Being a CNA - Experiences in a Skilled Nursing Facility vs. Hospital

This post will be formatted where we (Mark and Tert) give general information about CNAs, followed by individualized answers. This is because, although both CNAs, we had large differences in work environment, hours, and workflow. To preface this post below is some information on our jobs.

Due to some glitches, for now the blog post will be accessible through a google document. Click the link below to access the whole post!

Tert

Job position name: CNA (Certified Nursing Assistant)

Location: The Shores Post Acute Care Nursing Facility

Shift time: Graveyard, 8 hours (11:00 PM - 7:30 AM)

       Occasional:12 hours (7:00 PM - 7:30 AM)

                          16 hours (3:00 PM - 7:30 AM)

Full time/part time: Part time (2 days a week)

Unit/Department/Specialization: Dementia/Psychiatric Unit 

Pay: $17 to $20

Previous experience? No

Application requirements: CNA certification, BLS Certification, Interview Process

Hire bonuses? No

Scrubs/attire provided? No

Mark

Job position name: PCA (patient care assistant)

Location: Scripps Memorial Hospital

Shift time: Day shift, 12 hours (6:30am - 7:00pm)

Full time/part time: Full time (3 days a week)

Unit/Department/Specialization: Medical/Surgical/Oncology

Pay: $20 starting 

Previous experience? No

Application requirements: At time of applying they did not require an active CNA certification, only that you had previously completed a CNA program successfully. I believe previous experience was needed if you hadn’t completed a CNA program. BLS and an interview was required.

Hire bonuses? No

Scrubs/Attire provided? No

Sections/Table of Contents

General Info:

• What is a CNA?

• Difference in duties from CNA to CNA

• How do you become a Certified Nursing Assistant?

What is a CNA?

A Certified Nursing Assistant (CNA) is a member of a patient’s healthcare team that works primarily with nurses to make sure that patients have their hygienic, nutritional, and comfort needs met. The patient population cared for by CNAs often include individuals who have lost independence due to decline in their physical and/or mental state. As a result, these patients need assistance with daily living activities such as feeding, bathing, and toileting - and importantly, in a safe manner. Carrying out safe patient movement is a paramount responsibility of CNAs, as patients can be unstable with movement, connected to all sorts of things like oxygen, IVs, and wound vacs, and may even be confused to the point where they forget their location and mobility limitations. Falls are a big risk for much of the patient population CNAs work with. Patients’ beds will typically have bed alarms that will go off if the patient attempts to get out of bed, and it is always emphasized that the beds need to be at its lowest height, with the nurse call light button in reach of the patient when staff leave the room. Patient mobility, mental state, and environment always need to be taken into consideration when assessing how to carry out tasks.

CNAs obtain a great amount of bedside interaction - so much so that a part of your responsibility also includes monitoring for changes in a patient, whether it is behavioral or bodily. CNAs are often the members of a healthcare team that spends the most time with a patient, providing the healthcare team with valuable perspective in determining how to best care for the patient. 

Difference in Duties

Job duties can be a bit different from one CNA to another depending on:

1. Your shift (day, afternoon, or graveyard)

2. Specialization of the department you work in

3. Location of your workplace (CNAs typically work in either a hospital or SNF (skilled nursing facility)

1. Shift Times -Days/Afternoon vs. Nights:

CNAs for the day and afternoon shift assist more with feeding, and showering/bathing compared to CNAs who work graveyard. Night shift CNAs get assigned more patients to average out work demand since most patients are sleeping at night.

2. Specialization of department

The role and responsibilities of a CNA may differ depending on the department, or specialization of the SNF. For example the work of a CNA will look different in the ICU compared to the ED. We unfortunately can’t speak much to this since we’ve both only worked in one setting, but we can definitely give you a rundown of our experiences which will hopefully give you an idea of the differences in roles/responsibilities a CNA can have. The next section may help with this.

SNF vs. Hospital: 

Skilled Nursing Facility: 

In a SNF, you are expected to take vital signs and assist in daily living for every patient that you are assigned to. Additionally, you provide support for nurses during wound care ensuring the site is clean. In the dementia/psychiatric unit, patients may have psychotic outbreaks resulting in very hostile movements which a team of CNAs would have to work together to help comfort them. Just like in a hospital, the work varies depending on which unit you are assigned to. Examples include but are not limited to memory care, rehabilitation units, and etc.

The healthcare team that you majorly work with involves the nursing team, ranging from CNAs to Licensed Vocational Nurses to Registered Nurses. Occasionally, medical providers, physical therapists, occupational therapists, dieticians, emergency medical technicians, and restorative nursing assistants will be seen working in skilled nursing facilities during the day shift.

Hospital:

Much of the responsibilities are similar - you assist patients with activities of daily living while also assisting nurses with various tasks. One difference is that in a hospital setting (at least in my experience) nurse assistants are able to perform bladder scans and 12-lead EKGs. The healthcare setting in a hospital is also more acute compared to a SNF, where patients often require specialized equipment and a higher level of medical intervention. Patients typically don’t stay as long in a hospital compared to a SNF, so you’ll likely be caring for different patients each shift. The patient population is also very diverse in the unit I work on, with patients coming in for a myriad of different backgrounds with different medical conditions. From drug overdoses and withdrawal, broken bones, agitation/confusion, cancer, GI bleeds, the homeless, the terminally ill - the list can go on. This is also why the unit I work on is also a teaching unit. This department hosts a new-grad program, where new-grad RNs are taught from clinical coaches. You will also run into a variety of PTs/OTs, speech therapists, and MDs/PAs/NPs. However, most of your time will be spent alongside RNs. There is also a small chance you can be floated to a different unit. Where I work, CNAs also can be assigned different roles including:

1. CTA (care team assistant): similar to a secretary role. They primarily front the nurses station, assisting with paperwork, answering phone calls, directing guests, and answering call lights from patients. They also assist in patient care when help is needed from other staff. Night shift CTAs are often assigned patients, while day shift CTAs are not specifically assigned to patients

2. CO (constant observer): Constant observation for someone who is at risk for harming themselves. Staff must be within reach and have vision of the patient at all times. The CO is not allowed to chart, use their phone, and must remain awake. The room must be modified so that non-essential items that can be used for self harm are removed.

3. SP (safety partner): Assigned to a patient, sometimes 2, who require a higher level of monitoring due to them being at risk for harming themselves or others. This could be due to multiple attempts of unsafe ambulation, cognitive impairment, agitation, confusion, or behavioral issues. Unlike the CO role, a SP has the ability to chart. 

4. Resource: Not assigned to specific patients, but rather “floats” within the department offering help to any medical staff in need.

How to Become a CNA

The process of becoming a CNA is not complicated compared to other PCE jobs. There are different ways to become a CNA, and one of which is to attend schooling through various schools located around you. Some schools provide accelerated education as fast as 22 days, and some may take months. The benefits between these schools are often the cost of accelerated programs, *International Health Group (IHG) for example, while public schools, like Southwestern College, are very affordable. Some schools also offer weekend and/or night classes for those who may wish to pursue CNA schooling part time.

Another way you can become a CNA is through a partnership of a hospital or a SNF in which they will train you for free to become a CNA in exchange with a contract of working with them for a period of time. These contracts are usually about a year. Furthermore, you can also look at certain workplaces that accept applicants who are nursing assistants (NA) rather than CNAs. Both of these ways to gain PCE as a CNA or NA are beneficial for those who may not be able to afford the cost of schooling.

FAQ

1. What is the difference between a Patient Care Technician and Certified Nursing Assistant?

   1. Mark: there are numerous positions that are essentially similar/equivalent to a nurse assistant. I’ve seen “certified nurse assistant” (CNA), “patient care assistant”(PCA), “nurse assistant” (NA), and patient care technician (PCT). Duty-wise, they are all similar. The difference between them would probably be certification requirements. For example, where I work, we have both CNAs and PCAs, and both have exactly the same duties and scope of practice, but CNAs have an active CNA license. PCAs don’t require an active license, and (I think, and this might not be true) were created to address staffing shortages during the pandemic.

2. What is the most difficult challenge you face as a CNA?

   1. Tert: Besides caring for bedridden or demented patients, I think the most difficult challenge that I personally face as a CNA is the physical stress it has on your body where you use your own strength to basically assist patients who vary in body weight while trying to maintain precise posture to prevent any injuries. Assistance from other coworkers is sometimes dependent on the workload and number of patients we have to care for throughout the shift, which means that some days are harder than others.

   2. Mark: The work is definitely physically demanding as Tert said. I average walking 5-6 miles every shift, and am standing/moving for the majority of the time. Downtime is rare. The work can also be mentally taxing from witnessing circumstances of the very-ill. To answer the main question, I feel like the most difficult part of being a PCA for me is balance. The workflow is very dynamic. You don’t go from one room to another in order - you have to look at the needs of all your patients and decide what order will be most efficient and will allow you to carry out your tasks on time. For example, some patients need to be fed, get repositioned every 2 hours, have vitals taken at specific times, etc. This needs to be managed alongside numerous things that can disrupt your workflow including, nurses and patients calling for help at different times, getting new admits /discharging a patient, and other medical staff like PTs and OTs asking for help. It can be a lot sometimes, and it’s important to know when to ask for help, say no, and to communicate effectively with your co-workers to carry out your tasks efficiently and on time.

3. What are the pros/cons of your role?

   1. Tert: One of the many benefits of working as a CNA is the fact that you spend your entire shift with the patients that you are assigned to. In doing so, you are able to maximize hands-on patient interactions and populations that you have to deal with which helps narrow down certain specialties such as surgical, cardiovascular, neurology, and geriatrics. However, I would say this is highly dependent on the setting of your workplace. Being a CNA puts you in a position as the person the patients rely heavily on as you are one of the few who notices signs and symptoms when you start caring for them. This can either be a beneficial learning experience, but can simultaneously be a traumatic experience like seizures.

   2. Mark:

      1. Pros:

         1. A lot of patient interaction

         2. My department allows me to see a wide variety of patients / illnesses 

         3. Not role-specific, but the staff on my unit are very supportive, and I recommend everyone get insight on the staff environment/dynamic of a workplace before working there

         4. Three, 12-hour shifts a week allow for four days off 

      2. Cons:

         1. Physically demanding with little downtime

         2. Not a lot of opportunity to interact with MDs/PAs/NPs

         3. Having to clean urine/feces

         4. 12-hour shifts are tiring

4. What program did you guys attend and what was your experience with them?

   1. Tert: I attended San Diego Medical College and did the 22 day CNA class with them for about $2000 worth of tuition. My experience with them was great as they had a physician teach us the basics of being a certified nursing assistant. There were tests around twice a week to ensure that we learned everything and were very lenient with grading. We were also able to practice our skills whenever we had free time. As for our clinicals, we followed CNAs around in two different nursing facilities (feel free to contact me for specific names of them) and applied our knowledge from class to clinical. These facilities were also hiring which was an option provided for us to work after certification.

   2. Mark: I attended Pacific Health Education Center and did the 22 day CNA class. I don’t remember the exact tuition but I believe it was around what Tert had mentioned. My experience with them was good - the curriculum was very manageable, and the faculty was kind. Clinicals are where I felt like I learned the most, and it was definitely a bonding experience with my classmates.

5. What are the most beneficial skills that you have learned that you can likely apply in the future?

   1. Tert: Taking vital signs and patient interactions were incredibly helpful when transitioning to my current medical assistant job. Since working at the nursing facility for about 2 years, I have experienced different levels of patient interactions (some combative/hostile, confused, or very nice) and was able to apply it to my current job, which I believe would prepare me for PA school.

   2. Mark: Like Tert mentioned, I think CNAs get exposure to a patient population that is unique, in that you come across many patients whose mental state is altered. I think this helps prepare you for future patient interactions who are in a similar state. As a CNA you also get perspective on assisting with activities of daily living (feeding and toileting for example), so you get to see different illnesses and disorders affect patients on a more personal level. 

6. What is your most memorable experience as a CNA, whether with a patient or with coworkers?

   1. Tert: I think the most memorable experience as a CNA is having a team of amazing coworkers that is willing to help you whenever you need assistance. This experience, luckily, occurred on most of my shift and has helped me determine the worth of staying at a job with a great atmosphere. 

   2. Mark:  There was this one time when I was assigned to a patient for 2 consecutive days and got to know the family who were staying at the hospital helping take care of her. I was complimented on my kindness and level of detail in my care, and felt very appreciated and connected with the family and patient. On the second day though, the patient went into respiratory distress and a rapid response team was called in. The family was in turmoil, crying, as they watched their mother fight to get to a stable level. It was difficult to watch because the patient had dementia and didn’t really know what was going on and was fighting against care. Some of the family leaned onto me for support, and I felt a mix of emotions as I felt like I was part of the family. At this time, more family were coming in, and I was being introduced, being appreciated for my support and care I had given to the patient. I felt a wild mix of emotions, from sadness, connection and appreciation from the family, inspiration from watching the rapid response team, and like a “melancholy awe” from being reminded of the fragility of life. The story ends on a good note though - the patient eventually stabilized and was transferred to a different floor for a higher level of care. When I think back to this story it reminds me of the impact that healthcare has on both the workers and patients. Shouldering the responsibility of caring for others in some of their darkest moments can definitely be daunting and taxing, but can also be rewarding and an opportunity for growth. 

7. Was there a major learning curve?

   1. Tert: Personally, I don’t think there was a major learning curve with the responsibilities that were given to me. Everything from my clinicals were applied directly to the nursing facility with the exceptions of learning the environment of how the facility ran. Furthermore, since the responsibilities varied shift by shift, the graveyard shift was solely responsible for more patients compared to the day or afternoon shift.

   2. Mark: I felt like there was a pretty big learning curve for me. I think this is due to multiple factors, with the biggest one being that I hadn’t worked as a CNA elsewhere beforehand, and the last time I did my clinicals was around 2 years ago from the time I had started. The staff was extremely supportive however, and this emphasized the importance of having a solid support system in a new environment.

8. Do your current locations limit the number of hours you can work or can you pick up more shifts?

   1. Tert: My CNA job was at the Shores Post-Acure which did not really have a limit of working hours. You are able to do 8, 12, or 16 hour shifts as long as you let them know ahead of time. You are also able to pick up more shifts if needed.

   2. Mark: I pretty much never pick up shifts (the full days off are sooo nice haha), so I actually don’t really know the policy around this. I have however heard of people picking up shifts without much problem.

9. Have you worked in different departments in the past? If so, how do they compare with your current departments?

   1. Tert: In my experience, I have only worked in the dementia/psychiatric unit or the general senior living unit.The responsibilities are the same with taking care of each patient and what needs to be done, however, the ‘approaches’ to complete such tasks were unique for each patient as some has preferences, crushed food for example. 

   2. Mark: I haven’t worked in any other departments in the past. 

10. Do you feel like being a CNA will prepare you for what it’s like to be a PA?

    1. Tert: I believe that being a CNA can definitely prepare you for what you can expect to experience in patient interactions, however, I do not think it is beneficial when trying to further advance your knowledge in medicine. I do not regret being a CNA due to knowing what it was like working at the bottom ladder of a healthcare team and still making life changing services. Being the first person to see the signs and symptoms of the patient is extremely important, whether it could be bruising from fall or signs of abuse from another worker, it allows you to become a lot more observant unconsciously.

    2. Mark: I feel like this is difficult to answer as a pre-PA, since I have limited perspective on what it’s like to actually be a PA. However, I do feel like being a CNA gives you valuable perspective into the nursing side of things, as well as seeing how different illnesses affect patients on a more personal level. I imagine as a PA, this experience will help me to better understand patient needs and provide compassionate care tailored to their individual circumstances.

11. How can you find shadowing opportunities as a CNA? / Do you work with any PAs?

    1. Tert:: Unfortunately, working in a skilled nursing facility, you rarely work with PAs, rather you work more with nurses and doctors themselves. On the bright side, I have heard of a few PAs who work in a nursing home which could potentially turn into an interaction between you and them. 

    2. Mark: The lack of interaction with PAs is probably one of the biggest downsides of going the CNA route, but finding shadowing opportunities isn’t impossible! The first PA I shadowed I found by going through my job’s staff directory, filtering by job position, and emailing them. Shadowing opportunities become more plentiful the more connections you build in the pre-PA community, which is why it’s so important to put yourself out there and be involved in the pre-PA community.

12. Should I become a CNA or MA and which one do you think looks better on the CASPA app?

    1. Tert: I believe there are pros and cons to both patient care experiences. I was able to learn maximum patient interaction as a CNA and I believe it helped me carve the pathway to how I would become as a PA and how I would be helping patients. On the other hand, my MA job has led me to learn so much medical terminology that is specific to the department I work in. I was trained to remove sutures, assist in surgeries & wound care, and gain knowledge about the medications that doctors prescribe to dermatological patients. I personally believe that either of these experiences have their own benefit for yourself and in regards to CASPA, I think that neither of them would look better than the other, rather how you discuss it in your personal statement and your interviews. 

Mark: The decision process for choosing between the 2 should be individualized. There are pros and cons as Tert said, and balancing your options for maximizing your personal goals, is what I think is important. For example, I decided to go the CNA route because I wanted to strengthen my speaking skills with patient interaction. I knew I wasn’t going to be working with PAs or MDs, but I knew I was going to have more opportunities to converse with patients as a CNA. I also valued the opportunity to work in a hospital setting, as I believed that exposure to a more acute environment would be beneficial. As for which looks better on CASPA, I agree with Tert in that I don’t think one would be looked at as better than the other. It’s what you are able to draw out of your experiences in the context of pursuing the PA profession, and being ready to discuss it, that I think is important.