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Eager trainees take on tough nursing home job By JOE
CARLSON The Express Times, July 28, 2003 Dressed in her color-splashed nursing scrubs, Amy Thomas walks into a room at the Gracedale nursing home still rubbing her hands from a fresh washing. Thomas
walks to the bed of a resident and awkwardly raises her hand to close the
privacy curtain. "Hi, Jesse. We're going to do range-of-motion on you
today."
"How
is that? Any pain?" Thomas asks, smiling embarrassedly. "Range
of motion" is a serious exercise that happens hundreds of times a day
at Gracedale, the Northampton County nursing home in Upper Nazareth
Township. But
Thomas, 17, is near giggling. That's
because Jesse is 18-year-old Jessica Beebe, and she's only pretending to
be a nursing home resident. Thomas
and Beebe are both training to become nursing assistants at the county's
large public nursing home. Behind them, two county instructors and the
rest of the 12-member class of neophyte nursing assistants are observing
and critiquing. Despite
a countywide hiring freeze, officials at the home have hired more than 70
nursing assistants since January. Hiring is so intense for the job that
the home has full-time employees to conduct monthly in-house training
classes. Although
the nursing home employs dozens of professional nurses as supervisors,
nursing assistants perform the hands-on, frontline work of caring for the
740 elderly Gracedale residents. Many
residents at Gracedale don't need much help. They're there because they
can't afford the high prices at private homes and their families can't or
won't take them into their homes. Others
residents need much more help. They may need someone to spoon food into
their mouths, empty their bed pans and make sure they move at least once
every two hours. "You
have to be willing to make a certain commitment to work here. This job is
not for everyone," said Beebe, who has worked and volunteered in the
home for five years. A
tough job Being
a nursing assistant is difficult, unglamorous work. "The
touching and communicating with residents is really difficult at
first," said staff development trainer Michelle Jamann. "You
have to be able to touch people, and a lot of people have problems with
that." They
have to lift many residents into and out of bed. They have to bathe them
and make sure they move every two hours to avoid pressure sores. It's not
uncommon to clean up bowel movements and other bodily fluids. "I've
had people leave because of the smells," Jamann said. The
job requires long hours, most of it standing, and doesn't give reprieve on
holidays or weekends. They sometimes form emotional bonds with the
residents, knowing that death is inevitable months or years later. The
new hires say they seek out the job because of an innate love of people.
Others nursing assistants say they have family and friends already working
in Gracedale. Supervisors say the pay is decent and the jobs are
unionized. For
many nursing assistants, the job is a great way to get ready for a
higher-level nursing job, like registered nurse or licensed practicing
nurse. Some
of the nursing assistants come right out of high school. Others are
parents looking for a second income or older adults looking for a career
change. Leona
Pucci, 63, has worked in six different nursing homes over her career, but
her jobs have been in nutrition, not hands-on care. This month, she was in
training feeding a resident. "I
try to make the person laugh. It makes me feel good that I can take care
of someone," Pucci said. "This is such a dreary place for people
to come to. If I can make somebody laugh, I felt like I've done my part. "I'm
a people person. I love being with the people here." Pucci
intends to go back to school after about six months to become a licensed
practical nurse. If it works out, she said she'll come back to Gracedale
because she already knows the people there. Administrators
say another draw for Gracedale, as opposed to the private homes and
assisted living centers, is the in-house training program. The county pays
its new hires an hourly wage to go through the training, provides the
textbooks and handouts and then pays the cost for the Red Cross training. "There's
nothing out of the pocket except for the uniform," said Terry Bauer,
a staff development instructor. Bauer
helps train the nursing assistants on the large array of issues that come
up in daily work with Gracedale residents. Much of the training seems
academic, riddled with words like aspiration, dysphasia and gastronomy. But
delivering daily personal care also requires a humanistic flair for
knowing what outfits residents prefer to wear, when they like to go to bed
and what they like to eat. They also have to make individual decisions
every day about the kind of care provided by themselves and others. "You
are going to make a lot of moral, personal decisions here," Bauer
told her recent class. "Go above the heads of your supervisor, if
necessary, to report abuse." Later
on in the lesson, she added, "You're being watched. Know that." The
state The
state is a major fact of life in every nursing home. Once
a year, state inspectors come to Gracedale -- usually in January or
February -- to make sure care is given according to regulations. They
check everything from the temperatures of foods to the locations of
wheelchair-bound residents, who are supposed to be near the windows so
they don't block exits during an evacuation. Speech
therapist Jodi Walsh told the class that Gracedale is
"continuously" cited for deficiencies in thickening liquids.
Walsh produced two cans of Hormel "Thick and Easy," a substance
used to make fluids less viscose. She
explained the three levels of fluidity: nectar, honey and pudding. Walsh
taught the residents to add two spoonfuls of the thickening powder to 8
ounces of water to make it nectar-like, and six spoonfuls to make it
honey-like. Administrators
say it's important to thicken the liquids for the residents who have a
difficult time swallowing. Otherwise the liquids may seep into the lungs,
in a process called "dysphasia" and cause pneumonia. A
bill of rights Nursing
assistants and their supervisors are trained to know best how the
residents should maintain themselves. But
if the residents don't want to eat liquefied foods or thickened liquids,
they don't have to. They have the right to ignore any dietary
instructions, like limits on sodium intake. "Our
residents have rights. They have the right to have salt if they want it.
If this resident is persistent, we'll give them that salt," Bauer
told the class during training on feeding. Residents
can ignore just about any advice they want, although sometimes they will
have to sign an AMA form -- "Against Medical Advice." "If
they're perfectly oriented, they have the right to refuse good medical
advice, just like you can," said Rita Stellar, the director of social
services at Gracedale. Most
residents' rights issues revolve around food and feeding. In that regard,
the nursing assistants are trained to try to offer a compromise, like just
a little bit of salt with a meal. The
trainees said they plan to do everything in their power to ensure the
safety and happiness of their residents. "You have to give a part of yourself to them," Thomas said. "You ultimately feel responsible, because you're taking care of that person." Copyright
© 2002 Global Action on Aging |
