False Abuse

[am1313]

I currently work in a SNF (Skilled Nursing Facility) and have worked there for about 3 months (I have been with the company for 6.5 years in total. I am a CNA. Recently, I was assigned to a resident who was described as verbally and physically abusive. O was told to always take someone in the room with me when caring for her due to her sometines combative behavior. This day, I had put her on the commode next to her bed and she had pulled the call bell for me to help her get back into bed (she had just had hip surgery). I brought another CNA in with me. I assisted her into the bed where she then proceeded to tell me to pull her up in the bed. I told her she was as far up as she could go but she yelled at me saying she felt low in the bed and wanted to be pulled up and straightened out. Myself and the other aide then used the draw sheet to pull the resident up slightly in bed (there was barely any room to go) while doing so, she bumped her head on the headboard. She yelled at me and told me to get out and get ice, so I quickly ran and told the nurse what happened, and the nurse proceeded to scream at me about all the paperwork that was going to cause. I ran and got some ice for the resident and then the nurse went in and assessed her. She then told the nurse that myself and the aide took her and smashed her head into the wall on purpose. The facility had to report this to the state due to what she said and we had to fill out incident reports. It is a weekend so I'm not sure when the state will come in and investigate. I am so upset because it was truly an accident. I'm nervous as to what will happen as the nurses and director all seem to be angry with myself and the other aide and have been giving us a lot of attitude. I've never experienced this before and an freaking out. Anyone have an issue of the sort before?

[mrsboots87]

Were you sent home until the investigation is complete? I know this is a law in AZ, but thought it was federal level that when a healthcare worker is accused of abuse or neglect of a resident, they have to be suspended until the investigation is complete.

Anyway, this can take a few days to sort out. You had a second with you and if your stories are the same about what happened then your certification will be fine. Especially if this is a known "bad" resident. The nurses are likely just upset because you and the other aid just added time consuming paperwork to their already hectic day. Try not to take it personal. I have accidentally harmed a resident before. The nurse went home 1 hour late because of it. I can imagine that when you are accused of abuse, there would be even more paperwork to complete.

Anyway, you should know the result of the investigation within a few days.

[iluvivt, BSN, RN]

I do not think it was right or fair for the nurse to get angry with you over the fact that this happened and over the fact that it created paperwork. It is just part of the job and there is no justifiable reason for this persons anger because this was not done on purpose. I personally would not have pulled up the patient and would have tried to make her comfortable by elevating her legs, or readjusting her position in bed. You must never let a patient's intimidation,need to control or your worry over patient satisfaction scores cloud your better judgment even if the patient gets upset.

I hope you charted what actually happened and preferably verbatim what her request was.Luckily, you had a witness with you and you both can state the facts which will demonstrate it was simply an accident. If she had no damages it is even better. I would then take some seizure padding and tape it to the headboard so it does not happen again. There is no reason the staff should be mistreating you, NONE and stick to your guns that it was NOT intentional just an oversight since the patient was demanding that be she pulled up and it inadvertently was a tad too much. They may ask you why you pulled the patient up even after telling her no and determining that she could go up no further. Your first assessment was the best and you caved after she yelled at her. I would have said, "Let's see if we can adjust you in another way to get you comfortable" and if you could not then go get the RN and let them deal with her!

[jadelpn, LPN, EMT-B]

Interestingly if the nurse thought this was a valid issue, was the resident sent out to the ER for evaluation?

Yes, I am sure that the resident's head was bumped on the headboard, which can be startling. Bigger question is, how is it that the resident's behavior is going to be managed and boundaries set?

Sorry this happened to you, and make sure you document everything. In the future, I would make sure that there's padding on the headboard, and that a "well, you can not go any higher in the bed, but lets put your feet up for awhile..."

And if the resident is a 2 person assist due to her behavior, make sure that this is documented somewhere in the chart, it shows a pattern of behaviors.

[am1313]

Thanks for responding! I was not sent home afterwards, the DON was contacted and the charge nurse just told me and the other aide we are no longer allowed in the residents room, I know usually during investigation people are suspended but I have not been contacted as being so. My next shift isn't until the end of the week so I'm sure they will contact me on Monday about a suspension etc.

[am1313]

The nurse assessed her head but they did not send her out. I have documented all of her behaviors (I had her two shifts in a row) she was very mean and demanding, but the facility doesn't seem to set any boundaries besides two people have to go in the room

[am1313]

I know I should not have strayed from my better judgment. My problem with the combative, angry patients is that I try SO hard to make them happy and put a smile on their face at least once during the day that that interfered with my judgement. The nurse is a really mean coworker she is constantly yelling or screaming at people, I usually just try to avoid her because she is so miserable. My concern was my residents safety not the amount of paperwork that would result

[Horseshoe, BSN, RN]

Yikes. I've accidentally done the exact thing when using a draw sheet to pull someone up in bed with another nurse. Sometimes you can overestimate the effort required.

If this resident is demented, try to keep that in mind. She probably can't help it if this is about brain dysfunction. The nurse, on the other hand is a different story entirely. I find her behavior to be far more disturbing as she cannot blame her actions on cognitive deterioration. She might be overly stressed, but there is never a reason for a professional nurse to yell or scream unless she is saying "Code blue! I need help!"