Nursing aides are known by various titles depending upon the settings in
which they work. They might be known as health assistants or orderlies in
hospitals, certified nursing aides (CNAs) in long-term care facilities, or
home health aides in home care. They can also specialize in psychiatric care.
Hospitals are releasing people sooner, which means they need more nursing
aides at transitional care facilities and in the patients' homes. The relatively
high cost of registered nurses means more opportunities for nursing aides,
even at hospitals that are reducing staff.
In home-care settings, nursing aides might make sure patients take their
medications, help them bathe or even shop for groceries, prepare meals or
do light housekeeping.
"Sometimes when they're ill, even if it's just a migraine, they don't even
want to hear you say 'Good morning, Mrs. Smith' in a nice way. But then you
have to pester them to eat or take a sponge bath," says Denise Akinsanya,
a certified home health aide.
"One woman was so depressed, she didn't want to leave the house, but I
convinced her to let me take her to [the] hairdresser to cheer her up."
In hospitals or nursing homes, nursing aides may also answer patients'
call bells, deliver messages and take temperatures, pulses, respirations and
blood pressures. They also help patients get up and move around. They might
act as scrub nurses, escort patients to operating rooms, set up equipment
or handle supplies.
Whatever the setting, nursing aides are the front line of care and often
spend more time with patients than any other health-care provider. Therefore,
they are entrusted with observing patients' physical, mental and emotional
states and reporting problems to their nurse or physician supervisors.
"You know these people need to be helped," says Akinsanya. "With a good
agency, they don't feel alone. When one of the nurses discusses a problem
with a patient, they make them feel like they are the only patient. People
need someone to listen."
Nursing aides with higher levels of training might set up oxygen therapy,
clean wounds, monitor intravenous fluids and catheters, irrigate breathing
or feeding tubes and help with elimination procedures. They can't administer
They work under the supervision of a nurse or physician, but home care
workers in particular have a high level of independence.
Ronald MacLeod is a registered nurse and co-owner of a home care service.
"People who want to do home care want to be on their own. To see that the
job is getting done, we have assessments and routine visits from one of the
RNs. But the people we have employed like their independence and feel they
have more value here. Someone's not looking over their shoulder all the time."
Nursing aides are an integral part of the health-care picture. Their services
allow many patients to stay in familiar surroundings and avoid moving to nursing
homes. Elderly people are a large segment of the clientele, but children with
physical and emotional difficulties and people recovering from traumatic injuries
comprise a significant portion.
The work is hard and the turnover is high. (Many leave to go on to higher
levels of skilled nursing.) Stress factors seem obvious: nursing aides witness
illness, depression and even death. An Association for Health and Safety in
the Workplace study reported higher levels of stress, psychological distress
and depression among health-care providers than among other professions.
Yet if you ask those committed to the profession about the downsides, they
seem perplexed. MacLeod could only say, "Sometimes there is a lot of lifting.
Aides become desensitized, usually within three years, to the other things."
Nursing aides need maturity, patience, reliability and sensitivity to the
needs of patients. Good health and physical condition, efficiency, coordination
and an eye for detail are important.
"Anyone who is going into this type of work should have a compassionate
attitude. If you're not a people person, don't get into this," says Akinsanya.
Job hazards include potential exposure to infectious diseases and toxic
chemicals, as well as back injuries. Travel fatigue can be a problem for home
health workers who must drive back and forth to patients' homes.
"There are definitely more women in the profession, but certainly more
males have been coming into it in the last six or seven years," says Sondra
King of the Connecticut Association for Home Care Inc.
Many nursing aides start out as part-time workers. Some work full time
at other occupations and use this work as a way to earn extra money and fulfill
their desire to help people.
According to Tara Lepro, a RN and home health aide supervisor, people who
go into the field often mention that they "want to give something back to
The average workweek is 40 hours for full-timers. Home care workers in
particular may work a lot of odd hours due to the needs of individual patients.
Benefits for workers in hospitals and nursing facilities are good, but benefits
are scarce for home care workers.
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Nursing Aides, Orderlies, and Attendants
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