Can you refuse to give care to a resident in LTC? - page 2

Hi there! I've recently refused to give care to a resident. His Dr. has said his behavior is not caused by any mental illness or brain disease, as he has visited with him multiple times due to his... Read More

  1. by   JKL33
    Quote from chacha82
    Speak to your charge or whoever about a "buddy system" when providing care for this patient. To do AM care or answer a call light, have another staff member in the room with you. Do the same for others when they are assigned to him. This way there is a witness to any verbal berating, and if he accuses you of anything, there is a witness. Patients like this become "everyone's patient," because the whole staff has to support each other when it comes to providing care. But it's the best and safest way. He is lashing out at anyone and everyone. Try not to take it personally.
    Absolutely excellent advice!
  2. by   Julius Seizure
    Quote from chacha82
    Speak to your charge or whoever about a "buddy system" when providing care for this patient. To do AM care or answer a call light, have another staff member in the room with you. Do the same for others when they are assigned to him. This way there is a witness to any verbal berating, and if he accuses you of anything, there is a witness. Patients like this become "everyone's patient," because the whole staff has to support each other when it comes to providing care. But it's the best and safest way. He is lashing out at anyone and everyone. Try not to take it personally.
    This is what I got from your initial post as well. It doesn't sound as though he is targeting you. He is targeting everybody. Perhaps a staff meeting could be called, and a plan for dealing with his behavior could be made - something like not acknowledging his verbal abuse, and setting firm boundaries that protect staff while also supplying this residents basic needs. The buddy system is a wonderful idea.
  3. by   purplegal
    In a way, you can "refuse" to care for a patient. By that I mean, you can choose not to care for this resident ONLY if someone else is willing to take over his care for you. There is nothing wrong with asking to switch patients or assignments, as I have done so myself. Sometimes, we just do not click well with certain patients for some reason. I remember for awhile, I was constantly asking to switch assignments with a patient, because every time I went in her room, she asked for so-and-so. Even though I had done nothing wrong, she simply preferred different nurses, and they appear to have been nurses that were more experienced. It just became easier to have that person take her if they were available. Not just easier for me, too--for my coworkers, who no longer had to go in and see her because she had asked for them even though she was assigned to me, and for the patient, who clearly preferred someone else. I also remember a time when a new admit's night was not going well, and I ended up asking another nurse to take over, because the working relationship between me, the patient and the family was not working at all.

    As for your situation, you say some of your coworkers get along better with him than you. I see no problem with asking them if they would like to take over in exchange for one of their patients. However, if they refuse, and you're assigned to the patient, you may have to put up with some behaviors and continuously document them and report them. I agree having a second person in there may help prevent any physical abuse room occurring. Hopefully, you will have coworkers who are willing to help you out with this difficult patient and one day, you may do the same for them.
  4. by   CoffeeRTC
    Never, ever go into this resident's room alone. There should always be a buddy system and if possible the nurse should be there too. Not easy in LTC. I've taken care of my share of residents with similar behaviors. As a nurse, I would document word for for word what the resident is saying. His behaviors need to be care planned and there needs to be limits set. Family should also be involved and the facility should contact the ombudsman.
  5. by   Cruella de ville
    Are the social workers, supervisors and DON available to be the buddy?
    I would recommend asking the charge nurse every time to assist you with this challenging patient.
    Can you work with the social worker to help develop some guidelines for this guy?
    It sounds like he asks for staff to do things he may be capable of doing himself, in addition to asking for help with things he actually needs help with.

    I have certainly seen residents like this and it took a lot of brainstorming and lots of support from upper management to finally give the nursing aids a break and the support they had been asking for.
  6. by   CNA2016:)
    I work evening shift so we get 3 aides for 28 residents and a nurse until 7pm. Once 7pm hits our float nurse comes and is giving meds to our 28 and then 28 upstairs. We have zero support in the evening. No float aide, no management available. As far as care planning for this resident....basically a few nurses and the SW got together with us one day and asked us how we could make it better so that he would not get upset. They told us to write down what we think care aides should do to avoid a blow up...............we have hardly a clue what to do about this and because it doesn't affect them frankly they don't care
  7. by   CNA2016:)
    Thank you that's what I'll have to do I guess. If anyone wants to switch I will...otherwise he's mine. And yes he's a 2P so no one ever really gets a break from him.
  8. by   CNA2016:)
    Yes he is targeting everyone. But I believe the reason he hates me so much is because I tell him not to swear at me or yell or i will leave the room. Not everyone does this. Most just take the abuse. This is very hard for me I feel like a piece of garbage when I allow him to act this way towards me without reason. However when I say I will leave that makes him even more angry. That is why i believe he doesn't like me...he remembers I don't allow him to abuse me. Am I doing something wrong? Should I allow him to abuse me on the hopeful chance he won't do it so often if I take it?
  9. by   CNA2016:)
    Thank you for the support and advice. And yes I believe because I don't allow him to freak out and swear at me...i tell him I will leave until he can speak respectfully or I won't tolerate whatever basically...that makes him even more mad. Because most aides take the abuse and say nothing and allow it but that is very hard for me to do and I feel it's not right. Should I take his abuse so he doesn't single me out as the one that stands up to him? I honestly believe he just doesn't like being told no or that he is behaving in an unacceptable way. Most aides are to timid to say anything and there's only a couple nurses who care enough to talk to him when he has a blow up. One nurse stood in the room silently while he blew up at me and when I said I was leaving if he was going to speak that way the nurse still stood there and said to the resident she wasn't sure what had just happened. Basically didn't defend me whatsoever.
  10. by   JKL33
    Quote from CNA2016:)
    One nurse stood in the room silently while he blew up at me and when I said I was leaving if he was going to speak that way the nurse still stood there and said to the resident she wasn't sure what had just happened. Basically didn't defend me whatsoever.
    Well. There's at least part of your problem! Others are maintaining their own comfort level by benefitting from a "good cop-bad cop" routine!!
  11. by   CNA2016:)
    Yes I completely agree. But no one will listen to me I'm just a care aide lol the doc and sw will listen mostly to the nurses so yeah it's just a ****** situation very stressful I'm already feeling stressed and don't even work for a few hours
  12. by   JKL33
    CNA2016 -

    I wrote this out then erased it, but since you have to work tonight and are already feeling the stress, can you try this? It's a process I myself have had to work through in my career:



    I have learned to work internally (within myself) towards neutrality. It works like this (self-talk): "This individual knows nothing about me and is not an important person in my life. He also is indiscriminating (meaning, if I weren't there to be the object of his hate, he'd find someone else). I do not derive my sense of self-worth from my care-giving relationship with this individual".

    This method empowers one to calmly maintain boundaries, to exist without the burden and malignancy of constantly "feeling" insult, and to continue providing excellent care to the extent that the individual allows. It will become second nature and you will learn to deal with all difficult individuals along these same lines, even in your personal life. It's very freeing because it frees one from burden.

    Meanwhile, when you go into his room, take a deep breath, remember the things above, HAVE YOUR BUDDY WITH YOU, and remain calm.

    "Hello Mr X, what can we do for you tonight?"

    ---yelling, rude language

    "We will return when you're ready for help, just put your call light on."

    [Both parties must leave].

    Try it tonight. Let us know how it goes.
  13. by   CNA2016:)
    Thank you for your response. Yes I've sadly tried this many times. as soon as I say I will leave until you can speak respectfully he rings immediately...we go back in and he just yells again. it's just an endless cycle. But yes I will try to separate myself from him but it's hard when he is directing his hatred towards me.

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