Inappropriate CNA behavior?

Nurses General Nursing

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Hi, so I just had my first clinical this past Saturday, and the CNA that my partner and I were shadowing had some unsettling behaviors... I've read a few posts that were similar to this one, and a lot of responses were things like "you're new to the nursing industry, so things will differ from your class and the real world" or something similar. I understand this, though this particular scenario seems very unprofessional to me, even when trying to view it through the eyes of an experienced CNA or nurse, so I've decided to seek your input anyways.

When my partner and I first approached the CNA we were going to be shadowing, she already looked very annoyed and in a bad mood. I didn't mind, because I knew I was going to be working with her anyway, but that same attitude was directed at the residents of the nursing home we train in. As we were leaving the first room we had gone into, another CNA came inside and asked the resident if he was ready for breakfast, and he said yes, to which our CNA responded with "Oh, so you'll listen to HER but you won't listen to me?" The resident struggled to talk, but eventually we were able to make out "you need to speak in a friendlier tone." She repeated it, "Oh, speak in a friendlier tone?" then walked straight out. The resident looked mad, then he turned to me and said "One day, they'll learn." That was one of the first warning bells.

Other things that went on that day:

- A resident told me that he needed to use the bathroom, twice, and when I told my CNA, she went into his room and told him to go in his briefs. Both times. He didn't want to, so she made him hold his urine while he ate breakfast, and since he needed assistance with eating... It took a long time. When we came back, he again asked for assistance using the bathroom, and again, she told him to just go in his briefs.

- She CONSTANTLY bad-talked her residents, right outside the door, calling them cranky and rude, etc., talking about some of their bad episodes. I don't know how mentally "there" some of those patients were, but I'm sure some of them heard her. She talked loud enough to where I would've been able to clearly understand what she was saying had I been in the room, and I'm sure there must've been some residents who could have, as well.

- When trying to get a urine sample from one resident, the resident accidentally defecated into the bedpan. Both CNAs were laughing about the whole thing and going "ewwwww" the whole time. They kept commenting on how gross and big it was, how she ruined the sample, and talking about how it stank. The resident was laying right there when all of that was being said. I don't think that resident was "all there", but at the same time, to be talking about her like that right in front of her seemed demeaning. When we first came into the room, she also talked about the resident's crankiness, like scoffing about her bad temper as we were standing 5 inches away from her.

- She went to check in on a resident, who had a bag of chips in his hand, and she suddenly demanded to know whether or not he was done with his chips. It just seemed so abrupt and random, and the resident just kind of stared at her blankly and she angrily asked again, "ARE YOU DONE WITH YOUR CHIPS? YES OR NO."

- She and another CNA rolled their eyes and scoffed whenever a resident didn't want to get up in time for breakfast or lunch, as if it was this huge issue and "how dare they".

The whole day was like this, where she bad-talked residents either right next to them, or out in the hallway where they could still potentially hear her. Her tone, was absolutely terrible. She sounded like an annoyed mother, was very short with her residents, and talked to them like a teenager? She's in her early 20s, I'd say, but her tone of voice and her way of speaking was unprofessional, and at times, seemed downright mean. I mentioned to my instructor in private that it seemed that she might've come off as "rough" to the residents, and I said that I knew some things differed from class and real life, but I wanted to confirm that we weren't supposed to tell residents to "go in their briefs" to which she adamantly explained that no, you never do that.

My instructor said that she wanted to know these things, but I didn't go into detail because I wasn't sure if I was just making a big deal out of something small, and I don't want to be a complainer. The more I think about it, however, the more wrong I think it was. I think talking bad about the resident RIGHT as you are standing next to them, as if they weren't there, is absolutely terrible, even if their mind isn't completely there. They might be anxious or depressed that they were in that situation, and then because of mental deterioration and perhaps hormonal problems, they were lashing out. Nevertheless, it's still demeaning to treat them in that manner.

There were other CNAs that my partner and I tagged along with, and they were the complete opposite. They took their time with the residents, and were kind to them even when they were slow, or cranky. They used a kind and respectful tone, and one of the CNAs even went on telling us how to make sure that our residents looked nice before going down to the cafeteria, "pull down their shirts- make sure their stomach is covered and their clothes are straight. Think about how you would want your parents or grandparents treated in a nursing home." It was such a stark contrast, to where I feel like I can't look at the other CNA and pretend that it was normal or OK to act like that.

Is this something I should talk to my instructor about more? She works at this facility and is in charge of the staff. I don't want to complain or start drama, but I also want to do the right thing. I also have 5 more clinicals there. I also might get a temporary job there as a NAR... Am I being overdramatic? I want to hear your input. Thanks ahead of time.

There is no "tip-toeing" (as someone stated) around verbal/elder abuse here. Laughing at the inabilities of others, verbally insulting and derogatory comments equals abusive, bullying behavior. I think you and I both agree this is a reportable offense.

Furthermore, a facility cannot act on the report from a single individual. They must have multiple reports from multiple people to have a paper-trail supporting the decision to terminate the employment of an individual.

So those of you who are stating "someone must already know, don't worry about it" are then guilty of allowing the abuse to continue.

Whether CNA, LPN, or RN, we are all supposed to be advocates for our patients physical AND mental well-being.

There is no "tip-toeing" (as someone stated) around verbal/elder abuse here. Laughing at the inabilities of others, verbally insulting and derogatory comments equals abusive, bullying behavior. I think you and I both agree this is a reportable offense.

Furthermore, a facility cannot act on the report from a single individual. They must have multiple reports from multiple people to have a paper-trail supporting the decision to terminate the employment of an individual.

So those of you who are stating "someone must already know, don't worry about it" are then guilty of allowing the abuse to continue.

Whether CNA, LPN, or RN, we are all supposed to be advocates for our patients physical AND mental well-being.

That's why I reported it immediately.

Uff da... OP: I see you already disputed this advice -- excellent. This post being a few days old, might have gotten several shellackings... but I have to.

Bolded point #1: A "tattle tale" is someone who childishly reports petty things, or who reports for the purpose of getting the perceived offender in trouble.

Tattling: "MOM!! My sister keeps looking at me!!!!"

Not tattling: reporting abusive behaviors toward a vulnerable elder. And yes, if one witnesses these behaviors, it is absolutely his/her job to report it! If you were aware of abuse against a child, would you say that it must be reported, or that you are simply learning what not to do as a parent? Plus, doesn't someone become complicit in abuse if they know about it and do nothing?

Italicized point #1: If the resident did have a catheter, he wouldn't have been told to go in his brief. He would have been told "You have a tube that drains the urine into a bag. You can go -- you won't get wet." You don't tell someone on a bladder training program to wet his brief, either. His ability to walk or not is irrelevant. If he is a falls risk, refusing to help him will INCREASE his chances of falling! I personally have never seen dementia cause someone to ask 99x to go to the BR. Maybe if he had a UTI and can't remember/doesn't understand why he has that constant urgency.... but again, he still wouldn't be told to go in his brief.

Bolded point #2: No, it's not "what it is." We have a CNA who, no matter what you ask her to do or to help with, has a litany of things she says she has to do. She does do her job, but only after she says how busy she is. I swear, she would not get nearly as swamped if she didn't spend so much time complaining! That is an undesirable quality. Telling an elderly man to just wet his pants is WAY beyond an undesirable quality.

Italicized point #2 She is.

Thank you, you took the words right out of my mouth. What knocked me over was that was followed by this:

Every nurse, doctor, aide etc is a mandated reporter when it comes to elder abuse and that goes without saying. If you are aware of abuse and don't report it, you are negligent and complicit. I'm sure that was covered in your class work.

You are your patients' advocate..you observed what you considered abuse and allowed it happen in your presence...

No offense, and I'm sincerely not trying to be judgmental or put you down,(I wasn't there) but if you knew you were on solid ground and witnessing elder abuse, I'm curious why didn't you step up immediately and address the individual as it was happening?

This was your first clinical ..and you want to be a tattle tail? Careful...you have 5 more to go.

(I'm not excusing or accepting the behavior..it's obscene..... if you are not being overdramatic!)

It's not your job to criticize, squeal, or report, ....

Abusive behavior, as bad as you describe, has surely not gone unnoticed by others and they are aware and monitoring it...or not. But that is not your purpose for being there. Do your job and let the facility do theirs..../QUOTE]

Yes, It Is Your Job To Report Abusive Behavior! It is your job, from day one, to protect your patients from abuse, whether from staff or family members. Do your job and REPORT it so that the facility manager CAN do her/his job and rectify the situation. By doing nothing, you become an accomplice.

That's why I reported it immediately.

You did good! I'm loosing my patients with the other posters stating you should essentially ignore the situation. I feel like you are going to be a caring, good provider. It is not easy to go in on day one and have to deal with this kind of situation. You did the appropriate thing by informing your instructor.

Thank you, you took the words right out of my mouth. What knocked me over was that was followed by this:

I probably should've made some sort of comment to the CNA, but for the most part I was just confused, like "Is this really happening?" because it started 5 minutes into my first time in a clinical setting. I also was just trying to make sure that I was viewing it objectively. I've seen multiple people on AllNurses get criticized because they were a student, trying to "lecture" a CNA or nurse so it seems like a lot of times it's a no-win situation.

I spoke to my instructor an hour and a half later during breakfast because I did feel it was urgent. I tried to look at things objectively, and I wanted my instructor's input, as well. What if the CNA got mad and complained to my instructor, and then my instructor accused of stirring up drama? If I had posted this on here "I got sent home by instructor after confronting CNA" then I guarantee you, a lot of the responses would say something like this: "You should've just spoken to your instructor privately, so she would've known what was going on and she could've talked to the CNA herself. " But it's easy to say what you would've or should've done in a situation that you weren't in.

Let me ask you this- are you 100% perfect in handling every situation? When you witnessed poor behavior (I'm sure you have) did you immediately confront the person? What about 5 minutes into your first-ever clinical? Not to mention, that I tend to be more reserved, and reporting to the instructor ASAP what I was seeing was my way of handling the situation. Everybody is different, and I'm sure if this had turned into a drama-fest then people on here would've accused me of not just speaking to my instructor first. I would've had to report her behavior to my instructor anyways? The situation was handled cleanly, without starting drama half an hour into my first clinical.

You did good! I'm loosing my patients with the other posters stating you should essentially ignore the situation. I feel like you are going to be a caring, good provider. It is not easy to go in on day one and have to deal with this kind of situation. You did the appropriate thing by informing your instructor.

Thank you lol, I didn't ignore the situation. I literally reported it as soon as I could. My partner did nothing, and I wonder if half the people on here saying "I would've confronted right then and there" would've actually done so. Not to mention, we all handle situations differently. I didn't start drama or make tension with a person I knew nothing about within 5 minutes. I also think, that if I had gotten into a "tiff" with my CNA and it was brought up to the instructor, she would've told me to talk to her about it so she could speak to the CNA, and I think that if I had posted that on here then people would be agreeing with her. And I told her that I wanted her input as to how to handle the situation and just her input overall. It's easy to go "*GASP!* I would've handled it this way *puts hand on hip and checks nails, goes back to reading comments on the internet*"

(not to put down anyone who commented with good intentions, but seriously? glad to know you're a saint, but I've still got some learning to do)

I think you handled it as well as could be expected. Had I been confronted with this as a student on my first day of clinical, I have no idea if I would have had the stones to speak up. Sad but true. It has taken me years to grow the cajones and backbone that I have now. You are on your way to a good start.

You did good! I'm loosing my patients with the other posters stating you should essentially ignore the situation. I feel like you are going to be a caring, good provider. It is not easy to go in on day one and have to deal with this kind of situation. You did the appropriate thing by informing your instructor.

I think you meant you are losing your patience.

So, OP - did you tell your Instructor on Saturday? What came of it? Where do things stand? Did you find out why people tell the

patient to go in his briefs?

So, OP - did you tell your Instructor on Saturday? What came of it? Where do things stand? Did you find out why people tell the

patient to go in his briefs?

I don't know how you'll feel about this, but when I talked to my instructor, she seemed genuinely concerned, she really wanted to hear what I had to say and she took out pen and paper and noted it down, but at the same time she also told me that she thought that the way I saw it might've been because I was new and that was my first clinical. She did come and check up on my CNA a lot. I saw her sitting in the hall with the residents, making talk as she tried to watch my CNA. I don't know if she had a talk with her, but her personality did a 180. My last clinical she was like a different person. She was gently nudging patients awake and using "affection", saying things like "are you okay? Here, I'll turn the light on the lowest setting for you..." etc. She was completely kind to the residents this time, and they in turn were more talkative with her.

I know what I saw wasn't in my head, though. Not just the "actual" incidents, but my partner showed great disdain with our CNA, too, and told me she thought she was rude and liked the other CNA who was helping out more. A resident also told her to change her tone of voice when speaking to him, and then after my CNA bumped into another CNA (who was covering her break and mentoring us), she asked "I don't know what her problem is, if she's in a bad mood or what." It definitely wasn't in my head, other people saw it, too, but as of right now it seems she's changed, though I'll of course continue to watch.

I had a similar experience many moons ago and reported it to my instructor and was upset that I wasn't learning proper ways due to the inappropriate behavior of person I was shadowing. I was told that indeed I WAS learning... what NOT to do. True but I felt it should have been addressed. I realized it was better not to for the school-facility relationship in the big picture... It's difficult to find places to host students for clinicals and the schools are at their mercy in a sense to accomplish getting those clinical hours in. So try to lead by example and offer to assist the resident yourself if it is a task you are allowed to do.

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