The Discourse of CNA

The values and beliefs behind performing CNA work.

CNA’s or Certified Nursing Assistants are trained to be professionals who care for patients. They are required to have a set of skills, or values, that do not come naturally. Most people wouldn’t be excited to wake up at four in the morning to come in and work a twelve hour shift taking care of people. You have to have compassion, self-worth (beyond the normal amount), and an indescribable amount of integrity. CNA work is often referred to as grunt work, or being at the “bottom of the food chain” because there is a lot of manual labor and taxing on your body that you don’t always get credit for. Most people assume that the only role CNA’s play is to wipe people and give them baths, but there is a whole part about helping patients cope in a healthcare facility that is overlooked. CNA work connects with James Gee’s, theory of non-dominant Secondary Discourse, which by Gee’s definition is a Discourse that

“bring solidarity with a particular social network, but not wider status and social goods in the society at large” (Gee 8)

which means CNA work doesn’t bring prestige of any sort, but it does bring respect and a holistic approach within a social network. Gee, who is the author of Literacy, Discourse, and Linguistics: Introduction along with Darcy Fiano, the author of Primary Discourse and Expressive Oral Language in a Kindergarten Student introduce a set of “building tasks” (Fiano 67) or different areas that you apply information to, in hopes of making the Discourse more user friendly. These tasks are

Significance, Practices, Identities, Relationships, Politics, Connections, and Sign Systems and Knowledge.

To analyze a Discourse you must take resources and information and work through each of these blocks to fully analyze it. Both Gee and Fiano state that you do not have to use every single block, especially if it doesn’t connect enough to make the understanding of the Discourse easier.

By using those building tasks, you can raise points as to how a Discourse works, and by applying that to the Discourse of CNA you can come to understand the struggles and rewards of the field. There is no real social goods or prestige and status involved in the field at such an early stage. The determination of CNA’s to excel in every aspect, and provide the best care for a patient is underrated and overlooked by many, but to a CNA even the littlest of accomplishments is a reward.Using the building task politics devised by Gee and Fiano, described as

“situated meanings, social languages, figured worlds, intertextuality, Discourses,and Conversations being used to create, distribute, or withhold social goods or to construe particular distributions of social goods as ‘good’ or ‘acceptable’ or not” (Fiano 83)

you are able to examine the Discourse of CNA. There are a variety of “tests” CNA’s go through, some being literal and others, not so black and white. The main test taken by CNA’s is that of terminology and understanding of abbreviations.

This test, being the literal one, is on paper and is given to test your knowledge on the field of CNA work. You are required to go through 180 hours of training, 90 of which are clinical hours, on site, working with real people. ( The other “test” is a variety how-to’s, and how well you can perform and execute needed skills in the field. Each testing different aspects of “social goods”, meaning that each one tests you on different aspects of CNA work. The written test, on language and terminology, and the clinical test on how well you perform tasks and interact with patients and the healthcare team. Within each facility there is a different set of values and phrases used. The terms DNR, Advanced Directives, BP, I/O, HR are just some of the common terms used in the CNA field and are on a need-to-know list.

Learning how to read specifics in a facility is another skill altogether. Fiano states that this terminology is used to create a “distribution of social goods”, which is true. To be able to properly understand what is being said around you in a healthcare setting you have to be able to put together phrases and abbreviations being said to you. One could argue that the ability to understand these abbreviations stems from the amount of exposure given to you in your Primary Discourse. Fiano gives an example of this sort of filtering system with her discussion of Janie;

“Language from Janie’s primary Discourse was used within the politics building task (the distribution of various social goods) in school carried out by Discourses” (Fiano 73).

Here Fiano discusses how the language Janie learned in her Primary Discourse hinders her ability to properly learn language in her second. Having the ability to perform this understanding and conjunction of phrases and words gives you the opportunity to gain access into the “social goods” aspect of politics, and the easier transfer of information from Primary to Secondary Discourse.

CNA’s have the most complex relationships with people they are involved with professionally. The way Fiano defines relationships is;

“situated meanings, social languages, figured worlds, intertextuality, Discourses, and Conversations being used to build and sustain (or change or destroy) social relationships.” (Fiano 83)

Her idea of how relationships can affect a Discourse revolves around the idea of interactions between people, and the interactions between CNA’s and each of the people they interact with are very diverse. In order to correctly, safely, and efficiently take care of patients CNA’s have to be careful not to step on toes, and be a professional patients can talk to if they have questions, but also a “friend” they can talk to in confidence. Knowing where that line is, is a very difficult task that most people even within the healthcare field don’t struggle with. The difficulty with this can be related to Gee’s statement of

“Discourses which constitute each of us as persons are changing and often are not fully consistent with each other; there is often conflict…” (Gee 7)

What Gee is saying here connects with the Discourse of CNA because patient and CNA relationships are a constant give and take when it comes to professionalism. Attachment issues can ensue, especially in children or the elderly and CNA’s have to know to report without their personal input, a term often used to describe this behavior is reporting objectively. Another difficult position CNA’s often find themselves in is

“over advocacy, when we demand residents be given care, therapies and attention they don’t truly need.” (Professional Boundaries 4)

where the CNA, or really any caregiver, is demanding care for patients, which is not only unprofessional, but steps over the boundaries of human interaction all together because of the lack of decisional relation between the CNA and patient. Fiano’s idea of relationships in the area of Discourses are strictly linguistics based, but her idea of how things are supposed to connect can be related to the Discourse of CNA by way of literal professional relationships.

CNA’s are in a unique position because they have all the basic knowledge and licensing to further their healthcare degree in whichever way they think is the best. This can be categorized into Identities which Fiano defines as

“situated meanings, social languages, figured worlds, intertextuality, Discourses, and Conversations being used to enact and depict identities (socially significant kinds of people)” (Fiano 83)

What Fiano means here is by looking at the Discourse of CNA through the connections in Identities, you can see how each aspect of nursing in involved with creating the “identity of a CNA”. Because CNA’s are considered the “bottom tier” you receive with the title, a base knowledge of terminology used in the Discourse and have a clear understanding of the requirements in each stage of the nursing system. Each level of nursing has a different relationship with patients and the rest of the healthcare team, so each level has a different identity. Gee states that “Discourses are Identity Kits” (Gee 7), by stating this he describes the Discourse as multiple parts working together to form an Identity, or way of life. We know this to be true because CNA’s are required to enact each aspect of the Identity Kit; “how to act, talk, and often write so as to take on a particular role that others will recognize” (Gee 7)

In order to replace the vacant tier of LPN’s, Maine decided to offer furthering education classes for CNA’s through community colleges to become RCNA’s, Med-Tech’s, or continue through to become an RN. If you were to receive your CNA license in the state of Maryland, you would have to retake the written test in Maine to show that you have maintained working knowledge of the field. This relates back to Identity by exploring the different requirements each state has.

Regardless of if you are indeed a CNA in Maine, being a CNA in Maryland has a different system of how to maintain and receive your license. Most states have agreed that if you pass one states test, you are legally able to work in a different state, but because Maine is more strict when it comes to nursing, it may have stem from the new system of no LPN’s. With the more strict laws in Maine, the continuation of education required, and the professional and personal relationships of the CNA Discourse, CNA work can seem more challenging than rewarding. This is where the “acting” aspect of the identity kit comes in. Acting professional and logical are necessities in the field of nursing.

Even though it is often referred to as “grunt work” or being at “the bottom of the food chain” it is a base job that gives you the knowledge to move throughout the healthcare field with ease. It helps create relationships and establish a connection within a facility for future endeavors, and creates a holistic view of people as a whole society.

“About Licensing and Renewals.” Maine State Board of Nursing Website. N.p., n.d. Web. 16 Oct. 2015.

Fiano, Darcy A. “Primary Discourse and Expressive Oral Language in a Kindergarten Student.” Reading Research Quarterly (2013): 61–80. Print.

Gee, James Paul. Literacy, Discourse, and Linguistics: Introduction. Journal of Education Volume 171 (1989) 5–17 Print.

“Maine Registry of Certified Nursing Assistants & Direct Care Workers (CNA Registry).” Maine Registry of Certified Nursing Assistants. N.p., n.d. Web. 16 Oct. 2015.

“Professional Boundaries.” Nursing Assistant Resources On The Web RSS. N.p., n.d. Web. 16 Oct. 2015.

“Types of Nursing Degrees.” Types of Nursing Degrees. N.p., n.d. Web. 16 Oct. 2015.