First day of CNA clinical - Elder abuse?

[stefanyjoy]

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?

[leslie :-D]

in grand scheme of things, you will not always have one pt.

realistically, you will have at least 5-6 (in ltc and on days), depending on shift and facility.

on evenings, cna's" have more pts and on nocs, even more.

you just will not have the time to dote on each and every pt.

keep in mind, some pts will take full advantage and have you running around in circles.

i'm wondering if the cna is concerned about you perpuating some (demanding) behaviors they don't need to deal with.

i would share your concerns about mouth care, and even about pt wanting to wear red vest...

as i don't understand why cna was interfering with that simple request.

same with getting wrong meal.

i do have concern with you transferring pt with gait belt.

did pt have any wt bearing status, or was she completely non-wt bearing?

if non wt-bearing, what you did was risky (at least in the facility i worked in long ago) and would have either been assist of 2, or hoyer lift.

"abuse" is a strong accusation, and would proceed very cautiously.

while i do understand your concerns, i think you may be judging presumptuously, without knowing pt's poc and background.

by all means, confer w/your clinical instructor...

but i do not advise pressing charges.

once you become a cna and have a full assignment, i believe you will gain insight into much more, and will care for your pts the most efficient and respectful way possible.

until then, keep it betw you and your instructor.

and finally, i never saw a "thigh" ulcer.

me thinks it wasn't that specific anatomical site.

leslie

[ClearBlueOctoberSky]

No, I don't think you did anything wrong. You were right to take care of the patient the way you did and definitely right to inform your instructor about what you observed and were told by the staff CNA. IMHO, at the very least, this constitutes neglect.

I could say a lot more, however, I probably would be censored. To say the least, your post made me angry. (Not at you, YOU did a good job.)

[stefanyjoy]

I think she meant on the back of the thigh, close to the buttocks. Thanks for your input Leslie. I know that CNA's have many patients and can't provide such unique care to each and every one, but if she was my only pt then I don't see why the CNA had such a hard time just letting me care for her. This woman was very cognizant that I would just be there that one day. It was like talking to any other adult, and I didn't think she was too demanding. I should also mention she had a stage 1 ulcer on her buttocks, which is why I was concerned about keeping her clean and dry. I guess in at the end of the day I thought of how I would like her to be cared for as if she was my own grandmother. I definitely would be upset if someone treated my relative like that.

[Seas]

I think you did the right thing by letting your instructor know. This mean attitude should be addressed. I am a nurse now, but I have been a CNA in a nursing home too. So I know how busy CNA's get there. But this is not an excuse to be rude to residents like this. I hope that CNA gets reported to the DON or manager, whoever is in charge.

[Altra, BSN, RN]

A couple of points for some perspective --

While you had the luxury of doting on one patient, the CNA you discuss in your post likely ran her butt off for 8 hours trying to juggle the needs of as many as 15 patients.

The human mouth can be really scrungy ... when I worked in the ICU there were patients whose mouths I diligently swabbed, scrubbed, and applied lip balm to at least every 4 hours ... but at the end of that few hours they were once again crusty. Aging, and meds, greatly contribute to dry mouth.

Just throwing this out there ... you spoke of that particular resident's intelligence, pleasant demeanor, quoting poetry, etc. Would you feel the same about having given your undivided attention to someone less personable? Maybe someone with advanced dementia, repetitive speech, or aggressive behaviors?

I will say that I think your assignment was poorly facilitated -- there should have been an understanding with the CNA that you would be solely responsible for that one resident as much as possible, and that it actually would lighten her work load slightly. The two of you may have started off the day on better footing if that had been made more clear.

[Healing Soul]

Hello,

I would stop making fun of the way the Nursing Assistant speaks it comes off very divisive and pompous at best. I worked as a CNA for over 18 years and it is a tough job. In your post you do make some valid points but I see no abuse. However, I would remind the CNA that it is the resident's right to wear her vest, and if she cares, she will be grateful for your help and want her resident's to have good care.

[MyUserName,RN]

This is why I would never have my mother in a nursing home. You just can't trust that everyone will always do the right thing. Plus, they are overworked and understaffed, it's impossible to give everything each resident needs with the full plates that they have. This CNA is probably burned out from the demands of the job, but that doesn't give her a right to be cold and heartless to such simple requests.

[SuesquatchRN, BSN, RN]

She was receiving very poor care in a substandard facility. You are right to be appalled, ratios and reality aside. But don't, please, mock someone's accent. It sounds racist.

[RNperdiem, RN]

The care was shoddy, but the structured institution style is common.

To take care of a large number of people means putting people on a schedule that does not allow for much flexibility and freedom of choice sometimes.

Another way to compare your self to the CNA, is to think of what you did with the one on one care as being a private tutor with one student. Your CNA is like the teacher with a large class- a class that can decend into chaos quickly.

[fuzzywuzzy, CNA]

...once you become a cna and have a full assignment, i believe you will gain insight into much more, and will care for your pts the most efficient and respectful way possible...

She's not going to be a CNA. She made sure to point out that she's taking the classes because she has to be on the registry in order to start the RN program. That, combined with all the melodrama and her mocking of the CNA's speech made me take this whole post with a grain of salt.

[Altra, BSN, RN]

OP - how did Day 2 go?