CNA's are supposed to use unsafe lift!!

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One of the residents on my assignment is a sweet man but INCREDIBLY DIFFICULT to work with. He weighs 225 lbs, is 6'2, and has advanced Alzheimer's. He is extremely good with me, which means he's completely rigid and dead weight to move (instead of being combative as he is with most CNA's.) Officially, the policy at our LTC is that we're supposed to always have two people on any lift. Unofficially, we all do lifts solo all the time because we are understaffed. He was using a sit to stand lift and is very difficult to do alone that way, but at least possible.

Lo and behold I came back from the weekend to find out that the DON had written a note on his chart saying that all transfers were now supposed to be with a Hoyer lift. So not only do I supposedly have to get him on and off with the Hoyer, he also has to be turned from side to side now. I'm very strong, but... This is literally, physically NOT POSSIBLE for one person to do by themselves unless they're Mr. Universe. If I try, he will roll off of the bed and onto the floor. It is difficult for *two* people to do-- one can NOT!!! do it. The charge nurse told me privately that if I can't find someone else to help me, then I can use the sit to stand lift. The thing is that it won't be enough to just have someone to spot me, the way it is with other people who have the Hoyer lift used on them-- I'd have to have someone with me the entire time I'm turning him, getting him dressed, etc. This is IMPOSSIBLE at this understaffed facility. So the basic reality is that I will usually have to use the old lift.

I just feel really uncomfortable with this even though the charge nurse told me I could do it. The official statement from the DON is that I'm supposed to be using the Hoyer, but there is no possible way in this world unless they hire more people. I'll do it whenever I can, but most of the time, it will be totally impossible. The resident's condition hasn't changed, he's doing the same physically as he was before, and he doesn't like the Hoyer at all, so nobody seems to know why the order was changed in the first place. I know that the person who has him on the other rotation sure isn't using the Hoyer lift. But what if the DON somehow walked in (very unlikely)? It just seems really unfair that the CNA's should be put in this position. I don't know... what does everybody else think?

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Specializes in Peds OR as RN, Peds ENT as NP.

There are times when I question why patients are put on certain lifts. However, do not take shortcuts when it comes to patients being put on lifts like the Hoyer. You never know when someone might walk in when you are doing the wrong thing. Also, I completely understand the understaffed thing. Never do more than you can though. If need help, go get it.

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The bottom line is, the nurse herself told you that you can use the sit to stand lift. If the nurse says for you to do it, then if something happens let the DON know that you were instructed by so and so nurse to use the old method. That way it should be out of you hands.

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Specializes in LTC, assisted living, med-surg, psych.

I beg to differ with the above.

I've been a resident care manager, a DON, and now I'm back to being just a plain charge nurse (by choice), and I'm here to tell you: DO NOT go against the written care plan, no matter if the floor nurse tells you it's okay. Those documents aren't written just for fun; and while you may not know all the reasons why the care manager has put certain precautions in place, they carry the force of law and the facility will be cited if the care given is found to be out of compliance with residents' individual plans.

You may also find yourself on the wrong end of a lawsuit yourself if something goes sideways during a transfer and you're not doing it properly. A few months ago, a CNA where I work used a sit-to-stand to transfer a resident who is a Vander lift; in the process the woman's left foot slid under the sit-to-stand and scraped two of her toes. The wound became infected, leading to the amputation of one toe........and now it looks like she's going to lose the entire foot, since she is diabetic and has poor circulation to boot.

Needless to say, the family is up in arms and threatening a lawsuit, plus a complaint has been filed against the facility with the state, resulting in all involved staff being pulled in to answer questions. All of which is going to be enormously costly in the end.......and all because a CNA figured she knew better than the RCM or the DON how to transfer a resident.

If you have an issue or a disagreement with a resident's care plan, don't take matters into your own hands---talk to his/her RCM, the DON, or the administrator. Even I, as a charge nurse, would never assume the authority to upgrade a resident's transfer status without running it by the unit manager first. (I do have the ability to downgrade transfer status in the interest of safety, for example I can change a resident from stand-pivot to sit-to-stand or a Vander lift if his/her condition demands it.)

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There is no help to be had. This is not a situation where I need help for 2 minutes to spot me on a lift. I need help for the full amount of time it takes to get this person up because he cannot be rolled from side to side by one person unless they are basically able to benchpress 225 lbs. There is nobody available for this amount of time in this severely understaffed situation. I hate being put in this position because it is unsafe for everyone involved.

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Specializes in Pediatrics, Geriatrics, LTC.

Call the ombudsman this is illegal and totally unsafe! We are understaffed as well and 225 is one of our lighter pts! Yes really! Good luck this is a bad situation

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Specializes in CV Surgical, ICU.

But sadly, the bottom line is, the help needs to just be found.. Perhaps you could pair up with another aide to take care of their resident as well as yours?

It's a sad situation that there never seems to be enough help, but.. A stand-lift transfer can go terribly wrong, very easily.. Especially with a resident who has been known to be combative. Even if they are good with you, who is to say that one day they just get irked for no reason (with advanced alzheimers this can be very probable) This is most likely the reason they made him a hoyer. This happened to me once with a confused man who tried to walk off of the standlift in the midst of a transfer. The leg strap was on and all the proper devices, and they were working but even with that he began to shimmy his leg out from the back and started slipping out, and letting go of the handles. We almost lost him, and he was then reevaluated. I tell you it scared the daylights out of me. I mean this guy could start swinging and even just tip the lift over with his weight and height alone!

The point is.. a stand-lift is meant for someone who can consistently follow directions and has the strength to bear at least some weight. It doesn't sound like this guy met the usual criteria for a stand lift.

And you really shouldn't go against the care plan and policy using the stand-lifts/hoyers by yourself. It's truly unsafe and I know it's not your intention but you really could severely hurt someone. It sounds like you really care for this guy. And you really don't want that on your conscience.

I'm positive this guy must be a total dependent of 2 for his bed mobility according to the careplan. You have to follow that care plan. Just demand help. Call nurses if you have to. If you don't get anywhere, call the supervisor, just call anyone. Bottom line is, your friend has to be cared for properly and while the staffing isn't your fault at all, make it your mission to do things the right way for his sake, and yours :)

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Specializes in LTC.

So the problem is not his weight, but the fact that he stiffens up, braces himself against the side rails, and is combative? How do you turn him for repositioning? We have a combative resident about the same weight and I can turn her myself if I put 2 drawsheets on the bed (one for her upper body and one for her lower body). I throw a bunched-up blanket over her arms right before I turn her, so by the time she gets her arms out from under the blanket to hit/scratch me I'm already done putting the pillow or lift pad under that side.

Then we have another resident who's lighter but she stiffens up and braces against the side rails, and she hits hard. It's hard even with 2 people to get her done so we talked to the higher-ups about it. Bug them enough and they might change this person's medication to make them less combative, or improve the staffing. If you don't tell them, they can go on pretending not to know how bad things are. In my case, they actually improved the staffing. If this man continues to hit people then write it up. The facility has no excuse for not doing something about it when there are several incident reports on file. And if care is not getting done you need to document that as well so you don't get in trouble for "not doing your job" when he ends up with a bedsore or contracture.

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This resident is completely stiff all of the time (I think maybe it's part of the advanced Alzheimer's?) That never changes. He's never combative with me but has been to some degree with others (and I think they've put him on Ativan fairly recently to lessen that, actually). (Just for an example, I have a 300 lb lady who uses a Hoyer lift, and I have to turn her by myself, but she's no problem even though she really can't move much at all. She is flexible and she can also grab onto the side rails.) At this facility, we have to get everyone up every day, for the entire day, so the day shift (that would be me) doesn't really do the repositioning.

I guess I have to TRY turning him by myself tomorrow, because I know we won't have enough help for that; if I have all 4 bedrails up at least he won't roll off onto the floor! If I absolutely can't do it, then that's that. But I'm very strong (no problems with the 300 lb lady!) I will NOT try to put him on that Hoyer lift by myself though because that's just asking for trouble. Wish me luck... ;) And any suggestions, please post them!!

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ETA: The main thing I have to do is to dress and change him while turning him, and also get him on the Hoyer sling. It isn't just turning him to repostion him-- I don't think that would be so difficult.

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This sounds like a tough situation :( I have a few rather large folks right now too.

I'm a little confused though. How were you getting him dressed before, with the sit-stand lift? Any time I've had to use that one, I still need to roll the resident to get their clothes on, pants pulled up, etc. So I'm a little unclear on the difference with the hoyer.

I have one large man who is a hoyer lift. He can (when he wants and if he likes you) hold the rails and help turn but doesn't always. I've figured out how to get his shirt and pants on and lay the hoyer sling ready next to him so that in the first roll, I get pants up and shirt down and the sling under that side of his body. I have to go around the bed for the second roll, which gets pants and shirt straight and the sling under the rest of him. It's way easier to do this way than roll for clothes, THEN roll again for the sling.

I TOTALLY understand the staff issue. I don't have any good thoughts for you there but agree with the rest, DON"T put yourself in the position to go against policy. Everything will be fine and dandy... as long as nothing goes wrong. Admin is well aware of the see nothing/hear nothing method... until something DOES go wrong. And you can bet they won't be standing behind you saying, oh we (nurse so and so) said it was ok she did that. No, it will be YOU were breaking policy and that's that.

This happened at my facility and they walked the girl out the door. We don't want to see you be that girl!

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Specializes in LTC.

I actually don't really know what a sit-to-stand lift is. My facility doesn't have one. But maybe it's harder to get a hoyer pad under them or something.

What kind of clothes does this guy have? I know that dressing some people can be really hard depending on their clothes. Does your facility have a communal clothing bin that you can borrow from? Ours has a bunch of clothes that snap up the back and they're much easier to dress difficult people in.

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