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.
If she is saying things like this to one resident, then I can guarantee she is saying and/or doing things to others. I was an RN team lead for a LTC......if the tech was under my supervision....she would have found herself in the DON office and probably let go. I don't tolerate it. Period.
If she is saying things like this to one resident, then I can guarantee she is saying and/or doing things to others. I was an RN team lead for a LTC......if the tech was under my supervision....she would have found herself in the DON office and probably let go. I don't tolerate it. Period.
Not really to stir the pot here, but this is an issue I am passionate about, because this behavior is abuse to the ones who work there and no one above the aide seems to be doing anything about it, this is not normal behavior and shouldn't be tolerated. The CNA probably feel abused herself and her dignity stripped of her if she is expected to clean this man at his beck and call everytime he does this.
The CNA probably should have went to the RN, DON and said I will not be abused by this resident like this anymore and someone needs to put this guy straight or figure out why he is doing this.
Seems like his behavior is ignored. Why this behavior hasn't been brought to the higher ups, but this poor "girls" frustration with an abusive resident is so intolerable she should be reprimanded, and possible fired, just really irks me.
Ok, I have said enough now. It's just like no one ever fixes the actual problem. What happened to root cause analysis?
Her behavior is not acceptable and should not be tolerated.
Tell her exactly that and tell her you will write her up the next time and she will probably get canned. But surely, having to tolerate such behavior from a man who has no mental deficit surely gets you some leeway.
That being said, tell the resident the same time. "Your behavior is unacceptable. You are humiliating yourself."
He may be acting out from depression and that could be addressed. In any case, remember this; chemicals are your friend.
Not really to stir the pot here, but this is an issue I am passionate about, because this behavior is abuse to the ones who work there and no one above the aide seems to be doing anything about it, this is not normal behavior and shouldn't be tolerated. The CNA probably feel abused herself and her dignity stripped of her if she is expected to clean this man at his beck and call everytime he does this.
The CNA probably should have went to the RN, DON and said I will not be abused by this resident like this anymore and someone needs to put this guy straight or figure out why he is doing this.
Seems like his behavior is ignored. Why this behavior hasn't been brought to the higher ups, but this poor "girls" frustration with an abusive resident is so intolerable she should be reprimanded, and possible fired, just really irks me.
Ok, I have said enough now. It's just like no one ever fixes the actual problem. What happened to root cause analysis?
There are ALWAYS other ways to handle a situation like this. Acting like a 5yr old and name calling is not one of them. I have been disrespected by many patients, I have been disgusted by some of their actions BUT I don't treat them like dogs. Such as the tech was doing.
I don't know what has previously been done to correct the issue with the patient but the way it's being handled by the CNA is not helping. I would feel the same way if a family member was treating them the same way. There are always other options. JMO.
The resident does not have a specific disorder that would explain this behavior, but he has issues that need to be addresed and corrected .
Call a team conference and get help in identifying how this can be done. Use all of the disciplines working along with nursing to do this... it is their JOB.
I am quite sure this is not the first.. or.. only time this assistant has treated a resident with verbal abuse.
Only the first time it has been witnessed. Who were the witnesses to this abuse? If it was another assistant that will back her co-worker .. that will mean difficulties for you in proving the observation.
As the resident is not cognitively impaired, I would ask your immediate superior to evaluate the episode with HIM.
I am not saying what the CNA said was right, but not surprising. It just seems like people think more action should be taken against the CNA, rather than using this time and energy to get this resident to stop.
Let's get real here. The CNA gets reported, she will most likely get fired, when what she had was a human reaction to a very abusive, belittling situation to HER. And nothing will be done about the resident.
Remember, she is a CNA, there to do her job, unlicensed personal. Who is being her advocate. It seems like no one, since this is an ongoing situation. Evidently OP, who is an LPN knows this has been going on.
I am curious to hear what steps, OP, as Licensed Personnel, have been taken to stop the abuse of the "girls"?
Specializes in Gerontology, Med surg, Home Health.
The resident did not hit her or yell at her or do anything TO her. Granted it's nasty to clean up a poop painting but what the aide said to the resident is clearly verbal abuse. I'd she is this frustrated over this, will she push or slap the resident the next time? Or maybe confine him to his room!?! I'm dismayed that most of you think her reaction was justified. I would most certainly speak ro her (I'm the DNS) and most likely report this to the state as abuse. I would also most certainly speak to the resident and his doctor. It seems a psych evaluate would be in order.
We hold ourselves to a higher standard than those who are sick (mentally, spiritually, physically) that we care for. If something related had happened out in public, and the HCA was just a citizen, she would get to express herself without constraint (beyond what the law places on us all). She wasn't a citizen in a public situation, she was a caretaker for someone who was so ill that the extent of their life is a tiny room with little or nothing to say about what they do or when etc. This doesn't mean the patient's behavior was OK - it was far from OK, and it clearly has been overdue for an effective treatment plan. I empathize with the HCA's frustration. We all get frustrated- and we all know there are limits to how we can and should respond in the setting of our job as caretakers. Obviously this man's behavior has to be addressed- it is unreasonable to expect the HCAs to continue to have to deal with it. It is abusive towards them, and allowing it to continue tells them they have to accept abuse. They don't, and as their supervisors, we should ensure they don't. That said, this particular HCA has clearly hit Tilt, and is not currently able to govern her actions in a frustrating situation. She needs help. That help should be given while bearing in mind that it is not her fault things got to this point- but also making sure that she understands that there are no circumstances where we can tell our patients they are Pigs. I think you need to address the need to stop the abuse of the HCAs by this patient, and also to allow the name-calling HCA a cooling off period. The name-calling HCA needs to know where to go when she feels overwhelmed and abused. She also needs to know that name calling of patient's is not acceptable, whatever the situation. I think you have to talk this situation over with your immediate supervisor. When/if you end up talking to the HCA (some one will need to) there should be a mix of empathy (she WAS subject to abuse, and it sounds like it was repeated) and clear boundary setting. Also, some one who is qualified should evaluate the name-calling HCA to make sure she is safe around patients - even those acting horribly. I would have concerns about what she might do next time she is treated badly - and we all know that as caretakers, we ARE often treated badly. No one wants to allow a situation where someone gets overwhelmed and ends up causing serious harm to a patient, and this HCA's behavior is a huge warning light that such a thing might be possible.
so if he doesn't have dementia why is he doing this? Has he had a psyche eval I hope and been put on some meds to behave more appropriately?
I'm glad I'm not the one who has to clean up after him that's all I can say. I can certainly understand how the CNA was frustrated and lost her temper.
Specializes in Aged Care, Dementia, Mental Health.
I am struggling with the fact that this resident has no psyche issues and is doing this 'smearing' regularly. Has management not discussed his behaviour with him?? As a resident he also has an obligation to other people who reside in your facility. Do you and your staff feel supported by management regarding behaviour management for this resident? Is there any threat of being 'evicted' from the facility if his behaviour doesn't improve?
It sounds like a very passive-aggressive way to get attention, and it is working. As long as you continue to jump and clean him, his room and his linens as soon as he makes a mess, this behaviour will continue. If he had any self-dignity he wouldn't do this in the first place.
Ultimately, his actions are frustrating all of your workers and forcing you all to have less time to care for other residents. I understand your CNA's frustration.
That being said, your CNA's words were a little inappropriate (however, I have heard worse which has been reported without repercussions), and she needs some strategies to deal with these constant issues you are facing. Maybe a bit of a debrief after an 'incident' to work out a better way to handle the situation next time.
Unfortunately, working in Nursing Homes/LTC is only going to get more challenging, with more behavioural issues, and we will be working with less staff and more constrained budgets. Something has to give.
Wave Watcher
751 Posts
If she is saying things like this to one resident, then I can guarantee she is saying and/or doing things to others. I was an RN team lead for a LTC......if the tech was under my supervision....she would have found herself in the DON office and probably let go. I don't tolerate it. Period.