I really need some advice ASAP

[jocelynlpn]

I work in a nursing home. I'm the only LPN with 3 HCAs and 26 residents. There is an RN on the unit next to be which I can go to for help if needed. Something happened on my shift yesterday, and I wanted to post it on here and get advice from other nurses before discussing it with someone else in my facility.

I have a resident on my unit who is what you would call "difficult" and "attention seeking". For example, he's well known for having inconinent BMs and "painting" the bathroom a nice brown color before he rings his call bell for help. He doesn't have dementia or alzheimers and he knows very well that he should ask one of the girls for help beforehand. I can understand how this can be frustrating for some staff members.

So yesterday this resident did the same thing, made a huge mess in his bathroom, walls, toilet, floor...Then rang the bell for the girls to come and clean him up. I came down to the room to check on the girls and asked them if they needed any clean linen or supplies. The resident was standing in the middle of the room with his pants around his ankles and one of the HCAs was saying "Oh my God you are such a pig. I can't believe you did this. You should know better. You're such a dirty old man" She didn't know that I heard this. And I didn't say anything to her. I can understand that she is frustrated, and I know this resident can be difficult. But she was being very unprofessional and just downright mean. You don't tell an 80 year old man that he is a pig when he's standing in his room with no pants and covered in stool. Where is his dignity?

I'm not exactly sure what I should do now. I'm pretty upset at this co worker. I don't know whether I should confront her about it, go to the RN, or go directly to my manager. I would also like to add that I'm a new nurse (one year experience) and 90% of the HCAs I'm "in charge" of are way older than I am. So sometimes I find it difficult to confront them, and I've never had something like this happen before.

Any advice from you more experienced nurses??

[tiroka03, LPN]

The residents behavior needs to be charted and tracked, a psych eval done, and interventions placed

[leslie :-D]

i was also wondering...if this pt might be constipated/impacted, and is digging himself out, wiping finger on wall, digging himself out more, wiping finger on wall, and so on.

while i have encountered many pts with unexcusable behaviors, i'd like to r/o any physiological problem first.

at the very least, let's get a kub and take a look.

leslie

[psu_213, BSN, RN]

The other thing about the aide's comment...she might just be playing in to the resident's hands. Perhaps part of his actions are meant to "get under the skin" of the staff (or just down right P-O the staff). By her saying this, he realizes that he is doing just that, and it may make him do it even more. Yes, the aide committed verbal abuse and it needs to be dealt with for that reason alone, but the comment may have other consequences as well.

[CT Pixie, BSN, RN]

We have all encountered residents/patients that push us to our limit, but no matter what they say or do, mentally stable or not, you cannot talk like that toward the patient. Maybe I'll be flamed her but what that CNA did was patient abuse--verbal AND mental abuse to be exact. I'm not saying that I wouldn't have been thinking those exact same words in my head (really LOUD) but they wouldn't come out of my mouth. Add in the fact that the patient was semi-naked standing in the middle of the room??

In my facility, if someone witnesses something like that and doesn't report it and others find out, the non-reporter is just as "guilty" as the person who commited the "act".

Again, I can see how the CNA was frustrated but that doesn't excuse the behavior. I, for one, would have asked that CNA to leave the room, I would have explained that what was done was patient abuse and I'd be writing her up and reporting her to my Supervisor. Harsh? Maybe. But I've witnessed something similar to the OP and I did exactly that. If the State had witnessed what the OP described, that CNA would have been fired on the spot no ifs, ands or buts about it.