First day of CNA clinical - Elder abuse?

Nursing Students CNA/MA

Published

Good afternoon everyone. I just need some perspective on what I witnessed today to see if I can expect to see this kind of thing everywhere. I'm not sure if I can handle it. This is going to be kind of long but I really just need to describe my first clinical experience to someone.

I am in my final 2 weeks of my CNA course. I have applied for an RN program for this fall, but I am required to be on the CNA registry to begin. Anywho, today was my first day of my CNA clinical at a LTC facility. I was assigned to an 82 y/o female resident that suffered a CVA three months ago while at an ATF and was moved to LTC. She is a total care patient. She is unable to move very much at all but she does not suffer from dementia whatsoever. When I arrived this morning, I went into her room to wake her for early morning care and to wash my hands. When I turned the sink on, some black crap sputtered out that turned yellow. I went into the employee break room to wash my hands and used foam sanitizer. When I got back into her room, I noticed her emesis basin was on her night stand, and it was really crusty and disgusting. Her toothbrush was inside it and it was totally yellow and had some brown stuff crusted on the bristles. In fact her entire room was pretty nasty. I got out her wash basin and went to fetch her CNA to ask where I could fill it because the water in her room was yellow. The CNA yelled at me to just use the water in the room "de trays are comin out!". Eventually I found clean water to wash her face and hands and perform peri-care. It took me awhile because we had not gone over diaper changing in my CNA labs and I kind of had to wing it. I have one child but obviously changing a full grown adult is a lot different - and while I was performing peri-care she had a major BM. I cleaned that up and did my peri-care all over again to be safe. Naturally this was my first time doing this on a real person and it was taking me a while, and the CNA or my clinical instructor were MIA. So the CNA comes in and yells at me again for being so slow, and starts aggressively pushing this fragile old woman around to put her ted hose and bra and the rest of her clothes. I mean, she was just throwing her around on the bed. I could barely watch. I asked the CNA when I would have a chance to perform oral care because the resident still had her bottom row of teeth with god-knows-what caked between every tooth. She said "we don't do dat! she have dentures!" (she only had top dentures) and just threw the dentures in her lap even though she is completely paralyzed on her left side and her right hand tremored badly.

During this time, all the resident could talk about was that she wanted her red vest that was in her closet. The CNA yelled at her to just wear the clothes she put on her and let it go. I kept moving toward the closet to retreive the vest but the CNA kept turning around saying "Don't get that vest!" like it was such a huge deal. I waited until she left and went into the closet to get a very easy to put on red fleece vest that had the Cornell University logo on it. Her granddaughter was coming to visit today and she attended Cornell. The CNA was ****** when she came back in the room and the resident had the vest on. Why? I have NO IDEA... but the resident was as happy as a pig in ****.

I had reviewed my resident's chart the day before and noticed she had lost 20 lbs since she was transfered to this LTC in November. She is literally skin and bones. So I knew that I really wanted to encourage her eating when I got a chance to feed her breakfast. When the trays came I saw on the card that she had ordered an english muffin, cheese grits and oatmeal. I opened the tray and it was french toast and bacon. I went to find the CNA to tell her she received the wrong meal and the CNA said "that card don't mean nothin!" but the entire time I was trying to encourage the resident to eat she kept talking about the english muffin she wanted and she hated french toast. I felt terrible. I asked her why she's lost so much weight and she said it's because she doesn't like the food there.

After breakfast my resident needed to be moved to her wheelchair because her family was coming to visit a little later. Since she only weighed 107 I asked my instructor if I could use my gait belt instead of a lift (since we were not allowed to operate them just yet, and I wanted some kind of belt practice). With her blessing I went to get my gait belt but when I came back the CNA was in the room putting the resident's shoes on. I said I could handle the transfer to the wheelchair and started to pull out my belt. She said "No, that take too long!" and just heaved her up and into the wheelchair like a sack of potatoes. Mind you this LTC has a no-lifting policy. The resident had asked me if I could wheel her to the nurses' station so she could read the menus, so I asked the CNA where the foot rests to her wheelchair were. She snapped at me that the resident just needed to stay in her room. I repeated my request, "Mrs X would like to read the menus" and she started yelling at me that she just needed to stay out of the way. It was like she didn't like the resident for some reason - plenty of other residents were out of their rooms and just hanging out in the hallways and common areas. Luckily at this time her family showed up a bit early, so I just let them be.

Now would be a good time to mention the overall demenor of this resident. She was obviously a very educated woman, as the entire time I spent with her we discussed our families, education, traveling, literature, good food, politics, her upcoming 63rd wedding anniversary, pretty much everything. At one point before her family came she asked me if I liked poetry, and then recited Walt Whitman's "O Captain, My Captain" from memory. I actually had to turn away so she wouldn't see me tear up because my heart was breaking that such a beautiful soul was stuck inside such a broken body. She seemed so incredibly grateful that I was clumsily providing such basic care. Anyway...

While the family was visiting, I went to join some fellow classmates to assist with their residents. One girl said her resident had a nasty pressure ulcer on her thigh but it was not being taken care of, and she had to clean liquid poo out of the ulcer. One had told me that her resident had such a dry mouth that scales were falling out during her oral care. I told her about what my CNA said about oral care and she looked shocked. I went to my clinical instructor and told her that my CNA said she doesn't perform oral care, and she told me to do it as soon as I could. After the family left I went in to do oral care but then remembered that her toothbrush was disgusting. I threw it out and went to look for a new toothbrush but could not find one. I asked the LPN's at the nurses' station and they sent me on a wild goose chase looking for toothbrushes in every supply closet, but eventually I turned up empty-handed. The charge nurse just sighed, "I'll tell them to order more." I had to try to gunk out the resident's mouth with swabs. I was horrified the crap that came out of her teeth and I didn't even get most of it because I didn't have a toothbrush. At some point during this time the CNA yelled at me for cleaning her mouth and dentures ("she about to eat lunch! we don't clean dentures just put them in the water") but at this point I was so disgusted by how neglected my resident had been I just ignored her. After I performed oral care my resident told me she would like a new diaper. I went to get linens and my CNA of course stopped me to ask what I was doing. I told her I was about to change her diaper and provide care for her and the CNA grew furious and said "She's not that wet!". Of course at this point I had grown so fond of my resident through our conversations that I just didn't care what the CNA had to say whatsoever. And plus, she's my only patient, so who cares if I pay this much attention to her?!

At this point I had to move my resident from her wheelchair to her bed. She looked at me and said "Ok, so you get my legs and can get my head?" like the CNA's just fling her back onto the bed. I was horrified and explained to her I would be using my belt. So I get her back onto the bed and change her diaper, at which point she shows excitement to receive two AM changings, poor thing. She asks me for water so I go to get some. The CNA starts of course yelling at me about getting her water "The lunch trays are coming!" and I ask when, she says in an hour and a half. What? So what? The resident wants some water now. So I ignored her and went to get my resident water and whatever else she requested of me today. Ice? Lotion? Lip balm? Sure. I was having a good time caring for her, talking with her, making her smile, and she needed some extra attention. All the while the CNA is telling me to stop getting her stuff because "she'll run you all day!" and getting very angry that I was just ignoring her ranting. I was documenting all her fluids even though she was not on I&O (I don't know why, she is practically a skeleton, they seem kind of content to let her just circle the drain, which is none of my novice business but at least we could make her happy and comfortable). Her chart indicated she was just to be made comfortable, she was not on any kind of therapies or procedures scheduled or anything. Her only med was ambien.

A few other little things happened but this post is already too long and I think you all get my gist. During clinical I reported my concerns to my clinical instructor and I think she may have spoken to someone at the LTC about it. I'm worried that tomorrow when I go in (I'll be assigned to a different resident/CNA) that I will catch hell from the staff, but I couldn't let this precious angel of a woman be treated so poorly. It got to the point where I prayed she would pass soon so she wouldn't have to bear being stuck inside such a shithole LTC for much longer. Can anyone give me some feedback on this? Is this common for LTCs? Did I do anything wrong? Am I just too green?

Specializes in LTC.
Reading the update, you have to wonder where the State was with all this going on.

When I worked in a LTC facility the State would be breathing down our necks at the slightest hint of neglect. Maybe the families play a role. The facility I worked at was one of the best in the state and had a long waiting list, so the families expected a lot. Many of them seemed to regard the facility as a five star hotel and expected what was almost one on one care.

I guess there are also facilities where the poor and indigent get dumped, or families dump elderly people they want to forget about. Its kind of sad when investigators are spending all their time at expensive high end facilities because those are the places where family expect perfection and will report the facility because someone didnt get their HS snack at exactly the right time, while the really nasty dangerous nursing homes are largely left alone and few people bother reporting them.

Maybe that's why I had such a hard time believing this story. I work in what basically amounts to a 5-star hotel where there is drama if you put the wrong color socks on someone, and yes, families expect one-on-one care, as well as constant service for themselves too. I have seen things happen where a CNA tells a family member it will be a few minutes before they can get their 3rd cup of coffee (for them, not the resident!) because a bunch of people need to go to the bathroom first, and next thing you know the family is complaining that the CNA was "rude" and told them they couldn't have a drink. Minor things get exaggerated into "abuse" and the administration's excuse for constantly browbeating us over everything is "the state, the state." I cannot imagine how any facility would get away with 90% of what the OP said because our bosses are on us like white on rice for EVERY. LITTLE. THING.

Maybe that's why I had such a hard time believing this story. I work in what basically amounts to a 5-star hotel where there is drama if you put the wrong color socks on someone, and yes, families expect one-on-one care, as well as constant service for themselves too. I have seen things happen where a CNA tells a family member it will be a few minutes before they can get their 3rd cup of coffee (for them, not the resident!) because a bunch of people need to go to the bathroom first, and next thing you know the family is complaining that the CNA was "rude" and told them they couldn't have a drink. Minor things get exaggerated into "abuse" and the administration's excuse for constantly browbeating us over everything is "the state, the state." I cannot imagine how any facility would get away with 90% of what the OP said because our bosses are on us like white on rice for EVERY. LITTLE. THING.

I have worked in both a 5 star facility and a bottom of the barrel facility that took the residents no one else would take (abusive residents and those with no money/family) and the staff that no one else would take, and I can attest to the fact that standards and accountability are vastly different between the two (at least in my state!)

The first was much like your facility sounds - demanding residents and families, and you better meet their silly demands on time and as they want OR ELSE. And the other...well, I'll just say that I am NOT exaggerating when I tell you that it was the standard for the residents to be dressed and tossed into their chairs between 3 and 5 a.m. (breakfast was at 5:30 a.m. Who the heck wants to eat at 5:30 am???), and not touched again until they went to bed between 7-9 p.m. I'd never have believed it if I hadn't

worked there myself, for the worst 3 months of my life. Sure, they got poor scores on the state surveys, but I never saw state back in there to investigate anything, and I KNOW there were complaints made by family/visitors/staff.

SO, yeah, because of that experience, I can definitely see the OP's post as possible. Most LTC facilities seem to fall somewhere in the middle, but those hellholes DO exist.

TBH, it sounds like the CNA you had was of poor quality. There are so many of them out there, and not in the sense that they lack the skills, but in that they lack compassion and have started doing things only for the sake of just getting the job done. I have about 14 residents to care for, but most of them are pretty self sustaining. I just have to change them, get them up if they are in bed and dinner is about to be served and they eat in the dining room, or if they have an appointment or shower. I start by laying out towels and wash clothes in the rooms that require baths, and I put fresh bed linen in every room and I pull out briefs, and have them out so that I don't have to waste time, and I store a bunch of gloves in my pocket. My goal is to make sure that these people are not sitting in dirty briefs all day long and that they are where they need to be on time. I am new to being a CNA, but I've had the pleasure of being trained with an excellent CNA (I've also trained with some decent ones, and I can tell the difference, and I've observed the bad ones from a distance, thank god they didn't stick me with them for training.)

I didn't make it in LTC - I couldn't handle how the other CNAs were like "do XYZ while you give her her snack, or she'll talk your damn ear off". I get that time was of the essence (on nights we had 25-30 pts who needed to be rounded on 3 times in under eight hours after filling up water pitchers, dealing with the people who were CONSTANTLY getting out of bed, the morbidly obese lady who was CONSTANTLY on her frickin' call light, the sweet demented old man who was constantly on his light looking for his hat, with his wife on HER light telling him there was no damn hat.

I couldn't handle it. They did not get the care they needed from me because I could not be in so many places at once. I hated cutting the corners I had to. I did end up leaving the medical field (was originally going to pursue nursing) because of my experience in this place.

LTC is heart breaking. Those that care, don't always last.

Specializes in ED/ICU/TELEMETRY/LTC.

"

ltc is heart breaking. those that care, don't always last."

don't you dare tar everyone with the same brush. many many fine cnas and dedicated workers of all degrees of education do last for exactly the reason that they care. just because you didn't check out the facility before accepting a job, and couldn't last, doesn't mean we are all that way.

"4:42 am by nohika

I didn't make it in LTC - I couldn't handle how the other CNAs were like "do XYZ while you give her her snack, or she'll talk your damn ear off". I get that time was of the essence (on nights we had 25-30 pts who needed to be rounded on 3 times in under eight hours after filling up water pitchers, dealing with the people who were CONSTANTLY getting out of bed, the morbidly obese lady who was CONSTANTLY on her frickin' call light, the sweet demented old man who was constantly on his light looking for his hat, with his wife on HER light telling him there was no damn hat.

I couldn't handle it. They did not get the care they needed from me because I could not be in so many places at once. I hated cutting the corners I had to. I did end up leaving the medical field (was originally going to pursue nursing) because of my experience in this place.

LTC is heart breaking. Those that care, don't always last."

You sound just like me. I had to get out of LTC for absolutely exactly the same reason. It drained the life out of me, and no matter how much I gave out I could never give enough to all the people I was required to take care of. There was barely enough time for just the very basic of care, sometimes there wasn't enough time even for that. I sometimes felt like I was herding cattle. Blessings on all the dedicated souls who don't wash out of LTC like I did :bow:

Curious as to why some people would think I would make something like this up. I work full time, am a part time student, was just accepted into NS for this fall, plus I am a single parent. I have a lot better things to do with my time than to troll a nursing message board. I come here for advice, feedback, information and a funny story after a long day. To those wondering, the unit I was doing my clinical on was for mainly Medicare/Medicaid recipients (they actually had a seperate hall for people with private insurance - in the front of the building - so it looked all plush at first glance). I'm guessing the little family I did see visit just didn't have any other options. I know a lot of them did complain about it smelling like poop all the time in the halls. Most of the residents I was assigned to did not have family that visited, which is why they stuck them with the CNA students.

maybe the charge nurse realized that the patients needed a little 1:1 care, even if it was only one day of a cna student. you made a difference that one day. that's all we can do sometimes. well, that and call the state for a stat inspection.

I worked LTC for one year, and sadly that isn't surprising. As someone who has done plenty of oral care on residents, the crusty stuff may be caked on. Sometimes it actually hurts them if you try to scrub all of it off. I had one resident who had it on there so bad that when i tried to scrub it off as gently as possible, and even with just a toothette it bled and she asked me to stop (which of course I did). You can only do the best you can while you're there. As far as "spoiling" residents, here's the thing, the CNAs in most facilities are very overworked. I would literally be going as fast as humanly possible and still feel like I hadn't accomplished everything I wanted to through the whole day. Especially during a day shift, with meals, showers, visitors, it can get super hectic. CNAs get tired and don't always know how to compartmentalize it. When the students come in and help, it is tough to get everything done, because instead of just doing it we have to explain it, and the residents' routines aren't always in line with what you're learning at school. LTC is tough to see and even harder as a job to do every day (coming from someone who would most of the time work 6 days a week). I would remind myself every day that I needed to treat every resident like I would treat my grandparents, or how I would want my family to be treated. I'm really sorry you had to see that. If you do see abuse or neglect, though, report it.

As some others have said, you will have more than one patient BUT THAT DOES NOT MEAN A PERSON SHOULD VALUE QUANTITY OVER QUALITY. In my clinicals, my CNA was awesome. She was fast and always listened to her patients. She was also done 30 minutes before her lunch and used those 30 minutes to check on her residents.

Keep in mind, this lady had 12 residents.

Your CNA was god-awful and I feel sorry for anyone in her care.

Specializes in ER/SICU/Med-Surg/Ortho/Trauma/Flight.

I dont care who you are or how many pts. You have this may not constitute abuse, pretty close if you ask me although, but it does constitute neglet, and I was an aide and then an lpn before I completed my Rn, oooooh only if I was her charge nurse.Rod, Rn, Bsn, Cen, Ccrn

It's been over a year since I posted this thread and I just wanted to give an update. I'm an NAII now and halfway finished with NS. I've only worked in hospitals since but I have a much better understanding of the daily grind of an NA. This was abuse, neglect. These details are not fabricated, this is not hyperbole. I'm so happy to say I've only seen patients in the 2 hospitals I've been at receive only the most respectful care from the NA's. I don't understand how anyone could defend the behaviors of these "healthcare" workers. I still think about that first patient I ever had and wonder what became of her. I hope her family got her out of there.

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