Charge nurse

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Specializes in Long term care.

A little background on my self. I graduated nursing school last July so I'm still a fairly new nurse. I struggle with being in the "charge" nurse position at times. I would like to know how you, as the charge nurse, would have handled this situation. An aide came to me to tell me a resident was on the floor at 0530. She's incontinent with dementia. I witnessed the resident laying in floor, no injuries were noted, but she had a brief on that was soaked, and her bed was brown ringed. I was upset to say the least. So I ask the cna when is the last time you checked this resident. She stated she changed her at 0400. I didn't believe this to be true. I told her she shouldn't have been brown ringed if she was changed an hour and a half ago and it most likely contributed to her fall, that this was a verbal warning and if I found another resident in that condition it would be a written warning and we would be in the don's office if I seen it again. Do you think I handled it okay? I was a cna for two years so I understand it's not an easy job, but I took care of my residents and I'm responsible for the care they get now as a lpn. Your input would be appreciated. Thanks for reading.

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Specializes in retired LTC.

I see an issue in that you may have not gone far enough? Your DON should be in on this disciplinary action. It probably should be at her level.

From what you've described about the situation, looks to me like this was NEGLECT on the CNA's part. And neglect can be viewed as RESIDENT ABUSE because this pt did fall.

Fortunately there were no injuries. Had she sustained some major aftereffect, it might have had to be reported to your State Dept of Health/Ombudsman office. As is, the fall gets calculated into the facility statistics that survey people like to review. And it should be reviewed in-house by your safety committee.

I'm guessing that you had to notify the family re the fall. Depending on how upset they could be, they could notify the State themselves and State would have to investigate.

This sounds like it was a bigger incident than just at face value. Like maybe this was a lazy CNA with previous issues. Let the DON handle it. You started the process fine. The DON might have opted for termination or suspension (and next step termination if another infraction happens).

Just IMHO.

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Hi there,

Using your nurse's intuition, I strongly feel you believe in your conclusion that there was neglect. I always urge professionals like you to appeal to your audience by using your heart and compassion. Maybe if you appeal to this CNA in a compassionate route as in " this could be your mother, how would you feel?" or maybe she was swamped or whatever and could not change the patient in a orderly time....either way relay to the aide that this isn't okay and if she needs help please speak up. If this happens again, then of course pursue disciplinary action. I always feel there is a different side of the story and once that road has been ran, that's when action is the only option.

Thank you for protecting our seniors and congrats on becoming a new nurse!

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So if the CNA checked the patient last at 0400, when was the last time you did walking rounds. I feel this jumping to a conclusion was very premature. I don't know if this is a CNA who has a trend with not checking patients but I really hope this conversation was not done in-front of the patient/resident while they were on the floor.. Even patients with dementia shouldn't be subjected to someone accusing another person of neglecting a patient. I have worked with my share of "lazy' PCA/CNA's but I think if you feel it was something that was neglect, then gathering all the evidence and reporting to your supervisor was more appropriate.

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Specializes in Med/Surg, Peds, Geriatrics, Home Health.
So if the CNA checked the patient last at 0400, when was the last time you did walking rounds. I feel this jumping to a conclusion was very premature. I don't know if this is a CNA who has a trend with not checking patients but I really hope this conversation was not done in-front of the patient/resident while they were on the floor.. Even patients with dementia shouldn't be subjected to someone accusing another person of neglecting a patient. I have worked with my share of "lazy' PCA/CNA's but I think if you feel it was something that was neglect, then gathering all the evidence and reporting to your supervisor was more appropriate.

What is happening in this comment? Are you seriously suggesting that this nurse should spend her time doing walking rounds during a shift checking all of her patients briefs to see if they have been changed recently? Do you have time for this on your shift? And how is that a premature conclusion to come to when she asked the CNA straight out what time she changed her last, she got an answer, but you and I both know from experience that there is no way a brown ring can form in that amount of time? She also did not state she spoke to the CNA about this in front of the patient. I guess I just don't understand why you are being so judgemental toward Nightowl_lpn.

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You handled this correctly, in my opinion. You gave a verbal warning, be sure that there's some documentation regarding the same as part of a progressive discipline process.

I would, however, have a little huddle at the begining of your next shift. State that you are SURE that each and every CNA knows how to do their job, and do it well. That you trust that they are turn/repo/peri care at least q2 hours. That they document when this is done. Then check now and again to see if this is being done. You could also suggest that team work is important, and that perhaps 2 CNA's could be taking the total cares.

You could also institute "night minder" sheets for your hall. A clipboard outside each resident's door that the CNA signs off on as he/she is leaving the room after peri care/turning. If you are finding that sheets are not completed, or completed and you check and the resident is soaked, then their will be a discipline process.

Good luck with this, and any and all CNA's who consistently do not do their jobs affect patient safety. This is what needs to be avoided. And if it means teaming the CNA's to be able to turn and repo/peri care in a safe manner, then I would see about starting it especially with the total cares.

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Personally as long as you took the cna aside for the reprimand I feel you handled it perfectly. I would however keep a watchful eye out for other possible short cuts being taken as it is a very common occurrence.

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Specializes in Long term care.

Thank you everyone for your feedback. I don't feel like school taught me how to be a charge nurse And I'm still struggling with it, but I care about my pt. tremendously and I know if they could take care of themselves they wouldn't be in a ltc facility in the first place. I don't have a problem being there advocate. I just don't know the best way to always handle situations. Above all I do want to alway be professional and fair.

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I've charged before in an LTC facility. From my experience the CNAs know their patients very well. They are aware of who needs changing and how often and who is likely to climb out of bed when wet rather than just continuing to sleep. I have been charge when a patient climbed out of bed and was found in a place in their room that surprised the hell out of me as to how they were able to get there. The patient also had dementia and was dirty. I didn't reprimand anyone, as for one, I knew the CNAs very well and know that they did not neglect patients, and two, I am ultimately responsible for what happened. I wouldn't say I was to blame, as this happens, and no one is able to give 24/7 constant care to any patient and ensure that said patient remains dry, clean, in a comfortable-looking position at all times. We can do our best to prevent such things from occurring, but that is all we can do--the best we can to the best of our abilities.

I think you handled it just fine. You know your CNAs. You know what they are up to during their shift. I don't. If you really feel that this patient ended up on the floor because of this CNA's neglect, then yeah, giving her a verbal warning was the best thing you could have done. If that is the case, just keep an eye on this CNA, follow her to ensure she is doing what she is meant to, offer to help so you wont come across as a police officer. You guys are a team, and it is your job as charge to maintain the teamwork mentality.

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What is happening in this comment? Are you seriously suggesting that this nurse should spend her time doing walking rounds during a shift checking all of her patients briefs to see if they have been changed recently? Do you have time for this on your shift? And how is that a premature conclusion to come to when she asked the CNA straight out what time she changed her last, she got an answer, but you and I both know from experience that there is no way a brown ring can form in that amount of time? She also did not state she spoke to the CNA about this in front of the patient. I guess I just don't understand why you are being so judgemental toward Nightowl_lpn.

Excuse me what is happening in your comment. First of Nightowl asked for opinions and I gave mine. IF you don't like mine then that's you. Yes I DO walking rounds on my patients because I make time in my shift to make sure I check on my patients because, as the nurse I am responsible for them. I don't believe I said 'do you do walking rounds and check every patients brief" that's something you just made up. My concern is, and this is why walking rounds are now always done, is to make sure patients aren't on the floor. Perhaps wherever you work they don't do that. To make a automatic assumption that this person is lying is PREMATURE.

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Specializes in Long term care.

Nurse84 I appreciate all feed back that you have given. I am curious as to what your conversation would have been like with the cna who was assigned to this said resident? I do walking rounds at the beginning and end of my shift. 7p to 7a. The wrest of time isn't only used on charting, assessments and tx, I check the residents under my care as needed for any changes, I do not however have the time to make rounds when the cnas do there bed checks. Is this what you do? Maybe your pt load is different then mine. I have 40 residents under my care with 2 cnas. 10 of which are skilled patients, the other 30 are ltc patients. I do appreciate constructive criticism and I posted this thread for that reason. I'm a young new nurse, the youngest employee on noc shift. I try to lead by example and I help answer lights and the residents with adls when I have the opportunity to do so.

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What is the time frame required for a "brown ring" to develop?

What kind of evidence would need to be collected before one can decide if this CNA is lying?

Does the fact that no one in this thread has any idea what Nightowl_lpn experienced during this shift other than a sentence or two in the OP and to make assumptions about her believing the CNA was lying is premature?

Has anyone ever known that someone was lying to them before without anything more than their own interpretation of said liar's delivery of said lie and without any actual evidence? Is it humanly possible to decipher such information from one post?

Was the OP's question, hey do you think this chick lied to me? Or was it more along the lines of, hey..how should I deal with this situation?

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