Monthly Archives: July 2013

One of the healthcare industry’s largest segments, and growing by the day, is the long term care facility. This is evidenced by the booming LTC business fueled by the ever growing number of elderly entering the market place in need of a residence that supports their round the clock need for safety and comfort. Enter the long term care facility, i.e., the nursing home.

And who is the most valued member of the LTC healthcare team? The humble nursing assistant. It is the nursing assistant who logs the most time with residents of long term care facilities, satisfying their every day needs as they help the elderly LTC resident with their activities of daily living in this communal life style setting. It is the nursing assistant who interfaces with the nursing home resident, enhancing their quality of life by rendering compassionate, competent care while at the same time observing and reporting “red flags” to the higher-ups in order to stave off any looming healthcare crisis that may adversely affect the well being of their charges.

The role of the nursing assistant is so key that it is regulated by the government. In 1987 the Omnibus Budget and Reform act (OBRA) mandated that each state maintain a registry of nursing assistants. Since then, nursing assistants in each state have been screened,  trained and tested according to state standards and then entered into the state’s registry of Certified Nursing Assistants. Upon entering the state’s registry, the CNA is qualified to work in a nursing home, and the state keeps track of such things as certification dates and reports of abuse and neglect. The Omnibus Budget and Reform Act not only protects the vulnerable nursing home resident, it also validates the role of the nursing assistant in modern-day nursing homes. CNAs perform the most important and pivotal role in the long term care setting. Certified Nursing Assistants are the eyes and ears of the healthcare team in any nursing home – the first responders, if you will, in the care of nursing home residents. The CNA, by virtue of their job description, is the “canary in the coal mine” when it comes to the proactive delivery of care in nursing homes. 

While helping nursing home residents, the CNA is expected to recognize the initial signs of any number of healthcare crisis’, and know when and how to report those signs to the appropriate staff members who are authorized to intervene. The CNA is required by law to stay within the limits of their scope of practice, and that too is something they must be aware of and comply with. The CNA is the first line of defense for the residents they are taking care of. The role of the CNA is critical in the care people who are living in nursing homes. 

There are innumerable nursing assistants who have worked in nursing homes for years and years, caring for the needs of their residents often times without recognition for their selfless efforts. There is nothing more noble than the nursing assistant who has made a career of working in the nursing home setting. The job is often times thankless, except for the gratitude given by the nursing home resident who depends upon the kind and competent CNA who comes to them every day with a gentleness that can not be quantified. It is this quality that, undeniably, makes the CNA an important part of the healthcare industry’s infrastructure.

Bo Ramsey is a CNA Instructor at Express Training Services, LLC at the Destin Training Center. ETS is home based in Gainesville, Florida and has several other training centers in Florida that offer fast-track instruction for certification in many healthcare occupations. For more information call 866-346-0660 or go to


Caregiver burnout is becoming more and more common among caregivers in the United States with approximately 50 million Americans currently taking care of someone who needs assistance on a daily basis. Three out of four caregivers is female and many are caring for a family member in a home setting. But caregiver burnout is always a potential problem in the nursing home setting too, where nursing staff, especially nursing assistants, log long hours of hands-on time spent with nursing home residents.

Taking care of someone who is disabled, elderly or somehow incapacitated is demanding, both physically and emotionally and will take its toll over time, even on the strongest among us. Studies show that caregivers have higher than normal blood pressure and insulin levels than do non-caregivers and thus are at a higher risk for cardiovascular disease. But depression is the most common malady among caregivers with up to half reporting symptoms of depression and above normal usage of antidepressants. And in the nursing home setting, caregiver burnout can have unpleasant or even downright disastrous consequences which can include neglect or abuse of residents. The key to managing this kind of stress is to prevent it. In order to do that, recognizing the leading indicators of caregiver burnout is job one.

Caregiver burnout is not easily recognized by someone who has it, especially a professional caregiver such as a CNA, who is told, “don’t take your work home with you.” But there are different stages of caregiver burnout, and the beginning stage is frustration. Experiencing some frustration on any job is to be expected, especially for CNAs who are expected to act with compassion and understanding and the patience of an angel. But the stress that comes from chronic frustration can lead to ill health which could show itself in head colds, headaches, insomnia, anxiety or hypertension. Some caregivers resort to using drugs or alcohol to escape while others begin to avoid social contact. Any of these behaviors can be a sign of caregiver burnout, and is an indication that it is time to take a proactive approach to caregiver stress. The later stages of caregiver burnout are depression and despair, and can be avoided if the caregiver will take care of themselves so they can effectively take care of others.

The following is a rundown of five basic ways for caregivers to avoid caregiver burnout.

#1: Take care of your body

Make sure you get enough sleep! The importance of sleep cannot be understated. If you don’t know whether or not you are getting enough sleep, keep track of how many hours you sleep every night for a week or two. Compare how you feel/perform during the day to the amount of sleep you got the night before. You might be surprised when you get a good night’s sleep, the next day of caregiving is easier and more rewarding. And when you need some extra energy, drink more water! You will feel your best if your body is properly hydrated and sometimes an extra glass of iced tea, even herbal with no caffeine, will rejuvenate and refresh you, helping you shake off minor frustrations or sleepiness which can make you irritable. Another way to keep the juices flowing is to keep your body moving. Take a short break when you need to and “walk it off” when feeling stressed. Walking, along with a brief change of scenery, will clear your head, reduce stress and open your mind to accept any insights that can help you with the source of the stress. Sometimes it is just better to literally walk away from a situation. Which brings us to our next suggestion about how to avoid caregiver burnout.

#2: Make time to play

Some times you just need to let off a little steam and go have fun. Many people, caregivers included, work hard and shouldn’t be afraid to play hard. With all the challenges that come with caregiving, we are apt to begin accepting stress as just a part of life. Unrelenting stress does not belong in our lives, and when we let it in long term, we run the risk of making stress a part of who we are every day. The perfect antidote is making personal time to play. Take the time to do things that act like a release valve for stress. Take up a hobby or travel, if only for the weekend or every once in a while. Have fun and allow yourself to relax. You will be better for it, and so will those who depend upon your care for their daily needs. Plan a get-a-way with someone special. Just the act of looking forward to something fun helps relieve the stress of the moment.

#3: Get real with yourself, clear your mind and your space

If you are a caregiver either in the home of a loved one or as a staff member in a healthcare setting, you can prepare yourself for the stress you know is going to occur. Sort of “gird your loins” as it were. This will help you deal with normal stress from the onset. Get plenty of sleep the night before a day predictably rough, and take healthy snacks with you, including plenty of water, when you are caregiving that day. If you can manage it, get in a brisk walk beforehand or some deep breathing or yoga, that would be especially helpful when you know you are going to have a stressful day. Then at the end of the day, write in a journal to help “let go of” any residual stress. (Bonus: Reading your old journals can lead to personal insights about how you handle stress.) Then lighten your load and simplify your life by clearing your space. Believe it or not, clutter in your living space creates a low level of stress. When you can, pick a weekend and make it a family project to get rid of clutter. If your space is big and cluttered, take it one room at a time, emptying out every single thing in one room from ceiling to floor, wall to wall. This is a great time to clean, rearrange the furniture, perhaps incorporate other items from the rest of the house for a fresh feel. After dispensing with the clutter, bring back into the room only those things that you decide give you the most pleasure, beauty and use. It is as simple as that. You will be amazed at how good you will feel, and how that feeling will translate to the people you care for.

#4: Let others give you support when you need it

Find someone to talk to when you need to vent, but take care to avoid betraying a trust or professional confidence, (HIPAA, HIPAA, HIPAA!) When you need to talk, find that one good friend who is always willing to listen… and let ‘er rip! (Change the names to protect the innocent, of course.) There are also caregiver support groups that are available locally through agencies such as the Alzheimer’s Association and the Area Agency on Aging. Talking it out and accepting support from others in similar circumstance works wonders to relieve stress. If you don’t have to “hold it all in” you are able to catch your breath and continue on with a fresh perspective. Another way to accept the support of others is to join a group of people who share a common interest such as yoga, medication, running, stamp collecting. It really doesn’t matter. When you are enjoying time with others it is easier to relax, and relaxing is the name of the game when you are exposed to stress on a regular basis.

#5: Live in the moment and have gratitude

“I am safe and all is well,” are the famous words of self-help pioneer Louise Hay. Use this affirmation or another when you might be feeling especially stressed or even overwhelmed. Just remembering to say it will bring you back into the present moment and help you get a handle on whatever it is that is stressing you out. And believe it or not, feelings of gratitude work like balm on a bee sting. If, when in the middle of a stressful situation, you can manage to feel any shred of gratitude for anything that may be happening, you will be met with a flush of calm and tranquility and the ability to handle anything in the moment. (Remember to “walk it off” as soon as you can if you need to!)

Caregivers are everything to the people who depend on them. Caregivers are good listeners, and they feel compassion and show respect. Caregivers keep their charges safe and comfortable while encouraging their independence, preserving their dignity and protecting their privacy. Sadly, most caregivers put themselves at the back of the line when it comes to their own needs.

Caregiver burnout is a serious condition that includes depression and despair as it progresses, and these conditions respond to medical care. If you or anyone you know might be showing signs of caregiver burnout, please seek help. And, remember to take care of yourself first and you will always be at your best for others who depend on you.

Bo Ramsey is a CNA Instructor at Express Training Services, LLC at the Destin Training Center. ETS is home based in Gainesville, Florida and has several other training centers in Florida that offer fast-track instruction for certification in many healthcare occupations. For more information call 866-346-0660 or go to Special thanks to the NW Florida staff at Hopewell Home Health Care who inspired the subject of this blog.

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