Never Good Enough: Health Care Workers and the False Promise of Job Training

1. The Pull and Perils of Health Care Work

1 The Pull and Perils of Health Care Work When I met Veronica, a fifty-five-year-old nursing assistant and immigrant from Trinidad, she had been attending school in the evenings and on weekends for close to ten years, while working full-time and taking care of her family. First she spent two years attending a preparatory course offered by 1199 (more precisely, the joint labor-management Training and Upgrading Fund, described in chapter 3) for the general equivalency diploma (GED) exam, so she could obtain her U.S. high-school degree, and passed the exam on her third attempt. Then she enrolled in another union program , one that helps participants prepare for the entrance examination established for all four-year CUNY colleges, and passed the exam on the first try. As of 2002, Veronica had completed four college courses, for which her tuition was reimbursed by the union. Veronica first worked as a nursing assistant at a nursing home, but when we spoke was working in a hospital , where she was surprised to find she felt “more like a servant”: Yeah, I figured if you get into the hospital I could become an LPN [licensed practical nurse] or something. I always wanted a job that means—you 22 Never Good Enough know, it’s something, but as a nursing assistant you don’t get no respect— I mean you get treated—it should be an important job, because you take care of people, you listen to their problems, you console them, and yet you get treated as if you’re nobody. Veronica started to say that she always wanted a job that “means” something , like a licensed practical nurse, but she corrected herself, reminded herself (and me) that her job as a nursing assistant does mean something, the problem is that it is not treated as an important job and those who do it are not treated with respect. Nonetheless, she had begun to think of the work of licensed or registered nurses as more meaningful in comparison to her own. Her sense that her work was not valued motivated her to continue with school and strive for something more. Not feeling valued or respected is a common experience among allied health care workers and particularly resented. My observations of health care workers on the job, especially nursing assistants, suggest many frontline caregivers and other allied health care workers are treated as if they are nobody. Sometimes they are openly talked down to and treated with disrespect by coworkers, but equally damaging are the more hidden and pervasive ways their lack of worth is conveyed on the job, such as the organization of the spaces in which they work, the constraints on what they can do and record as part of their jobs, and the choices of their employers about when and how to cut costs (from the availability of toothpaste to staffing levels). Yet the same workers know their work is valuable and, more often than not, take some satisfaction from it, even if they feel undervalued or that their skills and abilities are underused. Winsome, another nursing assistant , spoke of the gifts and thanks she had received from patients and their family members. Steve, a respiratory therapist who thought of the workers and patients at the community hospital where he had worked since the age of eighteen as one big family, could not understand why more people do not go into health care given its rewards. They included the rewards of trying to save a person’s life, but also the more mundane: When you go to a patient’s bedside and you’re taking care of them...and they have a concern or they’re upset about something because someone either said something to them or they had some sort of miscommunication, The Pull and Perils of Health Care Work 23 you speak with them and just by listening—maybe two minutes, three minutes—it’s amazing what results you get from the patient. It’s like, wow, why doesn’t everyone listen? It’s really rewarding. Marie, the patient care technician described in the introduction, likewise took satisfaction from the care she gives, even its least glamorous aspects: You know, to tell you the truth, I take satisfaction that, if somebody’s dirty or whatever the case may be, that I’m the one that’s cleaning them. The simple reason...