can CNAs refuse patient care?

smk1, LPN · Jun 28, 2005

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

ditto to this idea.

UM Review RN, ASN, RN · Jun 28, 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..

while it's true that any patient can present a danger to staff, if a patient is a well-known danger to all staff, that's a whole 'nother kettle of fish. it's this statement that makes me feel that this patient may need a change to her psych meds. psych med doses can be very individualized. i know patients who are on a number of them without causing the patient to be snowed, yet they do facilitate care without causing a danger to staff.

my point is that the cna is afraid of this patient and has told you so. your statement aboves proves that you agree that the resident is generally combative. forcing the staff to deal with this patient with is unfair. all it takes is one good kick and the cna loses her livelihood, and the patient may wind up injuring herself (can we read "lawsuit" here?). it's just not worth it.

this is the type of behavior that you, as a nurse, need to report to the doc. it is your role to evaluate the effect of the medications. if the patient is this combative, the medications are having too little effect. holding a patient down to do care is demeaning, dangerous, and with the proper medications, largely unnecessary.

but it seems that you've already made up your mind that the answer is to force this cna to work with this extremely combative patient. just because the other cnas will work with this patient does not mean that it's safe or that they're "better" cnas. it may very well be that she's the only cna who's thinking ahead to the inevitable day when someone gets hurt.

i hope you will thoughtfully consider these points.

CapeCodMermaid, RN · Jun 28, 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

holding someone down to do a treatment is abuse and i believe against the law. i'd call the doctor and family and document the entire episode. never would i hold someone down to do a treatment. if they were that combattive, i'd ship 'em out section 12.

kelkel · Jun 30, 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?

ativan anyone?

kelkel · Jun 30, 2005

Ativan anyone?

CNA's know it all because they feel they are with these patients everyday and know what they need. Sometimes, it's just a matter of finding the root of the problem, which means sitting there and letting them talk. However, my first thought would be making sure the agitation isn't due to pain, perhaps, ativan or Lorazepam. If that doesnt' fix it, perhaps it's chronic pain. However, I had a demented patient tell me this weekend over and over how one "caregiver" spit in her mouth and touched her. I kind of let it go, until she continually repeated it. However, again, I am a visiting nurse in a facility, and reported it to the charge nurse, who blew it off as dementia. This is really bothering me though.......what if????

allnurses Guide · Jun 30, 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

holding someone down to do a treatment is abuse and i believe against the law. i'd call the doctor and family and document the entire episode. never would i hold someone down to do a treatment. if they were that combattive, i'd ship 'em out section 12.

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i had the same reaction - you can't hold someone down to do a treatment.

cna's, rn's and lvn's have a right to work in a safe atmosphere.

speaking to a resident in a "forceful" voice is wrong and borders on abusive behavior too. if you spoke to my grandma like that, i'd be very upset.

i think angie's post is well thought out . . . . i don't pretend to know all the in's and out's of ltc but when i've taken a shift there occasionally i can see that there are many regulations protecting the residents and the people who work there.

education seems to be an issue too, as others have mentioned. inservices on how to treat demented people is a good idea.

steph

obeyacts2 · Jun 30, 2005

This patient is a workmans comp case waiting to happen. This pt is mismanaged as well; One the aides need some training on dealing wiith the demented, two the poor pt needs her meds changed or adjusted.

I do CNA work in home health and our agency would "fire" this pt/family in a heartbeat. I did have one pt that suddenly started getting combative (normally a sweetheart) and I had to report the change in behavior. I only got to stay out (and was willing to stay) because the agency had confirmed that this was a new behavior and that the docs were actively trying to deal witht he problem with meds.

LAURA

**RosesrReder, BSN, MSN, RN** · Jun 30, 2005

I don't see why not. If the aide feels that she is in danger or that she is being mistreated I don't see why not assign another aide or take turns. After all, it shouldn't matter is she is an aide, nurse or housekeeping. No one deserves to be treated badly

lovingtheunloved, ASN, RN · Jul 12, 2005

Man. I work on an Alzheimer's unit, in a facility tailored to "behavioral" problems, and I always thought getting at least a bi-weekly a$$ kicking came with the territory. Besides, it's good for the reflexes.

EasygoingRN · Jul 24, 2005

no! a cna is not allowed to refuse an assignment. this is insubordination. i recently had a cna try to refuse to keep a resident on her assignment because she didn't like her and the resident also didn't like the cna. i told her if she refused the assignment it would be considered insubordination - i would send her home and she was not to return to her job until the don was in touch with her regarding the situation. she was afraid that the resident would get her in trouble. i agreed to go into the room with her and observe the interaction while she washed the resident up. they now like each other and there is no problem.

if this resident is always combative, document for several days and then talk to the doctor about possible medications that can help with this. if the documentation is there, he/she will be more likely to respond to your request.

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?