I failed my patient and lost my temper. What now?

[SeattleJess]

Please tell me what I should have done and what I need to do now. It would be wonderful if you could do that without calling me the names I'm calling myself right now.

I am a fresh out of the box CNA, working my first job half-time in the float pool. I pursued this work in preparation for nursing school which starts at the end of September. I could be doing other work that pays twice as much with much less effort or living on my savings. The other CNAs in this story, however, have worked for years at this facility. Their English skills don't give them entry into many other jobs. They will probably retire from this union facility with good pay and benefits whereas I am only passing through.

Yesterday I was assigned to the center unit of the TCU. Center had one nurse and two aids (me and "Francie") on duty for evening shift; South had three nurses and three aids on duty. When I arrived, I was told I'd have primary responsibility for two patients on center and six just around the corner on south. I was told not to leave center when the other aid assigned there took her breaks or just ordered me to be there because she had to leave to get dinners from the kitchen, etc.

One of my assigned patients on south needed to be changed near the end of the patient dinner period. She was a two-person assist so I asked the aid working next to me on the middle part of south to help. So began the difficulties for me and my poor patient. Southie (name changed to protect the perhaps guilty) said she'd help and then continued to work with her patients. She hadn't shown up by the time I needed to return to center to relieve Francie.

Francie was gone an hour for her 30 minute dinner break. When she returned, I said I'd be heading to care for my six patients on south. She told me I needed to go on my break immediately. I said I wanted to check on my incontinent patient before I took my break. She said no, I needed to go right now because we'd be too busy later and the CNAs on south would take care of it. I was gone 30 minutes. When I returned, the nurse and Francie both exclaimed about how short my break had been. I went around the corner to get my six patients to bed. First check was with the patient who'd needed changing. She still hadn't received care.

Then started a series of requests to Southie where she said she'd help and then proceeded to work on her assigned patients without helping me. I worked on my easiest assigned patients, returned after each on to ask Southie to help, got the same "my mouth says 'yes' but my actions say 'no' " response each time. While waiting for her to assist me, I got my folks (and two of hers) to bed. Of course, I checked in with Southie at regular intervals while I was doing this. (There was a huge workload and I do believe in teamwork.) It did seem to me that each time she could have said, "I'll be right back to help you brush your teeth" and helped me but she said, "I'll be there" and turned her back on me.

The back hall CNAs were nowhere to be seen, undoubtedly doing care behind one or more of the closed doors at the end of the hall.

Eventually, I reported to the nurses that I couldn't seem to find someone with time to help on a two-person assist pericare. One of the nurses said, "Do you want me to help?" in a tone that indicated to me that this was an outrageous request. (Looking back, I probably should have said, "Yes" or "I'd like you to help me to get someone to do more than say they'll be there eventually." Or you tell me? I was caught up short by this passive-aggressive behavior. I've never been any good at pushing string.) I confronted Southie again in the hall where she was talking to the CNA who was orienting. She told me to go ahead and set up and she'd be there. I waited in the hall outside the room. (Of course, I'd been set up the entire time.) Then Southie walked by me into the hall, punched the elevator and disappeared as I said, "Hey, I need help!" Again, the reassurance that she'd be right there.

I stood in the doorway and stepped out in front of her when she returned. I said that I needed help right now. My patient had been incontinent of bladder and bowel with a large, liquid BM that was smeared over her legs and onto the draw sheets. We cleaned her up, got on a new brief and then Southie started to close the tabs without putting on barrier cream. The patient protested that she needed cream and a topical ointment for an itchy patch on her back. Southie said, "Can you handle it from here?" and left. No ability to move the patient up in bed when I finished. Fortunately, two nurses arrived to set up the new IV infusion and said they would move her up afterward and I could go.

My patient had been lying in her own excrement for almost two hours. Well, maybe just urine. Perhaps the BM happened closer to changing time. Judging from the dried streaks on our patient's thighs, though, not too much later. Does that make this any better?

I made and quick report on south and made the last 5 minutes of report on center. I told the nurse I'd had a difficult time getting help to change a patient on south and that it had taken almost two hours to get help to change her. Then Francie leapt in to say she had a witness, a CNA, who was standing right there and heard Southie say that I should go ahead to set up and she would be right there. We got into a back-and-forth with me responding and Francie just repeating exactly what she'd said before, that she had a witness that Southie had said she would be right there.

"That's what she said, but not what she did."

Repeat.

"Look, I'm not disputing that's what she said but I asked many times and she didn't follow through."

Repeat.

"I get that someone heard her say she'd help but the patient lay in her own waste for almost two hours before I could get her to help."

Repeat.

(The light goes on that Francie is interested only in helping her coworker do CYA.)

"Look, let's just drop it.

Repeat.

"I understand what you're saying. Let's drop it."

Repeat.

Nurse: "You're really stressing out, my dear!"

(Ya think? I felt like I was in an altered reality, for sure. When did saying ever equal doing? And why wasn't anyone listening?)

Lesson to me: Never let them see you sweat. If I'm angry or upset, I need to be really sure I keep my smiley face on. Maybe I need to employ some of Southie's technique. Go to my patient's room, turn the call light on and sit by the bed? I realize now how much I was enabling her to string me along.

I know both the nurse and the aid on center were peeved about how the staffing assignment. (Truth is, several other units have a much more difficult workload.) They thought it made their lives tough and the nurse kept moaning about how she was alone and behind from the start. (Of course I thought I had it the hardest with most of my patients out of sight and sound around the corner so that I had to pace constantly to the end of the hall to peek around the corner.) They both complained bitterly about how hard it was for them and near the end of the day when the other aid was on her dinner break, the nurse told me I should report to my supervisor about how bad the staffing arrangement was on Center and ask her to change it.

I don't know the politics of my workplace but I do know there are always politics at work, especially in a large bureaucracy and that I do not want to get involved in them. Seems to me that if my nurse wasn't happy with the arrangements then she should discuss the situation with her supervisor... or mine if she thought that was who was in control. Nursey, however, thought that I should report the problems to my supervisor. I found myself wondering whether the rest of the center team was working an agenda by making my life as hard as possible so I'd complain but of course, theorizing about other people's motives is unproductive. We all know how extremely physically and emotionally difficult our work can be, how sometimes you are forced to do less than all you'd like because you just don't have the time or resources. The lonely, frightened person who wants to talk doesn't get all the time she wants because the person down the hall has toilet needs that take priority. And some coworkers are just plain old mean and/or lazy and/or whatever.

Should I tell my supervisor that it took almost two hours for my patient to get changed? I know I failed to advocate effectively for her and I feel rotten. Thinking about this has consumed almost all of my two days off. I suspect I'm embarrassing myself with this overly detailed posting. (Another sign of my swirling emotions.) I feel like a failure for not solving the problem and letting my coworkers see my agitation. Pass me that plate of humble pie, I'm tired of staring at it.

Thanks for your experience and wisdom. I have no one else to talk to about this. I could probably give good guidance to someone else in a similar situation but I'm still having an emotional hangover that makes it hard for me to think clearly. So different when you're in the muddle! I go back to work tomorrow and need to be over this. Sorry I wrote an article. I could use some suggestions on how to summarize if I do need to talk to a supervisor.

[mvm2]

Hope it will be smoother for you from now on. Hopefully it was a one time deal and things will improve for you find yourself on another floor or somethig to make you happier

[DosmoRN]

Missingyou,

I know this thread is for students, but as a nurse of many years, I felt perhaps my perspective could help.

I imagine you were told that working as a CNA would teach you alot about nursing. I think you HAVE learned a lot...not necessarily about nursing care, but about the kind of situations one must sometimes deal with as a nurse. And I commend you for your wisdom in speaking frankly and directly with your co-workers and finally the DON (Instead of just putting up with rudeness and neglect of your patient.)

Your main goal was, and always should be, seeing that patients get appropriate care, not "fitting in" with other CNA's. Fitting in with them would probably entail adopting some of their bad attitudes, which are not, unfortunately, so uncommon. The floor nurse might have helped you more, but evidently she was busy or didn't want to get distracted correcting bad behavior.(I'm just guessing here) You did the best you could do, without giving up your principles.

So DON"T get down on yourself. The patient who waited 2 and 1/2 hours will survive, despite missing out on care because of over-extended dinner breaks (unexcusable) and bad attitudes. And she may well get better care in the FUTURE because of you! If I had been the DON, I would have been impressed that your concern was patient care, not just complaining about your co-workers. You won't be working there long, but I hope you remember this experience when you encounter something similar in your nursing career (as you probably will).

[LadyFree28, BSN, LPN, RN]

Missingyou,

I know this thread is for students, but as a nurse of many years, I felt perhaps my perspective could help.

I imagine you were told that working as a CNA would teach you alot about nursing. I think you HAVE learned a lot...not necessarily about nursing care, but about the kind of situations one must sometimes deal with as a nurse. And I commend you for your wisdom in speaking frankly and directly with your co-workers and finally the DON (Instead of just putting up with rudeness and neglect of your patient.)

Your main goal was, and always should be, seeing that patients get appropriate care, not "fitting in" with other CNA's. Fitting in with them would probably entail adopting some of their bad attitudes, which are not, unfortunately, so uncommon. The floor nurse might have helped you more, but evidently she was busy or didn't want to get distracted correcting bad behavior.(I'm just guessing here) You did the best you could do, without giving up your principles.

So DON"T get down on yourself. The patient who waited 2 and 1/2 hours will survive, despite missing out on care because of over-extended dinner breaks (unexcusable) and bad attitudes. And she may well get better care in the FUTURE because of you! If I had been the DON, I would have been impressed that your concern was patient care, not just complaining about your co-workers. You won't be working there long, but I hope you remember this experience when you encounter something similar in your nursing career (as you probably will).

THIS.

If one lesson you can take from your experience is to NEVER (and I do mean NEVER, despite the adage of "never say never") stop advocating for yourself and your patients; a huge part of what nurses do is advocate; and if you stop now, you will most certainly have challenges in this business.

And I'm proud that you've learned to NEVER let them see you sweat-doing so has allowed me to enjoy this business.

Best wishes.

[duskyjewel]

Francie was so obnoxious that her team members had all complained; as a result, she'd been kicked off her team and into the float pool. (Great, my first CNA job is where the "broken" people end up!) She told me Eta was famous for her passive-aggressive tactics. As for the CNA at the end of the floor, he was well-known for "disappearing" for long periods of time.

It's exactly this that makes people wonder just what IS the point of having managers. This manager has three long-term problem people that are still working there and making everyone else miserable, causing patient neglect, and abusing breaks, basically robbing the company of pay they aren't earning. If all this is well-known, WHY DO THEY STILL WORK THERE AT ALL?! Especially in an economy like this, and with nursing employment the way it is, they could likely get 100 applicants for each job tomorrow if they fired those people today.

When/if I ever become the boss, people like that won't last a hot Arizona minute once they blow the ONE chance I give them to straighten themselves out.

[donwood1]

I don't have any nursing specific advice to give, as I am just a student as well, but I have worked as a carpenter for 20 years and there are places you can learn, and places you can learn only that you don't want to work there. Skilled people enjoy passing knowledge on to bright people who are interested in learning. They were once that learner, and it is rewarding and kind of funny to be on the other side of it. Unskilled people are only interested in one category of knowledge: What Do I Need To Know To Get By. This includes the easiest shifts to work, the pushover managers and every little detail of policy that might help them do less. They will see you as competition, which is wrong, because you are playing a completely different game.

But the real reason I want to comment on this thread is that I thought about nursing for a long time, but only started school last year after my experience with a nurse during my father's death. I have no idea how skilled that nurse was, or how smart, but I do know that nurse was a strong advocate for my Dad when my Dad was helpless to advocate for himself, and that is all that mattered to me. It made a huge difference. You will, of course, learn better ways to deal with problems as you get more experience, but I hope you never lose the intensity of your advocacy. Just, you know, maybe package and aim it more wisely. Hey, that's something I'm still learning 20 years into my first profession. Best of luck to you.

[betm, CNA]

This is a terrible situation. I don't think you failed your patient (two assists are two assists for a reason) and I would have lost my temper too. In my current facility, we are so severely short-staffed that the remaining staff members have no choice but to get along and work as a team (besides, the remaining staff is a truly wonderful group of people, with maybe the exception of only 1-3 staff whose attitudes do not represent the collective group). But, in the past, I haven't been so lucky and I can empathize with this ordeal in some respects. I'm sad to know that my five years working at an overstaffed (or perhaps properly staffed, not that I would know what that's like anymore) gas station were easier than doing resident cares.

Overstaff the gas station, understaff the ALF? I could get help from a coworker at the drop of a hat at the gas station and I would not have to wait very long, but in caregiving, I waste my time and end up infringing (not by personal habit or choice) on basic rights or cares because I simply don't have the time or resources I need to get everything done (but I could twiddle my thumbs at the gas station because there were too many people for too little tasks). It's outrageous.

Saying does not equal doing. You asked for help from several different sources and you asked multiple times. This person's ISP states they are only safe to assist with two people. Your coworker doubled up on her break time, put herself behind on the work she was hired to do, and then ran around trying to catch up (and, in the spirit of teamwork, you still helped two of her people). That extra half-hour she spent on break could have been used to help you with the two-assist and there would be time to spare. It was laziness on the part of your coworker and not failure on your part that this person sat in their own waste for two (!!!!!!!) hours.

This sort of thing happens to me all the time. Someone is a two-person Hoyer and I'm in the middle of cares. I analyze the situation and work on a solution from there. Sometimes I can leave the room and go help, other times I just make my coworker's request the very next priority. Even in my severely understaffed ALF, we find a way to work together. Anything else in unacceptable.

[SeattleJess]

Missingyou,

I know this thread is for students, but as a nurse of many years, I felt perhaps my perspective could help.

I imagine you were told that working as a CNA would teach you alot about nursing. I think you HAVE learned a lot...not necessarily about nursing care, but about the kind of situations one must sometimes deal with as a nurse. And I commend you for your wisdom in speaking frankly and directly with your co-workers and finally the DON (Instead of just putting up with rudeness and neglect of your patient.)

Your main goal was, and always should be, seeing that patients get appropriate care, not "fitting in" with other CNA's. Fitting in with them would probably entail adopting some of their bad attitudes, which are not, unfortunately, so uncommon. The floor nurse might have helped you more, but evidently she was busy or didn't want to get distracted correcting bad behavior.(I'm just guessing here) You did the best you could do, without giving up your principles.

So DON"T get down on yourself. The patient who waited 2 and 1/2 hours will survive, despite missing out on care because of over-extended dinner breaks (unexcusable) and bad attitudes. And she may well get better care in the FUTURE because of you! If I had been the DON, I would have been impressed that your concern was patient care, not just complaining about your co-workers. You won't be working there long, but I hope you remember this experience when you encounter something similar in your nursing career (as you probably will).

DosmoRN, thank you! Struggling for an analogy here, but I think you just turned what seemed like a steaming pile of horse dung into valuable fertilizer! Plus, your perspective lets me feel positive about the experience and the future! I learned so much. The world will always be imperfect people (including me), dealing with imperfect situations.

It must be tough for the nurses to supervisor a team of mostly rejects from other teams, especially when management isn't really going to do much to help you.

Here's to always, always, always advocating for our patients and treating everyone with respect and courtesy as best we can.

[SeattleJess]

It's exactly this that makes people wonder just what IS the point of having managers. This manager has three long-term problem people that are still working there and making everyone else miserable, causing patient neglect, and abusing breaks, basically robbing the company of pay they aren't earning. If all this is well-known, WHY DO THEY STILL WORK THERE AT ALL?! Especially in an economy like this, and with nursing employment the way it is, they could likely get 100 applicants for each job tomorrow if they fired those people today.

When/if I ever become the boss, people like that won't last a hot Arizona minute once they blow the ONE chance I give them to straighten themselves out.

Duskyjewel, there's much integrity in what you say.

[SeattleJess]

I don't have any nursing specific advice to give, as I am just a student as well, but I have worked as a carpenter for 20 years and there are places you can learn, and places you can learn only that you don't want to work there. Skilled people enjoy passing knowledge on to bright people who are interested in learning. They were once that learner, and it is rewarding and kind of funny to be on the other side of it. Unskilled people are only interested in one category of knowledge: What Do I Need To Know To Get By. This includes the easiest shifts to work, the pushover managers and every little detail of policy that might help them do less. They will see you as competition, which is wrong, because you are playing a completely different game.

But the real reason I want to comment on this thread is that I thought about nursing for a long time, but only started school last year after my experience with a nurse during my father's death. I have no idea how skilled that nurse was, or how smart, but I do know that nurse was a strong advocate for my Dad when my Dad was helpless to advocate for himself, and that is all that mattered to me. It made a huge difference. You will, of course, learn better ways to deal with problems as you get more experience, but I hope you never lose the intensity of your advocacy. Just, you know, maybe package and aim it more wisely. Hey, that's something I'm still learning 20 years into my first profession. Best of luck to you.

Thanks for the positive message. And for describing the characteristics of the "broken" team exactly! I will do my best to keep my focus on advocacy and delivery of care. That should let everything fall into place. I'm also grateful that the majority of the facility is professional, supportive and caring and that I work well with them. Here's to both of us continuing to learn. Wishing you well in your nursing career.