Any Advice on Caring for Combative Residents/Patients as a CNA/GNA?

Nursing Students CNA/MA

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So I've been a GNA for a couple of months now in a LTC...I went into it with a positive attitude and felt like I was really making a difference in the lives of others. Now reality has hit that not all patients reciprocate professionalism and kindness. Residents with Alzheimers/Dementia have an excuse if they are combative towards staff. However, I recently encountered a young man who called me every profane word he could think of; over his cup not being overflowing with ice. He even went as far as to threaten my safety. I understand that many residents are depressed and angry about their health situations, but taking it out on very kind GNAs is definitely not the answer.

I tried to work with him and refill his cup to his specifications, but he still maintained his irate demeanor. I informed the nurse that I did not feel comfortable working with him alone due to my concern for my safety. The other GNA's refused to work with him when the nurse asked, so she was kind enough to be a "witness" whenever I cared for this resident.

I'm finding that many residents treat me like a servant and disrespect me. Being new, I know many are trying to push the limits with me. I have let it be known that I'm nice, however, I won't be disrespected while doing my job. Management does not seem to take threats from residents seriously. Another GNA told them since they force her to work with a violent resident...she will call 911 next time and if she is assaulted and injured she will file a worker's comp claim. I only make $10.75 ph and that's definitely not worth putting up with physical threats. This GNA job is part-time and for experience only prior to RN school as a second degree.

Any suggestions on how to care for combative residents and keeping yourself safe in the process?

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Specializes in Critical Care.

Hey, I'm sorry you had this experience.

First off I would like to say that working for an LTC is no walk in the park. It has been the most difficult job I have ever had in my life.

I used to work for an LTC facility for four months after getting my license. Like you, I'm a pre-nursing student looking to get experience to help me in school (I also love to help :3) I had one resident that was so combative and verbally abusive we needed 3 people in the room to care for her. Management wouldn't do anything about it even after all the CNAs had issues with that patient. We couldn't choose to NOT care for the patient so it was difficult to do our shift.

I was FT...and after 4 months I quit. I got my phlebotomy cert and I was out of there. I worked for a blood bank in my area until the hospital called for me to work as a CNA/PCT. I can't tell you how much I love being a CNA/PCT at the hospital...you learn SO MUCH and the nursing staff goes out of their way to teach you things that will benefit you during school :3

Anyways, have you tried to look for another job?... Props to you though, I could never work in an Alzheimer's Facility.

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I'm sorry you're being treated that way.

For these types of patients, tread very carefully. Document everything that happens ASAP. Any behavioral issues they are having, the nurses need access to that information so that if it is a change in status they can deal with it appropriately.

If they are combative, it may be a good idea to go in with at least one other person when giving personal care. Never turn your back them. I've had it come close more times than I can count, and have only been hit once. Luckily it was a little old lady, and it was only on my back. She didn't hurt very hard (I was taking her shoes off for bed), but had been upset from earlier in the day and I didn't know she was still mad.

If you have a picky Resident, just do the best you can to accommodate them. If you mess up, like the ice in a cup guy (and he sounds like several people I've cared for before) just politely apologize. If you apologize, and he wants to get verbally abusive or threaten you, you have to let him know that is not ok. We had a guy in a facility I worked in swinging his cane at the nurse. We did call 911. I wouldn't threaten to call 911 to him, but let him know that hitting is not ok, and you are there to help him. The calmer your tone is the better. If this is something that happens on a regular basis in this facility, I would probably look for another job.

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First of all, talk to your charge nurse and wait for his/her advice. Report to a police in your jurisdiction if he or she says so. Don't argue. Just let your superior know how you feel. As the OP above said, document everything.

It happened to a friend of mine who is a CNA. Her client was so abusive, so she eventually reported to a police. The police visited the resident and had a conversation with the subject. Since then, the resident was more respectful to the CNAs and nurses. However, the best thing you can do is coaching yourself to ignore him/her unless if he punches you. Also, find a counselor and ask for tips how to deal with this kind of individual because you will meet more of them if you continue to stay in your field. Remember, they need you. Don't get me wrong, I sympathized with you.

I used to work in a place where I met difficult or sick individual, but not crazy enough to be locked in hospital. I heard all kinds of verbal abused. I can tell you this that I never got mad at them for some reason. I thought some of them were hilarious. Knowing my differences between me and them, it helped me to overcome some weird things and be able to understand them.

I'm not a nurse. I'm a prenursing student and I'm also in a nursing assistant program.

I wish for you that you'll find a way how to cope in your situation.

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Thank you all very much for your replies and terrific suggestions. I will definitely document any aggressive behavior and report it to the charge nurse. The mean residents and their profanity don't deter me. The alert residents that threaten physical harm are the ones that I am most detered by. All in all, I must say that the majority of the residents are kind, act civilized, and are respectful. I now realize that this experience won't be the last and comes with the job. In the meantime, I will focus on gaining all the experience I can and pursue certifications in EKG and phlebotomy. Hopefully this will increase my chances of working in a hospital. I'm sure hospital settings have difficult patients as well, but I think I could gain more valuable experience for the future.

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I have worked with many Dementia/Alzheimer's patients and many patients that were just plain nasty. Be as kind and patient as possible. If you find yourself getting frustrated make sure the patient is safe and simply walk out of the room. If you feel you need assistance have other aides/nurses assist you. I have been swung as a few times. (Thank god for fast reflexes:)) I would tell the patient that I would not accept that behavior. I have had residents grab me and try to pull me to the floor/yank my arm/etc. while pulling themselves to the floor. I would tell them that I am unfortunately not strong enough to lift them, and if they wanted to sit/lie on the floor for however long it took me to find someone to help me that was their choice. When patients scream profanities at me I tell them I will be back when they are calm (only if they do not need immediately changed or are in an unsafe area.) If they choose to continue to act that way I repeat that step. Now most of this will not work on the confused resident and frankly they are more like rolling dice. Just continue trying things with them, redirection perhaps.

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Thanks for the advice. I have been using your idea of redirecting residents when they become agitated or just plain mean. So far it's working. I can see how being in this profession (or any profession) CNAs have to maintain professionalism, yet take control of situations. I have past

childcare experience and remember using the redirection techniques whenever children became agitated. Seems like caring for residents in LTC, whether their alert or not, is similar to working in

a childcare environment. I try to remind myself that the residents don't have much control over their health situations anymore, so I guess they often try to gain control by being disrespectful towards staff. I just hate that they often tend to be so mean to the nicer CNAs. Alot of the CNAs I work with are not as nice to residents...they tend to not speak with residents when entering rooms or performing care, and some are so rough when turning residents. Funny thing is...the residents appear to show these type of CNAs respect.

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Specializes in LTC.

Dementia residents are one thing; sometimes it can be a trial-and-error thing figuring out what the best approach was. The young guy in the OP is an entirely different story. You have to try not to get flustered with them and only do what is reasonable rather than jumping through hoops to accommodate their every whim. When they try to get a rise out of you, don't show anything other than very mild irritation because remember, you get to go home after 8 hours :) You want to project the idea that his crap isn't really getting to you, so the game is not worth playing. If he threatens physical violence give him an "I don't think so" look and get your charge nurse. Unfortunately some nurses won't be very helpful about this sort of thing but some of them will go straight in there and explain why that sort of thing will not be tolerated... hopefully you have that kind of nurse behind you!

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Specializes in CNA, HHA, RNA,.

Well I hate to break it to you but nursing in itself is a thankless job. Not everyone will cuddle you with gifts of appreciation, often times its not just the patients that are rude, but their family and staff, administration and techs / doctors who show up deciding that you are their human punching bag. At the end of the day you ask yourself did you make a difference and it will feel like: no, no you did not make a difference.

But you will find few moments in life where the work is rewarding, you might find one gentle pt that's nice and thanks you and you are like, oh yeah now I know why I got in this work to begin with.

But the other part of you is learning how to speak like an adult, now that you are one. I don't correct every pt that comes my way, but I do look family members in the eye and tell them that I am one person and not a machine. Staff won't like this and that, but even when you become an RN - working with people won't change simply because you are higher up in the ranking field. You have to learn how to put your big boy pants on and own up to it.

Pt's don't have a "right" to physically hit you, but I've been pinched, kicked, spat and had my titty pinched by a dementia pt. Combative pt's are not easy to work with but require pt and "extra care" and time to manage them. I had one skinny pt with was 90 year olds and could summon the strength and fighting spirit of a warrior, it was up to ME however to know that she required a second person.

And chart, chart, chart + report, report report to cover yourself should anything occur.

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I have a special place in my heart for dementia pts I've been kicked & yelled at but you have to understand the place it's coming from. They're usually really frightened & don't understand what's happening. They are combative because they genuinely fear for their lives I believe, how else could a 90 y/o woman suddenly have superman strength? If one day someone told you your entire reality was wrong & all the things you believe about the world (place, time, person) were wrong wouldn't you too be scared?

I know sometimes pt may use things to their benefit but I give them the benefit of the doubt.

I once had to explain to a pt that the straps on my stretcher were seatbelts because she scratched, kicked , bit & fought me trying to secure her. She just thought I was trying to tie her down.

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Well, most of my patients have dementia/alzheimer's and they can be fine one minute and trying to punch/kick/spit/scratch you the next. I've had my fair share of being caught off guard and one or two have managed to scratch me up or punch me (not hard enough to bruise me though), and I just keep doing what I was doing before that. Those that are verbally abusive and they threaten you and are manipulative, I tell them "That's not very nice, you're being very rude to me." and if they flip me off, I simply tell them that once they calm down or change their attitude, I'll be more than happy to help them. I have 12+ patients to care for, and they get angry that I'm not at their side 24/7 and they scream like they're being murdered. I ignore it, they're perfectly safe sitting in their wheelchair in the hallway with other cnas and the nurse watching them. At this point, I just remain calm, tell them why I'm doing something and change the subject when they start cursing me out. I've never stooped to their level, and will usually come back to them while I change another patient. As long as I know I took care of them, they can go ahead and curse me out, report me etc. but the cameras and the nurse saw me provide care, and that's what matters.

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