I really need some advice ASAP

[jocelynlpn, LPN]

I work in a nursing home. I'm the only LPN with 3 HCAs and 26 residents. There is an RN on the unit next to be which I can go to for help if needed. Something happened on my shift yesterday, and I wanted to post it on here and get advice from other nurses before discussing it with someone else in my facility.

I have a resident on my unit who is what you would call "difficult" and "attention seeking". For example, he's well known for having inconinent BMs and "painting" the bathroom a nice brown color before he rings his call bell for help. He doesn't have dementia or alzheimers and he knows very well that he should ask one of the girls for help beforehand. I can understand how this can be frustrating for some staff members.

So yesterday this resident did the same thing, made a huge mess in his bathroom, walls, toilet, floor...Then rang the bell for the girls to come and clean him up. I came down to the room to check on the girls and asked them if they needed any clean linen or supplies. The resident was standing in the middle of the room with his pants around his ankles and one of the HCAs was saying "Oh my God you are such a pig. I can't believe you did this. You should know better. You're such a dirty old man" She didn't know that I heard this. And I didn't say anything to her. I can understand that she is frustrated, and I know this resident can be difficult. But she was being very unprofessional and just downright mean. You don't tell an 80 year old man that he is a pig when he's standing in his room with no pants and covered in stool. Where is his dignity?

I'm not exactly sure what I should do now. I'm pretty upset at this co worker. I don't know whether I should confront her about it, go to the RN, or go directly to my manager. I would also like to add that I'm a new nurse (one year experience) and 90% of the HCAs I'm "in charge" of are way older than I am. So sometimes I find it difficult to confront them, and I've never had something like this happen before.

Any advice from you more experienced nurses??

[mindlor]

Confront the person who spoke these words, but do so in a caring and understanding way.....teachable moment. She lost her temper and it is understandable...

Keep it between you and her, as a result she will learn and you will have a staunch ally

[mindlor]

Age should not be a factor. Be respectful, but kind, yet firm. This is a golden opportunity to gain more respect from the HCA's......

[tokmom, BSN, RN]

As difficult as it is to confront somebody, I would pull her aside and talk to her. You don't have to be mean about it or have an attitude. Tell her you have something that is difficult for you to talk about but you felt you need to do so and tell her what you heard and then be silent and let her absorb what was said. Hopefully she will feel some remorse for what she said.

If, for some reason, she becomes nasty to you, I would climb the food chain.

[netglow, ASN, RN]

If there is no pathology, age is not a factor. (repeat 10 times please)

But, as an employee and not a family member of this resident, she has to try to keep her anger to herself when she is with the patient and vent it out somewhere else. Letting a patient know that behaviors such as this are not acceptable is what should be done, however.

I'd be totally on her side with disgust, but be a team member and support her by reminding her to be careful. I'd also VERY MUCH pursue any avenue that has not been, in getting this patient and his issues managed.

[Whispera, MSN, RN]

There's a reason behind his behavior...all efforts should be made to figure it out, so he doesn't feel the need to act out!

No one should treat him with disrespect, but he should be confronted about how inappropriate he is. If he's aware of what he's doing and does it for attention, how can you give him attention in other ways?

Do talk to your coworker. This isn't something you can ignore, but you shouldn't go over her head without talking to her first.

[misswhitney]

There's a reason behind his behavior...all efforts should be made to figure it out, so he doesn't feel the need to act out!

No one should treat him with disrespect, but he should be confronted about how inappropriate he is. If he's aware of what he's doing and does it for attention, how can you give him attention in other ways?

Do talk to your coworker. This isn't something you can ignore, but you shouldn't go over her head without talking to her first.

I agree with this. Talk to her first. That may have been the 5th time that day she had to clean him up and she has other patients who would benefit more from her service. Granted, she should not have said those things to him, it is your job as the nurse to talk to her. And to him. When I have a difficult patient, I inform them that I will not run myself ragged trying to take care of them, when they can take care of themselves. I tell them I promote independence. He makes himself lose his dignity when he acts like that. No grown man should act like that to get someone to clean him up. My first thought was how inappropriate this is and he probably enjoys being cleaned up by women. Both situations need to be addressed, though. =) Good luck! I know how hard it is to talk to someone about their behavior and get a positive response.

[mazy]

Agree with others. There is a reason behind his behavior that needs to be explored, not just by nursing, but the dr. and a social worker/psych worker also. There may be a way to treat some of his issues medically to reduce the behavior.

As for the aide, it sounds like she was at the end of her rope, and I can see why. I would suggest that you just pull her aside and let her know that you understand where she's coming from but she has to be careful about the way she talks to the patient. Maybe let her know that if she wants to vent she can come to you. Let her know that you all are in this together.

[MomRN0913]

Flame me all you want, but I agree with her. Maybe not the use of the word pig, but I have said to a patient who has done stuff like that "disgusting" when they are doing it for attention seeking.

No dementia, no Alzheimers, just a plain A-hole you say? Someone should put him in his place. Sounds like everyone has been letting this man get away with what he does, so he keeps doing it.

So while no one should be called a "pig" something should be said to this resident. There is a possibility this aide was feeling like no one above her is trying to do anything to correct his behavior, so she felt like she needed to do something about it herself.

[MomRN0913]

oh, and apparently, if this man is doing this with no underlying medical reasons, just to get attention.

WHERE IS HIS DIGNITY?!!!!! It's one thing to have an accident, but to play Picasso with your poop so someone else could clean it up. He evidently has none.

[evolvingrn, BSN, RN]

That is disgusting behavior.....it would be extremely frustrating and i can understand her disgust. If this man does not have dementia then WHY? is he doing this, One thing might be the attention and time he is getting. a functional behavior assessment might be highly helpful in changing this behavior and meet his underlying need.

this may be unpopular to say..........but you have to put this in writing and address this with your superior and the person. you are a mandated reporter and he is a vulnerable person and this is verbal abuse. if you do not report you could face repercussions as well

[psu_213, BSN, RN]

First, the resident ruined his dignity, not the aide...

Also, as a former CNA, I kinda have a problem with aides being called "girls." Now maybe all the aides in the bathroom were teenaged females, but where I worked there were male aides, and some of the female aides were older the the nurses who called them "girls." Sorry, just a little pet peeve of mine.

Anyway, my end of the conversation with the aide would go something like "I realize that it is frustrating what this resident is doing...would you like to talk about it?" Hopefully she will be open to going from there...

Finally, this behavior needs to be dealt with at a higher level. Why is he doing this? The RNAC, MD, etc. need to find out why this man is doing this and what (within reason) needs to happen for this behavior to stop.