Ever "rip 'em a new one''?

  1. 0
    I'm a nursing student, one year into my ASN program. I have worked as a CNA in a local hospital for 2 yrs, and 3 months.

    Just browsing around these forums (and talking my sister who is an RN of 15 months), nurses get a lot of crap, from patients (pun intended), CNA's, other nurses, and doctors.

    Do you ever stick up for yourself? Obviously you can be assertive, but if you've been assertive before to no avail, have you been aggressive (yelled, aka ripped someone a new one)?

    Specifically i'm talking about coworkers more than patients. Assertive is probably the best you can do to a patient without being unprofessional.

    There are times when I (as a CNA) have been ripped a new one, and there are times when I have decided that in the future, similar situations will warrant ripping someone a new one.

    Example: I was doing clinical in a nursing home, my patient was your typical sad, contracted old man, only spoke spanish. He had multiple pressure ulcers and when you would turn him he would grimace in MUCH pain. The CNA working was didn't respect us as students (no big deal). There was a typical clinical conundrum, during our assessment we notice his extreme pain upon movement. At this time, the CNA comes in and tells us it's his shower day, I say okay and i'm going to try to get him pain meds. I go tell my instructor, we have to find the order, there is none. Last order was from over a month ago and is only tylenol. While this is going on, CNA goes back into pt room and starts getting him ready for shower, I enter room and tell CNA we're still working on getting pain meds, she goes on tangent about ''aint nobody got time fo dat, you students take too long'' etc. I directly said to her, "You're going to get this man out of bed without letting us give him pain med and despite his pain? She said yes. I asked again, she said yes. The CNA showers pt, she wheels him back into the room. She is extremely rough with him during transfer ( I won't go into detail due to length of my post already), patient is low in bed, CNA pulls him up in bed, ripping some of his necrotic Heel ulcers off, they start draining (scant), CNA dressed patient, rolling him from side to side (he's grimicing and making some noise- Grabbing the side rails), I actually cried at the bedside. CNA would lift the patient by his neck (while he's laying flat) to pull his shirt down, and then dropped his head from about 6 inches above matress.
    I told my instructor that I think this pt was abused.

    Long story short, if this was my patient and this woman was part of my nursing team, I would have ripped her a new one. Two reasons, A) for not caring about his pain, and B) being so rough with him.

    Do any of you do the same (when warranted)?
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  4. 1
    Well I don't think ripping someone a new one is the answer. When you do that, you just come across as the irrational angry one. And unfortunately, as the student, you are in their world. This is probably what they have been doing for a long time. So here comes this fresh faced student who tells them how to do their job. Don't get me wrong, you are absolutely right. Based on your description, the CNA was too rough with the patient, and he should have been medicated before being moved.
    What you could have done:
    1) Incident report for the damage to his pressure ulcers. I've worked in places where you have to write one up even if you leave a bruise while getting a patient up out of bed. If she gets upset, say it needs to be done. If anyone from the state comes in you have proof of how this happened, how you intervened, what will be done to prevent it happening again, etc.
    2)Get the patient's nurse to call the doctor and change orders for bath days at the very least. This happens frequently. IE 1 hour before bath, give x med by y route. Might not be feasible to give something before every transfer. From what you say, sounds like this person has to be turned every 1-2 hours. Can't go in there and give prns every hour. Well, you could, depending on the medication, but it wouldn't really make much sense. Perhaps pain management docs need to be involved in this patient's care, put him on longer acting meds, you know?
    3)As far as addressing the CNA directly...well, it's never ok to confront near a patient. If you need to speak to her, do so in private. Do so when you have calmed down. Anger, sadness, etc, make us irrational. We end up lashing out, insulting, and getting nothing productive accomplished. Stick to the facts. 'I realize that your work load is very heavy and that waiting for the patient to be medicated might put you far behind. Let's work together on this. If you can wait until we give him a prn and it kicks in, I will gladly help you bathe him. In the meantime, let's go clean up someone else.' Or try the whole sandwich technique. One thing you like about their work, what you are having a problem with, finish with something good. No accusations, just facts.

    But to answer your question, I don't think I have ever 'gone off' on a colleague. When I sense things getting out of hand, I walk away. Or just shut off the conversation. Or tell the NM to deal with it. Anything that is severe enough for me to lose it is something the NM needs to be aware of anyways. I think our jobs are stressful enough as it is without the added tension going off on a colleague would create.
    twinmommy+2 likes this.
  5. 0
    Your story made me sad. I don't think people with such little compassion (like that CNA) should be in healthcare. It happens daily but it doesn't make it right. I'd suggest reporting it to your clinical instructor although honestly nothing will probably be done. Clinical sites don't need to be lost and creating chaos will risk it.

    When you graduate and get a job you can advocate for your patients and it sounds like you will.

    ~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~
  6. 1
    Quote from blackvans1234
    I'm a nursing student, one year into my ASN program. I have worked as a CNA in a local hospital for 2 yrs, and 3 months.

    Just browsing around these forums (and talking my sister who is an RN of 15 months), nurses get a lot of crap, from patients (pun intended), CNA's, other nurses, and doctors.

    Do you ever stick up for yourself? Obviously you can be assertive, but if you've been assertive before to no avail, have you been aggressive (yelled, aka ripped someone a new one)?

    Specifically i'm talking about coworkers more than patients. Assertive is probably the best you can do to a patient without being unprofessional.

    There are times when I (as a CNA) have been ripped a new one, and there are times when I have decided that in the future, similar situations will warrant ripping someone a new one.

    Example: I was doing clinical in a nursing home, my patient was your typical sad, contracted old man, only spoke spanish. He had multiple pressure ulcers and when you would turn him he would grimace in MUCH pain. The CNA working was didn't respect us as students (no big deal). There was a typical clinical conundrum, during our assessment we notice his extreme pain upon movement. At this time, the CNA comes in and tells us it's his shower day, I say okay and i'm going to try to get him pain meds. I go tell my instructor, we have to find the order, there is none. Last order was from over a month ago and is only tylenol. While this is going on, CNA goes back into pt room and starts getting him ready for shower, I enter room and tell CNA we're still working on getting pain meds, she goes on tangent about ''aint nobody got time fo dat, you students take too long'' etc. I directly said to her, "You're going to get this man out of bed without letting us give him pain med and despite his pain? She said yes. I asked again, she said yes. The CNA showers pt, she wheels him back into the room. She is extremely rough with him during transfer ( I won't go into detail due to length of my post already), patient is low in bed, CNA pulls him up in bed, ripping some of his necrotic Heel ulcers off, they start draining (scant), CNA dressed patient, rolling him from side to side (he's grimicing and making some noise- Grabbing the side rails), I actually cried at the bedside. CNA would lift the patient by his neck (while he's laying flat) to pull his shirt down, and then dropped his head from about 6 inches above matress.
    I told my instructor that I think this pt was abused.

    Long story short, if this was my patient and this woman was part of my nursing team, I would have ripped her a new one. Two reasons, A) for not caring about his pain, and B) being so rough with him.

    Do any of you do the same (when warranted)?
    I think "ripping someone a new one" is unprofessional. Do you want to be feared or do you want to be respected? In the situation you described, instead of standing there watching the aide manhandle the pt, why didn't you immediately go for your clinical instructor, report it and ask what you should do?
    Rose_Queen likes this.
  7. 1
    Ripping someone a new one is never appropriate, highly unprofessional, and entirely subjective.
    First, I would report directly to your clinical supervisor as to what you saw. Let her take it from there as far as interiorly.
    There are ombudsmen for every nursing home. 800 numbers are posted, it can be confidential. Their job is to speak for patients who can not.
    There are also a state agency who license the nursing home. I would report this. How you describe the patient to be is neglectful, heartbreaking and inhumane. That the CNA handled him in such a poor manner even more so. But a contracted, decubitis covered patient goes beyond disturbing. Report it.
    Rose_Queen likes this.
  8. 0
    I would find out who the ombudsman is for the nursing home and tell them-they are the ones that advocate for NH residents.
  9. 0
    Mmmmmm...yup (hand raises in air guiltily)! Unprofessional behavior from an intern related to patient safety AND because I am NOT his mother or maid! Both the intern AND attending physician heard it from me! Intern's Behavior got corrected STAT! I am typically very nice to the interns and I don't EVER do that, but I made an exception with this particular time. I don't recommend it though.
  10. 0
    Well, I would have to say that "ripping a new one" would be tempting in this case and it would take every fiber of my being to maintain my cool.
    However, you need to let a cooler head prevail. Let her act the fool, which will lend a sharp contrast to your behavior and make your position stronger.
    Nobody listens to a fool.
    If I had seen the aide treating a resident like that, I would have pulled that aide away from the bedside and had a discussion. I certainly would not have just watched this happen and I could only imagine you were in shock at the deplorable treatment you were witnessing. Next time, I'm sure you will intervene.
    But... as a student, you are limited and you will not be viewed as any sort of authority. That aide isn't going to listen to you, I'm sure.
    Letting loose on anyone is a poor approach, but as a student, it could actually drive a few nails in your coffin. You are constantly being scrutinized for professionalism and self-control... because you must possess these abilities.
    My heart aches for this poor man. If this is how the aide treats him (and others) with witnesses present, God help us all when she is alone with no one watching.
    Report report report!
    Can you come back and tell us what all was done about this and what, if anything, happened?
    But, I will tell you what... if I did happen to see a nurse pop off on a aide in this scenario, I must admit... I would not blame her one bit.
    That aide is wicked.


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