How to deal with staff who seem to not care for paitents

calivianya, BSN, RN · Jun 14, 2013

I think it's pretty normal, sadly. You can report them and you can say something, but unless they are abusive they're probably not losing their jobs. It's hard to retain good CNAs because the job is very hard work for very tiny amounts of money, which obviously also doesn't help morale at all. At least 90% of the CNAs I worked with in the hospital when I was a CNA were burned out. Not all of them showed it to the patients - some still provided excellent care, others didn't - but it's just about impossible to stay upbeat and perky on some floors. CNA work is just too hard, too underappreciated, and undercompensated. It wears you down unbelievably fast.

Pangea Reunited, ASN, RN · Jun 14, 2013

I agree that there are a lot of burned out CNAs and nurses. On the other hand, I do think it's appropriate to "bend" standards of care on occasion. For example, I've had patients call and want to sit in their chair, then call five minutes later and want to get back in bed, then repeat those two steps about twenty times. At some point, you've got to set limits so you can take care of your other patients. A casual observer might think I'm being a jerk by "ignoring" the patient's 21st request, though.

The call light issue is a tricky one, too. If a patient is repeatedly hitting the button and doesn't need anything or even realize what they're doing, it's not really functioning as it's intended to. If the patient's needs are met and the patient can be safely observed, it's not always a bad idea to put the light aside and give them a box of tissues to play with, instead. Again, it allows you to take care of the rest of your patients without the constant interruption.

As far as people who just don't care, I wish I had a solution, but I don't.

amoLucia · Jun 14, 2013

Sorry to disagree with you Pangea, but you can't remove a callbell from a pt's grasp regardless of their constant nuisance usage. It has to be avail for pt use - what if they have a legitimate need of an emergent nature and couldn't call for help???

I've seen call bells looped over the bed headboards, on a siderail on a paralyzed pt''s bad side, or just inches out of reach of the pt. Done delilberately at times but also done absent-mindedly too. On incident reports when a fall occurs, there is usually a question that asks "was callbell in reach"? It has to be answered!!! Callbells rank right up there with siderails and proper footwear when a fall occurs! I have had to discipline staff for its absence when a pt falls.

I have seen where State surveyors have identified lack of callbell presence when they've done surveys. Frequently some places will have spare callbells avail for emergency use replacements, or have those old ding-ding tap bells for pt use. That's how crucial some places regard callbell availability. And they must provide special alternative type alarms if nec.

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To OP - it may be true that some staff may become burned out and/or seem less emotional when providing care to pts. NHs are demanding places to work for CNAs and nurses too. It's very difficult to provide the one-on-one type attention that many pts seem to need or want. You can only do your best to meet what their perceived needs are and then it's time to move on to the next pt.

That's part of time management and priortorizing. You can't keep fluffing the pts. Kind of reminds me of toddlers having tantrums - you have to set limits and continue on. Doesn't sound pleasant but that's the reality to be firm and say no.

JessicaSamunique · Jun 14, 2013

Thanks for your comments. It's really helpful getting the opinions of those who more experienced in this. Thanks again

Pangea Reunited, ASN, RN · Jun 14, 2013

Sorry to disagree with you Pangea, but you can't remove a callbell from a pt's grasp regardless of their constant nuisance usage. It has to be avail for pt use - what if they have a legitimate need of an emergent nature and couldn't call for help???
I've seen call bells looped over the bed headboards, on a siderail on a paralyzed pt''s bad side, or just inches out of reach of the pt. Done delilberately at times but also done absent-mindedly too. On incident reports when a fall occurs, there is usually a question that asks "was callbell in reach"? It has to be answered!!! Callbells rank right up there with siderails and proper footwear when a fall occurs! I have had to discipline staff for its absence when a pt falls.
I have seen where State surveyors have identified lack of callbell presence when they've done surveys. Frequently some places will have spare callbells avail for emergency use replacements, or have those old ding-ding tap bells for pt use. That's how crucial some places regard callbell availability. And they must provide special alternative type alarms if nec.

I'm not talking about "nuisance" patients who know what they're doing, I'm talking about patients who don't know what a call bell is and don't know how to use it when they need help...patients who look surprised when you show up because they don't see the connection. And yes, I know all of the rules, but I don't always follow the rules when they don't make sense.

mintygirl · Jun 14, 2013

I'm a student in school for nursing of course. But I'm taking a summer class to become a CNA so I can work during the school year. Our clinicals are at a CCU nursing home. I noticed that the CNAs that actually work there( and some nurses) are rude to the patients. Some of my classmates and I have witnessed and heard the employees saying they won't do things like help a resident off the floor because they've already done it once or they snatch call lights from patients who accidentally press the button. We notify our teacher and she says to mind our business, she'll handle it. I don't feel comfortable seeing these things take place. Is there more I could/should do??????

I think you're just not comfortable with CNA's being firm to patients. That's not to say that maybe your suspicions are wrong, but just wait until your a CNA. If you still see the same thing happening then I'd just do the obvious and report it, inform the pt that they can call Omnibuds for their rights and advocate patient rights.

amoLucia · Jun 15, 2013

I'm not talking about "nuisance" patients who know what they're doing, I'm talking about patients who don't know what a call bell is and don't know how to use it when they need help...patients who look surprised when you show up because they don't see the connection. And yes, I know all of the rules, but I don't always follow the rules when they don't make sense.

Please don't get in trouble for callbells!!! They still have to be within reach. Even with comatose pts who may have to have a halleluah (sp?) recovery in order to use it !!

I have seen dementia pts have rare breakthrough episodes of lucidity & orientation. And it would probably be then during those periods that they would fall. I agree with you that there are some things that just don't make sense and what would be the most realistic & reasonable approach can't be done because of some silly rule.

That's what makes our jobs so frustrating at times. And it's probably that frustration showing through when OP sees employees at their wits' end. I've dealt with those kind of pts who are 'clueless in Seattle'.

Your idea to give them something for distraction is right on. But you may just have to grin & bear it re the callbell use.

i_love_patient_care · Jun 15, 2013

They have those apron things with all the zippers and buttons for patients that need something to play with. I agree, though, that a lot of people get burned out.

TurtleCat · Jun 15, 2013

This seems to be all too common at the facility where I work and it makes me sad. I understand that it's a stressful job, but the least you could do is show the residents some respect and kindness. That could be your family member, or even you later down the line. The way I try and deal with it is by not being like them; just because they don't care about the residents doesn't mean I have to be the same way. Also, I think if something is bad enough, you should report it.

ComeTogether, LPN · Jun 15, 2013

I'm a student in school for nursing of course. But I'm taking a summer class to become a CNA so I can work during the school year. Our clinicals are at a CCU nursing home. I noticed that the CNAs that actually work there( and some nurses) are rude to the patients. Some of my classmates and I have witnessed and heard the employees saying they won't do things like help a resident off the floor because they've already done it once or they snatch call lights from patients who accidentally press the button. We notify our teacher and she says to mind our business, she'll handle it. I don't feel comfortable seeing these things take place. Is there more I could/should do??????

I remember being horrified at some of the things I saw at first. Until I started working full time I didn't understand it. When you have 16 patients to yourself the call light ringer really starts to take your attention away from those who need it. You absolutely can not remove it from their reach, but you can put it to the side where they don't actually see it but can still reach it if they need to. you can be fired on the spot for moving it out of reach.

Not helping someone off the floor? As in someone who fell? Can't say I've seen that one. I can understand being annoyed that Mr. smith got up again without calling.....but if he were on the floor? What if he were hurt? Don't really know what to say about that one. I've always been one of the first ones to help whoever falls because I have meat on my bones and am a good lifter.....Didn't matter whose patient.

You will see things you just can't wrap your head around such as people being double briefed so that one brief can be pulled out leaving a clean one behind, patients that aren't allowed to go to the bathroom because it just isn't safe to get them there, patients who are made to wake up at an ungodly hour because that is literally the only time the CNA has to get them up and someone has to go first. (I used to rotate and give people a break If I could)

CNA's in LTC have so many things to get done in such a short amount of time. I remember thinking this one girl was sooo mean until i got to know her and realized how sweet she actually was. She would give pedicures on the rare occasions she had extra time. She talked to the patients like they were her family--because to her-- they were. This sometimes involved comments that you wouldn't expect or that sounded rude but that's just how she was and had been taking care of these people for so many years. Every single day. They knew her just as well as she knew them.

If you see abuse, you must always report it. If you see something that you know is just simply wrong and putting safety at risk you must say something. Otherwise, try to keep an open mind and feel free to ask questions.

ComeTogether, LPN · Jun 15, 2013

They have those apron things with all the zippers and buttons for patients that need something to play with. I agree, though, that a lot of people get burned out.

Busy jackets!! (or blankets) Love those things!