Certified Nursing Assistants

comfortzoneIf you want to be successful, you can expect to be in new situations. Whether you are adjusting to new responsibilities, a new position or even an entirely new job, your learning curve will be quicker and easier, and success will be yours if you remember the basics of getting to know people. Be ready to move out of your comfort zone to master three basic people skills: introducing yourself, remembering  names, and asking questions.

Believe it or not, even successful people under perform because of the anxiety they feel in new situations. We all feel it, but the most successful among us has learned how to put our ego aside so that we can effectively introduce ourselves, reliably remember names, and overcome the fear of asking questions.

These three basic yet critical get-to-know-you skills can be learned, but to practice them we must push ourselves out of our comfort zone. Our confidence level in new situations will grow as we practice these people skills and we will realize success building upon success!

Introducing Yourself

It is important to push through feelings like fear of making mistakes or being rejected when it comes to meeting people. And you will get farther faster if you go up to people and introduce yourself rather than waiting for them to come up to you. All you have to do is learn how to get better at it.

Don’t hesitate to introduce yourself people, just go for it. Whether you are at a networking function to meet people, or at a meeting and your new CEO is there, don’t assume someone isn’t interested in meeting you. Be prepared by having an “opening line” about yourself and a firm handshake. The first few times you stretch out of your comfort zone to do this it will feel awkward, but with some word tweaking and continued practice your opening line will be great.

Then pay attention to what they tell you about themselves. Listen intently so that they feel heard, valued and respected. First impressions don’t have as much to do with what you say, but rather how you made them feel. It is a really, really good idea to write down details about them as soon as you can. Don’t rely on your memory, especially if you are in a setting where you are meeting more than one person. This will help you remember someone the next time you see them, which brings us to our next basic people skill.

Remembering Names

We all are challenged to remember the names of people we meet, but remembering names is a skill that you can master with practice. When you remember someone’s name you are likely to feel much more comfortable with them which will lead to trust that will pay dividends in your future endeavors. Here are a few tips about how to remember names.

Firstly, before the end of your first conversation with someone you have just met, use their name a couple of times. If their name slips your mind, just ask them. Don’t wimp out here. Remembering people’s names is a skill that will serve you almost more than anything else in life. As soon as possible, write down their name, or put it in your cell phone or other device. Go back later, look at their name and purposely bring their face up in your mind’s eye. Go through your list of new acquaintances from time to time to test your recall, and when you do, associate something in their name with something you remember about them such as the way they looked. For instance, Shirley Brown might have long curly brown hair, so you can associate Shirley with curly and Brown with the color of her hair. Association is a proven method of recollection.

Lastly, when you are going to be somewhere you are likely to see someone again, go over your notes so that you will recognize them and remember some things about them. Your commitment to remembering them will not be forgotten.

Asking Questions

Most of us resist the urge to ask questions, but according to studies, the more questions new employees ask, the better they perform. Asking questions shows a commitment to superior performance and organizational success. Overcome the urge to “go it alone” and ask a co-worker or boss for guidance. But before you do, consider what you want, why you want it, and who and when you should ask. Your question should be focused and to the point. Instead of asking “how to” do something, ask to be shown. Avoid multi-faceted questions. Then say thank you.

A good practice when starting something new would be to establish a “go-to” person early on. You can set this up during your introduction to this person by asking them if it is okay to get back with them about questions you might have in the future.

In summary, as you practice these three people skills basics, your confidence will grow as you become more adept at introductions, names and questions. You will become accustomed to being out of your comfort zone as you ramp up your game. Just make a promise to yourself that you will always push yourself out of your comfort zones where ever they are. You will be better for it!

Reference credit: Success in New Situations by Keith Rollag from the December 2015 issue of Harvard Business Review via Hennes Communications on Facebook!


toothbrushesProviding mouth care to the elderly who have dementia, brushing their teeth in particular, is often a challenging task for caregivers. Thanks to Rita Jablonoski, PhD who has 30+ years nursing home experience, we can explain a few things and offer some advice on the topic. If you have encountered someone who is resisting mouth care, even biting during it, this information should be helpful.

First, the best place to do mouth care is at a sink (bathroom is best, but even the kitchen sink will work) because the familiar setting will ease the anxiety being experienced by the person who has dementia. A mirror at eye level, whether the person is standing or sitting, is also helpful as it helps to reinforce self-care memories.

Second, smile a lot! This may sound overly simple, but the mouth care you are trying to give may seem threatening to someone with dementia. If you have a big smile on your face they may be less threatened. Also lower the pitch of your voice because this makes it easier for them to hear you (as we age, it is harder to hear the higher pitches.)

Allow them to do as much as possible. If you are afraid they aren’t doing a good enough job, however, you have a few options. You can guide their hand or pantomime the mouth care to guide them along. Try putting the toothpaste on the brush for them. It may also be helpful to just let them hold a toothbrush while you do the mouth care.

Some things to avoid include trying to reason with someone who has dementia as this will only increase the likelihood of their resistance. Instead, use simple one-step instructions, giving them time to process the request before you repeat it. Resist the urge to talk to them in a baby-talk manner using plural pronouns such as, “It’s time for us to brush our teeth.” This is called “elderspeak” and has been documented by nurse researchers as a guarantee for care resistance. It also raises dignity issues. People with dementia will forget many things, but they will not forget that they are an adult.

Try singing while performing mouth care if you meet with resistance. This will sometimes distract the person with dementia and if they sing along, you will have easier access to their teeth. Giving them something to hold on to such as a stuffed animal may provide comfort and help melt their resistance. Talking about their favorite things also serves to distract and relax someone with dementia. Sometimes getting creative works too. Rita describes an approach that worked for a lady in a wheelchair who clenched her teeth during mouth care. The staff tried sitting her in front of a mirror as they stood behind her, reaching around to do mouth care. This worked like a charm in her case as long as she could see herself in the mirror.

One more thing. Remember to use tepid water as gums recede as we age, making teeth especially sensitive to cold water. And make sure the toothbrush has soft bristles.

An alternative to brushing is flossing, but not with the typical waxed string. This flossing is done best with a small toothpick-like device called a proximal brush or interdentate stick. They can be used like toothpicks to go in between the teeth, and when dipped in mouthwash they are even better. After this type of flossing, tooth brushing may be met with less resistance. Rita recommends having the resident say “EEEEEEEEEEE” during this particular type of mouth care.
Rita admits that there is no sure way to get people with dementia to cooperate with a caregiver’s efforts to brush their teeth, but the advice she offers is to just keep trying. Her decades of experience has proven that eventually resistance will diminish with time.

interview picHow you handle an interview can make the difference between landing a job and continuing your search. Whether you applying for work in a hospital, nursing home, assisted-living facility, doctors office, or home healthcare agency, there are ways to gain an advantage when interviewing for a position in the healthcare field.

Tip #1 Be Ready to Dazzle
Research the company’s website if they have one and make sure of the location of the interview and allot ample time to get there. Know the name and title of the person with whom you will be interviewing. Gather copies of your current certifications, an exquisite copy of your resume and a list of references and letters of recommendation so you will have it available during the interview. Remember to take a copy of the job listing too.

Presentation is everything. Dress in “business casual” attire rather than scrubs. Make sure you are well groomed from head to toe (double check your fingernails) Men should wear clean trousers and a collared shirt. Women may wear slacks or skirt with a business appropriate shirt or sweater. Also a dress would be okay. Leather shoes are appropriate for men and women rather than the nursing shoes or athletic shoes worn on the job. Hair should be neatly groomed as it would be on the job. Body piercings and tattoos should be covered or minimized. Any jewelry worn should not be distracting. Women should avoid long dangle earrings because they can be distracting to the interviewer.

More than likely you will be meeting with a hiring authority. Depending upon the size of the organization, you may speak with other staff members too, perhaps members of the team you may be working with. You may be given a tour of the facility. While taking the tour, notice whether the staff seems friendly, whether the facility seems clean and well-organized, and whether the patients/clients seem satisfied with their care. After all, you are checking out the employer too.

#2 Exhibit Professionalism
It’s mandatory to be on time for an interview. Leave early enough to accommodate any last-minute problem that you might run into. Don’t chew gum at the interview. More listening and less talking is usually a good approach during a first interview. There is no need to fill an uncomfortable silence with words. Let them do the talking, and answer their questions thoughtfully. Remember good eye contact.

#3 Nail the Interview
You will probably be asked open-ended questions about yourself or past work experience. When answering these questions, remember that they are looking for answers that demonstrate your value to their organization. Provide answers that illustrate a good match between you and the company. It’s okay to ask about their expectations, the shifts you’ll work or the duties you will perform. Describe how you can help the organization meet its needs. Be as flexible as possible.

Also be ready to answer the following questions honestly and completely.
1. May we contact your current employer (and your references)?
2. Have you ever been disciplined or fired from a job (and if so, why)?
3. Why did you leave your past position?
4. What do you hope to be doing five years from now?

Keep in mind that if hired, you will be part of a team. Don’t underestimate the importance of the position for which you have applied. Convey the fact that you think every employee contributes to the success or failure of an organization. Specify your experience. Highlight your expertise and experience working with special cases and needs. Were you known at a past job for being able to do something especially well? If you are inexperienced, communicate your interest and motivation. Share a story that shows how you’ve gone above and beyond in the workplace.

You will be given an opportunity to ask questions. If not previously addressed by the interviewer, ask for such information as advancement opportunities and training/probation period. Things to not ask about during your first interview include questions about vacations or time off. Also avoid any questions about the race/gender makeup of staff or patients/clientele.

#4 Make sure you are making the right choice for yourself
Conditions at medical facilities, especially hospitals and nursing homes, can be vastly different from one shift to the next. Even if you are applying for an afternoon or night-shift position, your interview is very likely to take place during the day shift. Before accepting a position, try to visit the facility during the shift you will be working. Checking the internet for reviews may also give you some insight into a potential employer.

#5 Wrapping it all up
Be sure to thank the Interviewer, shaking their hand (no wimpy grips, please). Inquire as to a time it is appropriate to follow up with them if they haven’t mentioned it already. If they don’t specify a time, suggest a specific day and time in near future. Remember, the more people they are interviewing, the longer it may be before they separate the “wheat from the chaff.” Be sure to get their business card so you can follow up with a personal email, or even better, a handwritten note thanking the person who interviewed you. Mention a point from the interview that will set you apart from other candidates. Keep it short and polite.

Good luck in your job seeking!

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

Phyllis McCormack was a nurse who worked in a hospital in Scotland during the 1960s. She knew the importance of empathy in caregiving and so was inspired to write a poem about it for her hospital’s newsletter. The poem she first called “Look Closer” is known today under the title of “Crabbit Old Woman.”

Because Phyllis originally did not claim authorship of the poem for fear of offending her colleagues, urban legend has credited it to an old women who died in a nursing home when a handwritten version was discovered in her belongings. A poignant punctuation to the end of the old woman’s unhappy life in a nursing home. Yes, this story happens again and again in nursing homes everywhere because not all caregivers have empathy for their residents.

Today’s healthcare providers, including nursing homes are under constant pressure to cut costs and comply with a mountain of record keeping regulations while at the same time providing safe, comfortable and competent care to their patients/residents. It is not an easy thing to do, and stress from this dynamic potentially pervades every aspect of caregiving.

This is particularly true in the nursing home setting where the majority of people receiving care are elderly and require 24-hour attention.

In the words of the Crabbit Old Woman, “What do you see, nurse. What do you see? What are you thinking when you look at me?”

It is no surprise that in the high-stress nursing home work environment some caregivers go about their business (busy-ness) as they do their jobs, but never really “see” the people they take care of. Oh, these caregivers will notice things that may either amuse or annoy them while giving care, but what these caregivers really need to do is to try to see their residents as they see themselves. This is empathy.

“Open your eyes, nurse. You’re looking at me,” says the Crabbit Old Woman. The empathetic caregiver “sees” her residents differently and understands the losses a nursing home resident has experienced. At a minimum this person they are taking care of has been forced to release the roles they played in their former, younger, lives. Roles such as soccer mom, wife or husband, office worker, church volunteer, homemaker, all have disappeared. Their children have grown up, no longer needing them and the years have robbed them of their independence. And now that they can’t take care of themselves any longer, they find themselves living in a place where others must take care of them. They were once the parent but are now much like a child.

Many people living in nursing homes must feel like the Crabbit Old Woman, “Grace and vigor depart, there is now a stone where I once had a heart,” according to the poem. The empathetic caregiver will feel the pain of their residents, but won’t take the pain for their own. Instead, the empathetic caregiver will treat their elderly charges with dignity and honor, granting wishes to the extent that they are able, while fostering their resident’s independence. Empathetic caregiving immeasurably improves the nursing home resident’s quality of life.

“Inside this old carcass, a young girl still dwells.” The empathetic caregiver knows that inside every one of their residents dwells the heart of a young person. The empathetic caregiver plays to the strengths of a their residents. The empathetic caregiver is a good listener, is patient and kind. The empathetic caregiver is somehow able to see themselves in every Crabbit Old Woman (or Man) receiving their care, and can translate that into a healthy experience for their residents and a rewarding experience for themselves.

If you would like to read the poem “Crabbit Old Woman” click here.

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

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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