Student CNA and I need some help please!

[AngelicNurse2B]

Hi guys...I'm pretty new here, I'm currently 2 weeks from finishing my CNA class which is a prereq for the nursing program at my school. Today I ran into a situation, and I'm wondering if any of you might have some input for me:

I've taken care of (among others) one patient in particular almost every clinical day for the last 6 weeks that I've been in this class. He is the sweetest man and he really appreciates the care I give him. Every day when I leave he gives me a hug and thanks me for taking such good care of him that day. The one other time he was assigned to another student he kept asking for me.

Well today I didn't have a patient assignment because half of us were to spend the day practicing vital signs. Another student was assigned to him and when the other student went into the room the pt immediately asked where I was, and the student told him that I had some other work to do but I'd be taking care of him again as usual tomorrow.

Then one of the staff CNA's came in and informed the student that he couldn't take care of this pt today because the other day he requested that no student ever take care of him again. The nurse on this wing I guess had not been informed of this and no one had told my instructor. I should mention that there is another group of students that has clinical at this site on Wed & Thu (I go Fri & Sat). Apparently a student took care of him on Wed and then the state surveyors came also on Wed and this pt informed the STATE SURVERYORS that he didn't want any student taking care of him.

So on Thu they didn't assign any student to him and then pt is asking, "Why don't I have a student? I want a student!"

This pt is confused but can seem like is not confused, which is probably how he appeared to the surveyors. If you had only talked with him once you would think he was not confused but he is. He does not remember telling the state that he didn't want a student. And I know he wouldn't have said that if he knew it meant I couldn't take care of him any more--he always asks for me!

When I talked with him this afternoon I asked if he wanted me to take care of him tomorrow and he said, "of course!" He told me he missed me today etc. But I have to admit he doesn't seem quite "himself" and was acting a little strange. I can't put my finger on it but something is not right.

But the CNA says that she is going to have the nurse talk to my teacher because no students should be assigned to him since he told the state that, and what if something should happen when a student was taking care of him? I agree with that, but if he can make a decision that he DOESN'T want any student taking care of him, can he not change his mind and make a decision that he DOES want me taking care of him? I am currently assigned to him and his roommate tomorrow (and 2 others), so if my teacher has to change my assignment he will see me in the room and be upset that I'm not taking care of him.

I'm sorry this is so long. I don't even really know what I am asking, I guess I just want to know if any of you have any words of wisdom or experience on a situation like this.

Thanks,

Angela

[nursegoodguy]

Sometimes it's all in the grammar... He probably told the surveyor, "I don't want any "other" students"... Well when survey comes in the LTC facilities Freak! It can be intimidating having big brother "literally" looking over your shoulder! I wouldn't ask the patient if he wanted me to take care of him... It might be that he really doesn't want anymore students... (it's not personal, they just get a little tired of all the changes sometimes) Best thing is to talk to your instructor and just trust they will make the best choices for you and the patient.

[lumbeelpn]

i agree with nursegoodguy on this, talk to the pt., but before provinding care get clarification. It may just be that he doesn"t want any student besides you, and being that we are creatures of habit, that my very well be the problem. I guess it is confusing and sometimes upsetting esp. the elderly that thy may have a different caregiver qd. WE work best with a routine. Being that if you have the same pt. each time at clinicals you learn their preferences, needs, and wants, and that makes it easier for the both of you. Put yourself in the pt. situation, having to tell the same things oveer and over because of different caegivers. And thanks to you for being a future nurse that cares.

[alwaysthere]

I agree w/Guiseppe, Your teachers have probably worked with this facility for a while and the facility staff has worked with this patient far longer than you. Im sure they are really trying to make the best decisions for both of you. :)

[Cascadians]

Ah yes, the patient who seems just fine, verbally, until one observes over a period of time that they aren't quite tracking or able to follow through physically with self-care. These people abound, and a person casually meeting them or talking with them over the phone would not know that there are any confusion tendencies in the patient. These patients are also easily swayed by whatever is happening at the moment.

Always document your observations of confusion, contrary, opposite, or inconsistent statements / desires, and memory lapses, and also verbally inform your charge nurses of these observations.

This protects you in these awkward situations -- and yes, they will continue to pop up throughout your career! The key is to realize that this problem is common, and exacerbated when others try to use it to get you in trouble, and that your best approach is to document, involve other professionals in understanding the patient, and remain kind and courteous to the patient despite their flip-flops.