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.
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 to 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.
This view is disturbing to me. Very. Report her for abuse saying something "not nice"? So, the resident is only wrong if he hits her?
It's a break down of the system and it falls on the CNA. Just like when a nurse gives a med in error, should we be finding the root cause, or just blame the nurse?
She was venting. You must remember we are all human; there is only so much psychological damage the mind can take. She did not know you were listening. And these types of patients - let's face it - are just being a PITA. This resident needs a more firm approach, probably from you and management. He needs a psych assessment for a start. People usually smear faeces everywhere cos they want attention and are bored. They probly need to get him into some sort of activity or put a TV in the room.
Perhaps you and management should sit down with the resident and carer separately and discuss how best to manage this person. I wouldn't go making the carer ashamed of what she said: she sounds extremely angry and frustrated, and probly best just to let it go. If you chew her out too much, she very well may quit and you could lose a good worker.
Also, it is up to the RN in charge of the shift & management to deal with these types of problems, NOT the carer. That is why we are paid extra money.
If you (as iin u and management) don't deal with the problem at hand, you will get carers quitting anyway.
That is a tough situation...i experienced something very similar when I was an 18 yr old CNA in a nursing home. My belief is that, like has been mentioned before, the resident's behavior needs to be addressed ASAP (it's not only gross, he is endangering others) and the CNA needs to be counseled at the very least. The other perspective I would like to make a comment on is the CNAs own sense of integrity. What I mean by that is she should have the integrity to come to you or another supervisor and report herself and the situation instead of waiting for it to be addressed for her. Similar to what MomRN0913 said about nurses making med errors...I think (and hope) that most of us have the integrity to actually stand up and say "hey I made a mistake" instead of waiting for it to be discovered. When an institution fosters a culture of not blaming but actually addressing problems via root cause analysis, EVERYONE wins. The repeat offenders or "bad apples" will fall out in the course of it.
Talk to her about her statement-very nicely. Tell her he is only going to get worst if she seems shocked by his actions. That's how he gets his jolies. Then talk to the patient, so you can have something to write about in his chart,and do write about him. But leave the aides action out of it. Then go to the supervisor and his doctor. But write, write, write. so the doctor and others can justifie any actions
Specializes in Gerontology, Med surg, Home Health.
Wow...let's all care about the poor CNA and not for the resident. Of course an investigation would be done. Of course the resident would be examined. If the CNA needs to vent or blow off steam, she should have left the room and vented elsewhere. And to the poster who asked....I have NEVER yelled at or flipped out on a resident...EVER and I've been in the business since the mid '70's when I was an aide.
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.
Well because you're not the one in there cleaning it up each time. Don't nobody wanna clean after a grown man that ***** himself on purpose and gets it all over the room and himself multiple times a day.
Resident definitely needs a behavior consult done. This is a behavior that needs to be dealt with. His behavior is abusive to staff. This took away time from other residents that were truly in need. Has anyone done a one-on -one with him as to "why" he does this. Definitely a psych consult needed! How is this allowed to continue without being addressed?
For the aide - hmm... I can understand her frustration. I truly sympathize. I am sorry there is a, BUT it is so unprofessional. Is it okay for a parent to call their little children names when the behavior is appalling? It is not cool to ever call someone a name. When name calling starts it is time to get into some therapy to control that.
Well because you're not the one in there cleaning it up each time. Don't nobody wanna clean after a grown man that ***** himself on purpose and gets it all over the room and himself multiple times a day.
We can agree to disagree. Great thing about Allnurses.com is everyone has their own opinions....that's what makes the world go around. I have my standards and what's expected of myself and the care I give my patients.
Well you can't really say this man is doing it on purpose.....we don't know his health history and other factors. we had a man our facility where i used to work that would not finger paint but had colon cancer and would poop constantly and then it would get EVERYWHERE.....he would try to clean it up even though we asked him not to but to call us.......never did. he was a & o x 3 and there would be poop everywhere... and then he would walk around the facility with it on him sometimes before we realized it. This was a man trying to maintain his dignity but ended up making huge messes but it was certainly frustrating to everyone despite his kind nature and i never once heard unkind words to him.
We cannot give staff the benefit of the doubt , I stand by that if you witness abuse even if you feel its deserved you are required to report it..... and the law states that to. These cases of verbal abuse in nursing homes have been published in articles lately and the courts are taking them very serious. as a supervisor if it comes out later that you had seen this behavior and did nothing you could also be held responsible....and morally and ethically i think you are responsible. we as professionals are held to higher standards than the general public.
No reporting yet, no one got hit. Talk is the best on both sides. Why did the CNA freak out and why does the guy do what he does. When we listen good things can come out of it. I remember a Pysch hospital at which I worked. Patients were in restraint every shift. We started to listen to the patients. After about two weeks, the restrain use went down. until it was nil. Patient used to come up to the desk, say that needed to be put in restaints. So talk first if that doesn't work go to the next level.
I'm sure your facility has a policy against verbal abuse and this should be reported to the DON. The facility has to investigate and send a report to the state within a certain time frame. Abuse in any form should never be tolerated for any reason. If the CNA is unable to care for this resident without becoming verbally abusive she should not be caring for him (or probably anyone).
MomRN0913
1,131 Posts
This view is disturbing to me. Very. Report her for abuse saying something "not nice"? So, the resident is only wrong if he hits her?
It's a break down of the system and it falls on the CNA. Just like when a nurse gives a med in error, should we be finding the root cause, or just blame the nurse?