Inappropriate CNA behavior?

[matcha-cat]

Hi, so I just had my first clinical this past Saturday, and the CNA that my partner and I were shadowing had some unsettling behaviors... I've read a few posts that were similar to this one, and a lot of responses were things like "you're new to the nursing industry, so things will differ from your class and the real world" or something similar. I understand this, though this particular scenario seems very unprofessional to me, even when trying to view it through the eyes of an experienced CNA or nurse, so I've decided to seek your input anyways.

When my partner and I first approached the CNA we were going to be shadowing, she already looked very annoyed and in a bad mood. I didn't mind, because I knew I was going to be working with her anyway, but that same attitude was directed at the residents of the nursing home we train in. As we were leaving the first room we had gone into, another CNA came inside and asked the resident if he was ready for breakfast, and he said yes, to which our CNA responded with "Oh, so you'll listen to HER but you won't listen to me?" The resident struggled to talk, but eventually we were able to make out "you need to speak in a friendlier tone." She repeated it, "Oh, speak in a friendlier tone?" then walked straight out. The resident looked mad, then he turned to me and said "One day, they'll learn." That was one of the first warning bells.

Other things that went on that day:

- A resident told me that he needed to use the bathroom, twice, and when I told my CNA, she went into his room and told him to go in his briefs. Both times. He didn't want to, so she made him hold his urine while he ate breakfast, and since he needed assistance with eating... It took a long time. When we came back, he again asked for assistance using the bathroom, and again, she told him to just go in his briefs.

- She CONSTANTLY bad-talked her residents, right outside the door, calling them cranky and rude, etc., talking about some of their bad episodes. I don't know how mentally "there" some of those patients were, but I'm sure some of them heard her. She talked loud enough to where I would've been able to clearly understand what she was saying had I been in the room, and I'm sure there must've been some residents who could have, as well.

- When trying to get a urine sample from one resident, the resident accidentally defecated into the bedpan. Both CNAs were laughing about the whole thing and going "ewwwww" the whole time. They kept commenting on how gross and big it was, how she ruined the sample, and talking about how it stank. The resident was laying right there when all of that was being said. I don't think that resident was "all there", but at the same time, to be talking about her like that right in front of her seemed demeaning. When we first came into the room, she also talked about the resident's crankiness, like scoffing about her bad temper as we were standing 5 inches away from her.

- She went to check in on a resident, who had a bag of chips in his hand, and she suddenly demanded to know whether or not he was done with his chips. It just seemed so abrupt and random, and the resident just kind of stared at her blankly and she angrily asked again, "ARE YOU DONE WITH YOUR CHIPS? YES OR NO."

- She and another CNA rolled their eyes and scoffed whenever a resident didn't want to get up in time for breakfast or lunch, as if it was this huge issue and "how dare they".

The whole day was like this, where she bad-talked residents either right next to them, or out in the hallway where they could still potentially hear her. Her tone, was absolutely terrible. She sounded like an annoyed mother, was very short with her residents, and talked to them like a teenager? She's in her early 20s, I'd say, but her tone of voice and her way of speaking was unprofessional, and at times, seemed downright mean. I mentioned to my instructor in private that it seemed that she might've come off as "rough" to the residents, and I said that I knew some things differed from class and real life, but I wanted to confirm that we weren't supposed to tell residents to "go in their briefs" to which she adamantly explained that no, you never do that.

My instructor said that she wanted to know these things, but I didn't go into detail because I wasn't sure if I was just making a big deal out of something small, and I don't want to be a complainer. The more I think about it, however, the more wrong I think it was. I think talking bad about the resident RIGHT as you are standing next to them, as if they weren't there, is absolutely terrible, even if their mind isn't completely there. They might be anxious or depressed that they were in that situation, and then because of mental deterioration and perhaps hormonal problems, they were lashing out. Nevertheless, it's still demeaning to treat them in that manner.

There were other CNAs that my partner and I tagged along with, and they were the complete opposite. They took their time with the residents, and were kind to them even when they were slow, or cranky. They used a kind and respectful tone, and one of the CNAs even went on telling us how to make sure that our residents looked nice before going down to the cafeteria, "pull down their shirts- make sure their stomach is covered and their clothes are straight. Think about how you would want your parents or grandparents treated in a nursing home." It was such a stark contrast, to where I feel like I can't look at the other CNA and pretend that it was normal or OK to act like that.

Is this something I should talk to my instructor about more? She works at this facility and is in charge of the staff. I don't want to complain or start drama, but I also want to do the right thing. I also have 5 more clinicals there. I also might get a temporary job there as a NAR... Am I being overdramatic? I want to hear your input. Thanks ahead of time.

[caliotter3]

What you describe, I have found to be typical, to include the CNA behavior that was the exact opposite. You should discuss this with your instructor during conference, but think strongly about your approach and involvement since you want to work there.

[macawake, MSN]

Is this something I should talk to my instructor about more? She works at this facility and is in charge of the staff. I don't want to complain or start drama, but I also want to do the right thing. I also have 5 more clinicals there. I also might get a temporary job there as a NAR... Am I being overdramatic? I want to hear your input. Thanks ahead of time.

Are you being overdramatic? If this person did and said all the things the way you've described them, it is clearly unacceptable behavior. No one wants to be or should be treated that way.

Personally I wouldn't be able to watch that type of behavior, and not try to do something about it.

[pixierose, BSN, RN]

We all want dignity, for ourselves ... our loved ones ... and this should extend to our patients.

Like any situation that involves accusation, you must act professionally and certain of fact, not opinion. Let me ask, do YOU think you're being over dramatic?

[adventure_rn, MSN, NP]

As a student talking to your clinical instructor, it would be appropriate to debrief about these experiences; however, you'd want to keep the focus on you (how you're processing, what it made you feel, how you could use these experiences to provide more compassionate care), rather than on her (i.e. tattling). If you have a group debrief/discussion about 'things you saw today,' you may also use that as an opportunity to describe some of those behaviors anonymously in order to talk through your moral distress over the experience; your instructor may ask you after the fact who that person was (or she may already know).

Honestly, given your description, management and staff are probably fully aware of her attitude problems. Management may already be taking corrective action behind the scenes with a performance improvement plan. Unless you're witnessing a blatant safety issue, you shouldn't feel guilty if you decide not to speak up.

[matcha-cat]

I don't think I'm being overdramatic, but I've seen some people come on here with good intentions and the responses kind of alluded to that. However, I think it's safe to say this scenario is obviously different. The thing that's confusing is that this CNA would also act somewhat caring in other scenarios? She would be asking a patient if they needed something, and would use a more polite tone and would even throw in the affectionate "hun". She would also use a better attitude at times when explaining things to my partner and I, so it seems like she's not inherently trying to be malicious? But at the same time, she did all of these other things, and even before the first elderly gent early in the morning commented about her needing to speak to him in a friendly tone, I was thinking that she was acting rather brash with the vulnerable residents.

EDIT: She's also been working there for over half a year. Wouldn't somebody else have said something by now? A resident, co-worker, or resident's family member?

[macawake, MSN]

Unless you're witnessing a blatant safety issue, you shouldn't feel guilty if you decide not to speak up.

I can't agree with this. Wounded dignity might hurt a person every bit as much as for example a sacral pressure ulcer, sometimes even more. Not all abuse or neglect is physical.

I don't think it's about feeling guilty, or not. I think it's about doing what's right. I think protecting our patients' dignity is an obligation we have as healthcare professionals, even as students.

[Purple_roses]

I strongly believe that you should inform your instructor of every detail you told us. You were right to me alarmed. The best way for you to be an advocate for these patients is by telling your instructor about just how severely horrible the situation is. Your instructor will know exactly who to report this situation too, and it will be a great learning experience for you too! I hope you never meet another healthcare worker who treats people this horribly, but just in case you do, you can learn how to handle it professionally.

ETA: I would speak to your instructor in private about this. The more people you tell, the more drama that will ensue, and the less likely your school will be invited back for clinical in future semesters.

[matcha-cat]

As a student talking to your clinical instructor, it would be appropriate to debrief about these experiences; however, you'd want to keep the focus on you (how you're processing, what it made you feel, how you could use these experiences to provide more compassionate care), rather than on her (i.e. tattling). If you have a group debrief/discussion about 'things you saw today,' you may also use that as an opportunity to describe some of those behaviors anonymously in order to talk through your moral distress over the experience; your instructor may ask you after the fact who that person was (or she may already know).

Honestly, given your description, management and staff are probably fully aware of her attitude problems. Management may already be taking corrective action behind the scenes with a performance improvement plan. Unless you're witnessing a blatant safety issue, you shouldn't feel guilty if you decide not to speak up.

We do have group meetings- before the shift, before/after lunch, and at the end of the day to discuss these things. Although I'd prefer to talk my instructor in private about such matters, perhaps I should bring it up in front of my classmates in case they encounter similar behaviors?

[Purple_roses]

As a student talking to your clinical instructor, it would be appropriate to debrief about these experiences; however, you'd want to keep the focus on you (how you're processing, what it made you feel, how you could use these experiences to provide more compassionate care), rather than on her (i.e. tattling). If you have a group debrief/discussion about 'things you saw today,' you may also use that as an opportunity to describe some of those behaviors anonymously in order to talk through your moral distress over the experience; your instructor may ask you after the fact who that person was (or she may already know).

Honestly, given your description, management and staff are probably fully aware of her attitude problems. Management may already be taking corrective action behind the scenes with a performance improvement plan. Unless you're witnessing a blatant safety issue, you shouldn't feel guilty if you decide not to speak up.

This actually is a physical issue and can lead to a safety issue. Making a person wet themselves leads to skin breakdown and infection, and people who have to use the restroom sometimes will stop waiting for assistance and will try to make it to the restroom themselves and end up on the floor with a broken hip or head injury.

[matcha-cat]

This actually is a physical issue and can lead to a safety issue. Making a person wet themselves leads to skin breakdown and infection, and people who have to use the restroom sometimes will stop waiting for assistance and will try to make it to the restroom themselves and end up on the floor with a broken hip or head injury.

I didn't even think about it that way. He appeared adamant that he wanted assistance to the bathroom, otherwise he wouldn't have told me twice that he needed to go, right? He chose to hold it throughout breakfast instead of going in his briefs like the CNA told him to. Even the nurse working our area told him to go in his briefs... Ugh..

[ThrowAway_Account]

Wow, if everything you said was real with no over exaggeration - Please do us a favor and tell your instructor. The few bad CNAs will make the ENTIRE place look bad. Maybe have your instructor wait outside the door listening in secretly while the CNA is in the room bad mouthing the residents so she can personally see. Sort of like a stake out . I would suggest the best thing for you is to tell your instructor in private because no one should be treated like that.