Dealing with quadras

brillohead, ADN, RN · Nov 13, 2018

This is something you have to take up with your supervisor.

You're not going to lose your CNA license because you left a resident who wants someone to scratch his nose, but you have to find out what your facility allows you to say.

If allowed, I would try to set some boundaries. "I am doing my rounds, and I have five minutes to spend in your room before I go to the next patient. Please decide how you would like those minutes spent. Anything I don't get finished on this round can be addressed on my next round." You can even get a timer from the dollar store to keep in your pocket... set it for four minutes and thirty seconds, and when it goes off say, "I have 30 more seconds, do you need anything else that I can do in that time period?"

People who have almost no control in their lives will latch on to what little they can control. Setting limits and letting them choose within the parameters that are available is usually the best you can do. With a toddler, you don't let them choose from every outfit in their closet -- you set out 2-3 outfits and say, "These are your choices for today's clothes. You choose which you want." Same with demanding residents (quads or not).

If they're not going to pay triple the going rate for monthly care, then they don't get triple the time, plain and simple.

And thank you for your service. My son is currently in the Army.

Beldar_the_Cenobite, CNA · Nov 13, 2018

This is something you have to take up with your supervisor.
You're not going to lose your CNA license because you left a resident who wants someone to scratch his nose, but you have to find out what your facility allows you to say.
If allowed, I would try to set some boundaries. "I am doing my rounds, and I have five minutes to spend in your room before I go to the next patient. Please decide how you would like those minutes spent. Anything I don't get finished on this round can be addressed on my next round." You can even get a timer from the dollar store to keep in your pocket... set it for four minutes and thirty seconds, and when it goes off say, "I have 30 more seconds, do you need anything else that I can do in that time period?"
People who have almost no control in their lives will latch on to what little they can control. Setting limits and letting them choose within the parameters that are available is usually the best you can do. With a toddler, you don't let them choose from every outfit in their closet -- you set out 2-3 outfits and say, "These are your choices for today's clothes. You choose which you want." Same with demanding residents (quads or not).
If they're not going to pay triple the going rate for monthly care, then they don't get triple the time, plain and simple.
And thank you for your service. My son is currently in the Army.

Awesome advice. The management at my facility are kind of dimwittish. You ask them for a follow up on a TB shot they give you as you come on board and they tell you to keep coming back to them every 3-4 days. I eventually found out that after the first shot, you wait 7 days then come back to see if there was a reaction for the step two. They all seem to just forget about what they're doing and move on to other things. Pretty sad. In a way, if I do get to keep my housing assistance, I'll be glad to leave the facility, but on the other hand, I know the residents very well there for my runs and I like a lot of the people there so it'll be hard to leave.

And thank you! It's been hard since I've been out. I've been wanting to go back to school and earn a degree to where maybe I could re-enlist as maybe an officer or something. I've gotten no cooperation from my family over that and I'm starting to wonder if I should continue on with becoming a nurse because the whole getting into school thing is taking a toll on my patience.

brillohead, ADN, RN · Nov 13, 2018

Actually, after the first TB injection, you have to get it rechecked within 48-72 hours.... after that, it's useless.

But back to your original problem, I hope my comments help. It's really all about setting limits and STICKING TO YOUR GUNS. If you let them run you ragged, they will.

I think a lot of the time, they're worried / afraid that they won't see anyone for hours and hours, so they try to hold onto you as long as possible. If you can explain to them that you will be in their room every two hours at a minimum, and that you'll stick your head in the door in between then as often as possible, and then you follow through with your promise, you will hopefully see positive results.

Daisy4RN · Nov 13, 2018

Good advice from brillohead. To that I would just add that it may be helpful to have a meeting with Charge Nurse and other CNA's so everyone is on the same page re: boundaries. The other CNA's have probably been banned because they will not take his nonsense. This leaves too few CNA's to rotate in/out and the remaining will get burned out fast. I have also had patients like this (quad or not) and have at times simply told them I cannot stay any longer (after taking care of need) and then walked out. Again, best to try to set appropriate boundaries first.

I also thank-you for your service!! :yes: :yeah:

Beldar_the_Cenobite, CNA · Nov 14, 2018

One quad we have will cuss you out because he assumes you have common sense. He'll say stupid things to you like "It's common sense, man!", but does he say that because of his situation? Or has he always had a hard-headed way of thinking before his accident? Or does he think all the other residents think the same way he does? He's got no clue how other residents live and it's disgusting. He has a towel on his chair that we use as a bib when we feed him. An RN comes in and uses it for himself I guess to maybe wipe his forehead. The resident sees it and cusses the RN out. Yes, the RN was in the wrong, but it's amazing how small things get on the residents' nerves. You can't get up, you can't throw a punch at someone you don't like, you argue back and forth, you're putting too much energy into things you can't control. "Get channel 12 in here!!!!!", dude knock it off. We have passion for this field, but we're not going to put you first. He threatened me he was going to talk to the house supervisor. I could careless. The whole facility knows how he is even the DON. He threatened to talk to the house supervisor because after I got brought him taco bell that he had me go get with his money, he asked me if I was going to feed him. I said sure. I didn't know I wasn't his feeder. I go look to see if I'm supposed to feed him. Sure enough a new CNA we just hired and trained is his feeder and his CNA for the night, so I told his actual feeder to feed the quad first because he's demanding and to feed his second later as I had to feed somebody else. I come back an hour after everyone else has been fed, quad's feeder comes to me and says he wants you to feed him. I go into his room and he says, "You're a real ******* telling me you were going to feed me. You didn't tell me you weren't going to and you could have told someone else". I said "I went to go look at the schedule as to who was going to feed you and it's the new guy, not me, so yeah I did tell somebody to feed you first". He likes to argue. He doesn't like new CNAs. F'ing deal with what you get. Another quad who is in her early 20s has had police show up because her family thought she was being abused, Ombudsman constantly showing up thinking the facility isn't taking care of her. I even got torn by my RN because I asked two of our new CNAs to help me change two people while I fed someone I wasn't supposed to feed: The bossy quad. He likes me because I'm nice to him and requests me for almost everything. I'm flattered and appreciated of the reputation he sees in me. Customer service is the name of the game, but not favoritism.

bluegeegoo2, LPN · Nov 14, 2018

I have had a couple quads, and yes, they were...particular.

I had to mentally put myself in their shoes. I imagined that fear, anxiety, and above all, helplessness would rule my mentality. And anger. Definitely anger at the situation. That being said, I had to quickly establish boundaries with them.

One in particular had a habit of speaking down on staff, calling people idiots and the like. He tried that with me initially until I flatly told him that if he continued to speak to me that way I would leave, and proved it to him. Out the door I went. Of course I made sure his immediate needs were met and that his call light was within reach but I provided no "extra" care.

After that, his attitude with me changed. He became nearly pleasant and would "group" his requests so that his needs would be met without monopolizing my time. In turn, I would occasionally pop in just to see if he needed anything and was doing ok. He appreciated that I would check in on him. That small action on my part furthered his trust in my care, which cut down on him riding the call light and yelling for help.

There's a lot of psychology in caring for anyone, and seems more so with quads. In my experience, if they learn to trust that you will meet their needs that seems to lessen their anxiety and makes for a more pleasant encounter.

Best of luck.

brillohead, ADN, RN · Nov 14, 2018

He threatened to talk to the house supervisor because after I got brought him taco bell that he had me go get with his money, he asked me if I was going to feed him. I said sure.

NEVER touch a resident's money, and be careful about doing these little "favors" for them. You could end up losing your job and your certification from that.

Boundaries, boundaries, boundaries.

All it takes is someone claiming you stole his money, and you will be shown the door with no ability to defend yourself.

If residents need / want items that they can't purchase themselves, check with someone in management to see what allowances can be made for the resident. Maybe they can have a staff member serve as a "concierge" for a day where that's their assigned duty to do shopping trips, or maybe a family member or guardian (if applicable) can be notified to take care of the resident's wishes, etc.

But do NOT do things for residents off the clock, no matter how hard it is to say "no" to them. Your job and your professionalism and your licensure/certification have to come first.

Daisy4RN · Nov 14, 2018

One quad we have will cuss you out because he assumes you have common sense. He'll say stupid things to you like "It's common sense, man!", but does he say that because of his situation? Or has he always had a hard-headed way of thinking before his accident? Or does he think all the other residents think the same way he does? He's got no clue how other residents live and it's disgusting. He has a towel on his chair that we use as a bib when we feed him. An RN comes in and uses it for himself I guess to maybe wipe his forehead. The resident sees it and cusses the RN out. Yes, the RN was in the wrong, but it's amazing how small things get on the residents' nerves. You can't get up, you can't throw a punch at someone you don't like, you argue back and forth, you're putting too much energy into things you can't control. "Get channel 12 in here!!!!!", dude knock it off. We have passion for this field, but we're not going to put you first. He threatened me he was going to talk to the house supervisor. I could careless. The whole facility knows how he is even the DON. He threatened to talk to the house supervisor because after I got brought him taco bell that he had me go get with his money, he asked me if I was going to feed him. I said sure. I didn't know I wasn't his feeder. I go look to see if I'm supposed to feed him. Sure enough a new CNA we just hired and trained is his feeder and his CNA for the night, so I told his actual feeder to feed the quad first because he's demanding and to feed his second later as I had to feed somebody else. I come back an hour after everyone else has been fed, quad's feeder comes to me and says he wants you to feed him. I go into his room and he says, "You're a real ******* telling me you were going to feed me. You didn't tell me you weren't going to and you could have told someone else". I said "I went to go look at the schedule as to who was going to feed you and it's the new guy, not me, so yeah I did tell somebody to feed you first". He likes to argue. He doesn't like new CNAs. F'ing deal with what you get. Another quad who is in her early 20s has had police show up because her family thought she was being abused, Ombudsman constantly showing up thinking the facility isn't taking care of her. I even got torn by my RN because I asked two of our new CNAs to help me change two people while I fed someone I wasn't supposed to feed: The bossy quad. He likes me because I'm nice to him and requests me for almost everything. I'm flattered and appreciated of the reputation he sees in me. Customer service is the name of the game, but not favoritism.

It really doesn't matter whether or not any patient acted this way prior to illness or not. You will never be able to win with some people. Hopefully after discussions (with all staff in agreement) you can set appropriate boundaries, although most patients will fall back to their negative behaviors (in my experience) so it is usually an ongoing thing. The best way to handle (IMO) is to try to remain calm and professional while at the same time not letting yourself be manipulated into actions. Try to keep the conversation focused, do not make excuses for other staff (re: the towel issue etc, and btw are you saying the RN used the towel for the RN's forehead? cuz if so gross!), say something like "I am here now to take care of the need, do you need ....", if patient says yes, go ahead, if pt starts rambling again then just say something like, " I see you are still upset, I will take that as a no and be back in awhile" (but do go back later). You need to find and use what works for each patient. I know this is frustrating and draining! You also need to protect yourself from any potential liability. I would immediately stop doing favors for the patients this WILL eventually came back to bite you. Not only could you be accused of stealing but if you bring outside food and the patient becomes ill (food poison etc) you could be blamed. Your facility probably has a policy against this but even if not, it is never a good idea, why take the risk period (and esp if not appreciated by the patient). While I do understand that you are trying to be nice you do need to set boundaries, if this patient does want you more than other CNA's you will become burned out. The other CNA's need to step up and do their job also. I would just keep talking to your supervisors and keep them updated of the situation and hopefully they can schedule a meeting with patient to set boundaries.

Cora_Ann · Dec 10, 2018

Another helpful thing is anytime you go in there try to bring a nurse with you so they can witness what is said. I work in a similar facility and this will save you from them being able to say what you did or didn't do.