When I entered into the nursing home system on December 7, 2006, I was
going through a gambit of emotions. I felt as if I had just been abandoned by
my family. I had been removed from the community that I was not only
comfortable in and been unable to run around freely for a decade, but was full
of friends and had served as my most valued support system. Being forced into a
nursing home is one of the most feared predicaments for anyone with an
extensive physical disability. I was entering an alien environment which I had
feared since my injury and that was full of the types of people that I had been
extremely phobic about since being confined to a wheelchair (anyone with a
diminished mental capacity). And I would have to get used to a completely
different and random cavalcade of caregivers. To say the least, I was mortified
at the prospects of my new situation.
One of those issues, getting used to different caregivers, continues to be
a challenge in my life due to the rapid turnover rate in employees at my
facility. But the very first day I came into the nursing home I was matched up
with a very – let's say unique – CNA that we will call Jane Doe. She is big,
loud, over-the-top, and unapologetically inappropriate. But, once one has a
chance to break through her tough outer shell of her personality, she has a
tender heart and generous soul. But on that first night it certainly did not
seem so. You see, I am a man of routine and habit. It was not so before my
injury, but it is a necessity when it comes to regulating and controlling my
care. I spent more than three months in the hospital after my injury, over two
months of which were at a physical rehabilitation center. There was no
disputing that at this rehab center the focus was not on trying to help me gain
ground on the amount of control I had on my body. That ship had sailed. I have
a complete spinal cord injury which means that my spinal cord was severed
completely and that there was no hope of ever regaining any of the function or
nerves below my collarbones. So, while I was at this rehab center I was to
learn every minute detail of how to perform my care so that I could direct
others into doing so for the rest of my life. I had to direct every caregiver
how to stretch my limbs and digits every day. I had to explain exactly how to
give me sponge baths so that I will not get wet enough that my body temperature
might drop drastically and beg caregivers not to bathe so hard on my shoulders
or collarbones due to those body parts being where I begin to have sensation
and are very sensitive to touch. I have a system for rolling me in bed from
side to side that not only is comfortable to me, but was designed by physical
therapists to be the least strenuous on the person rolling me. Brushing my
teeth and washing my face should always be done at least twice a day for two
minutes, as my dentist insisted, and there is a thousand other different other
systems of routine that I had been having my caregivers perform for 11 years.
Not only was this the best way of taking care of me, it was all I knew about my
care and all I had to offer to the person taking care of me other than a
promenade of "thank yous", "pleases", and other expressions
of gratitude. These routines sometimes clash with the routines of many CNAs and
become a struggle of wills between us. Jane Doe was no exception from these
battles.
Jane Doe and I were the same age but we had very different life paths.
Whereas I was a wild young person yet responsible enough to stay away from
teenage pregnancy and able to get a good education. Jane had children at an early
age without much participation from the father(s) and had doomed herself to a
life of backbreaking work and meager salary. After I got used to her and she to
I, we were like peas and carrots. We were fast friends and each serves as the
other's emotional punching bag to this day. Although we do not get to see each
other very often these days because she left my facility to work at another and
only works at my facility on a PRN basis, I still consider her a close friend
and hope she feels the same way about me, which makes the following even more
difficult to write.
Burnout in direct care employees has become a major research area for me in
the past three years. Not only is it a subject that I research in journals or
textbooks, but it is something that I witness with great regularity in the
facility that I unfortunately have to call home. As a matter of fact, a partner
and I have performed inservices with nursing homes on how to prevent, treat,
and recognize burnout in CNAs, the effects of burnout, and specifically how it
impacts quality of care in nursing homes (our website on these issues and more
can be located HERE).
Jane is a perfect example of burnout. She has a tumultuous home life. She
is a single mother of four and, at the age of 39, is a grandmother by one of
her teenage children. She spends quite a lot of time taking care of the
grandchild while Jane's daughter (and mother of the child) does everything from
jumping from miniscule part time job to part time job always at fast food
restaurants to going out with her friends as if she has no responsibilities as
a mother. The teenager is a high school dropout. Jane's other teenager, a boy,
is in trouble on a constant basis with the law and has been expelled from the
school bus due to fighting and leaving Jane scrambling for ways to get him back
and forth to school before he drops out or is expelled. Her next child, also a
boy, seems to find great amusement in the behavior of his older brother and
Jane is plagued by the thoughts that he will follow the same path. On the work
front, Jane works a full-time, 40 hour a week job as a CNA from 7 AM – 3 PM in
one nursing home then four or five days a week she drives 45 minutes to an hour
to another nursing home where she works until 11 PM and then drives 45 minutes
to her home. What little bit of social life she had disappeared when she became
a grandmother causing her to see no social or romantic relationship
opportunities. The few men that she has had relationships with are quickly
chased away because she cannot spare the time to show them the attention that
they crave or receive from Jane. She is physically exhausted from morning to
night every day. She has a very short fuse and is irritable at both work and
home. After over a decade in the medical field she feels as if she is not doing
a good job anymore. She has a pessimistic attitude in nearly every situation
that arises. And finally, even though she works as much as 70 hours a week or
more, she struggles to put food on the table for her family every night and is
heavily in debt due to high rent, medical bills, and automobile payments.
Luckily, Jane realized that she needed some sort of psychological and
therapeutic intervention before she had a nervous breakdown or even worse. What
finally drove her to seek out therapy was when she realized that she could go
from jocular laughter to depression and tears on the turn of a dime. Her
insurance would only pay for a single, one hour visit to a psychiatrist once a
month (which she was still having to pay for more than half the therapist's
fees). The doctor, which Jane readily describes as inattentive and preoccupied
with things other than care, simply prescribed her a cocktail of
antidepressants. Each month she visited he would listen to her for around 15
minutes of a one hour session and up her meds. At this point she is so
overmedicated that she cannot sleep and rarely eats.
