can CNAs refuse patient care?

caroladybelle, BSN, RN · Jun 27, 2005

I don't know about legal, but it is inappropriate to assign a CNA to a patient that mistreats her. It is a bad scenario for both the CNA and the patient.

The CNA has a right not to be abused and it could endanger her safety to handle that patient.

But it does behoove you to find out why the patient acts that way. It may be something benign or a symptom of something more serious.

Antikigirl, ASN, RN · Jun 27, 2005

What that CNA did is called abandonment and it is the same for CNA's, LPN's and RN's! You can't dump a patient during your shift!

What needs to be done, if the CNA really doesn't want to be with this patient (which is proably best since it proably isn't good for the pt to be with her anyway) is for her to talk with the administration and be relieved of having to work with that patient in the future (which wouldn't happen in my facility...you take all patients you are assigned in a service area, or you are fired).

This instance should be written up and given to administration so it doesn't occur again.

I feel for any of us no matter our titles when you have a patient that is combative...and I totally understand, but sadly we have to do what we can during our shifts and then talk to administration to make a change. It is not fun, but a formal abandonment charge can be far worse sadly (normally doesn't happen...too much legal stuff to bother with).

NOw...how do I know this??? Oh man...I worke d in a hospital and after 9 mnths I was called into a managers office whom I didn't even know or had seen before in my life! She started yelling at me about missed days...which I corrected her saying not only have I never missed a day, but took on other's shifts to earn extra money! She was really screaming at me...So I said I was out of there after my shift...I didn't want to work there if I had to deal with this obnoxious woman!

Well...I worked my shift and gave my badge and keys to security and had them walk me out (just CYA there!). Found out a day later from another nurse there that they had drawn up 'abandonment' papers to give to the BON in case I left before end of shift!!! Good thing I stayed, but I stayed for my patients...not them!!!

If you dump a patient at any time during shift, it can happen! When you report in you accept the patients for your shift.

UM Review RN, ASN, RN · Jun 27, 2005

i have a patient who is combative when cna tries to give care to her. this cna told me that shes going to leave her in bed instead of getting her up because shes combative. i told her to get another aide to help her she made all kinds of excuses. i convinced her to get another aide to help her to get her up and she got up for dinner. after dinner, she said shes not going to put this patient back in bed because she is combative. she even threatened to go home if she have to put this patient in bed. so again, i told her to get another aide, she refused. so i went to her room, helped her to put her in bed. i had no problem putting her in bed, and we got the job done. so my question is.. do cnas have a right to refuse to take care of patient who are combative? what do you do in a situation like this?

i had one patient who took an immediate and intense dislike to me because she thought i fooled around with her husband. she dropped the hint in the main dining room when she pointed a fork at me, shook it, and told me loudly that i'd better never go near him again! :chuckle

never mind the fact that she was demented and her husband had been dead for 10 years when we took her in as a patient.

she would get quite combative if i tried to take care of her, right up to a few days before she died. i'd have to leave her up wheeling around the halls until my last patient, because she was quite strong--she grabbed my $350 pair of glasses and flung them across the room once, breaking them, scratched me, tried to bite and kick me, and would hurl insults at me or give me the evil eye from the moment i stepped on duty.

my position was that so much anger has to be unhealthy for a frail old lady. to keep the peace, i requested to switch patients with a different cna (because of course, other cnas had problems with patients who just loved me to pieces) and many times that would work. otherwise, i had to take my life in my hands and both of us would be miserable while i dressed and dodged her hands and feet, and then finally, tricked her into getting in bed.

so my advice would be to try to get another cna to care for that resident. it may be just an isolated incident as it was for me.

hollyster · Jun 27, 2005

I had one patient who took an immediate and intense dislike to me because she thought I fooled around with her husband. She dropped the hint in the main dining room when she pointed a fork at me, shook it, and told me loudly that I'd better NEVER go near him again! :chuckle
Never mind the fact that she was demented and her husband had been dead for 10 years when we took her in as a patient.
She would get quite combative if I tried to take care of her, right up to a few days before she died. I'd have to leave her up wheeling around the halls until my last patient, because she was quite strong--she grabbed my $350 pair of glasses and flung them across the room once, breaking them, scratched me, tried to bite and kick me, and would hurl insults at me or give me the evil eye from the moment I stepped on duty.
My position was that so much anger has to be unhealthy for a frail old lady.
To keep the peace, I requested to switch patients with a different CNA (because of course, other CNAs had problems with patients who just loved me to pieces) and many times that would work. Otherwise, I had to take my life in my hands and both of us would be miserable while I dressed and dodged her hands and feet, and then finally, tricked her into getting in bed.
So my advice would be to try to get another CNA to care for that resident. It may be just an isolated incident as it was for me.

I agree with Angie.

It is better for everyone involved to change the pt's caregiver. We had one pt bite a nurse and would not let go. The nurse had a deep wound and a huge bruise. No stitches, just had to go and get it cleaned out and be drug tested.

The pt was confused at times but had never been violent. Pt just took a instant dislike to the nurse.

smk1, LPN · Jun 27, 2005

everyone has the right to a safe work enviornment. If it is a personal isssue, then please just assign the cna who has the least difficulty with this patient. If she is otherwise a good reliable cna, then try to accomodate her on this otherwise she'll burn out and leave pretty quick. Also maybe an inservice on how to deal with combative, aggresive behaviors. Just because the reisdent didn't give you any problems putting him to bed doesn't mean the same is true for the CNA. I recently had to swtich halls and give a shower to a resident who took an instant dislike to another girl on the floor for no apparent reason. She was screaming and hitting and when I walked in the room she calmed down so we switched, rooms to keep the peace. If there is a way to fix the situation please fix it and don't get stuck on the "rules". This will only lower staff morale and end in high turnover. Just my opinion as a student and CNA.

Ms.RN · Jun 27, 2005

so my advice would be to try to get another cna to care for that resident. it may be just an isolated incident as it was for me.

no this incident wasnt an isolated incident. this resident is always combative to all cnas when they are taking care of her. she swings her hands and screams etc.. there are always patients who are like that in nursing home. always.. the trick is to know how to approach the patient and use different techniques and one is to get assistance from another cna. listen to this. "i am going to leave her in bed for dinner because she fights with me" does this make any sense at all? all this is an excuse to leave her in bed to make her job easier. when i helped her to put her back in bed, it took us only 5 minutes.

so let me put myself in her shoes. i had a patient who would kick, yell, swing her hands when i tried to do her treatment on her leg. it is impossible for me to do it by myself, becuase she is just kicking so hard. i had 2 people to hold her down while i did her treatment. if i was in this cnas shoes, can i say exactly the same and say " i'm not going to do her treatment because she fights too much?" :angryfire

UM Review RN, ASN, RN · Jun 27, 2005

so my advice would be to try to get another cna to care for that resident. it may be just an isolated incident as it was for me.

no this incident wasnt an isolated incident. this resident is always combative to all cnas when they are taking care of her. she swings her hands and screams etc.. there are always patients who are like that in nursing home. always.. the trick is to know how to approach the patient and use different techniques and one is to get assistance from another cna. listen to this. "i am going to leave her in bed for dinner because she fights with me" does this make any sense at all? all this is an excuse to leave her in bed to make her job easier. when i helped her to put her back in bed, it took us only 5 minutes.

so let me put myself in her shoes. i had a patient who would kick, yell, swing her hands when i tried to do her treatment on her leg. it is impossible for me to do it by myself, becuase she is just kicking so hard. i had 2 people to hold her down while i did her treatment. if i was in this cnas shoes, can i say exactly the same and say " i'm not going to do her treatment because she fights too much?" :angryfire

actually for a patient like that, i would have to, in all seriousness, recommend psych medications. and 2 cnas to do any personal care. jmo, take it or leave it.

CoffeeRTC, BSN, RN · Jun 27, 2005

no this incident wasnt an isolated incident. this resident is always combative to all cnas when they are taking care of her. she swings her hands and screams etc.. there are always patients who are like that in nursing home. always.. the trick is to know how to approach the patient and use different techniques and one is to get assistance from another cna. listen to this. "i am going to leave her in bed for dinner because she fights with me" does this make any sense at all? all this is an excuse to leave her in bed to make her job easier. when i helped her to put her back in bed, it took us only 5 minutes.
so let me put myself in her shoes. i had a patient who would kick, yell, swing her hands when i tried to do her treatment on her leg. it is impossible for me to do it by myself, becuase she is just kicking so hard. i had 2 people to hold her down while i did her treatment. if i was in this cnas shoes, can i say exactly the same and say " i'm not going to do her treatment because she fights too much?" :angryfire

actually for a patient like that, i would have to, in all seriousness, recommend psych medications. and 2 cnas to do any personal care. jmo, take it or leave it.

i totally understand. psych meds...hah...for some residents like this you would have to snow them...not an option. the 2 cna assist at all times works. also have the behavior management team (aka the assessment nurse) draw up a plan of care. approach and reapproach.

UM Review RN, ASN, RN · Jun 27, 2005

for some residents like this you would have to snow them.

Not necessarily. I've seen some of the newer psych meds work wonders on people who were horrible to work with otherwise. It's very common for a new med to cause a patient to appear "snowed" until the patient adjusts to it. It's usually just a matter of working with the patient until a good combination is found.

Ms.RN · Jun 27, 2005

this patient is already taking psych meds, from seroquel to ativan around the clock. she also has order for prn ativan for both p.o. and im injection. do you know what this cna sees as a solution of this problem? she think this patient need to increase dosage of her medication, not to get assistance from antoher cna !!! ha !! :angryfire

txspadequeenRN, BSN, RN · Jun 27, 2005

I am a Alzheimers and Dementia nurse and work many, many shifts on the Combative unit (hospice too). Obviously this is a demented patients and since one is aware of the diagnosed status, approach the patient calmly and slowly. Just because this patient is combative doesnt mean she does not need care. Your CNA needs some dementia training. I get the hell beat out of me everyday on our combative unit. I never know when Im going to have to duck from a flying chair or dodge a clinched fist coming my way. How is this patient approached? Is this patient on Alz or psych meds? Can we get a psych consult? The only reason the CNA needs to be moved is to go get dementia training unless it is a personal conflict. What if you started getting combative patients on a routine basis. By the time youget done the CNA wont have anyone to take care of. I would never assist her with less than two people maybe even three people. Maybe she needs some ativan before personal care. Maybe she just needs routine ativan. I have patients like this left and right. I used to have to give Ativan 1 mg IM just to give a lady a shower 3x weekly. You can use ativan gel and I always say "oh this is the newest beauty lotion from Este Lauder" . AHHH no problem . Point is the CNA needs to have some sort of training with combative patients and no she should not be allowed to refuse care for a resident. When my CNA's tell me this I give the patient a cool down time and then go back in about 10 min, by then they have forgotton and we try a different approach. I wish you luck