them as they wash themselves. There are exceptions though, and some patients do require complete hygiene care. A CNA who works in the ER will be responsible mainly for vital signs, providing assistance with toileting and answering patient call lights when they need assistance. They must also clean a room once the patient has been discharged, providing clean linens and hospital gowns.
Hospital CNA's will usually work a forty hour week, with rotating weekend and holiday schedules. There are some who are hired as part time and yet others who choose to work on a per diem schedule. With per diem, they will list certain days through the month they are available to work and may or may not be scheduled, as full and part time CNA's receive priority. A per diem schedule does require that the CNA work at least one week-end a month. Due to the nursing shortage, many CNA's are able to work overtime, including double shifts and extra days. There are many hospitals and facilities who will offer a monetary bonus for those who are willing to work extra hours.
Being a CNA is a physically demanding job. You are on your feet more than not, and lifting a great amount of weight throughout the day. It is not a pretty job, as there are many tasks such as cleaning a person after they have had a wetting accident or who have experienced bowel incontinence. They are also expected to assist the nurse in wound changes, which in some cases, are extremely graphic and not for the weak. The biggest obstacle a hospital CNA may face is continuity of care. When working in a nursing home, you will generally have the same patients each day. In a hospital, you will most likely have different patients every one or two days. The patient turn around in hospitals can make it difficult to know your patients as well as you know your own family. This aspect is important because the better you know your patients, the better your care for them will be.
Regardless of the setting, thirty percent of facilities are cited each year for patient abuse and neglect. If you are a CNA who has witnessed any type of abuse, physical or verbal, it is your job to report it to the person in charge. You are responsible for the safety and well being of every patient, not only the patients on your assignment sheet. Also, if you have grown comfortable enough with the family members, it may be a good idea to mention it to them as well. Sadly, many facilities do not want the family members to believe they have made a bad choice in the facility they have chosen their loved one to receive care in. Therefore, making it known to the family members as well, will insure that proper investigation of the incident is pursued.