For one memorable year, I taught full-time at a school for certified nursing assistants, or CNAs. My students, ranging in age from sixteen to sixty, came through job corps or workforce training, with a few taking the course as required training before launching a healthcare career. Many were family caregivers with hands-on expertise and their own ways of doing things. My students’ unifying quality was the desire to help others in a direct and immediate way.
They were an empathetic group, helping each other to succeed in skills’ lab, encouraging those with tenuous ESL skills, and even expressing concern during my menopausal hot flashes. “Are you alright, Miss?” I often heard. I complimented them on their observation skills, and assured them that my bright-purple face and profuse sweating did not mean I was going to die.
My students had varying educational backgrounds, some with GEDs, some with advanced degrees. College professors and high-school dropouts, police officers and juvenile delinquents, English teachers and recent immigrants from West Africa shared the classroom and the afternoon lab that followed. Teaching is a constantly evolving, responsive process, and I employed a variety of learning styles and techniques. At the end of our short two weeks together, there was a test — and my goal was for every student to pass it with flying colors. After that, they’d learn on the job, just like I did. Not everything can be taught in the classroom.
We broke up our reading, lectures, and critical thinking Q & A by watching short videos. Then, each afternoon after lunch, we retired to the skills lab. It was a simple arrangement of donated hospital beds, mannequins, and assorted healthcare paraphernalia. To these aspiring students, it didn’t look terrifying in the least, and it certainly wasn’t high-tech. I tried to instill a little fun and humor in the routine, and it seemed to work. Standing around in skills lab watching the person in front of you struggle to put a stiff, plastic mannequin on a bedpan properly, students developed friendships and camaraderie. In skills lab, a student might think, hopefully, “I could imagine working with this person.” In healthcare settings, effective teamwork is essential.
I followed our morning reading with a brief question and answer session focused on critical thinking. One thing was clear: too many students in the US school system are not taught critical thinking. This was readily apparent when I put them on the spot, asking for an answer to a straight-forward question after providing a lot of background. I watched patiently as panic filled their eyes, as anxiety shut out rational thought, as their wildly offered answers threw themselves on my mercy, but I didn’t let them off the hook easily. I had two weeks to teach twenty-six students everything they needed to know to pass a state exam — an exam that would allow them to earn a living caring for our most vulnerable. It was intense. But they needed to learn to use their own critical thinking skills, to have confidence in their own judgment, and to take effective action without hesitation, and gradually, they did. Anxiety perpetuates indecision, while critical thinking saves lives.
I often told my students a true story that occurred when I worked in a hospital setting. Soon after the nursing staff had delivered all the lunch trays, a physician came out of a patient’s room, stating in a calm, clinical voice, “Excuse me, but this man appears to be choking.” The CNA on duty ran into the room, jumped on the bed behind the patient, and performed an abdominal thrust that dislodged the blockage, saving the patient’s life. All the while, the doctor continued to do his charting, offering no assistance. I believe the CNA had far superior critical thinking skills in this situation.
Over many months in the classroom, gaining valuable experience, my teaching intuition grew stronger, and my empathy for these students became profound. Professional caregivers are some of the kindest people I know, but I hope they left my classroom also knowing how amazingly capable they are. They may or may not ever earn a college degree — but they will earn the respect of those they work with and care for because they deserve our respect.
Critical thinking skills, caring, and intuition are all essential to being a great caregiver, but they’re not, in any way, necessarily associated with a university education. They can be learned in any language, in any healthcare setting all over the world. And I learned a lot from my caregiver students, too.
My students were from Ghana, Sierre Leone, Honduras, Guatemala, Mexico, Ukraine, and Ethiopia. Also from the Salish-Kootenai reservation near Flathead Lake, and from poor, outlying areas of a large urban metropolis. My students were also from the Bronx, and from Russian Orthodox farming communities in Oregon’s Willamette Valley. In my last month of teaching, I even had a student from Tibet. She knew almost no English but was a quick learner with eyes like a hawk. She had to take the course twice, only because of her limited ESL skills, but she was able to demonstrate every exercise in the skills lab, flawlessly. Ten years down the line, I’m extremely confident that she is a degreed-nurse and probably running a unit somewhere — maybe an ER charge nurse.
Each time a new cohort began the two-week study course, I marveled at the rainbow of colors, ethnicities, and languages. Day one in our skills lab includes learning proper handwashing. The water ran almost continuously for hours, over hands in every shade from alabaster to ebony, but many, many shades of brown. I never grew tired of watching water flowing over gentle human hands.
These same hands are caring for our most vulnerable patients, now, in every hospital and long-term care facility in the country. Tens of thousands of CNAs are putting their own lives at risk, spending time away from their families, missing weekends and holidays, working long, exhausting shifts, earning far less than they’re worth.
I was briefly a CNA-2 clinical preceptor for a Long-term Acute Care Hospital (LTAC) that cared for patients with quadriplegia, chronic wounds, and other conditions necessitating heavy-duty, hands-on care. Ten years ago, the nursing assistants in this well-run facility earned $21/hour. It is my firm belief that no one who provides direct hands-on care in any clinical setting should earn less — and yet they do.
According to Ziprecruiter.com, the current average hourly wage for a CNA in the US is $14.05/hour. Some earn less than $9.00/hour. This is unconscionable. CNAs are trained, experienced professionals who work harder than anyone I’ve ever worked with in any setting in my forty-year career. Let’s pay them what they’re worth, provide them with good health insurance, and in light of the battle they’re currently fighting, hazard pay.