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.

I do not think that you're overreacting. That CNA's behavior was very inappropriate. To the poster that insinuated that only the resident's dignity would be injured, well... you're wrong. If someone is able to be safely walked to the restroom or bedside commode, then why make them go in a brief? When patients sit in their excrement for extended periods of time, they are more likely to develop incontinence-associated dermatitis and/or skin breakdown leading to a pressure ulcer. I bet that unprofessional CNA wouldn't want that to happen to their family member, so why do that to their patient?! I don't understand people.

You'll make an awesome nurse someday.

You are definitely not overreacting. The situation you described above is bad enough to be brought to your clinical instructor's attention. Someone needs to talk to that CNA because that kind of behavior is unprofessional. Some patients pee when they are seating on the toiled, imagine holding urine while eating how uncomfortable it must been to that resident, holding urine for too long can lead to UTIs so if a resident asks for help to the bathroom i take them.

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.
THIS. YES. Exactly. She is deriving perverse pleasure out of making people suffer, and in very vulgar, embarrassing, dehumanizing ways.

Sorry to keep responding, but this issue is so close to my heart. I just keep thinking of my parent, and it really really REALLY rubs me the wrong way here. I have taken care of elderly people who were violent and belligerent, and I never treated them like this. Never.

The whole abuse aspect aside, yes, she is putting those people at risk for real health complications, and if you want to get down to the nitty gritty and things that will get the attention of the administration, talk to them about reimbursements. Medicare and medicaid don't reimburse for things like CAUTIs or bedsores due to neglect. Speak to the people up top in terms they understand if you can't appeal to their sense of basic human decency: money. This woman will end up costing them money in the long run as well. That ought to get somebody's attention.

You are definitely not overreacting. The situation you described above is bad enough to be brought to your clinical instructor's attention. Someone needs to talk to that CNA because that kind of behavior is unprofessional. Some patients pee when they are seating on the toiled, imagine holding urine while eating how uncomfortable it must been to that resident, holding urine for too long can lead to UTIs so if a resident asks for help to the bathroom i take them.

When it happened, I was very confused because our instructors had very much stressed the fact that you don't ever tell a patient to go in their briefs... And it happened almost as soon as I started the day, and the NURSE, an older woman who probably was knowledgable of the rules and had experience, told him to go in his briefs TOO!!!

Well, when the nurse is complicit, little you can expect. Are you sure you want to work there?

THIS. YES. Exactly. She is deriving perverse pleasure out of making people suffer, and in very vulgar, embarrassing, dehumanizing ways.

Sorry to keep responding, but this issue is so close to my heart. I just keep thinking of my parent, and it really really REALLY rubs me the wrong way here. I have taken care of elderly people who were violent and belligerent, and I never treated them like this. Never.

The whole abuse aspect aside, yes, she is putting those people at risk for real health complications, and if you want to get down to the nitty gritty and things that will get the attention of the administration, talk to them about reimbursements. Medicare and medicaid don't reimburse for things like CAUTIs or bedsores due to neglect. Speak to the people up top in terms they understand if you can't appeal to their sense of basic human decency: money. This woman will end up costing them money in the long run as well. That ought to get somebody's attention.

I'm glad to see each of your responses; it's good to see other people caring about the situation, as well, and I needed to hear that what I was seeing was something that isn't a normal thing and something I should talk to my instructor about. Again, I think she'll handle the situation well.

Well, when the nurse is complicit, little you can expect. Are you sure you want to work there?

Every single other CNA and employee I worked with was kind (except for one, who was a little "off" and malicious. She was "buddies" with the CNA I'm talking about in this post). The women who worked the cafeteria came by to take care of residents, and they looked genuinely concerned about the patients, and happy to be with them. Even the cleaning staff were super helpful in answering my questions and were smiling and positive. The nursing home has great reviews on their Google page, it's just that there was a handful of people (that I saw, in my area, admittedly) who were not-so-good. I think the facility prides itself on being kind and friendly, so I'm sure that when I talk to my instructor (who is a SDC) she'll know what to do.

The reason I wanted to work there is that I thought it would be easier since I have my clinicals there. I have my "foot in the door" already, and I would understand how this particular nursing home functions and... Also admittedly, I've only ever had one other job (I've worked the same job since I was 16-21) so I kind of like the idea of not jumping to a new place since I'm the type of person who feels comfortable with committing to something. I think I also, subconsciously, like the idea of being around one of my instructors as I gain experience as a CNA, so I could talk to her about my questions or concerns.

The otherrrrrr thing, is that if something really does come up out of this whole situation and she gets fired, I think there will be tension with me working there. It's a small facility, so I'm sure word would travel fast and I hate drama. I DO still have to complete my clinicals (though there's a possibility, I suppose, that I could transfer to the other nursing home that the other half of my class is training in). Where I do my clinicals is about half an hour away, and where I live, there is actually PLENTY of job openings for a CNA. I've never seen so many requests for a job position!

So, I like the comfort of staying at the nursing home I'm training in, though there are other options that I might need to consider.

edit.

When I was very young the summer just prior to college, I too worked as a CNA. I worked alongside a middle-aged man who was physically aggressive with patients. There was one patient who had some extent of cerebral palsy who could use sounds to interact with this other CNA. The CNA would tease him verbally and also slap his cheeks with both hands, so that it might sorrrrt of appear that it was all in good fun (like patting someone's cheeks?) - but he did it HARD. The patient would start out smiling then start to yell and grimace. I was very frightened by it all, since the other CNA was either massively assertive or downright aggressive in ALL his interactions and comported himself as though he owned the place. He scared me so much that I was afraid to even quit the job, because it wasn't a big town.

When I think about that, I'm ashamed of myself. Granted I was very sheltered and rather meek at the time. I still feel ashamed.

Not sure why I'm writing this...maybe just to get it off my chest after all these years.

I've seen that kind of behavior before- a certain person will be mean (they'll say offensive things) but then laugh as if it was a joke so they can "get by" with saying it, though you can clearly hear the malicious tone and see it in their face. It's pathological. The CNA I'm referring to doesn't necessarily do that, but she's like the worker you're talking about in the sense that everything she does is aggressive. She constantly acts like she's pissed off or annoyed, doesn't care.. I imagine it being like an abusive mother, who is short with her children. She doesn't outright yell at them, but she's very short, like when she talks with her children she sounds like they're always annoying her (even though they stay out of her way and do nothing). Like she's trying to make them feel guilty for things they haven't done because she's angry at life and she wants someone to pay for it.

Anyway... If it feels better to get it off your chest, then I'm glad you made the comment. I, too, was in a situation a few years ago where I witnessed something bad happen, that I probably could've stopped, but I just watched it happen because I was scared and didn't want to get involved. The worst part is, is that growing up I would amuse myself by imagining "bad situations" like a robbery, and I would stand up to the villain and be a hero, but when the time came, I did nothing. I think about it every now and then and I get hit with a wave of guilt. I've learned from that situation, and I've also grown in confidence, too. We just have to accept that the situation didn't turn out like we wanted it to, and learn from our mistakes and be pro-active about doing the right thing in the future.

I am once again reminded that the CNAs I work with and have worked with in the past, in both acute care and long term...are AWESOME. They are kind, empathetic, considerate and the hardest working people I have ever worked with.

I pray that neither I nor anyone I love ever has to be in the clutches of anyone like this monster you have described. It would be so good to die quietly in our sleep, at home, after no suffering. We can skip the whole concentration camp scene.

The aide is a miserable person in her personal life, she hates her life situation, she is poor, she might be physically ill, she is mean, she needs to be reported for abusing the helpless people in her care. So does the nurse who told the pt to void/defecate in his briefs. I'm sure there is quite a history there. Maybe someone long ago decided that this pt needs to go too often and is too slow or too heavy or whatever to keep being repeatedly toileted. Perhaps he has irritable bowel syndrome or a UTI or some other malady, like prostatic hypertrophy, and he has to keep emptying bowel and bladder - or trying to.

Back to the aide - she does not belong in this line of work. She hates it anyway, she is as ignorant as a tin can, she is jealous, she just does not belong anywhere near helpless people. And the nurse is a mess, too. She needs to take a leadership stance, not go along with this approach to "caring " for the patient.

So, have you spoken with your Instructor yet? What are you going to do, OP?

Specializes in New nurse, nursing assistant 5 years.

As a CNA, you have to be careful that you don't lose your grace and compassion for the job. I disagree with telling a pt to wet their "underwear", but I also feel as though you didn't give all of the details. How many pts does she have to deal with? Part of the problem with SNF is that you have a lot of patients and not enough time to do everything. That is why a lot of the day shift aides love , when they have students. No doubt you didn't like what you saw, so you could've stepped up and offer to step in when you didn't like the outcome. If you didn't like the pt being told to go to the restroom, I would have personally offered to take the pt. When you pass your boards, you will be a nurse but you will still have the ability to assist the pt to the toilet as well. And high pt ratios maybe something you have deal with, that is an issue that CNA's have to deal with also. She seems to have a bad attitude, but I think its a reflection of the bigger issues that currently effect healthcare.

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