Maybe that mutual respect would also keep CNAs from watching the parking lot to see what the administrator is driving.
Exactly. You just hit the nail on the head. We have always been about breaking down the us versus them mentality. One of the things that made [co-founder] Lisa Cantrell and I the right people to start this organization is that we were both line staff before we became management. I checked out from my $4.25 job as a nurse aide on a Friday, and started as an administrator on Monday morning. And in the first few months in my new position, I remember thinking over and over, “If I had only known this as a nurse aide.” It made me realize that we often have CNAs, our largest employee group, working out of ignorance and in the dark.
What was your most eye-opening moment as a new administrator?
The budget—how limited the resources were to do the things we all cared so much about. There was just such a thin margin. When I was a CNA, every time I'd go in and say, “Hey, we need a new shower chair,” I'd hear, “Sorry, it isn't in the budget,” and I'd leave that office thinking all they cared about was money, money, money, not quality. Well, why continue to perpetuate that misconception when all you have to do is sit down and help people understand the budget?
What other misconceptions do CNAs have?
One of the biggest laughs I get in a speech is by telling how, when I wanted to become an administrator, I made a list of things I'd do when I got in charge. I was going to help answer call lights and make beds. I was going to help feed in the dining room, and not just when the state's there. It always gets a roar of a laugh, because CNAs are still working under the impression that everybody comes out when the state's there just to try to pull the wool over their eyes.
Sounds like you came into the job like a certain Democratic candidate from Illinois, on a change crusade.
Absolutely. I had high ideals. I really did. I carried a little steno pad in my lab coat pocket, making my list. I wish I had kept the dang thing. I wasn't going to hire any riffraff, just neat, clean professional people. I was going to have the best facility and survey. I thought seven years as a nursing assistant had taught me everything I needed to know about being an administrator. What I found out was I had a license to be one, and no idea how.
Did you also vow to pay your caregivers better? Was that on your list?
That's another misnomer that is so paralyzing to our profession. Nurse aides still today, in 2008, think they're paid what they're paid because they're not valued. They have no idea about reimbursement. So once I got in the administrator chair, I never again jumped to the conclusion that the owner was at fault.
Maybe Wal-Mart could pay their people better, but our profession will never have that choice to make. The government will make sure of that. When we still have states that pay more to house a prisoner than they do to take care of an old person, we've got problems with funding. My brother owns some motels. He gets 79 bucks a night, and he doesn't have to toilet or turn anybody. They check in at 3 p.m., they're out by 11 a.m., and he doesn't even have to give them a continental breakfast if he doesn't want to.
For about 30 bucks more, look what we are required to do for a resident? It's sickening. And if the government doesn't want to raise reimbursement because they think the owner might get it, why not a direct wage pass-through right to the caregiver?
Speaking of transforming the culture, I've been to one of your conferences. Hundreds of CNAs were screaming and waving pom-poms and standing on chairs and dancing around the room. I was genuinely frightened.
(Laugh) But wasn't it nice to know that we have some very spirited caregivers who are that proud of their profession?
I was worried you were going to get written up for safety violations.
Yeah, well, one year we had a gal fall off the stage backward.
Isn't all that positive spirit a little misguided? Don't they realize they work in long-term care and should feel badly about themselves?
(Laugh) Well, we've had a long run of that, there's no doubt, but the residents can only benefit from having an enthusiastic workforce. Nursing assistants are where families get so much of their information—that's who they know the best, that's who they ask how mom's been eating or dad's been sleeping. But we don't train them to know how to be experts, or to believe that they are. Many of the things that go wrong in our profession happen because they don't know their own value.
When it comes to workforce, we don't have a recruitment problem. We have a retention problem. And that's because we have to change the existing workforce culture to one of mutual respect and understanding before we can ever maximize the gift of new people.
How's your crusade to get CNAs to stop calling themselves “butt wipers” going?
It's really not very hard for them to abandon that once I make an analogy. “If you see yourself as a butt wiper,” I tell them, “you're reducing your residents to butts. And I know you care more for them than that.”
In terms of the future, are you worried about caregiving robots stealing all the jobs?
(She laughed, but ignored my question.) We have a lot to offer in this profession. Where else could a 17-year-old high school dropout like me have the opportunities I've had?