Inappropriate CNA behavior?

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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.

Hello! I was a CNA for 3 years before I became an RN (passed my NCLEX in May... I start work on Monday so I really haven't done anything as a nurse yet). Unfortunately, this behavior is completely inappropriate, unprofessional, and unsettling, it is very very common. In nursing school, you learn that you always want to try and do as much as you can to preserve the patient's independence and dignity. You have to make sure it is safe for the patient to do so, but you should always keep that in mind. While nursing school is different from the real world, this CNA completely threw that core ideal out the window and betrayed her role. I cannot even imagine someone telling my loved one to just "go in your brief". Not only is that debilitating to one's ego but will indefinitely lead to skin breakdown and infection... not to mention I am sure the CNA ignores that he is at a high risk for bed sores. The other things that you mentioned just absolutely disgusted me. Here the thing: while I am not defending the CNA, several nursing homes (which I am assuming that's where your clinical was at), are severely understaffed. And while that is not an excuse by any means for her behavior, it can be a result of the situation.

This is why I left my nursing home job. I was placed in a unsafe work environment for both myself and the patients, and I didn't want that liability to ruin me for nursing before I had even started.

I applaud you for wanting to speak up about this. Think about yourself and your end goals and the type of CNA you want to be and hold onto those values. Standing up for your profession and the patients should never bring you any shame. This kind of behavior should not be tolerated. You are not being dramatic. Good luck and let us know what happens (I am sorry if you already posted and I haven't seen it yet). Good luck to you and your new journey as a CNA! It is very hard work - but try and remember why you decided to go into the profession to begin with.

You report this CNA! You are watching abuse take place and doing nothing about it!

Copy/Paste what you have typed here and give it to your instructor. Once it is in her hands, then it is her responsibility.

Abusive behavior, as bad as you describe, has surely not gone unnoticed by others and they are aware and monitoring it...or not. But that is not your purpose for being there. Do your job and let the facility do theirs.

Actually, it sort of is part of my job. I'm supposed to report elder abuse, and if a caretaker is telling a resident to go in their briefs or is embarrassing a patient/treating them without dignity, you think I'm supposed to just ignore that and observe? I'll talk to my instructor about it, so I can at least see what she has to say. But to just "ignore" something and observe is a terrible thing to tell someone.

It's not your job to criticize, squeal, or report, but to learn the basics and decide what kind of CNA/Nurse you want to emulate...Unless there is a safety issue that needs immediate attention..your job is to observe!

Also, making it sound like I'm "squealing" is extremely rude, and that adjective doesn't really follow well nicely when the thing I'm "squealing" about is patient dignity and treatment.

Hello! I was a CNA for 3 years before I became an RN (passed my NCLEX in May... I start work on Monday so I really haven't done anything as a nurse yet). Unfortunately, this behavior is completely inappropriate, unprofessional, and unsettling, it is very very common. In nursing school, you learn that you always want to try and do as much as you can to preserve the patient's independence and dignity. You have to make sure it is safe for the patient to do so, but you should always keep that in mind. While nursing school is different from the real world, this CNA completely threw that core ideal out the window and betrayed her role. I cannot even imagine someone telling my loved one to just "go in your brief". Not only is that debilitating to one's ego but will indefinitely lead to skin breakdown and infection... not to mention I am sure the CNA ignores that he is at a high risk for bed sores. The other things that you mentioned just absolutely disgusted me. Here the thing: while I am not defending the CNA, several nursing homes (which I am assuming that's where your clinical was at), are severely understaffed. And while that is not an excuse by any means for her behavior, it can be a result of the situation.

This is why I left my nursing home job. I was placed in a unsafe work environment for both myself and the patients, and I didn't want that liability to ruin me for nursing before I had even started.

I applaud you for wanting to speak up about this. Think about yourself and your end goals and the type of CNA you want to be and hold onto those values. Standing up for your profession and the patients should never bring you any shame. This kind of behavior should not be tolerated. You are not being dramatic. Good luck and let us know what happens (I am sorry if you already posted and I haven't seen it yet). Good luck to you and your new journey as a CNA! It is very hard work - but try and remember why you decided to go into the profession to begin with.

Thanks for your response! I did consider that maybe she was overwhelmed with the amount of patients (I heard of this profession being hectic, but I still was completely awed when I saw that it really WAS that busy. Still, I think if the resident declined going in his briefs after the first time he was told, it was probably because he didn't want to go in his briefs (which would also explain why he again asked for help after he ate)... But that means he could have potentially gone in his briefs because he could no longer hold it while he was eating, then would've had to have sat in it for the entirety of breakfast. :no: It sounds like with the nursing profession, you can't really escape unsafe ratios, though, huh? At least, I haven't heard anyone on here ever mention that they have safe ratios before lol

Thanks for your response! I did consider that maybe she was overwhelmed with the amount of patients (I heard of this profession being hectic, but I still was completely awed when I saw that it really WAS that busy. Still, I think if the resident declined going in his briefs after the first time he was told, it was probably because he didn't want to go in his briefs (which would also explain why he again asked for help after he ate)... But that means he could have potentially gone in his briefs because he could no longer hold it while he was eating, then would've had to have sat in it for the entirety of breakfast. :no: It sounds like with the nursing profession, you can't really escape unsafe ratios, though, huh? At least, I haven't heard anyone on here ever mention that they have safe ratios before lol

Several places do struggle with keeping safe ratios for nurses and aides, however there are plenty of places that do have a manageable load. That's not to say that sometimes you won't have to take extra... but you get the gist. Despite the fact that you're going to learn to adapt to juggling several patients with time and experience, you need to also remember that patient safety is the priority... that means knowing when to walk away if you know that you cannot handle it. Don't be afraid to ask for help. There ARE good facilities to work at with team-oriented people. Being a CNA is physically hard work, but you'll learn how to time manage to handle your patient load. Like others have been saying - this was your FIRST clinical. Unfortunately it gave a glimpse of a negative reality... but you'll see the positives the longer you are in this field. When you feel comfortable, try and jump into patient care when you are allowed! It will give you get experience... and it sounds like you won't be worse than the CNA those patients already have. ;)

Several places do struggle with keeping safe ratios for nurses and aides, however there are plenty of places that do have a manageable load. That's not to say that sometimes you won't have to take extra... but you get the gist. Despite the fact that you're going to learn to adapt to juggling several patients with time and experience, you need to also remember that patient safety is the priority... that means knowing when to walk away if you know that you cannot handle it. Don't be afraid to ask for help. There ARE good facilities to work at with team-oriented people. Being a CNA is physically hard work, but you'll learn how to time manage to handle your patient load. Like others have been saying - this was your FIRST clinical. Unfortunately it gave a glimpse of a negative reality... but you'll see the positives the longer you are in this field. When you feel comfortable, try and jump into patient care when you are allowed! It will give you get experience... and it sounds like you won't be worse than the CNA those patients already have. ;)

Heheh!:D Tomorrow I'm going to be better about "taking the reins" and I'm nervous... But I'm also excited to conquer the areas that make me nervous. Of course I would always prefer safe staffing ratios for patient and employee safety, but seeing all the call lights going off also gives me an adrenaline rush. :lol2:

I would report it to the DON at least. I'm sorry but the "we're shortstaffed" stuff is a load of crap. I've been a CNA with 18 patients, many of whom are total care and the nurse refuses to help, I've been on a med/surg floor where we routinely have 6 and 7 patients with little or no help from a tech, I've been in an LTACH with 4 critically ill trach/vent patients (and the tech and RT are nowhere to be found), and I have NEVER treated a patient this way. There have been times I didn't give the kind of care I wanted and had to apologize, but I've never treated someone like what you're describing. It sounds like this CNA just has a little attitude on her and is going to be worthless employee until she grows up and gets over it.

I would report it to the DON at least. I'm sorry but the "we're shortstaffed" stuff is a load of crap. I've been a CNA with 18 patients, many of whom are total care and the nurse refuses to help, I've been on a med/surg floor where we routinely have 6 and 7 patients with little or no help from a tech, I've been in an LTACH with 4 critically ill trach/vent patients (and the tech and RT are nowhere to be found), and I have NEVER treated a patient this way. There have been times I didn't give the kind of care I wanted and had to apologize, but I've never treated someone like what you're describing. It sounds like this CNA just has a little attitude on her and is going to be worthless employee until she grows up and gets over it.

Exactly.

In all you do in your nursing career, you won't be wrong if you treat your patients with the compassion and respect that you would in caring for your own loved one's. Follow your instincts.

Rod, RN

Yes sometimes you have obnoxious CNA.

But these situations are exceptio nal cases and totally unacceptable.Sometimes when CNA are misbehaving they are sending a message to you as a student nurse/the primary nurse."You are a student nurse and you should be able to assist with some of these patients needs rather calling your CNA to do everything for you".The CNAS are most of the time foreigners and are not that young.The hospital administration value the CNAS and not willing to part with them because they are valuable members of the medical team.Sometimes they are the eyes and ears of the management.So you should understand the CNA and be willing to be a team player.And accept the CNA because you have a lot to learn from them and management are not ready to quickly fired them easily.They are the eyes and ears of management.

Every nurse, doctor, aide etc is a mandated reporter when it comes to elder abuse and that goes without saying. If you are aware of abuse and don't report it, you are negligent and complicit. I'm sure that was covered in your class work.

You are your patients' advocate..you observed what you considered abuse and allowed it happen in your presence...

No offense, and I'm sincerely not trying to be judgmental or put you down,(I wasn't there) but if you knew you were on solid ground and witnessing elder abuse, I'm curious why didn't you step up immediately and address the individual as it was happening?

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