can CNAs refuse patient care?

txspadequeenRN, BSN, RN · Jun 27, 2005

ok, now what is the dosage of the seroquel and ativan.

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

if at one point she was not combative on these meds and now she is , she may need a med change. but, the cna still needs to have another cna with her to assist. have you ever watched her give care to this resident? perhaps, when she didnt know you were watching.

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

have they tried her on zyprexa , maybe the zydis form.

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

Marie_LPN, RN, LPN, RN · Jun 27, 2005

I've been on both sides of the fence.

A second person is not the solution to a repeatedly combative pt./rt. Rt. can see this as a gang-up threat, possibly making them even more combative.

While i consider the resfusal as abandoment, i do not think it's reasonable to send people to a rt. to get the crap beat/kicked out of them, and not get something ELSE done about it. Meds may not be the solution, but neither is sending in the staff to do her care, and seeing an extra person as the solution, when in fact it could be aggravating the problem.

Something else needs done before someone really gets hurt.

chadash · Jun 27, 2005

i had a patient who had liked young boys, and that hit close to home with a family situation. I would have to go to his home alone, and he was really strange with me (he really took to me, if you know what I mean....go figure, I'm a girl)....I never had asked to be reassigned before, and when I did it was the beginning of the end of my job.

I still feel guilty. I never would abandon anyone, I just asked to have a replacement.

caroladybelle, BSN, RN · Jun 27, 2005

I've been on both sides of the fence.
A second person is not the solution to a repeatedly combative pt./rt. Rt. can see this as a gang-up threat, possibly making them even more combative.
While i consider the resfusal as abandoment, i do not think it's reasonable to send people to a rt. to get the crap beat/kicked out of them, and not get something ELSE done about it. Meds may not be the solution, but neither is sending in the staff to do her care, and seeing an extra person as the solution, when in fact it could be aggravating the problem.
Something else needs done before someone really gets hurt.

I agree.

The fact is, if this CNA gets hurt - bitten/scratched (infections can occur), beaten - they may sue the facility. Every person has a legal right to safety in the workplace. There are expensive repercussions to ignore to situation.

The MD/shrink needs to brought in to consult.

Are there people that are "always" - yes, but some sort of accommodation has to made for the safety of staff.

In addition, I have had coworkers/CNAs (very passive-aggressive sorts) that, after continual assignments with combative patients, found ways "becoming" injuried so that they did not have to care for them and would get workers' comp. That can be expensive for the facility, also.

Keely-FutureRN · Jun 27, 2005

I had a confused patient I was sitting for grab my stethoscope from around my neck, cross and pull the ends apart, trying to strangle me. (He was angry and wanted to leave the hospital, many pain meds, etc.) I called for some more help and eventually we got him under control. I was a little shook up so at 2300 they switched assignments for me to be on the floor and a male cna was asked to sit. You just have to get more help, approach in a non-over powering or judgemental way, and help them. It's not fair to them to just ignore them because of their attitude. (even though it can be hard to deal with) :)

Keely

blueeyedgoose · 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?

as a previous cna the answer to your question is " yes & no." if an alert patient gets upset by the presence of a certain aide or even a certain nurse i would chart this info and pull the aide out and excuse myself from having access with the patient. but if i understand what it is your asking i personally would have chewed this aides butt out for making a big issue out of nothing. the solution to this aides problem was exactly as you handled it...ask another aide to assist with the transfer.

debbie,ma

chadash · Jun 28, 2005

Bear with me, this may be strangely related:

Oddest day. Simply wanted to retain my certification as a nursing assistant, and got such a run a round, had to ask myself: "what was that all about?"

Worked for a home health agency for 10 months during my 2 year certification period but I have been working private duty since January. Our state law says you need to work under the supervision of a RN for at least 8 hours, and "Walla!" you get to be certified for 2 more years. I though I had that more than covered. Well, I get my form back in the mail, with a postem on it from a RN who I worked with, (and just loved), saying it had been a few months since she worked with me and she did not feel comfortable filling out my form. (Don't think I was supposed to see the postem.) I then emailed the company, and got back an email saying the problem was I needed to have it filled out by a RN I worked with (I had worked with her, a bunch!). Then I called the office and the supervisor said that the RN was unwilling because I had let my certification lag since April. (My understanding was, as long as I verified I had worked during the two year certification period, they would re-up me.) Well that was three explanations but no willingness to fill it out for me.

I don't think nurses understand how important that little piece of paper is to the little people. It means a job, or no job. I have been doing this for 10 years and "it's always something!"

Finally, the supervisor directed me to HR, and the HR person said "what's the big deal, they just need to verify your employment."

But if the RN is unwilling to sign it, I am out of luck...

You guys are nurses: why would someone not want to sign a certification renewal?

Not angry, just sort of hurt my feelings.

blueeyedgoose · Jun 28, 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

lol...tell her she is practicing medicine without a license!

Ms.RN · Jun 28, 2005

ok, now what is the dosage of the seroquel and ativan.

she is taking 100mg of seroquel, ativan atc two times per shift. plus, we can give her ativan either po or im as needed.

i watched her taking care of this patient. no wonder this patient is combative. she took her shirt off without telling her first what shes going to do. she need to be explained in a firm voice step by step what she is going to do before actually doing it. when i tried this, patient was more complient and less combative.

Marie_LPN, RN, LPN, RN · Jun 28, 2005

Perhaps an inservice is needed, for nurses and CNAs on communication.