Inappropriate CNA behavior?

Nurses General Nursing

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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.

Specializes in MDS/ UR.
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..

In Minnesota, I have seen CNAs' fired, reported to the licensure board and striped of their certification under abuse.

Telling someone to eliminate in their diapers is a dignity issue among other things.

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 :p. I would suggest the best thing for you is to tell your instructor in private because no one should be treated like that.

I think it would be best if I brought it up to my CNA instructor. What's the worse that could happen? I'll try to explain it to her objectively, also mentioning that perhaps I'm "over-exaggerating" the events in my own mind. But the first resident telling her to speak to him in a friendlier tone, her telling another resident to go in his briefs (twice), and her making somewhat of an ordeal about that resident defecating by accident are straight, "solid" points.

Specializes in ED, psych.
I think it would be best if I brought it up to my CNA instructor. What's the worse that could happen? I'll try to explain it to her objectively, also mentioning that perhaps I'm "over-exaggerating" the events in my own mind. But the first resident telling her to speak to him in a friendlier tone, her telling another resident to go in his briefs (twice), and her making somewhat of an ordeal about that resident defecating by accident are straight, "solid" points.

No, please DON'T state in any way that you believe you may be "over exaggerating" if you believe you clearly are stating the facts.

All patients deserve their dignity to be protected. Even the ones who may not be "all there," those that are most dependent on us, just EVERY patient, period. It's a good life lesson, as you may enter the workforce ... and see the exact same scenario play out on the floor.

You've received good advice within this thread. But I think starting off by stating, "I might be over exaggerating/overdramatizing but ..." is not going to set the tone appropriately. This behavior you're describing is not appropriate; sometimes we have to do what's hard when it's what's right -- I'm sorry it's happening so early on for you.

No, please DON'T state in any way that you believe you may be "over exaggerating" if you believe you clearly are stating the facts.

All patients deserve their dignity to be protected. Even the ones who may not be "all there," those that are most dependent on us, just EVERY patient, period. It's a good life lesson, as you may enter the workforce ... and see the exact same scenario play out on the floor.

You've received good advice within this thread. But I think starting off by stating, "I might be over exaggerating/overdramatizing but ..." is not going to set the tone appropriately. This behavior you're describing is not appropriate; sometimes we have to do what's hard when it's what's right -- I'm sorry it's happening so early on for you.

I appreciate your response. It is stinky, and I certainly wasn't expecting to see it so soon, either. It must've shown on my face or in my voice, because my instructor seemed really concerned (all day she was communicating with me with her eyes, like trying to hold my gaze to see if everything was okay), but I told her I'd prefer to speak privately and at that point, I just didn't want to make a big deal out of it. I do think it's important that I bring it to her attention. She's the type of instructor who's intelligent and in-charge, and she looks out for the patients' best interest, so i feel like I can trust talking to her about the situation and trust that she'll handle it well.

matcha-cat,

First, I appreciate the manner in which you made your post. You are right to be humble about your observations as someone new to all of this. So thanks for that.

What you have witnessed is cruel and unacceptable. The toileting situation goes way beyond dignity (although that may indeed be the worst part of it) - treatment such as what you describe is a common contributor to constipation and impaction issues in this population. And guess what, although it is rare, severe constipation and impaction in this population can lead to bowel perforation - which is an automatic death sentence without surgical treatment - and maybe so even then. Obviously I'm taking this to an extreme example, but my point is that the elderly regularly experience health issues related to constipation. That's why they are supposed to have bowel programs! Telling someone to defecate in one's brief when s/he is capable of being properly toileted is certainly negligent if not abusive.

I know what I would do, I would report this place to the state survey agency. Any other licensed individual who has observed this and hasn't reported it?? Guess what - they are all mandated reporters of elder abuse. And your particular example qualifies.

**I can not suggest what you should do, and I'm not advising you. You are in a particular situation that requires some finesse. I'd ponder it and wait to read others' replies before coming up with a plan.

Specializes in Psychiatry, Community, Nurse Manager, hospice.
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?

Try not to analyze why she would be the way she is. Human behavior is extremely complex even if you had all the relevant information and you never have all the relevant information.

I think you should tell your professor about everything you witnessed, in detail. Detail is better than non-detail. Detail represents objective information and is not as likely to be skewed by your interpretations. Therefore, reporting with detail is the most noble thing to do. For example "The CNA was rude and mean to the patient" is your interpretation. Whereas "The CNA stated 'go in your briefs' when the patent asked to go to the bathroom." is a representation of the facts. Tell everything, but stick to the facts. I do not think you should talk about your feelings about the situation unless the professor asks you to, because I think it will then be hard to separate your feelings from what you are reporting.

It isn't tattling when someone is being harmed and you feel you have to speak up. It's tattling if you want to get someone in trouble or make yourself look good by telling on someone.

Specializes in Clinical Research, Outpt Women's Health.

Anyone who spends any time in LTC will have seen this. I think if most are not this way you may have a chance to address this without it biting you in the butt.

Talk with your instructor. Let her know the specific instances that concerned you (and should). It is not ok for the CNA to be nice "some of the time", but tell others to defecate in their pants. I get that they have an extremely hard job and it is very time consuming to toilet during meal times, but it is part of the job and some times it must be done.

Please report their behavior. Your post made my blood run cold. I have a parent with advanced dementia and Parkinson's, and the thought of my parent being "cared" for by these people is horrifying. If they treated my parent this way and I knew about it, I would be in the administrator's office raising Cain.

My parent is difficult to care for, and I myself have worked as a CNA for very difficult total care patients in a nursing home AND in a residential facility. I got frustrated on the job. I STILL didn't treat my patients like that OR talk about them like that. What you're describing tiptoes around the edges of verbal abuse and elder abuse. Those CNAs are abusing their position of power over the residents, and in a disgusting manner. Report them. Leave out no detail.

Please report their behavior. Your post made my blood run cold. I have a parent with advanced dementia and Parkinson's, and the thought of my parent being "cared" for by these people is horrifying. If they treated my parent this way and I knew about it, I would be in the administrator's office raising Cain.

My parent is difficult to care for, and I myself have worked as a CNA for very difficult total care patients in a nursing home AND in a residential facility. I got frustrated on the job. I STILL didn't treat my patients like that OR talk about them like that. What you're describing tiptoes around the edges of verbal abuse and elder abuse. Those CNAs are abusing their position of power over the residents, and in a disgusting manner. Report them. Leave out no detail.

Thanks for your input. I'm glad you mentioned that even though it's a difficult job, you still didn't treat your patients like that. Like I said earlier, that CNA is fairly young, probably a few years older than me at the most (so she's probably in her early to mid 20s) and she said she's only been there for half a year. The other CNA who was extremely kind and patient had worked there for several years. Most of the other staff were extremely kind and friendly. Even the "lunch ladies" in the cafeteria were coming down and checking on the residents. It was just the particular CNA who was bad (at least from what I was able to see) and this other CNA who was like her friend. She would do the whole "well she didn't want to get up for breakfast *eyeroll* sooo *smirk and shoulder shrug*" ... As if the resident, who is in her late 80s, is a terrible and moody person for not wanting to wake up at 7AM on this particular morning. :sniff:

Specializes in pediatric neurology and neurosurgery.

This post makes me very sad. Imagine if that were my mother being treated like that? It definitely needs to be brought to your instructor's attention, and she can pass the information along to the appropriate person.

Thanks for your input. I'm glad you mentioned that even though it's a difficult job, you still didn't treat your patients like that. Like I said earlier, that CNA is fairly young, probably a few years older than me at the most (so she's probably in her early to mid 20s) and she said she's only been there for half a year. The other CNA who was extremely kind and patient had worked there for several years. Most of the other staff were extremely kind and friendly. Even the "lunch ladies" in the cafeteria were coming down and checking on the residents. It was just the particular CNA who was bad (at least from what I was able to see) and this other CNA who was like her friend. She would do the whole "well she didn't want to get up for breakfast *eyeroll* sooo *smirk and shoulder shrug*" ... As if the resident, who is in her late 80s, is a terrible and moody person for not wanting to wake up at 7AM on this particular morning. :sniff:

*I* was young when I was a CNA, I was only 19-22. I still had the ability to have compassion for those who could not do for themselves. This woman is displaying a basic lack of empathy, something that is quite unsettling (to put it mildly) for someone in a position of power over a vulnerable person. She needs to be put in check, and right away, before she hurts someone.

Please report their behavior. Your post made my blood run cold.

An apt description. OP, maybe the idea of someone soiling a brief doesn't seem horrifying because we see that all the time due to incontinence - it is especially common in LTC. But that isn't the case here. This isn't basic incontinence - it is the case of a human being who is capable of toileting, being forced to hold stool uncomfortably while fretting about soiling himself. Not just until he makes it 3 more steps to the bathroom, but indefinitely, until this girl "allows" him and helps him. That is abuse. So it doesn't involve inappropriately "judging" this girl or nitpicking her personality, or deciding whether she is simply immature. Her particular "style" is not a matter of preference. I don't say this lightly: I believe her behavior is pathologic. There is something very wrong with deriving some sort of pleasure by seeking to control someone else's intimate (i.e. private) process of producing a bowel movement. She should not be taking care of people. Experience tells me this is a mindset that isn't going to be changed in real-time.

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