The Nurse Aide

I think I may safely say that the nurse aide is a linchpin in effective patient care, a linchpin that is often overlooked, underestimated, and improperly trained. I say this not because I am currently employed as an aide, but because of what I have witnessed in my work and nursing training. The properly trained nurse aide who performs his or her duties conscientiously has the closest, most intimate contact with the patient and is consequently first aware of changes in patient condition and privy to patient confidences, fears, concerns, and noncompliance.

The work of an aide may be basic, but it is foundational to any sort of medical treatment or care. The patient who receives his medications but is not bathed, turned, talked to, changed, listened to, or fed, will die. A person may have the best surgeon in the world, and the best (if overextended) nurse, but if he consistently is cared for by a lazy or incompetent aide, his body’s recovery will be poor at best, and his human soul ignored and humiliated. The measurements that an aide takes – intake and output, weight, vital signs – may be simple and routine, but accuracy is paramount. Recognition, diagnosis, treatment, and safety depend on these measurements. Doctors dose medications (and no medication is safe) based on weight, blood pressure, intake and output. Vital signs are not called “vital” for no reason. Significant changes indicate life or death crises which accurate early recognition can correct. When aides (or nurses) are sloppy, estimate, or fabricate values, they are dealing with more than merely recording a number so their shift’s work appears complete: they are jeopardizing the lives of the patients entrusted to their care and crippling the ability of the physicians to effectively treat their patients. They are working against the goals of their employing hospital.

That said, many well meaning aides do not understand the critical nature of the tasks they perform. What’s a little urine dumped down the toilet that didn’t get recorded in the strict I&O? So Mr. Smith didn’t get a bath today – he looks pretty clean. Mrs. Mega was sleeping – surely I shouldn’t have to turn her every two hours and wake her up. Mr. Chuck had a wet brief for half the morning, but he pees nearly every half hour and after all isn’t that what a diaper is for?
I cringe when I encounter scenarios like this. It’s not that the aides intend harm. It’s just that they don’t understand the rationale behind the tasks required of them. They don’t understand the ramifications of their actions for the patients’ health, and frankly, many of them don’t put themselves in their patients’ shoes. They feel sorry for their patients and are just awfully glad they aren’t where their patients are physically and mentally. Or the aides are focused on doing only what is required for their job. They do what they have to do. But patients aren’t checklists or job descriptions. Patients have unique needs that require a genuine commitment of caring in order to be discovered and met.

This brings me to the intended topic of this post: what qualities make a good aide good?

• Conscientiousness
The nurse aide must be deliberate and conscientious about the core tasks he or she performs. He needs to know which corners cannot safely be cut and commit to not cutting them. She needs to be willing to redo a poorly done task if other staff is unwilling to complete it properly.

• Empathy, Compassion, Dignity, Humanness
The nurse aide must care. She must “give a rip” about how the patient is feeling today, about the patient’s new stuffed toy, the car that he imagined he drove during the night, the kids that the demented patient is convinced she must pick up from school, the pillow that makes the patient feel uncomfortable, the particular way the patient wants his stuff arranged on the table, the fact that the patient in room 42 is offended that he didn’t get cream of rice for breakfast while the patient in room 43 insists that cream of rice is only for babies and she wants real food.
The aide must show interest in her patient’s lives, in their comfort and distresses. More than interest, she must be ready to intervene in whatever way she is occupationally able to diminish the distress associated with a hospital stay and promote fuller function while preventing further deterioration and distress.
The aide must treat his clients with dignity, even when they don’t look or act very dignified. Each of your patients is a human being with a human soul like yours, no matter how hemmed in it is by malfunctioning flesh. They can hear you and see you and feel you even if they cannot tell you. Your hands are touching the bodies they can no longer care for. Your actions and reactions can make them either feel helpless and worthless or preserve their dignity and sense of inherent worth. The aide must think about what he would wish were he in the hospital bed.

• Understanding
The good aide knows why he does what he does. She may not understand fully the physiology behind her work, but she is aware of the significance of her work and how she fits into the healthcare team. He also recognizes when he needs help. He doesn’t try to fix his client alone, but secures the appropriate help. He recognizes when what he sees in his client’s condition or vital signs requires prompt medical or nursing intervention and reports his observations immediately and appropriately.

• Priority
The good aide prioritizes care to meet patient needs. If you are an aide, chances are you have more work than you could ever accomplish during your shift. Even if you didn’t have to get specific tasks done, patient wants and requests alone would keep you busy all day. The good aide is able to organize herself so that she addresses the most pressing needs first, can accomplish the maximum amount of tasks with the minimum of trips and time, and still finds a way to satisfy as many patient requests as possible.

• Advocacy
The good aide is a patient advocate. He works the system for his patients because he knows how and they don’t. If he identifies a need, he finds a solution by contacting the appropriate personnel and watching to see that follow up is actually done. Example: it’s 1pm and your patient hasn’t had lunch yet because no tray came for him. Now you could let him be hungry, or you could call down to the kitchen and get one sent up. C’mon, it doesn’t take that long. Maybe your patient is groaning and tells you that his pain is at an 8 on a 0-10 scale and that the nurse hasn’t been in with his medicine yet. You could shrug and walk off, or you could go find the nurse, ask how soon she can bring the medicine and tell her how you found the patient. If necessary, you can keep reminding her of the patient’s need until she goes in and addresses it. Hopefully, you won’t have to, but you need to be willing to put up some polite fight for your patients if the situation calls for it.

There are plenty of other qualities that round out the good aide, but these come immediately to mind. To all aides: please cultivate these qualities in yourself. And know that you are vital to the life and health of your residents or patients. The effectiveness of the whole medical team is influenced by your care and the measurements you take. Take your work seriously – how you go about your tasks changes lives.