Don't You Just Want to Scream?!?

[CapeCodMermaid, RN]

Got called today from the facility. A bruise was found on a resident. We knew which CNA had her....had the supervisor call the CNA who says...NO I didn't use my ADL card because they are always wrong. NO I didn't use a gait belt because I didn't want to, and NO I didn't have help.

This is the 3rd time we've counseled the CNA about the need to follow the ADL card and use a gait belt. She is either totally disregarding what is right or she really is as dumb as she seems. Would you call it a day and terminate her?

[ltcconsultant]

Why does she perceive the ADL cards to always be wrong? What is her rationale for not using the gait belt? Was help not available, or did she have a reason for choosing to work alone? There are four primary goals for misbehavior: Attention, power, revenge, and display of inadequacy. Of course, there are a few more goals in LTC: trying to get everything done in a timely manner, trying to meet demands from residents or supervisors that are perceived as unreasonable, etc. What was her underlying goal? Irregardless of what you do with her, I think it would be worthwhile to try to get into her head in order to prevent similar occurrences in the future.

Without knowing all the circumstances, I would probably fire her. I might also consider keeping her part-time as a paid feeding aide or some other quasi-clinical position that doesn't put her in a position of endangering resident safety, but only if you are short staffed. If she really is a persistent danger to resident safety, however, she doesn't need to be there at all.

[Jolie, BSN]

Yep.

I can't think of a greater liability than an employee who refuses to follow basic safety protocol.

Just think of the time, trouble, money and suffering involved if the resident's bruise was reported to the state and you had to defend against abuse allegations. Not to mention the liability of a future resident under the CNA's care who falls and breaks a hip sans a gait belt.

She's not worth it.

[donsterRN, ASN, BSN]

Ditto to all of the above. Counseled three times? That's two too many. Cut her loose. If you don't, she's going to cost your facility a lot of trouble and money.

[sissiesmama, ASN, RN]

Got called today from the facility. A bruise was found on a resident. We knew which CNA had her....had the supervisor call the CNA who says...NO I didn't use my ADL card because they are always wrong. NO I didn't use a gait belt because I didn't want to, and NO I didn't have help.

This is the 3rd time we've counseled the CNA about the need to follow the ADL card and use a gait belt. She is either totally disregarding what is right or she really is as dumb as she seems. Would you call it a day and terminate her?

Hey - based on what you have stated, I would have to terminate the CNA. It's not like this is the first time that she has not followed protocol or nursing instructions, and she sounds like her attitude could use a makeover. And, now it's a bruise, next time it could be a hip fracture or a head injury if she let the resident fall. It doesn't sound like she would be honest to her nurse or supervisor if a resident did fall. Sounds like you have already given her ample chances.

Anne, RNC:twocents:

[VivaLasViejas, ASN, RN]

Yep, if that CNA were working at my facility, the second warning would've been the last. As bad as most LTCs need staff, they don't need this sort. Compliance with resident safety measures is non-negotiable, IMO.........this aide needs to go and then be reported to the BON. She's going to hurt someone badly one of these days, and if you don't get rid of her, resident endangerment citations will stick like $#** sticks to a blanket.

'Nuff said.

[locolorenzo22, BSN, RN]

so, she refuses to follow the cards based on what assessments have been done with patients? Yeah, you don't need this kind of walking lawsuit roaming the halls....I personally assist EVERYONE, unless I can CLEARLY see it is not needed....

Call it a day, and kick her butt on out of there.....it's not in her job description to pick and choose what policies to follow....

[squeakykitty]

Any staffing shortage couldn't possibly be so desperate that the facility needs to keep her. Safety obviously isn't a priority with her, so she needs to go and lose her license, before someone is seriously hurt.

[lil' girl, LPN]

Yep, tell her not to let the door hit her on her way out!

[SuesquatchRN, BSN, RN]

She doesn't want to be bothered, CCM, because doing it right takes more time.

Buh-bye.

[CapeCodMermaid, RN]

An update--we found her a different job so she's still employed but not in a position where patient safety would be an issue....worked out for everyone.

Thanks for all your comments.