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The Nurse Aide Conundrum in LTC

2014; Elsevier BV; Volume: 15; Issue: 10 Linguagem: Inglês

10.1016/j.carage.2014.09.024

2377-066X

Jerald Winakur,

Geriatric Care and Nursing Homes

The Commission on Long-Term Care, comprising 15 members appointed by President Obama and congressional majority and minority leaders, presented its final report to Congress in September 2013. The report provided a framework to discuss various issues in long-term care, but no legislation was proposed. An important aspect of this report noted the paid long-term care workforce. The CLTC report acknowledged the shortages in this arena, stating “The Commission recommends that states permit nurses to delegate and supervise certain tasks to direct care workers with sufficient training and demonstrated competency to perform them… .” Eli Saslow's article, “Opportunity Knocks,” which appeared in the May 31 issue of The Washington Post (www.washingtonpost.com/sf/national/2014/05/31/), should be required reading for every post-acute/long-term care (PA/LTC) administrator, director of nursing, medical director, and every member of AMDA. I will go so far as to say that anyone interested in the welfare of our burgeoning elderly population should read this article, and it should be forwarded to every elected member of our state and federal governments. Mr. Saslow aimed a spotlight into one of PA/LTC's darkest corners. In the article, he reported on Tereza Sedgwick, a laid-off furniture factory worker and single mother, who enrolled in a 2-week course to attain a certificate as a nurse aide. The brochure for the class had read: “A NEW CAREER and a NEW YOU in just 75 classroom hours.” Tereza, he wrote, “knew little about health care beyond its abundant job openings … but she had gone three years without full-time work, and she liked the idea of caring for people.” The brochure enticed with phrases like these: “Need: Urgent. Necessary work experience: None. Necessary skills: None.” Early training emphasized “caregiver stress,” with its attendant symptoms of headaches, teeth grinding, apathy, depression and anger. Tereza received a handout in class that suggested: “On the way home from work, try to focus on one good thing that occurred during the day.” She had to master skills such as hand-washing, hair care, bed-making, bathroom etiquette, vocabulary terms, and dealing with “catastrophic outbursts.” And she had to learn all this in the first week of classroom time – along with constant quizzes and tests. The second week she walked into a nursing home for the hands-on part of her training. Here, she would spend the week learning to bathe and feed patients, and how to keep them “comfortable and calm.” She was assigned a patient with advanced dementia, with this instruction: “See if you can get her to have about five bites.” No one was by her side; no one was there to give her some advice or experiential wisdom. She had no one on whom to model her approach. “Tereza opened and closed her own mouth, mimicking eating,” Mr. Saslow wrote. “ ‘Can't you just try it?’ she said, whispering this time. ‘Please?’ She counted to 10 and pulled away the fork. Her hand was trembling. Sweat ran down the bridge of her nose. Was it bad to force a patient to eat? Was it worse to leave her hungry? She had been inside a nursing facility for 30 minutes and already she was failing.” Diane Morris, the classroom teacher, visited the nursing home during the week to observe her students. “There isn't a Florence Nightingale in the bunch,” she said in the article. “We crammed six months of work into 75 hours,” and she wondered who benefited from this training system: “The students who would make $8 an hour in jobs they weren't prepared for? Their future employers who would be hiring novice workers? Or the 72 million aging Americans who would spend their last years living through their caretakers’ mistakes?” Even so, America's elderly need caretakers and America's unemployed need jobs, the article stated, and Tereza earned her certificate. Her mother – who had paid for the course – urged her to hang it up somewhere. But at the end of her 2-week training, Tereza was unsure about her skills and confidence to do the work. “ ‘Do I really want to look at this thing every day?’ she said. She put it away in a drawer,” Mr. Saslow wrote. I am not an expert on how nurse aides are trained throughout the country. Perhaps in Ohio, where this story unfolded, a 2-week course is all that is required, and that elsewhere in America there are more stringent standards. With time, Tereza may make a fine nurse aide. But with her minimal initial training, who could possibly say that she is competent to have any real responsibility thrust upon her? In my 40 years in medicine, I have known many wonderful nurse aides. Those who stay in the field for long careers are dedicated, hard-working, and compassionate people. They deserve kudos, opportunities for advancement and higher pay for the difficult work they do. But do you – as professionals in PA/LTC – truly believe that a 2-week training course to gain a nurse aide certificate is anything but a sham? Compare that with the 1000-2000 hours of training required in most states to become a licensed hairdresser. Would you and I – as sons and daughters of elderly patients in long-term care facilities – be content to know that novices like these are providing the shift-by-shift care needs of our loved ones? It is true that America's elderly need caretakers and Americans need jobs. But let's carefully examine how nurse aides are trained around the nation and come up with reasonable standards, a rational curriculum, and a national certification process. Let's support our nurse aide colleagues who make PA/LTC work hour by hour, who can either make the rest of us in the profession look good or incompetent. Stand with them for better working conditions, reasonable patient loads, more than decent pay, and reasonable benefits. Otherwise, we are shirking our own responsibility to those whom we purport to care so much about.