CNA Policy and Protocol Questions

roser13, ASN, RN · Jul 3, 2017

The answer lies in your facility's Policies & Procedures manual. Every facility has different P&P's.

Having said that, there is no reason that you cannot file an incident report on the issue, noting the CNA's responses to the situation. That should sort things out nicely.

Atl-Murse · Jul 3, 2017

Have you asked admin ? Such a policy may exist but it will be written by individual facility. Ask admin

JKL33 · Jul 3, 2017

In your role as receptionist, are you expected/allowed to do provide personal care to the residents?

Here.I.Stand, BSN, RN · Jul 3, 2017

I'm guessing that it may be a facility policy -- not something statewide-official such as you might see in a state's Nurse Practice Act. Plus, ALF residents have a degree of independence, unlike someone with akinetic mutism or someone in critical condition. That threshold of neglect is therefore higher, because the resident has that relative independence.

I don't know your facility's staffing practices, but the CNA could have made an agreement with another CNA/RN/LPN to swap apartments. It's also possible that the resident had been dry at the time of the last visit but took a diuretic or drank coffee or beer resulting in a large volume of urine five minutes after the staff left her apt.

It could be a resident rights issue -- that apartment is the resident's home, and they can allow or refuse the CNA entry into their home.

It could also be to protect the CNA from further allegations, or the facility from a liability. Kind of like how lots of times, if a male OB-GYN has to do a pelvic exam, they have a female nurse or MA present -- it's in part to protect that MD against false allegations.

Now the CNA could have said "I'm not permitted in there, but I will give the other CNA a heads-up," or "Would you mind throwing the clothes into the hamper? I'm not permitted in there." vs. "You do it." And wet clothes are icky. but, are you officially in a supervisory role? It doesn't sound like it, because a supervisor would know the P&P's the CNAs are bound by. If you're not, it's really not your place to assign tasks to the CNA, such as laundry.

amandanicole · Jul 3, 2017

Thank you I wrote my own personal report that I left for my boss. When I asked a different nurse today they said there is no policy stating that.

JKL33 · Jul 3, 2017

That's great, but why are you the judge of this situation?

I didn't say it in my first reply because I was hoping to hear more about what your assigned role is before commenting further. If you consider the residents your family, that's a situation where one would be treading on questionable territory, blurring lines that aren't meant to be blurred, etc. This situation can be a compromise of workplace ethics in the healthcare field, just as truly neglecting a resident can.

If someone is truly neglecting residents, I, too, would let my supervisor know. Just realize that if these are all your "family", you are at risk of not considering work situations very objectively. I personally would not let someone remain in his/her role if this emotional-attachment factor couldn't be kept in proper perspective. I mention it not to chastise you, but to give you fair warning that there could come a point where your supervisor feels the same.

amandanicole · Jul 3, 2017

To answer additional questions, my facility believes that a different face and approach can help with getting a resident to comply with things in their best interest like showers, eating and other adl's. Which is why sometimes they call on me to help see if i can get a resident to cooperate, i have also worked on the floor as a resident assistant at this facility and another one to help with call outs so i am able to appropriately help out. I am not expected to, but i am allowed under certain circumstances.

The matter with telling her the clothes were in the bathroom was due to we have an industrial washer that i was told was used for soiled items (urine, feces, blood). I also know that it's not right to put a (1) bed pad and a (1) pair of pants in it, because it messes the washer up. I did not know the protocol on what to do with such few items, or if there was even a regular washer available at that time. I of course had to go back to my post to answer calls and greet family members, which is what i am there to do. We are a secure facility which means residents family can not get in or out with out an employee to let them in or out.

I was not in any way shape or form assigning her tasks. I was letting her know of the soiled clothes so that it didn't leave the room smelling. I would never tell someone to do something that i myself wouldn't do. I have washed my fair share of icky clothes and wiped a many of rears.

My question though was just on whether or not she was allowed to refuse to enter the room. I appreciate the feed back and have handled the situation accordingly. Thank you all so much for your help.

caliotter3 · Jul 3, 2017

Any place where I have worked, her staying out of a room would have come from a charge nurse. Next time, refer the situation to the person having supervisory control over the CNA's.

amandanicole · Jul 3, 2017

JKL33, I'm sorry if i have miss stepped i didn't mean to. I also didn't see your response till after i posted my lengthy one. Me, Myself, with the little knowledge i have gained from various nurses and cna's and so on feel like you can't work in a facility without getting attached to some. I myself say "family" in loose way, but as in the fact i treat them how i would want myself to be treated in their state as well as how i would want my biological family treated in the situation. I also stretch the term family to the other staff as well, i've worked in other facilities were we were just one big happy family together.

I am not the judge of the situation, and i will admit i was fairly hurt and confused about the way the CNA acted toward me when i first asked the question so some of my words might have come off to you differently than i had in mind. I do apologize if i have offended or upset you in any way. I assure you my heart is in the right place when it comes to the care of the residents.

TriciaJ, RN · Jul 4, 2017

JKL33, I'm sorry if i have miss stepped i didn't mean to. I also didn't see your response till after i posted my lengthy one. Me, Myself, with the little knowledge i have gained from various nurses and cna's and so on feel like you can't work in a facility without getting attached to some. I myself say "family" in loose way, but as in the fact i treat them how i would want myself to be treated in their state as well as how i would want my biological family treated in the situation. I also stretch the term family to the other staff as well, i've worked in other facilities were we were just one big happy family together.
I am not the judge of the situation, and i will admit i was fairly hurt and confused about the way the CNA acted toward me when i first asked the question so some of my words might have come off to you differently than i had in mind. I do apologize if i have offended or upset you in any way. I assure you my heart is in the right place when it comes to the care of the residents.

You described a CNA who sounds like she has an attitude problem, but hard for us to know since we don't know her. When you engage with her about workload issues, you are at risk of looking like a pair of squabbling schoolgirls. Since you aren't her supervisor, she may have resented you telling her anything. You probably were just passing on information rather than directing her, but she may have misread that.

Your best bet would be to communicate all issues and needs to the charge nurse. It's up to her to delegate appropriately. That would take the weight off your shoulders and not leave you in a position of someone lipping off to you.

JKL33 · Jul 4, 2017

amandanicole - no offense taken at all. I write in an fairly straightforward manner; I just wanted to offer a small word of caution about the overall situation, that's all. :)