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.
I am certainly not defending what the CNA said to the pt...she was wrong to say it...but I am absolutely going to the DON asking what is being done about the situation....why this man who appears to be in control of he faculties continues to do this merely to create work for and upset staff? That needs to be dealt with...period. If the DON does nothing I would go to someone else. Either way, not acceptable for an oriented person to act like this.
Why do you refer to grown women, some much older than you, as a girl?
Being a nursing home aide is physically, mentally and emotionally hard. Much harder than being a nurse. They get abused all the time and nothing is done about it. I read a thread a while back where it was discussed if it okay to wear a mask around a spitting patient. I was astonished that anyone would even debate that it is okay to allow someone to be spat upon, for any reason.
In what other profession do we expect employees to subject themselves to spitting, verbal and physical assults, and demeaning names such as "girl"? Yeah, what this woman said wasn't okay, but this man knows what he's doing. He's not confused. He's just trying to provoke her. Why is management allowing this to go on? That's not okay either.
I'm sure she didn't mean to be calling him a "pig" per say but I was told many times as a child, by my mom, that my room looked like a pig lived in here!
Act like a child, treated/scolded like a child.....#I'mjustsaying
Did this pt have a work up? I believe labeling the pt as difficult and attention seeking as well as conveying the message that smearing of feces is to be expected, because it's a nursing home pt. set the stage for what happened. My question to the nursing staff, if this was your dad, would you not seek the underlying cause? My question to the CNA, if this was your dad, would you call him a pig?
Okay..........Flame away. This is verbal abuse and the CMS guidelines are very strong about any type of abuse. I understand that the aide was frustrated, but she has/had no right to say those things to the resident.
I agree that his behavior needs to be addressed. Be sure and document each time this happens and be sure to address this behavior with his physician.
I has to be reported. End of story. It has to be investigated. If this happens with one resident, what about the others you haven't heard about yet? What about the residents who can't speak for themselves? You are mandated to report it.
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??
It's verbal abuse, even if the HCA is tired and frustrated. Even if the resident is purposefully being awful (and some will), it's unprofessional and abusive. You are required to report it.
I didn't pick up on the fact that the OP referred to the aids as "girls" and then said 90% of them were older than she is (at 21). That's kind of strange.
A couple of things. I don't know if people on this thread are defending the aide. I know I'm not. The statement was not acceptable. However, it sounds like this is a situation that has been going on a long time and no one has done anything to correct the problem with the patient.
That is, IMO an abuse on the part of the facility toward the patient in terms of his right to recieve adequate care and to have his dignity protected. There is a problem with this individual, who seems to be in an extreme state of distress, that is not being addressed, which is neglectful on the part of the facility.
The patient is at the end of his rope here. The people who have the authority to help him aren't helping him. The aides are left on their own cleaning up this mess. The aides are at the end of their ropes as well.
This is not a straightforward situation of an aide being abusive toward a patient. We spend a lot of time as nurses on his forum talking about the chaotic structure of healthcare delivery that we are finding more and more of in our jobs.
We come here and discuss our fear that something terrible will happen or that we will make a terrible mistake (or that we already have) because there is no support from management or any effort on their part to provide us with the resources to provide good patient care.
Instead of castigating this aide, why don't we extend the same courtesy and look at the whole picture. There are many problems here. The aide's comment and the patient's behavior is fallout from a chain of events that is coming down from the top of the ladder.
This nurse needs to be proactive and find a solution to the actual problem, rather than simply taking action against the aide.
Should the comment be addressed? Absolutely. But more important is to advocate for the patient with the people who actually should be doing something about it.
Thinking and verbalizing thoughts are two different things. As a CNA, I admit that I would have been frustrated and not too thrilled with the patients actions. Really who likes to clean up smeared feces from the walls, especially if this is a common occurence?
Could someone possibly keep an eye on him while he is the bathroom and stop him before the playing starts? I get that staffing does not always allow for it. I think that you should talk to the aide and give her the inappropriate comments spiel. It is never cool to call someone a pig, deserved or undeserved.
It's frustrating when something goes on and on and you are powerless to stop it. I can totally understand the aide finally losing it. Was it right? No. But I understand it.
We've had babies on the floor that NOTHING calms them. And they'll have that neuro cry, that's REALLY annoying. There have been times that I've been trying to get one to sleep, and finally have to go to a coworker and tell them, "TAKE THIS BABY BEFORE I SHAKE HIM!" Point being, luckily I have a coworker I can go to, that can take over when I've reached my limit.
Does this aide have that option?
I remember in my past life as an aide, there came a point where my usual assignment was burning me out. And this one old lady was blaming me for her clothes being too small while I was cleaning up the poo she'd spread all over her room. (She was not A&O.) And every single morning she'd yell at me for shrinking her clothes when it was time for her to get dressed. EVERY MORNING. And I think it was the same morning I'd been bitten. And I don't think I ever said anything inappropriate. But I just wanted to scream at her, "I don't wash your clothes, and they haven't shrunk, you've gotten fat because you steal everyone else's food, and I work overnight so I don't even serve you the food so it's not at all my fault that you're too fat for your clothes!!!" Unless it was during a psychotic break that I don't remember, I don't think I ever said anything that would be labelled abusive, but I definitely became a little less nice and a lot less cheerful in demeanor.
So forgive me for defending the poor "girl" who's been putting up with this behavior. If he couldn't help it, if he's not A&O, then that would be different to me. But screaming about HIS dignity isn't going very far with me if we aren't looking out for our coworker's dignity at the same time. HE is abusing HER. And if she hasn't been getting any support in this matter, then before we go and get her fired, I'd be pulling her aside, saying something along the lines of, "I know it's frustrating, but we can't call him names." You get rid of her based on this, and don't fix the problem, how many other aides are you going to let be abused and burned out?
Pick on someone defenseless? Absolutely you should be thrown to the wolves. Reacting in self defense, albeit in a poor manner? Let's fix the problem and give a warning to exercise more self control in the future.
I would say pull her aside and have a verbal counseling regarding the incident. Also, keep hypervigilant regarding patients she cares for and take any comment from the patients seriously.
We had one aide who would make comments that were less than optimal. When I heard her the first time, I gave her a verbal counseling. After that, I began paying closer attention to the patients she cared for. A while after that, while cleaning one of our patients, the little old lady tells me,"I am so glad it's you...that other lady pinches me sometimes." Upon further questioning I found that the aide had been abusing our patients (i.e. pinching, yelling, arguing). It explained why one of our confused patients would become aggressive and agitated whenever she would enter the room (he was a sweetie w/everyone else, though!).
I was lucky that I started paying attention and did bring this to the DON's attention. As a result, the woman was removed from my unit and placed in the 'Twilight" unit, our locked unit (poor little old people, even less able to voice when things happen to them!). This woman was furious w/me and told me I had betrayed her and how could I think she would ever hurt anyone.
However, shortly after her transfer to the other unit, she was terminated...apparently for patient abuse.
I felt very bad for her, but relieved for my patients. Whenever I hear someone being ugly to a patient, I try to remember that sometimes, where there is smoke, there is fire and being proactive for our patients is our duty.
psu_213, BSN, RN
3,878 Posts
I am certainly not defending what the CNA said to the pt...she was wrong to say it...but I am absolutely going to the DON asking what is being done about the situation....why this man who appears to be in control of he faculties continues to do this merely to create work for and upset staff? That needs to be dealt with...period. If the DON does nothing I would go to someone else. Either way, not acceptable for an oriented person to act like this.