How to approach this?

[Meraki]

I went to pick up my grandmother yesterday (from an LTC) to go out for lunch and when I got there she was agitated and angry. She was so upset she could barely get herself together to leave with me. According to her there was a new CNA on nights the night before (my grandmother had never seen her before) who was rude, abrupt and "mean". She had no idea how anything worked and couldn't get the pad (diaper) on right. My grandmother tried to tell her what works but the CNA refused to listen and kept trying to do it her way, and in the process caused my grandmother pain/discomfort. Examples being telling her she had to stay standing (my grandmother can only stand for a short time - so she sits because she collapses - not from noncompliance) and trying to roll her a way she physically can't move. Then the CNA left her 1 pad for 24 hours!! My grandmother immediately asked for more and the CNA said there was no more. When my grandmother got upset the CNA told her she's just have to "make do" as it was only for one day and that she could probably get more the next night. At this point my grandmother told her to leave the room and never come back!

I get the CNA was brand new and didn't know any routines or any of the people and probably had minimal orientation but to me there is no excuse for her behavior. I mentioned it to the RN on days (who is wonderful) and she kind of threw up her hands in a "I can barely keep everything on days together, I can't do much about nights" way. That RN did track down a couple more pads (wrong size but better than nothing) to get her through the day. Also they are short staffed so pretty much have to take anyone they can get. The regular night RN left awhile ago so there have been random RNs filling in.

So should I have this documented? Is it sufficiently inappropriate to make an issue of it? The admin is truly useless so I would go to them solely to have it documented - not because I would think they would do anything about it. There is only one CNA on nights on her wing so if this woman is on, then I'm not sure what the options are. My grandmother told me "I'll die before I let her touch me again"!

So any thoughts on anything I can do to resolve this?

I should add that this new CNA has been hired to fill in on the regular night CNA's nights off (so 2 nights a week). The regular CNA is gentle, kind, and absolutely amazing.

[canoehead, BSN, RN]

It sounds like they don't have enough supplies for even minimum care. Probably very pressed for time too. If the new CNA has a system she always uses for briefs, and is in a huge rush I can see a clash in personalities coming. If she slows down to take direction it will easily take 5x as long, and people won't get care. Of course it's not right, but it's also not her fault.

Your grandmother had only one pad for 24 hours...but that CNA wasn't on for the full 24h. That's a system problem. If someone feels more secure with 3-4 pads beside them it's an easy way to make them happy. Even a bad nurse would stack 'em up to make the shift smoother.

That CNA was a new person in a bad situation, and didn't know all the shortcuts to make each resident feel happy and cared for. You said admin is not family friendly to you, they are probably worse when staff complains. If you bring in pads for your grandmother they are absolutely going to use facility provided pads only for people without family, and possibly some of yours too. Keep them in her room, not at the desk.

[caliotter3]

I worked as a CNA. One thing I distinctly remember was running out of pads, diapers, chucks, whatever, on a regular basis on night shift because CNAs on the other shifts (or other night shift CNAs) would take all of the available supplies and hide them for their own use. I distinctly remember the nurses claiming there was nothing they could do about the problem. They told us to work it out ourselves. The stealing, hoarding CNAs would walk around with smirks on their faces every time this happened.

[c.oconnor]

There is truly no point in this case in going to admin, DNS, DON. They are not family friendly. Their knowing about it will have zero effect. I understand in most cases that would be the right approach but in this particular LTC they will do absolutely nothing. To my face they will tell me all kinds of wonderful things they will do....and they will do absolutely nothing. That is why I can go to them but the sole outcome would be that it had been documented. There is a well established history of this. It isn't about management/admin as a whole it is about these particular 2 people. Therefore my only option is to go above them...either to the company that owns the LTC or through the government complaint line. I have gone through both before however I don't really think they are going to act on this...it isn't significant enough.

I wish there was a regular night nurse I could speak to but they haven't replaced the one that left...they are just filling the nights at the moment with whoever they can find so there is no consistency. I will wait and see how it goes this weekend when she is back on. My grandmother can stand up for herself in the moment however it leaves her very agitated, anxious and upset and then she obsesses about it for days/weeks.

I know this is an old post, but I was a bit offended by this.

I am an administrator and I (just now!) spent 45 minutes on the phone with the family of a resident in my facility who has dementia. It is 8:24 pm in my part of the US, and I am still at work. I ALWAYS have time for family...complaints, compliments, concerns, whatever! So does my DON...if she is not here in person, she is ALWAYS available by phone.

You should ALWAYS go to the DON (DNS) or Administrator when you have a complaint/concern. If you do, and they will not help you, then you have a problem. I don't have eyes on the back of my head, and I am not here 24/7, so sometimes things happen that are not right, and I need someone to inform me!

Overwhelmingly, the posts on this website lead me to believe that a lot of the members are not thrilled with management. I am sorry that so many DONs and/or Administrators have not fulfilled their roles well.

We have hard jobs, too. We really do. And please never forget that an Administrator has a license that is on the line, also.

[Meraki]

I haven't been back on this site for a while! just to respond...

It sounds like they don't have enough supplies for even minimum care. Probably very pressed for time too. If the new CNA has a system she always uses for briefs, and is in a huge rush I can see a clash in personalities coming. If she slows down to take direction it will easily take 5x as long, and people won't get care. Of course it's not right, but it's also not her fault.

Your grandmother had only one pad for 24 hours...but that CNA wasn't on for the full 24h. That's a system problem. If someone feels more secure with 3-4 pads beside them it's an easy way to make them happy. Even a bad nurse would stack 'em up to make the shift smoother.

That CNA was a new person in a bad situation, and didn't know all the shortcuts to make each resident feel happy and cared for. You said admin is not family friendly to you, they are probably worse when staff complains. If you bring in pads for your grandmother they are absolutely going to use facility provided pads only for people without family, and possibly some of yours too. Keep them in her room, not at the desk.

The system in this home is that only the night CNA and the admin have keys to the supply room so whatever the night CNA leaves out is ALL that is available for the next 24 hours. It used to be that the nurses also had keys but these were taken away form them as they were getting supplies for residents. the admin here are very much about the budget and don't want a single extra supply going out. I met with the DON three times months ago trying to get them to leave her an extra brief for the days she needed it but was refused (well to my face she said yes but it never happened and when I followed up she had 1000 reasons why)

This facility is not family friendly and I agree they are even less staff friendly. I have gotten to know the nurses well over the years and while all the good ones leave I have heard many vents about admin just before they leave. It bothers me that they treat staff so poorly. I know many of the staff are very scared of the admin and have asked me not to say things because it is always put back on them (even if it is a policy thing out of their control).

I worked as a CNA. One thing I distinctly remember was running out of pads, diapers, chucks, whatever, on a regular basis on night shift because CNAs on the other shifts (or other night shift CNAs) would take all of the available supplies and hide them for their own use. I distinctly remember the nurses claiming there was nothing they could do about the problem. They told us to work it out ourselves. The stealing, hoarding CNAs would walk around with smirks on their faces every time this happened.

This does happen a bit on evenings - the night CNA leaves a box of a few extra briefs and these get fought over and hidden

I know this is an old post, but I was a bit offended by this.

I am an administrator and I (just now!) spent 45 minutes on the phone with the family of a resident in my facility who has dementia. It is 8:24 pm in my part of the US, and I am still at work. I ALWAYS have time for family...complaints, compliments, concerns, whatever! So does my DON...if she is not here in person, she is ALWAYS available by phone.

You should ALWAYS go to the DON (DNS) or Administrator when you have a complaint/concern. If you do, and they will not help you, then you have a problem. I don't have eyes on the back of my head, and I am not here 24/7, so sometimes things happen that are not right, and I need someone to inform me!

Overwhelmingly, the posts on this website lead me to believe that a lot of the members are not thrilled with management. I am sorry that so many DONs and/or Administrators have not fulfilled their roles well.

We have hard jobs, too. We really do. And please never forget that an Administrator has a license that is on the line, also.

I have no idea why you are offended - I said very explicitly that the issue was with these two particular people and I was not generalizing to all admin. I have gone to them many times, they do not help, yes it is a problem. That is great you are family friendly - not all admins are. As I have said - these admin will spend time with me but do absolutely nothing in terms of action. Thankfully I just heard that the DON is retiring so maybe there is hope they will get someone decent.

Oh and as to the original problem - the new CNA only lasted two weeks then was never seen again. We also buy briefs and these are strategically hidden throughout her room!

[Meraki]

Am I the only one who thinks you should give it more time? A lot of residents are unhappy with any changes in their routine and get frustrated by new people who can't get anything "right." For example, there's one lady who loves her weekly bath where I work, and I have it down to a science. If I have a different assignment on her bath day she throws a fit and nothing her CNA for that day does is ever right. Later on I can hear her calling her family on the phone and telling them about how terrible her CNA was and how she will never let them give her a bath again.

I disagree and I think this is a dangerous position to take. Of course there is as you say frustration about changes in routine or new people. However I think to dismiss all complaints as just being resident complaining is dangerous - especially as in this case my grandmother said the CNA caused her pain and discomfort because she was going to do things her way no matter what my grandmother said - . There are aides that can be rude, disrespectful and actually abusive in some cases. While I don't think what happened was abuse I would never accept that it is okay to hurt a resident in order to get things done in their own ' new' personal way. My grandmother complains all the time about one thing or another but when I find her in a state of extreme agitation as I described and in pain from being twisted in a way she doesn't bend I am not going to tell her that is okay and she needs to give the new CNA more time.

[lumbarpain, ADN, RN]

On nights I have seen CNAs use towels because they ran out of supplies. So they started to hoard supplies like packrats to take care of their patients. I couldnt believe my eyes when I found a towel inbetween a patients legs one time. Plus, they do double diapers too....something so they could just hide somewhere and snooze and not worry about changing them again. It is frustrating. THEN if you reprimand them(of course in a stern, firm, pleasent way....you get labeled....as a Hitler, or other nasty name..believe me I was nicknamed that already at one nursing home when I had asked a CNA to go into a patients room to take care of something....SHE DEFIANTLEY walked away while I talked to the the back of her head, not even stopping or turning around to face me like a decent human being.!!!! After that...it was HITLER, I was called. I wrote her up for insubordination and It was miserable for me after that. She labeled me and it spread like wild fire. And I wasnt nasty at all to the CNA....she was the one who refused to take care of that patient when I requested her to do so. So...I am sure that she was a repeated offender and did this to other nurses. Some of CNAs just resent being told what to do. These are people that shouldnt work a job like this if you cannot have a supervisor instructing you with your work. Everyone has a boss. And the top BOSS is God himself.

[signet, LPN]

What you need to do is WRITE a letter to the nursing home administrator explaining your concerns about your grandmother. Be sure to keep a copy for yourself. If nothing is done, there will be a written record of your attempts to make management aware of the situation. If something bad were to happen to your grandmother, this record could be used in a legal action. I believe the administrator will be aware of this, and may act to get the issues resolved. Nurses are told,"If you didn't document it, it wasn't done." If this comes to court, those whom you verbally complained to will have selective memory loss.

[CapeCodMermaid, RN]

Facilities must have a grievance procedure. Ask what their procedure is and fill out the form.

[lumbarpain, ADN, RN]

If medical personnel werent so fearful of being written up and such and if they were just honest in doing their job without fear of losing their jobs people would be more likely to be more efficient and honest. I think 95% of medical personnel are truley honest people wanting to help people who are sick and convalesing through an illness. But there are the other 5% that are strickly in for it just for a job and nothing else that makes it bad for those of us who truley love their jobs.

[pixie120]

I disagree and I think this is a dangerous position to take. Of course there is as you say frustration about changes in routine or new people. However I think to dismiss all complaints as just being resident complaining is dangerous - especially as in this case my grandmother said the CNA caused her pain and discomfort because she was going to do things her way no matter what my grandmother said - . There are aides that can be rude, disrespectful and actually abusive in some cases. While I don't think what happened was abuse I would never accept that it is okay to hurt a resident in order to get things done in their own ' new' personal way. My grandmother complains all the time about one thing or another but when I find her in a state of extreme agitation as I described and in pain from being twisted in a way she doesn't bend I am not going to tell her that is okay and she needs to give the new CNA more time.

Thank-you for saying what needs to be said. As a DON/DNS, I MUST fix these complaints, they are not systems problems, these are people problems, and the fact that your grandmother is anxious only proves the point further. It really is something that should be investigated and addressed immediately. If I heard a complaint from a "new" CNA, I would want to address it asap and find out why this aide is making it SO difficult for your grandmother. It seems like she is "reinventing" the wheel, and why won't she listen to your grandmother? As a nurse, resident's often don't want to turn that way or this way, I couldn't care less which way they turn,as long as we get to the business at hand, and fighting only adds time to the duty. I wouldn't ever try to have someone Stand toput on briefs, silliest thing I have ever heard. When resident's try to stand, I have them sit or lie if possible, last thing I need is for them to fall while I am trying to helpthem.

I do think you should call this in, however, it is your preference not to, and I respect that. I think the next best thing is talk to the regular night shift RN asap.