Charge nurse

[Nightowl_lpn]

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.

[Nurse-84]

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.

Nightowl- Thank you for replying back. I actually wasn't aiming my walking rounds question on you. That statement was to the nurse who said " do you really have time to check all the patients briefs' or whatever she said. I have done nursing home and hospital and we have a system in place to split the patients between the nurses and CNAs so everyone is hourly checked, with priority to patients who are at most risk checked more often. My initial post wasn't meant to offend and accuse you of anything, I just read it and imagined the scenario in my head.

If I would have walked into a room I would have of course which I'm sure you did attended to the patient, called supervisor to come assess the patient for injuries and such, and then pulled the CNA in the back with another nurse or supervisor and sit them down and go over how this incident happened. Like I said gathered some evidence with them to see if in fact the patient was checked or not. I honestly can say I have checked a patient and 10 mins later they are soiled and when I reported to the next nurse that we just changed the patient, it looks like we did not. I have my issues with my PCAs AND I know their patterns so its always clear when someone isn't doing their job. But if I thought they weren't doing their job and neglecting a patient its always best to pull the supervising nurse or another nurse for a witness to sit down and talk and if this person is clearly lying then they need to be sent home.

[malestunurse]

Are CNAs able to take responsibility for patients? Don't CNAs work under the license of a nurse? Shouldn't it have been the responsibility of the nurse caring for that patient not the CNA that should have of taken the wrap?

[klone, MSN, RN]

Nobody works under someone else's license. If she delegated appropriately, then no, she would not have "taken the wrap ".

[Glycerine82, LPN]

It really depends on the aide, and if you feel she/he truly neglected the patient or if they were just so crazy busy they just didn't get to it. Either way, there is no reason to lie, especially when they've been caught. Is it possible the brief was changed but the pad was not? No doubt the fall was caused by the resident needing to void. I always put my patients on the commode or toilet if I am able to get them there. Many times they will completley empty their bladder once their seated. I hate the word "incontinent". To me, it just means "will pee in breif if you don't take them to the bathroom". That's a whole other topic, though.

If you know that the CNA in question totally let her patient sit there in her own pee for hours, I say you were not hard enough on her. If the CNA was running like a mad woman I'd tend to agree with what you did. It CAN be so hard to keep up with several patients, its not hard to let time slip by and realize someone hasn't been checked recently.