Audio Recordings and Patient Abuse

[MissSpectacular]

I need advice on what to think here. Before I start, I feel incredibly stupid for not realizing this ahead of time, and I need your opinions.

I work in a LTC center on a Medicare floor, so many of our patients are higher acuity. We have one particular patient, a young-ish woman for LTC, very bitter and angry (ex-gangmember, shot in the lower spine and paralyzed from the waist down), and extremely hostile to the female staff, particularly the aides. (verbally harrassing, kicking, spitting) The aides have complained multiple times to administration about this patient's behavior, and administration has done next to nothing regarding their complaints except tell them "it's part of the job".

One particular CNA was having a very difficult time with this resident and asked to be assigned to a different team because she felt she could no longer care for the patient. Administration told her if she did not take her assigned team, she would be written up for insubordination or something along those lines. Apparently, the aide entered the room, the abuse started up, and the aide snapped at the patient and told her if she didn't knock it off and be quiet, she would go to administration and let them "hear the tapes she had recorded" of the resident's verbal abuse.

She informed me, one of the other nurses and quite a few of the other CNAs what she had told this resident. This CNA is a particularly emotional person who spits out a lot of "hot air" and no one believed her that she actually was recording the patient. The patient, however, was extremely upset with what the aide had said, and several weeks later, filed a complaint with administration. When I was questioned as to whether the CNA had ever told me that she was recording conversations between the patient and herself, I told them the truth, yes, she had informed us of this in a heated vent-conversation, no one took her seriously. Administration then informed me that I had been an accomplice to abuse and I was written up for this.

Am I in any sort of legal trouble here? It was honestly a mistake....this CNA is very hot headed and spouts of things she doesn't mean quite frequently in her "vents" after her patients care. I blame administration for failing to hear their staff's frustration!

Help! Any advice is appreciated.

[caliotter3]

I had been working as a CNA at a place for a very long time before another CNA told me that a resident was secretly recording us when she constantly was on the call light and was nasty to us when we went to take care of her. She got me good one night and I told her I didn't care what she was recording, there were others to take care of, and I wasn't going to spend all night with her, etc. I immediately let the nurse know what had happened. Nobody cared one bit about the situation and nothing was ever done. If I were you, I would start looking for another job. You should not have been treated that way and you don't know what will happen down the road. Go elsewhere while you can.

[dorisc1981]

Find out through a delegate or the department of labor/human resources what can you do regarding this situation. The CNA had to do what she had to do and that was her choice. Recording of any kind is a no no but you are not an accomplice. It's best to resolve this issue and not stand for a blemish on your work profile. If it was me I will deal with an abusive patient in the future by writing incident report after incident report and then keeping my own log so I won't be pinned with why I didn't bring it up (administration) but a write up of any kind will not go on my file because of someone else's actions.

[oncrnpa]

TOS prohibit any genuinely helpful advice here outside the general phrase get a lawyer.

Despite how poorly the patient behavior is on a daily basis the CNA used a verbal threat on this patient and would also be in violation of HIPAA and possibly other laws if any recordings were actually made. If you were told this and did not report it you are also at fault. The question I would have for a lawyer would be does my professional reporting requirements change as this patient is not a child or elderly per your post and as such does not fall under the special protection categories, the key may lie in if the patient is there as a "ward of the state". Look into it with a professional and good luck!

[Emergency RN]

Under the TOS, we cannot give legal advice. However whether recording someone is legal or not, if one party is aware of act, may depend on the state or locality in which it occurs. Consult an attorney.

As for being an "accomplice" to abuse; it would be more a case of hearsay as you did not personally witness anyone being recorded (the alleged "abuse"). If you have a union, get them into action for your defense. If you don't, hire your own attorney. The institution obviously wants a pound of flesh and if your's happen to be convenient, it doesn't matter to them whether they're right or wrong, being fair or not.

Good luck.

[ktwlpn, LPN]

When dealing with a resident like this always have cna's give direct care in a team.We have 2 on our unit right now and for the staff's protection they never attend to either one of them alone.And document,document,document. Your post is not clear to me-did the cna actually record the resident? Or did the resident report her for threatening to do so? Her remarks towards this resident were verbally abusive. These residents do have the right to be as mean,nasty and spiteful as they can possibly and we are duty bound to find a way to safely provide care. Your cna's may need a little support. The art of giving "sterile attention" does not come naturally. It is really,really difficult. That's why giving care in pairs is so great-No one can tell a lie and the cna's can police each other. Your younger or more emotionally labile staff should be paired up with stronger,steadier staff. You need to address this in your team meetings with this residentYour social worker is your first line of defense-use her (or him ) to try to set some limits here. Physical abuse towards staff by someone whom is alert and oriented is NOT ok. Admin can't do anything until you exhaust all of your resources. THis cna's problem is that she can't control her own behaviors- why reward her with never assigning her to this difficult resident? That is NOT a trend you want to start because it won't stop with this particular resident and your staffing will be a nightmare and the rest of the staff will resent it and you'll end up with a mutiny. A psych consult is in order -no guarantee that the resident will be compliant but a anti -depressant and an anti -anxiety med would certainly be helpful. Maybe you could work with your admin and staff developement to learn how this could be better handled? You've been written up-we can't allow the staff to speak to the residents in this way.I understand that this resident is a handful but look at her life. So she was a gang banger-most of my residents are right were they are because they made poor choices.That cannot be a factor in their care plan and we have to educate and support the direct care staff to prevent things like this from happening. Bottom line-where else is she going to go? I work in the county "poor house" -100% medicare certified.Unless you have a pension there is no place else to go. This really is a great learning opportunity for you and your staff----go for it and good luck

[Not_A_Hat_Person, RN]

Is social work involved? Has the patient had a psych consult? Has the abuse been documented?

[MissSpectacular]

When dealing with a resident like this always have cna's give direct care in a team.We have 2 on our unit right now and for the staff's protection they never attend to either one of them alone.And document,document,document. Your post is not clear to me-did the cna actually record the resident? Or did the resident report her for threatening to do so? Her remarks towards this resident were verbally abusive. These residents do have the right to be as mean,nasty and spiteful as they can possibly and we are duty bound to find a way to safely provide care. Your cna's may need a little support. The art of giving "sterile attention" does not come naturally. It is really,really difficult. That's why giving care in pairs is so great-No one can tell a lie and the cna's can police each other. Your younger or more emotionally labile staff should be paired up with stronger,steadier staff. You need to address this in your team meetings with this residentYour social worker is your first line of defense-use her (or him ) to try to set some limits here. Physical abuse towards staff by someone whom is alert and oriented is NOT ok. Admin can't do anything until you exhaust all of your resources. THis cna's problem is that she can't control her own behaviors- why reward her with never assigning her to this difficult resident? That is NOT a trend you want to start because it won't stop with this particular resident and your staffing will be a nightmare and the rest of the staff will resent it and you'll end up with a mutiny. A psych consult is in order -no guarantee that the resident will be compliant but a anti -depressant and an anti -anxiety med would certainly be helpful. Maybe you could work with your admin and staff developement to learn how this could be better handled? You've been written up-we can't allow the staff to speak to the residents in this way.I understand that this resident is a handful but look at her life. So she was a gang banger-most of my residents are right were they are because they made poor choices.That cannot be a factor in their care plan and we have to educate and support the direct care staff to prevent things like this from happening. Bottom line-where else is she going to go? I work in the county "poor house" -100% medicare certified.Unless you have a pension there is no place else to go. This really is a great learning opportunity for you and your staff----go for it and good luck

I do not believe she actually recorded the resident, I believe she used "I'm recording everything" as a threat towards her to get her to stop harassing her. Later on, the resident took it upon herself to report her. I agree 100% with what you said: that it's unfair to remove a staff member from a hostile situation because the staff cannot control her actions, thus making the rest of the good staff have to take on the heavier patients, essentially rewarding the "bad" staff for their unprofessional behavior.

Management, however, was dead-set determined on firing this staff member, not only due to her altercation with this particular patient but because of her general attitude. This was the perfect opportunity to terminate her without a problem (the CNAs at our facility are unionized=more difficult to terminate). My administrator even told me that if the CNA hired a lawyer, she needed a paper trail to prove she punished all staff involved, which is why I was written up.

Augh, what a nasty situation.

[caliotter3]

If the administrator told you she was only writing you up to CHOA, then you should not feel so threatened, but I would still be wary at that job.

[ktwlpn, LPN]

ohhh-you are collateral damage....That's a tough situation to be in.In my experience in LTC there is almost always a unit or 2 where this type of intimidating verbally abusive behavior by cna's and sometimes nurses has become the culture.It 's hard to stop but it has to be done because these staff members almost always escalate their own behaviors into outright physical abuse and you end up with a unit of terrorized little old folks. Make sure you add your own written statement to your file and use this as a learning experience.We have to be always vigilant for this type of behavior from the aides and we can NEVER overlook it-no matter how un-popular it may make us...

[classicdame, MSN, EdD]

if asked, only give information on what you personally heard of witnessed. No opinions. And contact the health dept and OSHA about working in a hostile environment.

[RN1982]

I had a patient tell me he was recording me. Said he was gonna sue me, "blah blah blah"...I said sure, whatever, record me, it's not admissible in court anyhow. He was a drug addict, very hostile with staff, think he was also on police hold, meaning as soon as he was discharged, he would be arrested.