I failed my patient and lost my temper. What now?

[SeattleJess]

Please tell me what I should have done and what I need to do now. It would be wonderful if you could do that without calling me the names I'm calling myself right now.

I am a fresh out of the box CNA, working my first job half-time in the float pool. I pursued this work in preparation for nursing school which starts at the end of September. I could be doing other work that pays twice as much with much less effort or living on my savings. The other CNAs in this story, however, have worked for years at this facility. Their English skills don't give them entry into many other jobs. They will probably retire from this union facility with good pay and benefits whereas I am only passing through.

Yesterday I was assigned to the center unit of the TCU. Center had one nurse and two aids (me and "Francie") on duty for evening shift; South had three nurses and three aids on duty. When I arrived, I was told I'd have primary responsibility for two patients on center and six just around the corner on south. I was told not to leave center when the other aid assigned there took her breaks or just ordered me to be there because she had to leave to get dinners from the kitchen, etc.

One of my assigned patients on south needed to be changed near the end of the patient dinner period. She was a two-person assist so I asked the aid working next to me on the middle part of south to help. So began the difficulties for me and my poor patient. Southie (name changed to protect the perhaps guilty) said she'd help and then continued to work with her patients. She hadn't shown up by the time I needed to return to center to relieve Francie.

Francie was gone an hour for her 30 minute dinner break. When she returned, I said I'd be heading to care for my six patients on south. She told me I needed to go on my break immediately. I said I wanted to check on my incontinent patient before I took my break. She said no, I needed to go right now because we'd be too busy later and the CNAs on south would take care of it. I was gone 30 minutes. When I returned, the nurse and Francie both exclaimed about how short my break had been. I went around the corner to get my six patients to bed. First check was with the patient who'd needed changing. She still hadn't received care.

Then started a series of requests to Southie where she said she'd help and then proceeded to work on her assigned patients without helping me. I worked on my easiest assigned patients, returned after each on to ask Southie to help, got the same "my mouth says 'yes' but my actions say 'no' " response each time. While waiting for her to assist me, I got my folks (and two of hers) to bed. Of course, I checked in with Southie at regular intervals while I was doing this. (There was a huge workload and I do believe in teamwork.) It did seem to me that each time she could have said, "I'll be right back to help you brush your teeth" and helped me but she said, "I'll be there" and turned her back on me.

The back hall CNAs were nowhere to be seen, undoubtedly doing care behind one or more of the closed doors at the end of the hall.

Eventually, I reported to the nurses that I couldn't seem to find someone with time to help on a two-person assist pericare. One of the nurses said, "Do you want me to help?" in a tone that indicated to me that this was an outrageous request. (Looking back, I probably should have said, "Yes" or "I'd like you to help me to get someone to do more than say they'll be there eventually." Or you tell me? I was caught up short by this passive-aggressive behavior. I've never been any good at pushing string.) I confronted Southie again in the hall where she was talking to the CNA who was orienting. She told me to go ahead and set up and she'd be there. I waited in the hall outside the room. (Of course, I'd been set up the entire time.) Then Southie walked by me into the hall, punched the elevator and disappeared as I said, "Hey, I need help!" Again, the reassurance that she'd be right there.

I stood in the doorway and stepped out in front of her when she returned. I said that I needed help right now. My patient had been incontinent of bladder and bowel with a large, liquid BM that was smeared over her legs and onto the draw sheets. We cleaned her up, got on a new brief and then Southie started to close the tabs without putting on barrier cream. The patient protested that she needed cream and a topical ointment for an itchy patch on her back. Southie said, "Can you handle it from here?" and left. No ability to move the patient up in bed when I finished. Fortunately, two nurses arrived to set up the new IV infusion and said they would move her up afterward and I could go.

My patient had been lying in her own excrement for almost two hours. Well, maybe just urine. Perhaps the BM happened closer to changing time. Judging from the dried streaks on our patient's thighs, though, not too much later. Does that make this any better?

I made and quick report on south and made the last 5 minutes of report on center. I told the nurse I'd had a difficult time getting help to change a patient on south and that it had taken almost two hours to get help to change her. Then Francie leapt in to say she had a witness, a CNA, who was standing right there and heard Southie say that I should go ahead to set up and she would be right there. We got into a back-and-forth with me responding and Francie just repeating exactly what she'd said before, that she had a witness that Southie had said she would be right there.

"That's what she said, but not what she did."

Repeat.

"Look, I'm not disputing that's what she said but I asked many times and she didn't follow through."

Repeat.

"I get that someone heard her say she'd help but the patient lay in her own waste for almost two hours before I could get her to help."

Repeat.

(The light goes on that Francie is interested only in helping her coworker do CYA.)

"Look, let's just drop it.

Repeat.

"I understand what you're saying. Let's drop it."

Repeat.

Nurse: "You're really stressing out, my dear!"

(Ya think? I felt like I was in an altered reality, for sure. When did saying ever equal doing? And why wasn't anyone listening?)

Lesson to me: Never let them see you sweat. If I'm angry or upset, I need to be really sure I keep my smiley face on. Maybe I need to employ some of Southie's technique. Go to my patient's room, turn the call light on and sit by the bed? I realize now how much I was enabling her to string me along.

I know both the nurse and the aid on center were peeved about how the staffing assignment. (Truth is, several other units have a much more difficult workload.) They thought it made their lives tough and the nurse kept moaning about how she was alone and behind from the start. (Of course I thought I had it the hardest with most of my patients out of sight and sound around the corner so that I had to pace constantly to the end of the hall to peek around the corner.) They both complained bitterly about how hard it was for them and near the end of the day when the other aid was on her dinner break, the nurse told me I should report to my supervisor about how bad the staffing arrangement was on Center and ask her to change it.

I don't know the politics of my workplace but I do know there are always politics at work, especially in a large bureaucracy and that I do not want to get involved in them. Seems to me that if my nurse wasn't happy with the arrangements then she should discuss the situation with her supervisor... or mine if she thought that was who was in control. Nursey, however, thought that I should report the problems to my supervisor. I found myself wondering whether the rest of the center team was working an agenda by making my life as hard as possible so I'd complain but of course, theorizing about other people's motives is unproductive. We all know how extremely physically and emotionally difficult our work can be, how sometimes you are forced to do less than all you'd like because you just don't have the time or resources. The lonely, frightened person who wants to talk doesn't get all the time she wants because the person down the hall has toilet needs that take priority. And some coworkers are just plain old mean and/or lazy and/or whatever.

Should I tell my supervisor that it took almost two hours for my patient to get changed? I know I failed to advocate effectively for her and I feel rotten. Thinking about this has consumed almost all of my two days off. I suspect I'm embarrassing myself with this overly detailed posting. (Another sign of my swirling emotions.) I feel like a failure for not solving the problem and letting my coworkers see my agitation. Pass me that plate of humble pie, I'm tired of staring at it.

Thanks for your experience and wisdom. I have no one else to talk to about this. I could probably give good guidance to someone else in a similar situation but I'm still having an emotional hangover that makes it hard for me to think clearly. So different when you're in the muddle! I go back to work tomorrow and need to be over this. Sorry I wrote an article. I could use some suggestions on how to summarize if I do need to talk to a supervisor.

[caliotter3]

In short you see that you are going to get nowhere. You do not belong to the culture, in more ways than one. Yes, report the two hours situation to the nurse. From now on, make your request once, when you get refused, go to the nurse. The nurse will get tired of you bothering her and do her job, that is, supervising the other CNA, or the nurse will tell you otherwise. Do your best. You can not make up for what the people of culture do or don't do, say or don't say. You can't win against the culture if the nurse laps up what the culture says about you. If you can not deal with this situation at work, then you will end up without the job and whatever benefit you are getting from it. After a short period of time, you might want to consider leaving this job for a better paying job. I can assure you that the benefit from working as a CNA while in nursing school is not what they paint it to be.

[SeattleJess]

In short you see that you are going to get nowhere. You do not belong to the culture, in more ways than one. Yes, report the two hours situation to the nurse. From now on, make your request once, when you get refused, go to the nurse. The nurse will get tired of you bothering her and do her job, that is, supervising the other CNA, or the nurse will tell you otherwise. Do your best. You can not make up for what the people of culture do or don't do, say or don't say. You can't win against the culture if the nurse laps up what the culture says about you. If you can not deal with this situation at work, then you will end up without the job and whatever benefit you are getting from it. After a short period of time, you might want to consider leaving this job for a better paying job. I can assure you that the benefit from working as a CNA while in nursing school is not what they paint it to be.

Thank you for your excellent, insightful, useful advice and the clear, objective procedures. Ask once. Tell the nurse. Then it's no longer my business. Don't tilt at windmills or culture. (Fortunately, it is only the culture of these two units. I've been part of hardworking, caring, supportive teams for the vast majority of my time.)

Thanks also for the assurance that working as a CNA during nursing school may not be as beneficial as it's cracked up to be. I may have acquired all the learning I'll need after three months.

Thank you so much!

[Missingyou, CNA]

Once, I reported to a nurse that I was having trouble getting help from the other aide. I was told (also in a tone of "I don't have time to deal with that") to communicate directly with the aide I was having trouble with. In other words "deal with it yourself".

So that is exactly what I did in as a professional manner as I possibly could. She looked at me like I had two heads. Then suddenly I didn't fit into the grove anymore. Every time I asked for help from then on, they spoke to me as if I were a lonely child looking for attention from "adults" who were busy doing important things.

So I went directly to the D.O.N told her of residents not getting care because I couldn't get help, that I talked to the nurse, and to my fellow CNA and tried to work it out on my own without success.

A few short days later, I was getting the help I needed....with glares...but help nonetheless! I didn't make any friends working on that unit, but the patients got the care they needed.

[SeattleJess]

Once, I reported to a nurse that I was having trouble getting help from the other aide. I was told (also in a tone of "I don't have time to deal with that") to communicate directly with the aide I was having trouble with. In other words "deal with it yourself".

So that is exactly what I did in as a professional manner as I possibly could. She looked at me like I had two heads. Then suddenly I didn't fit into the grove anymore. Every time I asked for help from then on, they spoke to me as if I were a lonely child looking for attention from "adults" who were busy doing important things.

So I went directly to the D.O.N told her of residents not getting care because I couldn't get help, that I talked to the nurse, and to my fellow CNA and tried to work it out on my own without success.

A few short days later, I was getting the help I needed....with glares...but help nonetheless! I didn't make any friends working on that unit, but the patients got the care they needed.

That is an inspiring story, Missingyou. Thank you for being a role model and mentor to me.

I need to focus on delivering quality care for patients and keeping my behavior acceptable to myself. The rest is just noise. I can't control how my coworkers behave and what they think of me is none of my business. These two will soon be only a small blip in my rearview mirror.

[SeattleJess]

Follow up: I talked to my manager, keeping focused on the issue of a patient waiting two hours to be changed. Her first response was, "One hour lunches are not allowed! We must stop this right away!" I said, "You realize that if I ever need to work with Francie again, my life will be a living hell?" She said, "Don't worry, I'll send out the memo out to the entire floor." (And the effect of that will be?)

I asked about the standard of care issue and she responded that no patient or family member had complained so that wasn't a problem. Unlike abusing break time, neglecting a vulnerable patient does not require action.

Then she told me that the unit where I'd been assigned was a "broken" unit and that Francie was so obnoxious that her team members had all complained; as a result, she'd been kicked off her team and into the float pool. (Great, my first CNA job is where the "broken" people end up!) She told me Eta was famous for her passive-aggressive tactics. As for the CNA at the end of the floor, he was well-known for "disappearing" for long periods of time. (I wondered why he was no where to be seen when I was looking for an alternative to Eta but I'd just assumed he had a clean up of a C diff patient or something around the L and that was why I never saw him.)

Caliotter3 was right. I don't fit into this culture!

[Paws2people]

I don't know if I would of used the phrase, "my life will be a living hell" to my manager.

[SeattleJess]

I don't know if I would of used the phrase, "my life will be a living hell" to my manager.

You're right, that was unprofessional and I probably won't do it again.

Still, it was the only time I strayed from the path. I used a light tone and playful body language. She laughed, so it couldn't have been too bad.

But you're right, best to limit oral communications to the type that cannot possibly look negative if transcribed to paper. Thanks for the comment.

[aeris99]

I worked with a few who would not help me no matter what was going on. I never ever hesitated to ask my charge to assist. I they're grumpy about it let them chase down the others who disappear and won't help. Especially on a 2 person assist!

[FutureLPN16]

One of my co workers was having a hard time on a floor and the head nurse was really nasty to her. They had a screaming match on the floor in front of everybody. My co worker reported that nurse to the DON and shes a floater and they just made a note that she will not be back on that floor. You should she if you can permanently not be on that floor.

[SeattleJess]

I worked with a few who would not help me no matter what was going on. I never ever hesitated to ask my charge to assist. I they're grumpy about it let them chase down the others who disappear and won't help. Especially on a 2 person assist!

Right on! That's why my poor patient had to wait so long. Alone on a two-person assist is the greater of two evils. Love your idea about asking the nurse in charge to chase down the slackers! Brilliant.

[SeattleJess]

I thought float pool would be the crème de la crème since it does take extra work to get up to speed on new care plans and team routines. How wrong I was. Just applied to per diem on a regular assignment to one unit.

Meanwhile, soldiering on.