A note from the editors: This piece was submitted anonymously and without a correspondence email, which did not allow for communication with the author in the edits process. As editors, we wished we could have encouraged the author to explore more of their personal narrative rather than generalizing to a full group. In the words of one of our reviewers, “this piece uses very broad strokes that this author uses to set up an antagonistic ‘us versus them’ mentality that does not account for differences in race, gender identity, sexual orientation or ability.” We were able to empathize with the writer’s frustrations, but want to emphasize that this piece represents the opinions and experiences of the author. It does not represent the opinions of all CNAs, techs, home aids, medical assistants, and others the piece mentions. However, we also recognize that the perspectives of those holding these professions are not often sufficiently celebrated and elevated in medicine; thus, we made the decision to publish this piece with comment.

Us CNAs, techs, home aides, medical assistants and other feminized professionals on the lower rungs of the healthcare hierarchy know that caregiving is not for the faint of heart. The hours are grueling, the pay is meager, the stakes are high, and the expectations are through the roof. It is tough to give our patients the care they deserve during times of short-staffing or inadequate leadership, or when things become physically or emotionally demanding, and it is tough to give ourselves the care that we deserve when work becomes all consuming. Survivorship in this career requires a great deal of advice and restructuring the ways we, our patients, and our bosses think of the work we do. We are the foundation of the healthcare system, the main people that patients see day to day – and we have some bones to pick.

Dear providers (doctors, nurse-practitioners, and physician assistants),

You need to remember that we need to take care of our own health, too. Not only because we make better caregivers when we are at our best, but more importantly because our physical and mental health matters. We will not be made to feel bad for using the restroom, drinking water, or taking a full lunch. We will not allow you or our patients to make us feel guilty for recovering when we are ill provided that we called off in time and found a replacement. We will not take on challenges that we are unable to handle, such as lifting and turning a patient that is too heavy for us, or entering the closed room of a patient who is known to be physically or sexually violent: in these cases, we will ask for help, and we will not be made to feel badly for asking for help. Too many good caregivers have been punched, groped, kicked, flashed, and slapped by patients on your watch without any consequences. By asking for help we are not “making people go out of their way”, but ensuring our safety and that our patients' needs are being met.

We will strive to give patients the most autonomy and dignity possible, even when you are pushing us to take shortcuts because it is easier for you. We will not join you in talking down to patients, ever, or making people feel badly for their bodily functions that may “inconvenience” us: sick people, disabled people, elderly people, children, incarcerated individuals, impoverished individuals, and anyone else who is more marginalized than us all deserve respectful and clear communication. We will help one patient walk to use the toilet and clean themself up if they are able to, even if you tell us to put them in a diaper to save time because the person in the next room needs a ginger ale. We will close the doors and window shades when patients are exposed and remind our colleagues and even the doctors, who are the ones who forget the most often, to do the same. We will take the time to do the job right and give top notch care, even when you are telling us to go go go. We will not become complicit in pushing our colleagues and trainees to rush through care, because that’s when fatal mistakes are made.

You may not talk down to us, and those of us with the privilege of not being afraid to lose our jobs will call you out on behalf of those who can’t. We may not have doctoral degrees, but many of us know things that you don’t thanks to lived and professional experiences. We are in these positions rather than yours not due to a lack of intelligence, but because of a lack of money, citizenship, luck, life experience, etc. I know of CNAs who were doctors and nurses in their previous country. Some of the best colleagues I have worked with had maybe a high school diploma but knew everything there was to know about human behavior, anatomy, and physics thanks to their twenty plus years of working in a hospital setting. You are not above us, and no aspect of healthcare is beneath you. If you have a spare moment (and you have far more of these than we do), please help us in wiping ass, wiping tears, changing sheets, lifting and turning, delivering water. We know that your many years of school have covered these skills.                                          

Dear patients,                                                          

We promise we are doing our very best for you, even when it doesn’t feel like it. We are dealing with forces beyond our control. We must do everything that our bosses tell us to do, even when we don’t believe it’s right, for fear of getting fired or legal action. There is so much we wish we could do for you that we simply are not allowed to do. Additionally, hospitals and nursing facilities are packed to the brim and understaffed, especially in the wake of covid, creating dangerous patient to provider ratios that make it difficult for us to do more than the bare minimum required for safety. It is difficult to find time to get you chocolate ice cream instead of vanilla or to change the channel on the TV or to braid your hair or to sort your paperwork when the patient in the next room has keeled over. Being sick and vulnerable is extra scary and uncomfortable, and we know that these little things help bring you comfort and routine during an extremely difficult and unpredictable time, but we need you to know that we are overwhelmed and may have trouble delivering these things in a timely manner. We are not waiters, baristas, hair stylists, secretaries or maids: while these professionals all deserve the utmost respect, we are highly trained healthcare professionals, and our healthcare duties come first.                                                           

Despite our genuine desire to give you the best possible care, we will not tolerate disrespectful, bigoted, dangerous, or sexually aggressive behavior on your end, even if it may seem that way to you because the bulk of us are women and/or otherwise marginalized individuals. We may laugh along at racist jokes or flirtation, but do not confuse our discomfort and preservation of our own safety with consent or agreement. We will be reporting you and taking measures to preserve our boundaries.              

We want you and your loved ones who may be visiting you to remember that we are also people. Many of us have been patients, too, or have had a friend, partner, or family member in your position. We do not want to hurt you when we are delivering healthcare interventions that might be painful or uncomfortable, like drawing blood or giving a vaccine, even if it may seem that way. If we aren’t as smiley or cheery or chatty as you would like us to be, remember that we might be having an off day: our boss might have yelled at us, we might be going through a breakup or divorce, we might be exhausted from school or another job, we might be grieving, we might be physically uncomfortable from a healthcare condition ourselves, we might have had a scary or emotional experience with another patient right before we entered our room.        

To my fellow CNAs, techs, home aides, medical assistants,                                      

We are doing the best that we can, and we should be proud of ourselves. We will lift each other up when we have the capacity to and communicate to each other when we can’t. We will believe each other when we say a patient or colleague or provider has hurt us in some way and offer help in the ways that we can. We will do the best for our patients but not at the overwhelming expense of ourselves. We will combat our own personal biases when interacting with each other and patients and hold ourselves and each other accountable when we are wrong. We will respect our patients and colleagues but we will not tolerate harm.                                                              

We will let those in our personal lives know when work has been too hard for us, when we need a break from caregiving, when we may need to be cared for. We will take care of ourselves with the same dedication and kindness and respect that we reserve for our patients, and remember that what’s best for us might not be the easiest or most comfortable. We will set firm boundaries with others but be gentle and kind to ourselves. We will fight for better working conditions, wages, and benefits when we have the space and ability to. We will seek better employment opportunities and potentially legal action when our requests for respect, safety, our own health, and a livable wage are not honored. We will know our own worth and feel confident in our own skills and knowledge but understand that there is much that we can learn from each other.