Inappropriate CNA behavior?

Nurses General Nursing

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Ruas61, BSN, RN

1,368 Posts

Specializes in MDS/ UR.
I didn't even think about it that way. He appeared adamant that he wanted assistance to the bathroom, otherwise he wouldn't have told me twice that he needed to go, right? He chose to hold it throughout breakfast instead of going in his briefs like the CNA told him to. Even the nurse working our area told him to go in his briefs... Ugh..

In Minnesota, I have seen CNAs' fired, reported to the licensure board and striped of their certification under abuse.

Telling someone to eliminate in their diapers is a dignity issue among other things.

matcha-cat

136 Posts

Wow, if everything you said was real with no over exaggeration - Please do us a favor and tell your instructor. The few bad CNAs will make the ENTIRE place look bad. Maybe have your instructor wait outside the door listening in secretly while the CNA is in the room bad mouthing the residents so she can personally see. Sort of like a stake out :p. I would suggest the best thing for you is to tell your instructor in private because no one should be treated like that.

I think it would be best if I brought it up to my CNA instructor. What's the worse that could happen? I'll try to explain it to her objectively, also mentioning that perhaps I'm "over-exaggerating" the events in my own mind. But the first resident telling her to speak to him in a friendlier tone, her telling another resident to go in his briefs (twice), and her making somewhat of an ordeal about that resident defecating by accident are straight, "solid" points.

Specializes in ED, psych.
I think it would be best if I brought it up to my CNA instructor. What's the worse that could happen? I'll try to explain it to her objectively, also mentioning that perhaps I'm "over-exaggerating" the events in my own mind. But the first resident telling her to speak to him in a friendlier tone, her telling another resident to go in his briefs (twice), and her making somewhat of an ordeal about that resident defecating by accident are straight, "solid" points.

No, please DON'T state in any way that you believe you may be "over exaggerating" if you believe you clearly are stating the facts.

All patients deserve their dignity to be protected. Even the ones who may not be "all there," those that are most dependent on us, just EVERY patient, period. It's a good life lesson, as you may enter the workforce ... and see the exact same scenario play out on the floor.

You've received good advice within this thread. But I think starting off by stating, "I might be over exaggerating/overdramatizing but ..." is not going to set the tone appropriately. This behavior you're describing is not appropriate; sometimes we have to do what's hard when it's what's right -- I'm sorry it's happening so early on for you.

matcha-cat

136 Posts

No, please DON'T state in any way that you believe you may be "over exaggerating" if you believe you clearly are stating the facts.

All patients deserve their dignity to be protected. Even the ones who may not be "all there," those that are most dependent on us, just EVERY patient, period. It's a good life lesson, as you may enter the workforce ... and see the exact same scenario play out on the floor.

You've received good advice within this thread. But I think starting off by stating, "I might be over exaggerating/overdramatizing but ..." is not going to set the tone appropriately. This behavior you're describing is not appropriate; sometimes we have to do what's hard when it's what's right -- I'm sorry it's happening so early on for you.

I appreciate your response. It is stinky, and I certainly wasn't expecting to see it so soon, either. It must've shown on my face or in my voice, because my instructor seemed really concerned (all day she was communicating with me with her eyes, like trying to hold my gaze to see if everything was okay), but I told her I'd prefer to speak privately and at that point, I just didn't want to make a big deal out of it. I do think it's important that I bring it to her attention. She's the type of instructor who's intelligent and in-charge, and she looks out for the patients' best interest, so i feel like I can trust talking to her about the situation and trust that she'll handle it well.

JKL33

6,777 Posts

matcha-cat,

First, I appreciate the manner in which you made your post. You are right to be humble about your observations as someone new to all of this. So thanks for that.

What you have witnessed is cruel and unacceptable. The toileting situation goes way beyond dignity (although that may indeed be the worst part of it) - treatment such as what you describe is a common contributor to constipation and impaction issues in this population. And guess what, although it is rare, severe constipation and impaction in this population can lead to bowel perforation - which is an automatic death sentence without surgical treatment - and maybe so even then. Obviously I'm taking this to an extreme example, but my point is that the elderly regularly experience health issues related to constipation. That's why they are supposed to have bowel programs! Telling someone to defecate in one's brief when s/he is capable of being properly toileted is certainly negligent if not abusive.

I know what I would do, I would report this place to the state survey agency. Any other licensed individual who has observed this and hasn't reported it?? Guess what - they are all mandated reporters of elder abuse. And your particular example qualifies.

**I can not suggest what you should do, and I'm not advising you. You are in a particular situation that requires some finesse. I'd ponder it and wait to read others' replies before coming up with a plan.

Specializes in Psychiatry, Community, Nurse Manager, hospice.
I don't think I'm being overdramatic, but I've seen some people come on here with good intentions and the responses kind of alluded to that. However, I think it's safe to say this scenario is obviously different. The thing that's confusing is that this CNA would also act somewhat caring in other scenarios? She would be asking a patient if they needed something, and would use a more polite tone and would even throw in the affectionate "hun". She would also use a better attitude at times when explaining things to my partner and I, so it seems like she's not inherently trying to be malicious? But at the same time, she did all of these other things, and even before the first elderly gent early in the morning commented about her needing to speak to him in a friendly tone, I was thinking that she was acting rather brash with the vulnerable residents.

EDIT: She's also been working there for over half a year. Wouldn't somebody else have said something by now? A resident, co-worker, or resident's family member?

Try not to analyze why she would be the way she is. Human behavior is extremely complex even if you had all the relevant information and you never have all the relevant information.

I think you should tell your professor about everything you witnessed, in detail. Detail is better than non-detail. Detail represents objective information and is not as likely to be skewed by your interpretations. Therefore, reporting with detail is the most noble thing to do. For example "The CNA was rude and mean to the patient" is your interpretation. Whereas "The CNA stated 'go in your briefs' when the patent asked to go to the bathroom." is a representation of the facts. Tell everything, but stick to the facts. I do not think you should talk about your feelings about the situation unless the professor asks you to, because I think it will then be hard to separate your feelings from what you are reporting.

It isn't tattling when someone is being harmed and you feel you have to speak up. It's tattling if you want to get someone in trouble or make yourself look good by telling on someone.

CrunchRN, ADN, RN

4,530 Posts

Specializes in Clinical Research, Outpt Women's Health.

Anyone who spends any time in LTC will have seen this. I think if most are not this way you may have a chance to address this without it biting you in the butt.

Talk with your instructor. Let her know the specific instances that concerned you (and should). It is not ok for the CNA to be nice "some of the time", but tell others to defecate in their pants. I get that they have an extremely hard job and it is very time consuming to toilet during meal times, but it is part of the job and some times it must be done.

quazar

603 Posts

Please report their behavior. Your post made my blood run cold. I have a parent with advanced dementia and Parkinson's, and the thought of my parent being "cared" for by these people is horrifying. If they treated my parent this way and I knew about it, I would be in the administrator's office raising Cain.

My parent is difficult to care for, and I myself have worked as a CNA for very difficult total care patients in a nursing home AND in a residential facility. I got frustrated on the job. I STILL didn't treat my patients like that OR talk about them like that. What you're describing tiptoes around the edges of verbal abuse and elder abuse. Those CNAs are abusing their position of power over the residents, and in a disgusting manner. Report them. Leave out no detail.

matcha-cat

136 Posts

Please report their behavior. Your post made my blood run cold. I have a parent with advanced dementia and Parkinson's, and the thought of my parent being "cared" for by these people is horrifying. If they treated my parent this way and I knew about it, I would be in the administrator's office raising Cain.

My parent is difficult to care for, and I myself have worked as a CNA for very difficult total care patients in a nursing home AND in a residential facility. I got frustrated on the job. I STILL didn't treat my patients like that OR talk about them like that. What you're describing tiptoes around the edges of verbal abuse and elder abuse. Those CNAs are abusing their position of power over the residents, and in a disgusting manner. Report them. Leave out no detail.

Thanks for your input. I'm glad you mentioned that even though it's a difficult job, you still didn't treat your patients like that. Like I said earlier, that CNA is fairly young, probably a few years older than me at the most (so she's probably in her early to mid 20s) and she said she's only been there for half a year. The other CNA who was extremely kind and patient had worked there for several years. Most of the other staff were extremely kind and friendly. Even the "lunch ladies" in the cafeteria were coming down and checking on the residents. It was just the particular CNA who was bad (at least from what I was able to see) and this other CNA who was like her friend. She would do the whole "well she didn't want to get up for breakfast *eyeroll* sooo *smirk and shoulder shrug*" ... As if the resident, who is in her late 80s, is a terrible and moody person for not wanting to wake up at 7AM on this particular morning. :sniff:

Specializes in pediatric neurology and neurosurgery.

This post makes me very sad. Imagine if that were my mother being treated like that? It definitely needs to be brought to your instructor's attention, and she can pass the information along to the appropriate person.

quazar

603 Posts

Thanks for your input. I'm glad you mentioned that even though it's a difficult job, you still didn't treat your patients like that. Like I said earlier, that CNA is fairly young, probably a few years older than me at the most (so she's probably in her early to mid 20s) and she said she's only been there for half a year. The other CNA who was extremely kind and patient had worked there for several years. Most of the other staff were extremely kind and friendly. Even the "lunch ladies" in the cafeteria were coming down and checking on the residents. It was just the particular CNA who was bad (at least from what I was able to see) and this other CNA who was like her friend. She would do the whole "well she didn't want to get up for breakfast *eyeroll* sooo *smirk and shoulder shrug*" ... As if the resident, who is in her late 80s, is a terrible and moody person for not wanting to wake up at 7AM on this particular morning. :sniff:

*I* was young when I was a CNA, I was only 19-22. I still had the ability to have compassion for those who could not do for themselves. This woman is displaying a basic lack of empathy, something that is quite unsettling (to put it mildly) for someone in a position of power over a vulnerable person. She needs to be put in check, and right away, before she hurts someone.

JKL33

6,777 Posts

Please report their behavior. Your post made my blood run cold.

An apt description. OP, maybe the idea of someone soiling a brief doesn't seem horrifying because we see that all the time due to incontinence - it is especially common in LTC. But that isn't the case here. This isn't basic incontinence - it is the case of a human being who is capable of toileting, being forced to hold stool uncomfortably while fretting about soiling himself. Not just until he makes it 3 more steps to the bathroom, but indefinitely, until this girl "allows" him and helps him. That is abuse. So it doesn't involve inappropriately "judging" this girl or nitpicking her personality, or deciding whether she is simply immature. Her particular "style" is not a matter of preference. I don't say this lightly: I believe her behavior is pathologic. There is something very wrong with deriving some sort of pleasure by seeking to control someone else's intimate (i.e. private) process of producing a bowel movement. She should not be taking care of people. Experience tells me this is a mindset that isn't going to be changed in real-time.

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