Thriving on Challenges : Karen Farrington's Story

Karen Farrington has many qualities of a great CNA: flexibility, insight that comes from years of experience, an easygoing nature and good sense of humor. Karen has been a mentor to new CNAs as part of the Orientation Assistant (OA) program at her nursing home. This program is helping to lessen turnover rates by easing new CNAs into the job and making sure they have an experienced worker who is available to them, who is supportive and willing to teach them what they need to know. Karen needs to keep her mind busy in order to feel challenged. She has accepted a job writing the schedule for the CNAs at her facility. This is not an easy task since, as in many nursing homes, there is a real lack of CNAs who are available to cover shifts. Having to work without enough people is one of the biggest sources of stress and burnout for Direct Care and Support Workers, and the problem is prevalent in nursing homes across the state. Karen has a sharp mind, and effective ideas for trying to keep good workers and reduce burnout among those who've been working for a while. It is no small challenge, but Karen's own CNA experience and strong connection to the rhythms of working "on the floor" makes her more than qualified to tackle this new job.

Seeing the Job Through New Eyes

I started to do the OA program because four years ago when I first stepped into my nursing home I was thrown directly on the floor with a list of my own because they were working short that day. I remember thinking to myself, "If I'd been a brand new CNA out of school I probably would have flipped right out." I'm very active and had experience, so I wasn't going to sit there and be useless, but to have my own list right off the bat was tough. I'd go into the rooms and these poor residents were confused. I just said, "Hi, I'm Karen, I'm new today. Nice to meet you. Um, let's get up and get washed." The CNA who was supposed to help me did her best, but she was running around. Not any fault of hers, but there I was, just totally on my own. In many cases I didn't even know if they could walk. I was getting one resident up and I asked, "Can you walk?" She said yes, but come to find out the woman was a two-assist. I was getting her out of bed and, whoops. Luckily I was on my toes and had experience, so I caught her and swung her back onto the bed. But someone new could have seriously hurt herself and that resident.

That's why I became an OA, because I did not want someone else to have to go through the shock of that experience. I'm the type of person that would stay and hang on for the ride, but other people would just be like, "See you." That's how you lose workers, and we need as many good workers as we can get. When the nursing home started the OA program I knew immediately that I wanted to be a friendly face when new people walked through the door. I wanted to fight for them if they had a problem. When I started, I didn't have anybody to fight for me. The OA program makes it so that doesn't happen.

It helps new workers' comfort level when someone is there to meet them at the door or have someone to go to if they have a problem. At least they know, "This person's helped me out before. If I need help, I can go see her." A lot of CNAs that are supposed to help train will do things by themselves and not include the new person because they have so much work to do themselves they can't slow down to show a new person what they are doing. The orientee will say, "I need help with this." "Oh, well, give me a minute." Then a minute turns into five and the next thing I know they're running down the hall, "Karen, I need help. What do I do?" Sometimes when you're a new employee you can't express yourself as well; an OA can help get your voice heard to a Nurse Manager or the Director of Nursing.

When I know that I'm going to have an orientation I will call the new CNAs before they begin working to try to make them comfortable before they even set foot in the place. And, hopefully, I can answer some of their questions over the phone and then when I meet them at the time clock and they'll already know me. I crack a few jokes and get down to business. I'm always cracking jokes. I'm flexible and friendly if they accidentally mess up. I had an orientee recently drop a plate and break it. No big deal. She said, "Oh, the resident's so mad at me." She wasn't mad at the new CNA. "At least you didn't put the food back on the plate and give it to her. That would have been really rude." I said that to her and then she started laughing and said, "You know, you're right. It would have been different if she knew I had picked up the food and given it to her anyway."

Usually the first day is more paperwork than anything else. Then there are two or three days of job shadowing, where the orientees will not touch a resident unless they feel like they want to be helpful. They come with me in the room, they meet the residents I'm working with and get familiar with them. Then as the day goes on they feel a little more comfortable where they can help me out with the bedpans. That's how they learn about the residents and what they can and can't do. As time progresses, depending on the person, they will settle down and start to really help out.

It takes different amounts of training for each individual person to feel comfortable working with the residents. I find it depends on the orientee's personality. You know you're going to have a good worker when they get right in it; you're looking at someone who's going to jump right into the job and be part of the team. Then there are those who come in and say, "No, I'm just here to watch you. I'm here to watch, that's it." Well, they only get six to eight days of training and if they're still having problems by the eighth day we have to sit down and look at where the problem is. Is it that the OA is not helping this new person to acclimate to the environment? Or is it just the person that can't handle the workload? Maybe they just can't handle ten residents and they need to go to assisted living where they can work with the residents one-on-one.

The Rhythms of the Job

Even with the OA program, problems still come up when we we're really short-staffed. Say, on her second or third day an orientee comes in for training, and it just happens that two people called out that day. Someone decides, "Well, Karen, we'll just put you and the orientee on a wing. That will cover that wing and we can use the remaining people for the other wings." Even though she is still working with me, on the same wing as me, the orientee is being viewed as a fully trained worker who's ready to have her own list, basically. The orientee is going to get overwhelmed because she doesn't know the residents yet. She's either going to panic or roll up her sleeves and say, "Let's go." Those are the ones that you know are going to make it. But the ones that panic -- it's hard for the OA if the new person doesn't know what she's doing yet. Plus, I'll have my own 14 residents to deal with. It's a terrible situation for both of us. When it happens I don't want to scare them by saying, "Well, we're short today. This is just what happens, get used to it." Instead I'll be like, "I'm sorry this has happened. We'll work together. I'll do the best I can and you do your best and we'll get through this day." Hopefully, the next day it won't happen. Sometimes it does happen again, and that might be enough to make someone decide they don't want to work there.

Because it's such a problem, we've implemented a policy that says that an orientee is an orientee until their training has been completed. If that means if we have to work short with just four CNAs, we work with four CNAs. That's hard to swallow because some of the other CNAs don't think that way. They think, "Hey, there's this extra body just standing there. Come on, we need the help." It makes the orientee very pressured. You don't want them to be pressured, you want to kind of nurture them until they know what they're doing.

I think one of the problems with the CNA classes is that they don't give the students enough hands-on training. The reality is that working in a nursing home is not an ideal job for some people. It's hard work. You can't do this job if you don't want to get dirty, don't want to help. Also, if you can't deal with the elderly being sick you're going to have a hard time. Some orientees have a hard time with the aging process and here they are on their first day of work looking reality in the face. These are elderly people and this is what you might end up being like. I've had a couple that just freaked right out because they weren't ready to face that situation.

The new students have to know time constraints. They have to be flexible, be able to jump around because sometimes they don't have forty minutes with a resident. Sometimes they're lucky to get fifteen at the most. Working in a nursing home is a rhythm, and if you have somebody not in the rhythm we all feel it. It's all about timing; getting them up, getting them dressed, getting them to breakfast. If you fall behind you're putting everything behind. The whole day's one revolving door and if you're falling behind it means someone is not getting what they need, and another worker's job is going to be harder.

The staffing at our facility changes a lot. I can't say I'm short-staffed a lot, but I can't say we're working fully staffed very often. It's kind of in the middle. We can go a couple of weeks and be six on the floor, and then we can go another two weeks when we're only four. If we're working short, not only do you do your six or seven residents, you pick up two more, and you still have to work under the same time constraints. Most of the time I don't cut too much out of the residents' routines. I can't; it's all necessary. I just work at a double pace. We have a couple of residents that will ask, "Are you short today?" And I'll just say, "Well, we're less than ideally staffed." That's my quote, "Less than ideally staffed." People get such a kick out of it because it's like saying we're working short without actually saying it.

The residents don't usually get upset at us when we have to rush. They're upset with the office people, because they know we need the help. They don't get mad at the CNAs because they know we work awful hard. They understand that. They just get upset that there's no one there to help us. It surprises me how much they stick up for us. They'll go to the resident meetings and say, "You need to get these ladies some new coworkers. They're running ragged. You need to do something about this." But then of course you have the few residents who don't care if you're working short, that still have to do their morning ritual. I don't skip over what they want, but I've memorized their ritual so well that I can do it in half the time. Nothing really gets skipped, it's just a matter of managing my time to meet their needs more quickly. And when I'm working ideally staffed then I can take the time to fix their hair a little bit more than I would do if I was short.

A seasoned CNA doesn't have a problem managing time or dealing with the difficult situations that typically come up with residents. A new CNA might have problems because they've never had to deal with it before. For example, when a resident says, "I don't want to get out of bed." Well, you can't leave the resident in bed all day because it's bad for their health. A seasoned CNA will say, "Oh, I know you don't want to get out of bed today, Mrs. So-and-So. But, you know, you really don't want to stay in bed all day because it can really just make you feel worse." It's all in your wording. "Why don't we get up, get dressed, then if you want to lie down again after breakfast that'll be fine." And before you know it, they're up and everything's fine. But a new CNA who doesn't know the residents very well will just leave them there and go on to someone else because they don't realize there's another way to approach the situation.

A New Challenge

A couple of weeks ago I started doing the scheduling at work. The difference between being a CNA and a scheduler is that I'm not working on the floor all of the time, I'm at a desk with a computer and a phone trying to put people in the schedule so that I cover all the holes that are there each week. I'm so used to the crazy days I had as a CNA on the floor that I thought being a scheduler would be boring. I figured on sitting there behind a desk looking at the clock being like, "Oh my god, this day is going so slow." But, no. From the time I get there in the morning, I am swamped. I've been eating lunch at my desk trying to catch up with things. And before I know it I look at the clock and it's 3:30. I think, "Wow, where did time go?" Then I look down and I see I filled that hole in the schedule, and that hole and that hole.

It helps that I know the different floors and I know what the workers are going to need. I know they're going to need six CNAs on this side and they're going to need two here. I know what's going to make the CNAs comfortable because I've been there. Because I am on good terms with almost all of the CNAs I can go out onto the floor and say, "Oh, I need a little favor." "Oh, sure Karen. What do you need for me to help you?" I'll ask if they can cover this shift or that one and sometimes they say no and that's fine. I don't push the issue.

A lot of the work call-outs are related to family. I've always had a "family first" philosophy anyway. If my son or daughter gets sick, I don't want anyone saying, "No, you have to come to work." If someone is calling out for a reason like that, okay. It's a problem for us, but family does come first. Then there are people who just call out all of the time and I'm keeping track of them. That's a new thing I've started as a scheduler; going back and tracing how many call-outs people have had so that the Director of Nursing can address the issue with them if it's become a problem, and hopefully that will stop them calling out so much.

I have been doing things a little differently than the last scheduler. Especially the fact that I've enforced the policy that no matter how short we are, an orientee gets full training with an OA. We can't keep workers if they're being thrown out on the floor without being trained. That's how you lose good people. The other CNAs are going to have to accept it and I do feel bad because they're working short so much right now. I know how hard that is; I have to deal with it myself. We need new people to come in and stay. Right now if somebody calls out I don't have a backup because there are no people. So other CNAs can disagree about my putting an orientee with an OA and keeping it that way, but in the long run it will be for their benefit.

My biggest challenge right now is trying to get the schedule at least a month ahead of itself. Right now I'm barely keeping up with it day by day. They all know their days off and they all know their days on and unfortunately I don't know them yet. Thankfully there's a lot of understanding in their direction. Still, there are certain things about the schedule that have irritated the CNAs and nurses. A couple of times people have come in really upset. I've had to tell them, "Look, I'm just learning everyone's schedule. I'm sorry. Just because there was a mistake on the paper doesn't mean I won't fix it and make sure you get your hours." That's the biggest thing; if their name is not on that schedule when it's supposed to be, they get nervous. People are not happy about the idea of having hours taken away from them because they are counting on the paycheck.

I miss working with the other CNAs. Because I am at a desk I will tell people to come see me. I have a lot of people who come in. I have a chair next to my desk, people come and catch me up on what's going on out on the floor. It's a family atmosphere where I work. It's really unique in that way. We're very friendly, open; we talk about everything under the sun. When new CNAs come in, we try to just blend them right in. It's great when people come in willing to work and ready and eager to learn in this new environment. You need to be easygoing, because you're going to have to deal with a lot of stress, and you need to be flexible enough to handle whatever situations arise with the residents. You've got to take it with a calming factor, you have to be able to organize yourself and adjust to whatever develops.

I know that everyone I work with will honestly give new CNAs a fair chance. But the reality is that it doesn't always work out perfectly. For example, as CNAs we care for all of the residents, but we each have our own lists of people that we work with each day; getting them up, bathing them, dressing them, things like that. Often CNAs will team up with each other to share the workload. Two CNAs will combine their lists and go into rooms together to help with each other's residents. If you work well together, it can be much nicer than working alone. Well, if a CNA is doing things really slowly, or her work is not up to par people don't want to team up with her. They don't want to share that responsibility with her because if she doesn't get residents done in time, they don't want to get blamed. She ends up having her list and that's it, and she takes full responsibility for it. The CNAs I work with would never be unkind to other workers or do anything to make their job harder because they understand that we are a team, so they'll give her a hand if she asks for it, or of course when she needs help lifting or transferring. It's tough because CNAs sometimes feel bad because they may like her as a person, but they just can't afford to be blamed for someone else not doing good work.

Working with other people can be a challenging, but one of the reasons I like this job is because it's challenging. Somehow we make it work. I like doing the scheduling now because I really believe I can help change things for the better, I can get the help I know they need. I like keeping my mind busy and that's what the OA program was good for. I had to pay attention and see the job through new eyes all of the time. I'm glad I got offered the scheduling job because it was time for a new challenge. I love being a CNA though, and thankfully with the new scheduling job I can still be a CNA on the floor a couple hours a day. I do two hours on the floor each morning and then go to my office, and it keeps me really in tune with what's going on. Plus, I like being out on the floor because it offers its own challenges; dealing with other people, helping, making a difference, flying by the seat of your pants sometimes. It's crazy sometimes, but I do miss it -- and I do love it.