I believe this was neglect, ADON disagrees...what should I do?

[littleone25]

I am a CNA in a continuing care facility. We have both long-term and rehab residents. Recently, one of our long term residents had a nasty roll off her bed from near-chest height while with another aide...a second aide had been in the room, but had left to get some supplies. This resident was sent to the ED and was kept at the hospital for several days and came back to our facility with over 20 stitches in her face and a fractured leg, receiving hospice care. Myself and another aide that care for her on my shift (7p-7a) had told the charge nurse that her "good" leg was bending the wrong way at the knee. She did everything she could do to resolve the problem, but it was 2 more days before this resident even got an xray. It was found that her other leg was broken as well(obviously!) This is my first issue..being fully aware that legs arent supposed to bend that way, not one other nurse bothered to look at this resident, or even follow up with the MD for several days. Neither did administration. The family is threatening legal action regarding this incident, and I believe it should have been taken care of on monday at the latest (it was first discovered at 3am sunday) On to the next...I was listening to report to another aide about this resident, and when asked about her condition, the aide getting report was told, "I really have no idea how she is, Im not allowed in there." So we asked the other girls on shift who had been caring for her..everyone answered, "not me", myself included. Apparently, the 2 aides involved with her fall were banned from her room by the residents family, and the aide responsible for her that evening didnt tell anyone. So I went with another girl to check on her and we found her in bad shape...1130pm and she was still dressed in her day shirt, saturated with urine from the middle of her calves to the middle of her back(keep in mind that both legs are in stabilizers which are also saturated and cannot be removed long enough to clean and dry) due to a leaking foley. She had not been turned, changed or cared for since around 8pm. It took over an hour to clean her up, put new sheets on the bed, and assist the nurses with inserting a new catheter. The ADON called me back into work the following am to discuss it, and she says it was not neglect because it had only been 3 hours since someone had been in there. To me, that is assuming the previous aide had given care before she left at 7pm, which is assuming too much. Also, this resident had orders to be turned and checked every hour due to her condition...3 hrs minimum is way more than 1. I am disgusted by this, and it made me ashamed to be associated in any way with 90% of the people I work with..CNA's, nurses, and admin. alike. I am considering reporting this to the state, but Im not sure if it really constitutes neglect. Advice anyone?

[littleone25]

Thanks everyone...I thought about this all night and called to report first thing today. There were 3 CNAs that day allowed in her room, and I am one of them, so I suppose Im partly responsible, even though none of us were aware that 'her' aide couldnt care for her. Im not okay with taking the fall for this, but I would prefer that to the alternative...seeing it happen, and doing nothing, and potentially allowing something like this to ever happen again. your input is much appreciated!

[CherylRNBSN]

I have had (unfortunately) several broken bones. PAINFUL!

Cannot imagine any reason to go two days with obvious deformity (noted due to your good assessment skills) without X ray. NONE.

I agree. It is neglect, at the least.

The only question you have to ask yourself is...what if that were me, or my mother, or my grandmother? What would I want done?

And congrats to you, for seeking advice and being concerned. You sound like a smart little cookie. I would want YOU to take care of me. Listen to your small, still, inner voice. It will never steer you wrong.

Don't be afraid to defend the defenseless (and do it anonymously if needed, I know it's tough. But do it.)

[FORTHELOVEOF!!!!]

Why wouldn't the tech tell someone that they couldn't care for one of their patients, they need to go! I'm not one who likes to see people fired but I hate neglect more!

[canchaser, BSN, RN]

I, too, was a CNA... and had this happen to me and the LPN and another CNA. PT returning from hospital, we move her off the stretcher. ALL OF US walk out of the room leaving the bed in high position. Again, I say all of us. We heard a thud.She was confused and we found her on the floor at the foot of the bed with a gash above her eye,falling from stretcher height. Loaded her right back on the stretcher cause it hadnt even left the floor. A sad lesson to learn at 19, NEVER leave a bed up and NEVER leave the side rails down. I dont know if it were reported as neglect.

It was the nurse on duty to be aware that the family kicked the CNA off as caregiver, the nurse needed to make assignment changes and have one CNA switch for another CNA. You are not responsible if you did not know she had been removed from the case. You resolved the situation when you were aware.

[tigerlogic]

Advocate for your patient and look for a new job. If you are in contact with the family perhaps they would like to transfer their relative (and all the money she brings to the nursin home) somewhere else. The system is horribly broken find a way to sustain your wonderful good intentions as a health care provider. Do what will help you sleep best at night.

[sunflowerlamb]

I would report it for sure. I would also quit working there. I would never want to be associated with a facility that treats patients in the manner you have described.

[Cat_RN, ASN, BSN, RN]

I think management should have handled this better but I really think 'calling the state' is a bit drastic. Who made the assignment and why didn't the aide who couldn't take care of her SAY anything to her charge nurses? I feel she is very much responsible for this mishap as well. She needs to be dealt with regarding this situation.

[tyvin, BSN, RN]

Did you document in your CNA notes when you cleaned her and all the circumstances surrounding it? Or does the documentation show that care was done each hour. I know what goes on in those types of LTC places and you need to document to protect yourself first. If I were you I would check the documentation first before reporting anything. Be ready to be amazed at how good her care will look in the notes...especially in the nurses notes.

Why wasn't the leg caught when the lady was taken to the ER? It sounds like a typical understaffed, overworked LTC where most people don't give a rip and few care. Sorry to sound so cynical but I've seen it all and I mean all. Protect and fight for the ones you can. Thank you for cleaning her up.

BTW; this isn't about the aids, it's about the RN who was in charge...where was that person and why weren't they taking care of business?

[caliotter3]

Judging from what you stated in your post and how you feel about it, I would report it. I can see where she could have been missed for three hours, but knowing how things usually go down in LTC, it is most likely deliberate on the part of the CNA(s) who were responsible for her. The attitude of the ADON is also typical and disappointing. Yes, you should report it, but be aware there will probably be negative repercussions. Not like they can't figure out who would be doing the reporting.

[CoffeeRTC, BSN, RN]

As everyone already stated...that is neglect.

I'm surprised that the family wanted the resident to come back to the facilty after that fall. I'm surprised that the facility didn't make this resident more of a VIP type of resident too.

We have a few CNAs that some res/ families refuse. If that is the case, they normally remind the nurse that makes the assignments or the other CNAs that they can't take care of so and so and that person is traded for someone else.

If you feel like the ADON is brushing you off, go up the chain of command. It might be that the DON or ADM don't know. What the hospice nurse...let them know too.

[GLORIAmunchkin72]

The family definitely would have a case if you documented everything.

[RLHamby]

Being short handed is no excuse, anyone with common sense would know that the objective for that particular shift would focus on basic care (feeding, hydration, clean and dry and repositioned at LEAST every 2 hours). If you have followed your chain of command and they all want to turn a blind eye to the situation then I would report this to the state. Obviously there needs to be some outside intervention if the people who were hired to ensure that the resident's are properly cared for are failing to do so. Not reporting it makes you just as guilty as the staff who failed to care for this poor resident...if you aren't part of the solution then you are part of the problem. In addition to reporting this I would also be looking for a new job and wash my hands of that facility asap!