Can you refuse to give care to a resident in LTC?

[CNA2016:)]

Hi there! I've recently refused to give care to a resident. His Dr. has said his behavior is not caused by any mental illness or brain disease, as he has visited with him multiple times due to his behavior (calling the ambulance over 12x since I started at this facility, screaming and swearing at care aides, unwilling to accept anything short of all staff doing anything he asks at anytime no matter how difficult it is or out of our scope or if he has to wait because we are busy). Yes I understand the resident is probably experiencing depression/anxiety etc etc, however, this resident has made accusations against me countless times, sworn at me when I can't give him what he wants because it is unsafe or frankly impossible, many more times I have dealt with this residents behavior professionally. I've taken so much abuse from this resident verbally and finally I had had enough. I told nurses and staff I refuse to be treated the way he was treating me because it was burning me out. Tonight my co-worker needed help with him because he is a 2P so I considered calling the nurse but felt I needed to assist so I did and the second the resident saw me he made a comment about me having an attitude and swore. I said nothing and helped turn him and left. Now I am feeling that I don't ever want to assist again but I'm wondering if I am technically allowed to refuse or not. He does not have dementia so it is a behavior and abuse he is aware that he is doing and choosing to do. I understand it's in my job to take some form of abuse if it's a demented resident who is resistive to care or a demented resident swearing at me but this man knows what he's doing and is targeting me for whatever reason he has remembered from when I have helped him. I just don't know what to do I don't want to put stress on the other aides but I don't want to put up with abuse directed at me like that. Nurses and management are little help with him and they've tried to send him to other facilities but no one will take him because of his abuse. So my question is do i have a right to refuse and for other aides to have to switch residents etc because he isnt always bad to them like he is to me? Thank you

[djh123]

Having been a LTC/rehab nurse for 4+ years, I an sympathize with your situation, but I don't think you can refuse to care for a resident. You could possibly talk to mgt. about why you think they should be transferred to another unit, or why YOU should be transferred to another unit, but I think that's about it.

[tyvin, BSN, RN]

It would appear that none of this behavior is being put on the MDS or else the behavior would have triggered a care plan/action for it. What is the MDS coordinator doing about this? If the behavior is not being put in the MDS that is a big no no...big. There are codes for all this type of behavior and it sounds like the MDS coordinator doesn't know any of them (refer them to the RAI manual). That should be seen as a joke but these days I don't know.

It also depends on how your facility does the MDS as well. If the nurses are filling out the MDS they should be filling it in correctly (this is why I dont' like the system where staff fills out the MDS instead of the MDS coordinator). It isn't the job of staff to fill in the MDS document. Places do that so they only have to hire one MDS coordinator that does all the residents which is impossible as seen at your place for instance...why isn't this behavior on the MDS?

You have rights and he is not entitled to emotionally abuse anyone he want to at his convenience.

Write out a detailed incident report everytime this guy emotionally or psychologically abuses you. This is why I work for union places only. You'ld have a union rep and a union lawyer to assist in your dilemma.

[CNA2016:), CNA]

Yes our union is not good at all. But I'm fairly certain this resident has been put in the MDS but the doc is very lazy and the only other management we have is the general manager and we have a brand new one as of now because our facility goes through GM's like crazy. Then it's just up to the 2 ft nurses on the floor and they are just as lazy in my opinion I really do feel that it's a bunch of different issues together....bad management...bad nurses....and this particular resident. This isn't the first time something has happened where management and nurses needed to step up and they didn't, and it won't be the last. I'm planning to do my nursing in a city a couple hours away next year so I think leaving this facility will be better all around. I know why people always leave haha thanks for response :)

[CapeCodMermaid, RN]

And exactly just what would a union do? They can't go against the regulations of the federal government or the state DPH.

[Kooky Korky, BSN, RN]

Yes our union is not good at all. But I'm fairly certain this resident has been put in the MDS but the doc is very lazy and the only other management we have is the general manager and we have a brand new one as of now because our facility goes through GM's like crazy. Then it's just up to the 2 ft nurses on the floor and they are just as lazy in my opinion I really do feel that it's a bunch of different issues together....bad management...bad nurses....and this particular resident. This isn't the first time something has happened where management and nurses needed to step up and they didn't, and it won't be the last. I'm planning to do my nursing in a city a couple hours away next year so I think leaving this facility will be better all around. I know why people always leave haha thanks for response :)

Keep trying, friend. Rome wasn't built in a day and all that. LOL but I mean it, it just sounds cliche.

Leaving isn't always possible, so try to blossom where you are planted for now.

[JinnSchlajfertig]

If there are psych people at your facility they can set up a behavior contract with him. He sounds like he desperately needs it.

Also you may want to ask for feedback from trusted colleagues to see if they have any ideas about why he is targeting you. This is absolutely NOT YIUR FAULT. But there may be something you are doing that makes you an easier target than others. If so, then a small change on your part might make a big difference. It may be something you can't control, but if it is, that may be very helpful to know.

I mention this because I have learned a lot on the way and rarely get targeted anymore. I see other nurses dealing with obnoxious behavior from various inmates/patients and this doesn't come up for me or other nurses who are experienced at working with difficult people.

Good luck

[Nightnurselife]

Have you ever tried asking him why he treats you in such a way? The next time you have an interaction with him, just very politely ask him, "Why do you feel you need to act this way towards me? I want nothing more than to provide you with good care, but you make it difficult for me when you treat me this way. What can i do to make this situation better for both of us?" Maybe he will fire you if he really has disdain towards you. Then you don't have to worry about refusing to care for him because he refuses your care. But hopefully you guys can come to an understanding.

[CNA2016:), CNA]

He actually has refused my care a couple times but after a few days my coworkers always encouraged me to go in and see if he let's me assist with care and he always did allow it after a few days. He hasn't refused me in a long time but I'm sure it's because he enjoys yelling at me too much

[Bobbipoo]

I have worked with behavior residents/mental illness/ dementia residents for four years now and you simply cannot take a personal comment or negative remark that has been made to you to heart...NOT AT ALL!!! And ya darn sure cannot let them see or know that it bothers you in anyway at all because guess what,????, every time that residents sees you now they know they can get under your skin and bygolly they will. You have to find it in your heart to smile back at them or as I tell some of my techs "you better pull that FU smile outta your butt and put it on before you go in there otherwise you will have a crappy day!!!" You don't have to comment back to the resident but if you feel you need to say something kind to them...it will throw them off kilter and maybe shut them up or change their attitude. But if they don't change just make sure you always have someone else there to take your place, so you can step out for a breather, if the words get too bad.