Archive for game of life

State Certification Exams, and the End of Certified Nursing Assistant Training.

Posted in Uncategorized with tags , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , on 03/05/2014 by Angel D. Vargas

3/5/14

My Nursing Assistant training is put to the test during a four day externship to a long term care facility. The adventure begins with the scheduling and organization of the entire affair, but by the time the dust settles, I’m decidedly chagrined with the end result. I somehow have it in my head that we are supposed to get our choice between two facilities. Furthermore, I’ve deduced that those of us who get the required medical forms filled out the earliest are supposed to have first choice in where we want to go, as in a “first come, first serve” basis. I seem to be the only member of the class that got this taken care of early. Since home for me is at my girlfriend’s apartment in Harlem, I am hoping to be placed in what appears to be the only Manhattan location affiliated with my particular training program. Given the living situations of my classmates, they are all more or less hoping for the same placement. I am silently confident that I am going to go exactly where I wish.

Before I even set foot in a Program Administrator’s office for what feels like an official debriefing, my hopes are dashed. Our professor has come back to the classroom and dispersed our assignments to us. Not only has everyone been sent to the same facility, but its “way-the-fuck-out-in- Brooklyn” location staggers us all, as though, like some distant star, its light would take billions of years to reach our planet. Our one student who hails from New Jersey looks at me as though she wants to throw something. Another female pupil lowers her eyes to the ground, a defiant “Hell no” escaping pursed lips.  I cross my arms over my chest and turn my head, disgusted. Once again, I feel as though I’m being backed into a corner and forced to accept yet another arbitrary set of rule changes. Moments of frustration comprise my patchwork quilt of experiences with this school’s administrative communication. This nasty realization comes in the middle of my preparations for state certification tests which suddenly seem to loom like Servants of Darkness on the periphery of my life, waiting. Now I find myself wondering if those rules will change too, or if I will be handed the wrong exam without my knowledge. I vow to be extra vigilant on the first of two scheduled exam dates.

Sure enough, exam day creeps up on me like a stalking burglar. Contrary to the other two of my classmates who will be with me this day, I no longer feel as though I need to do any last minute studying, or partake in any hurried, whispered discussions of what it might be like. Our maternal professor wishes us all luck, marches her “children” into the CNA state exam room for one hour of focused study, and closes the door. The three of us sit at a large table and go over a practice exam, but I just can’t bring myself to care during “the Zero hour.”

It takes no time at all for any of the three of us to complete the Patient Care Technician exam. Sure enough, one of us is handed the wrong test, I am handed the wrong identification number for my test, and the last of my classmates has her name spelled wrong on the official roster. Despite all this, panic blossoms in the middle of my chest, and I forget to be indignant. Once the test begins, however, I feel as though I am in my element, dispatching each question with brutal efficiency. My fabulous progression sends a thrill through my body. Post test, my confidence begins to manifest in a warrior’s swagger. As I calmly stride over to the proctor to take my Phlebotomy exam on little more than a whim, I might as well have the flat of Masamune’s legendary blade resting against my shoulder. My classmates look at me as though I’ve grown an extra head, but then they nod. One of them pats me on the back as I begin the second exam.

“I know you got this,” she whispers before exiting the exam room for the day.

The externship is set to begin shortly after the test on a Monday, the 24th of February. As the day looms closer, tensions rise in the classroom. Some students begin to express doubt about travel time and cost. Others seem to lose their focus, chatting with each other or texting on their phones when they are supposed to be practicing skills for the yet unscheduled C.N.A. practical exam. One exhausted student who also works retail becomes so testy that others begin to express concern.

I become a knot of anxiety and resentment. I will have to wake up at the ass-crack of Dawn and be on a D train headed toward Coney Island for more than a hour each morning. I need to buy new white scrub pants and new white sneakers in order to follow the official facility attire standard. Meanwhile, I get the grim news that I am being laid off “until further notice” thanks to the cold calculations of a regional manager with whom I’ve only exchanged two words in almost as many years. I am still grading the test papers of nearly all my classmates, and our teacher has not stopped handing us paper after paper for our folders, all of which seem to be bursting at the seams like the bellies of expectant mothers.

None of this adds up to anything with which I would want to deal. In fact, the discussion I have with my girlfriend less than a week before the externship’s inception includes both the news of my lay off and the news about my new “wake-up” time.

I won’t bore you all with how awkward the words were as they came tumbling out of my mouth, but I will say that there is a reason to celebrate the love, understanding, and companionship of someone special. Without fail, she arranges for a couple’s massage treatment at a midtown Manhattan spa, a late one-year anniversary gift that comes just at the heels of my surprise dinner reservations for two at the Thai restaurant where we first met. There could be no better time for something like this. The treatment is so lovely and enjoyable that I almost cry when my girlfriend dashes off to a stage management assignment while I go home to melt into a puddle on our futon.

I settle in for the weekend. The fact that I’ve had my last official class in school settles on me like a spring dew. I smile, albeit wearily. It doesn’t take long to map out the walk I need to take once I get off the D train somewhere near Coney Island. I am forced to buy a pair of pants one size too large for me, and without any pockets. It’s all I can afford, and after an exhaustive search in the city, I am lucky to have found that much. My sneakers are cleaned and ready to go. I am as prepared as I am going to be, and I try to take the time to rest.

Monday

It seems, however, that the weekend passes within the blink of my burning, wearied eye. Church bells cut through the night,  and I sit up in a panic until I remember that this is the phone alarm that we’d agreed upon since my schooling began. My girlfriend jokes about wedding bells, but she can’t bring herself to climb out of bed before the sun begins its game of “peek-a-boo” with the clouds. I don’t blame her, and I don’t ask her to go through any more trouble than she already has. Until now, she’s made my breakfast at close to 6 in the morning for almost two months. It would be madness for her to wake up even earlier without a damned good reason. Love and emotional support can only go so far for those of us who are not Mother Theresa.

Without sufficient cause to travel on the D train, I might avoid the aggressive aura from the 125th street stop in Harlem. Still, the train arrives at about ten minutes to seven in the morning. I trundle on, aware that I’m already feeling stand offish. Fellow straphangers can make me feel as though I’m about to enter an arena rather than a public transit vehicle. Getting from point A to point B can be tiresome on such mornings. I don’t manage to attain a seat until about 34th street, but that is still at the very beginning of my journey. I’ve not traveled toward Coney Island for more than a decade, and I forget how long a ride it can be.

I also forget the cold. And this isn’t just any kind of cold. It’s the frigid, carve-a-hole-in-your bones-and-leave-a-wet-mildew-on-your-soul kind of arctic blast you can only  find near the water in the middle of the winter. A coastal city like New York will make you pay for any gaps in winter attire. I chose to wear my white uniform pants without a thought to long underwear. I also chose to don my winter coat without a sweatshirt beneath. The wind howls, and my teeth rattle as though I am a baby being shaken by a mother in the throw of alcoholic rage.

I still manage to get to my assigned Long Term Care facility in once piece. Many of my classmates are already there, dressed from head to toe in white. I find myself torn, wanting to either turn around and walk away, or look for the hospital identification band around my wrist. Everyone except our instructor for the day sports the raised eyebrows and hunched shoulders of apprehension. I forget to be hungry for a few minutes while we settle ourselves in, and our instructor for the week explains the importance of following the facility’s rules for attire, for conduct, and for the treatment of patient information. HIPPA is a big deal, and yet there seem to be so many different ways to violate it. By the time speeches are made and questions are answered, I’d rather like to become a deaf mute.

Receiving our assignments is fraught with nervous tension. We go to our assigned floor, and we receive a warm welcome from the charge nurse. However, the C.N.A.’s under her command are already busy. They arrive an hour earlier than we did, and it appears as though a good portion of their morning duties have been accomplished. Just when I begin to feel like a fifth, white-walled wheel, I, along with the only other man in the class, am assigned to a Nursing Assistant. She takes us to the male patients on the floor, and we set to work right away.

Our first assignment is breakfast. We get to feed a male resident who cannot even hold a spoon in his hand. Nerves mount once more as my partner steps in, meal-tray in hand, to begin. The first few spoons of hot cereal dribble down the man’s chin in embarrassing rivulets. After some nervous titters, we clean the detritus from his face and attempt to find a rhythm to the rest of the meal. I’ve hung back, surprised that my partner feels more comfort with this than I do. Our instructor finds us, nods in approval at our progress, watches my classmate feed the older gentleman, and then tells us to switch places. I don’t know why, but this takes me by surprise. In the end, I remember the classroom training, and I begin by offering the resident his apple juice. “Three sips, three spoons, three sips, three spoons.” This becomes a silent mantra in my head as I calm the shaking of my spoon-hand and proceed to offer encouragement.

The meal is soon taken from my hands by a smiling Nursing Assistant. My confused expression prompts the N.A. to tell us that the man’s wife will be visiting later in order to feed him a lunch. I am almost mollified by this explanation until I hear the bedbound man’s teeth grind against each other so hard, I’m afraid he’ll tear one of them from his gums.

“Does he do that often?” I ask.

I find out, of course, that this is regular behavior for him. It makes me curious, but something in the N.A.’s light, but insistent tone tells me we’d better get going with the rest of our morning duties. Sure enough, there is plenty to do. By the time all is said and done for the morning, my partner and I have made no less than six beds, participated in three bed baths, and learned why bedsores are not something to be taken lightly.

After a lunch and a debriefing with our instructor, our afternoon looks to be more or less the same. The morning’s activities make three hours fly by in a cosmic blur, yet the afternoon seems to drag as though someone pressed the “slow motion” button on my life. Still, things seem to be going rather smoothly. We’ve learned the scope of a Nursing Assistant’s hands on duties, and we are soon taken back to the employee break room. It’s only one o’clock in the afternoon, and our assignment keeps us here until four p.m. for each of our four days.

Our class doesn’t return to the floor. Nor are we released early. Our instructor, a registered nurse, has to go over so much paperwork and administrative procedure with us that I, along with all my other fellow pupils, become slack-jawed and bleary-eyed. Once the end of the first day arrives and we are released to our respective destinations, I find myself hoping that the next three days are just as easy. Yet I am also certain that they won’t be.

Tuesday

When I arrive the following morning, the only apparent difference between Monday and Tuesday for me is that I am now following a male Nursing Assistant instead of a woman. I am sure there will be differences in the male assistant’s approach to the male residents. I am right of course, but that doesn’t stop the work from getting done. He moves quickly, allocating duties for me and my fellow male classmate without missing a beat. Things appear to be the same as the day before, right down to our first task of feeding the same man his breakfast.

Just as we begin to find the rhythm to how to week might progress, another C.N.A passes by the room door and utters something to the effect of “the state is here,” and my stomach almost drops. Just to clarify, our class was taught that the State will often do inspections of long term care facilities in order to document procedure, look out for resident safety, and “ensure the quality of all the employees.” Facilities can be fined for evidence of resident neglect or abuse, and some have even been closed down and the staff arrested and charged with various crimes against the elderly and otherwise vulnerable. In theory, we should all be thankful that State regulators have arrived to oversee our stay at this facility.

The staff’s reaction to a state visit could not be further from one of gratitude. A frantic energy begins to build in the facility. It affects the way we handle the rest of breakfast. It alters the speed with which we attend to the other residents. The sheer volume of cleaning seems to climb exponentially. Even the charge nurse seems apprehensive, and I don’t know why until I recall our visual lesson regarding bedsores. Now I wonder what the State will observe in its tour, and why it seems that we as students are doing three times the work that we were doing just the day before.

Then I think back to my work at a major metropolitan hospital in Minnesota, and I sigh. I’ve dealt with important inspectors before in a healthcare setting. JCAHO (Joint Commission for Accreditation of Healthcare Organizations) sends their own investigative officials to hospitals and clinics. I’ve met with and spoken to these people during my time as a nightshift Psychiatric Associate at a major Midwest Metropolitan hospital. The entire affair ceased to intimidate me the moment I realized I always did what I was supposed to do and did right by the psych patients with whom I was in contact. There was never a real need for me to worry.

Wednesday

Still, the state inspectors give off an aura of self importance. During our Wednesday afternoon repose in the employee lounge, our guiding instructor leaves to run an errand, and no less than three state officials open the double doors and stand there, their roaming eyes calculating, their postures tall and aloof. I glance around, quickly noting the varied expressions on my classmates’ faces. Undaunted, I turn my attention back to the interlopers and nod. After another long day, the smile on my face is small, and I can feel my facial muscles tighten. The self-appointed State Official leader and I exchange pleasant remarks, and I exhale as my fellow pupils chime in with their own greetings. I am well aware that we can’t forget the function of State Inspectors, but I refuse to think of them as above me in any way. It does help my case that I recognize the leader of the group, a tall man wearing what appears to be an ornate yamaka. I only recognize him because we bumped into one another in the men’s restroom just that morning. A chance meeting of that nature has a way of humbling both participants.

After a tense few seconds, the double doors close, and I feel like a gunfighter that just bluffed his way out of a Spaghetti Western Standoff. I want a piece of tumbleweed to roll across the floor. Our instructor returns from her apparent disappearance, and we regale her with the sordid details of what feels like a clandestine waltz with fate.

Thursday

We finally come to the last day of our externship. All of us are tired. At this point, we’ve been told so many things to do and NOT to do because of the State visitors, I’m growing increasingly paranoid. I’ve washed my hands so many times using “state mandated technique,” that my fingers are beginning to dry, and a painful crack has erupted like a tiny fault line along the outside of my pinkie’s knuckle joint. Staring into the faces of my classmates doesn’t provide much consolation. Many appear to have grown sick of the commute, the bags beneath their eyes telling more stories than I can ever truly record. Our instructor reminds us to remain grateful for the opportunity, but I’m sure we’re all more glad that our time here is up in less than eight hours.

My final day at this facility proves to be the most challenging. As adept as my partner and I have become at feeding a particular male resident, we are denied this opportunity because we refuse to allow ourselves to be left alone as students without another employee’s supervision. This continues to be a frustration for us all, as the Nursing assistants all appear to be anxious to get things moving, yet none of the residents seem to be having an easy time of it. At our instructor’s behest, students are forced to stick like glue to their assigned C.N.A.’s. Our C.N.A. is not annoyed with us, but he does appear a bit more distant, as though his morning coffee hasn’t quite kicked in. I don’t blame him. I feel much worse for wear just having contended with this added stress for four straight mornings. I try to remind myself that my C.N.A. has chosen to do this for a living, yet this is when the existential questions begin to manifest like apparitions at the foggy cemetery of my mind.

Did I ever tell you I think too much?

In the middle of handling a struggling male resident who refuses to allow us to clean him, another male resident who can’t seem to eat his hot cereal without coughing up a lung, and a final male whose condition appears to have deteriorated so badly this week that he proceeds to vomit and defecate in the same moment, I ask myself the one question I thought I would save for a lonely walk in the park.

“Why would anyone do this for a living?”

Much to the credit of the staff, they answer me without my having to ask. One female Nursing Assistant reminds me that she chose this occupation because she feels for the elderly and vulnerable of our world, and wants do as much as she can to provide care and comfort. Another employee tells me her grandmother was in such a place, and was treated well by her caregivers, which inspired the Nursing Assistant to pursue this line of work. My C.N.A. doesn’t offer us a tale of woe or of courage, but he simply does his thing. A sparkle does seem to come to his eye as he assigns me and my partner certain rooms where multiple beds need to be made, confident that we will both do a good job. At this point, my partner and I each make our own beds, and I am encouraged by our individual progress.

We also learn to chart on resident cares on the computer. I am surprised at how little one actually gets to comment on their individual impressions of resident progress, and I don’t like being left out of the equation, so to speak. Visual icons represent the various items on a patient’s care plan itinerary. A bedpan, a toilet, or a commode icon speak for themselves. Just point with a mouse, click, and a patient’s abilities with toileting have been recorded for the day. After watching a Nursing Assistant do this with a series of activities for one resident, I realize that this can become rather mundane. I wonder if we’ve made a mistake depersonalizing patient charting, ultimately removing ourselves from the empathy needed for such undertakings. For me, the act of writing something down elicits emotion, for good or for ill. I suppose that’s why I am pursuing professional level fiction writing. Being able to talk with others about what has transpired also matters. As a former mental health worker, I am all too aware of how subtleties in body language and tonal voice changes can comfort, alarm, or galvanize an individual. This new way of charting comes off as cold and impersonal, and leaves me feeling as though my accomplishments were just not that important. Nobody should feel this way about such an important job.

This proves to be the longest feeling day this week. By the time I sit my aching body down on the most comfortable chair in the employee lounge, I find myself unable to process much of anything. My thoughts shift uncomfortably, as though they are a series of songs on a malfunctioning ipod that won’t do anything but shuffle. To make matters worse, during our lunch break, we spy snow falling outside our window, as though we are sitting inside a gigantic snow-globe. As we eat our way through our three dollar meal tickets, the wind outside intensifies until I’m sure I’m looking at the beginnings of a blizzard. This year’s winter has worn New Yorkers down, and I groan as though I’ve been asked trek through the tundra and procure snacks for everyone in the cafeteria.

The afternoon seems to fly by us like a flock of snowy owls. The storm passes quickly, and my mood lifts almost as fast. My partner and I rush around at the beck and call of our Nursing Assistant/mentor, fully aware that this will be the last time we make a bed or dispose of unpleasant human biological deposits in such a setting for a time. Finally, when the last piece of electric assistive equipment has been put away, the last bed has been made and the last resident have waved a frail but warm goodbye to us both, my partner and I head back to the employee lounge for the last of our debriefings. More paperwork followed by words of encouragement and pride seems to hover just in front of me. I think back on my experience, and I can’t help but note one ultimate truth.

This is not the work I will pursue once I graduate the program.

My conclusion has less to do with the residents than I thought it would. But, as always, one is forced to think of the big picture when undergoing such things as internships or externships. And why shouldn’t this be the case? As shaky as the economy still feels, I didn’t go back to school just to feel as though I have to take yet another job I don’t want. School is a risky investment of time as well as money. For this to feel like a success, there must be a true reward for the work I’ve put in. Gainful and meaningful employment was the goal here. Even when the idea of volunteering here is presented as an option to our group, I shudder. The location is just too far for it to be worth an unpaid opportunity.

I am the brave soul who volunteers his reluctance to pursue this line of work. I am also forced to accept another reality for which I was not prepared. The elderly and infirmed force me to face my own mortality in the simplest of terms, in the most direct line of sight. There is no escaping the ravages of time. The human body ages and dies. I may not have been alone in my awareness of this phenomenon, but I admitted it to my class. It depresses me almost unutterably.

The externship is ultimately a humbling experience for me and for so many others. Our goodbyes are short, and the Nursing Assistants can’t seem to let us go without words of advice or encouragement. I don’t give away my true feelings about the work they do, but I understand the meaning of caring for another person in the twilight of their lives. I can’t begin to imagine where I will be at that age, or what society will become in regard to its elders. I can only hope that I am surrounded by warmth and compassion, even when I forget the spelling and meaning of such words.

 

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