I am a new CNA, and first I want to say that nothing in class comes anywhere close to the real job. We were all informed of our rights and patient rights, but I need advice on a bad situation. Keep in mind, I have been working for 4 days at this point, fresh out of training, and have been given the full list of 11 residents that was the responsibility of a CNA that just abruptly quit.
I have a LTC patient who is verbally abusive and refuses all care when you ask to bathe or change her. The charge nurse on my shift told me that I am not allowed to listen to her refusal for care and that instead of asking I just have to tell the patient that I am going to do it either way. The nurse forced me to do this today. When within reach of the resident she scratches and digs her nails into arms, hands, cheeks, anything she can get ahold of, drawing blood with almost every scratch. Six hours since the nurse made me do this and the scratches are still bright red all up and down my arms. If she can't get an arm she will smack you in the back of the head full force. I was advised to hold her hands down, which I know from class is a restraint. And either way, if her hands are held down she raises her legs and drives her knees into your stomach as hard as she can. I am 9 weeks pregnant and my employer knows that. I cannot be kneed in the stomach.
This patient refuses care, which I know is her right. My question is, is it within my rights to refuse to go against her wishes even if the nurse commands me to? Is it within my rights to refuse care if she is combative and I feel that the safety of my baby is in danger?
I don't want to risk abandonment or neglect charges, but the resident is blatantly refusing care. If she refuses care then she should not be forced. But I also don't want insubordination accusation from the nuse on my hall. I am also unwilling to risk my baby's safety.
I just need to know what is within my rights to do here.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
Everyone made excellent points. 1. This patient requires a team effort; no one should be sent in alone to care for her. 2. Absolutely a care conference needs to happen. There should be decisions made about how this lady is to be cared for; they need to be documented AND they need to be realistic. (People in high places are great at making lame-brained plans for other people to have to implement.) 3. Every single scratch to anyone's skin needs an incident report.
OP, you have been thrown to the wolves. Tough to extricate yourself when you're so new on the job, but you'll get good at it. Don't forget, the last CNA quit abruptly. Unless they want to pay for orientation for a steady stream of CNA's it might be in their best interests to do some appropriate problem-solving. Because this is above your pay grade. Good luck.
Is there any way OP can look for another job? It's quite obvious as to why the other cna"left abruptly" no support whatsoever.
Your nurse is an a- hole. They should be helping you , especially when this pt is known to be violent. The fact that the rest of the whole staff is leaving you alone with this monster doesn't say much for "teamwork"
There are times when the other staff have to suck it up and help out. I can't believe some of these people.
Also noted was that you say the nurse doesn't give the pt her meds as she refuses them. well, that's WHY she's acting out.Obviously the meds are ordered for a reason. It's too bad that the facility wont order a psych eval on this pt to determine competency to refuse care/meds, etc. Or is it possible this pt ISN"T competent, the nurse isn't telling you, and you're being left alone in a dangerous, liable situation.
Please- go find another job- there must be other jobs that pay around the rate this one does, with way less of a hassle and safer.And I do mean NON-MEDICAL. Your kid will thank you for it later.
Unless they want to pay for orientation for a steady stream of CNA's it might be in their best interests to do some appropriate problem-solving.
It's quite clear they don't care if they have to pay for a steady stream of CNAs. If I am reading it right , OP said it was her 4th day OTJ. Wow- great orientation. They dont lose any money if they hire a new cna every week. The CNA's are the ones paying for the certification, not the company.
Health care workers are a dime a dozen. No incentive to keep any. Actually more incentive to go through them, as the subsequent ones will be started at cheaper and cheaper rates. Where I am a tech gets 9 bucks an hour. Wal mart or costco might be wayyy less of a hassle for the same amount of pay.
It's quite clear they don't care if they have to pay for a steady stream of CNAs. If I am reading it right , OP said it was her 4th day OTJ. Wow- great orientation. They dont lose any money if they hire a new cna every week. The CNA's are the ones paying for the certification, not the company.
Health care workers are a dime a dozen. No incentive to keep any. Actually more incentive to go through them, as the subsequent ones will be started at cheaper and cheaper rates. Where I am a tech gets 9 bucks an hour. Wal mart or costco might be wayyy less of a hassle for the same amount of pay.
But correct me if I am wrong.
No corrections, absolutely correct. I worked for a LTC facility that had an insane policy...employees could have two no call/no shows in a row (had to have three in a row for termination...largest company in the nation)...so, they would call off two days scheduled, work one (do the math, saturday+sunday=2 days, work monday= no consequences)...and when does state show up during the weekend? Only in rare circumstances. The rate was exactly $9/hr for a caregiver....and home depot paid this much 15 years earlier for a cashier (had a friend from college who worked their prior to getting her degree). For this rate, no one is going to put up with being abused and they shouldn't have to deal with it to begin with. Management will bend rules to keep the resident there. Usually it's when they are a potential harm to other residents that corporate will question the placement of the client. And when they need to hire a replacement aide, the generic sign goes up in front of the building for the next person that sees the beautiful interior and peaceful lobby to apply and interview for the always open position.
We don't know if this patient is mentally competent and therefore, as others have said, we need a thorough evaluation.
The OP was instructed to go in and do the care regardless, which I do not agree with. The nurse is being informed of the resident's combative behavior and is telling the aide to "deal with it" rather than going in with them and assessing the situation for themselves. At this point, if it is still a concern, phone calls should be made by the nurse assigned to the patient to coordinate an evaluation. This is not the CNAs responsibility. The aide should, however, speak up when an unsafe situation is present and not go in to care for the patient alone. I agree with others that the nurse cannot force them to do anything, though some may try. At this point, get management involved and if nothing is done, then a much less stressful job may be just across the street waiting for them with the same pay rate.
just a suggestion, but if she is scratching you and drawing blood fill out an incident report. You never know where their fingers have been and I'd suggest making sure you cover yourself for injuries.
TriciaJ, RN
4,328 Posts
Everyone made excellent points. 1. This patient requires a team effort; no one should be sent in alone to care for her. 2. Absolutely a care conference needs to happen. There should be decisions made about how this lady is to be cared for; they need to be documented AND they need to be realistic. (People in high places are great at making lame-brained plans for other people to have to implement.) 3. Every single scratch to anyone's skin needs an incident report.
OP, you have been thrown to the wolves. Tough to extricate yourself when you're so new on the job, but you'll get good at it. Don't forget, the last CNA quit abruptly. Unless they want to pay for orientation for a steady stream of CNA's it might be in their best interests to do some appropriate problem-solving. Because this is above your pay grade. Good luck.