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.

Specializes in ICU.
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?

Shes only been there around 6 months? Definitely not a long time. People may not have complained yet. You should say something to your instructor. The more this is reported early on, the more likely she will be asked to find a new place to work. Its easier to get rid of bad employees if they havent been there as long vs someone whos been there for 30 years.

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.
Yes, thank you, that post was completely out of order. "Tattle tail?" Really? What is this, the 3rd grade?

My concern is that you did nothing to relieve that patient's distress at the time that you felt he was being abused. You did not speak up. You did not get help for that individual whose dignity and treatment you objected to so intensely in your post.

That leaves room for people to question your motive for not getting 'immediate' help...and waiting to 'discuss' with the instructor what you considered elder abuse.

Sorry, but I don't get if that you left a pt. in distress, watched and listened, and then later documented a day's worth of elder abuse for us in your comment, but did not once step up to confront the abuser or mitigate the abuse as it occurred.

I'm sure you can understand why that leaves your comments suspect of being over dramatization. Your actions were not in the immediate best interest of the patients...but you later documented a litany of abuse which you did not address as it happened. That is very disturbing.

Specializes in ICU; Telephone Triage Nurse.

I ran into behavior like this at times in the past. How horrible for you, and everyone that had the misfortune to interact with them. It makes me wish they would be caught on video and never be allowed to work with another helpless living thing again.

In my 2nd year of nursing I filled in at a nursing home PRN for a week. I filled in for the LPN who went on vacation, but got PRN RN wages - though the pay was off the charts for 1996 the experience was hellish.

There was an RN who I think may have been there for decades I termed "The Queen Bee". She walked around like she was some weird parody of empress of the universe. At the time nurses could wear any color, but she wore all white head to toe every single day so no one could miss she was "The RN".

Then there was an LPN (who did all the actual physical work) and a legion of CNA's to provide all the necessary care to the residents this place had. Everyone in this category (which included me for that one week) worked hard, while Queen Bee sat on her derriere ordering us all around. To my horror she rudely referred to all the CNA's as "The Kids", even though many were her own age.

I personally struggled with the med and treatment cart wondering how the heck the LPN could actually do everything in 8 hours??!?!!

I didn't see Queen Bee do much, if any patient care, but what little I did witness was savage. Personally I was counting the hours until I could leave that particular place never to return, while also sadly pitying everyone else (staff and residents) who weren't so lucky.

One day I was in a resident's room and she needed to be toileted, so I helped her to sit on the toilet instead of inefficiently going to get a CNA and making her wait. However, getting her safely up alone was a whole nother story ...

I couldn't find any CNA's that weren't already busy, so I trudged over to Queen Bee to request assistance. She was displeased, pursuing her lips while studying me over the top of her reader glasses like I was some kind of nuisance (okay, I was: I wanted her to get off her skinny butt to help).

We went into the resident's bathroom - I figured we would do a 2 person lift assist. No. Queen Bee grabbed the back of this woman's pants and underwear and hoists her up to her feet atomic wedgie style! The resident cried out in pain, and I stepped back in shock covering my mouth also softly (and involuntarily) crying out in sympathy. I couldn't believe my eyes!

I reported it later. Nothing was done about it.

Queen Bee basically told me the next day that was her bailiwick, and she ran it as she saw fit. I, on the other hand was an incomer, and leaving soon: mind my own business and butt out!

I told her then I felt she was depraved and abusive, and that I hoped the universe paid her back in kind. I sincerely hope with all my heart that has come to pass over 20 years later.

So, you see my friend, this level of abuse (because what you described sure sounds like it to me) it can happen amongst any level of staff. I was a pest and reported it, and you need to tell your instructor in a private setting.

I always try to imagine that abuse happening to my own son decades from now when I'm not around to protect him. That always is the deciding factor for me, because every one of those residents are someone's child.

You seem to have a good, kind heart - you know what you need to do.

Yes in as much as she is applauded for speaking out.

I totally believe that if her story is 100% true, then I am completely disappointed.

Because as a nursing student,she is not a good patient ADVOCATE, not assertive and will be a lazy nurse that doesn't bring her brain to work.

Picture this,imagine if these are your relatives and were humiliated and abused.How will you feel?She is very lazy and a backstabber.What stopped her from reacting immediately.Leaving the annoying and obvious CNA alone walked out and report them to your instructor and their charge nurse.You have failed those patients if you are telling the whole truth.This is elder abuse in all its ramifications and you swept it under the rug and failed the innocent patients.You should please try not relegate your patients to the background.Advocate for them.That is what we do as professional.Protecting our patients life and applying safety measures as much as we can.Good luck.

Specializes in SICU, trauma, neuro.
This was your first clinical ..and you want to be a tattle tail? Careful...you have 5 more to go.

(I'm not excusing or accepting the behavior..it's obscene..... if you are not being overdramatic!)

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!

Did you offer to help take the patient to the bathroom ..or get him a urinal....did he have a catheter...is he on bladder training...can he walk..or does he think he can...does he have dementia and ask everyone 99 x a day to be toiletted...is he a falls risk etc etc etc

No matter where you go, you'll run into coworkers with less than admirable qualities..it is what it is...

I hate it!

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.

You will have a group opportunity to discuss your clinical experience with your instructor and coworkers.

Maybe they'll back you up with the same observations..or not!

That's the time and place to discuss your observations..what you liked, didn't like, what bothered you and what your responsibility entails and how to handle what you observed.

If you decide that you did not overreact..so be it! Nursing is called a 'practice' and we learn by others' mistakes and try to keep our own to a minimum!

Uff da... OP: I see you already disputed this advice -- excellent. This post being a few days old, might have gotten several shellackings... but I have to.

Bolded point #1: A "tattle tale" is someone who childishly reports petty things, or who reports for the purpose of getting the perceived offender in trouble.

Tattling: "MOM!! My sister keeps looking at me!!!!"

Not tattling: reporting abusive behaviors toward a vulnerable elder. And yes, if one witnesses these behaviors, it is absolutely his/her job to report it! If you were aware of abuse against a child, would you say that it must be reported, or that you are simply learning what not to do as a parent? Plus, doesn't someone become complicit in abuse if they know about it and do nothing?

Italicized point #1: If the resident did have a catheter, he wouldn't have been told to go in his brief. He would have been told "You have a tube that drains the urine into a bag. You can go -- you won't get wet." You don't tell someone on a bladder training program to wet his brief, either. His ability to walk or not is irrelevant. If he is a falls risk, refusing to help him will INCREASE his chances of falling! I personally have never seen dementia cause someone to ask 99x to go to the BR. Maybe if he had a UTI and can't remember/doesn't understand why he has that constant urgency.... but again, he still wouldn't be told to go in his brief.

Bolded point #2: No, it's not "what it is." We have a CNA who, no matter what you ask her to do or to help with, has a litany of things she says she has to do. She does do her job, but only after she says how busy she is. I swear, she would not get nearly as swamped if she didn't spend so much time complaining! That is an undesirable quality. Telling an elderly man to just wet his pants is WAY beyond an undesirable quality.

Italicized point #2 She is.

Specializes in SICU, trauma, neuro.
Yes.... [/Quote] I do think this was unnecessarily harsh. It was her first day of CNA clinicals. I can't see how old the OP is, but plenty of nursing students are 18 yrs old. For some, assertiveness isn't a natural attribute, but a skill that needs practice. That doesn't mean she has no hope to grow into a strong advocate, or that she is lazy. She came here for advice, and once assured she really did witness abuse and not overdramatizing, she resolved that she IS going to do something. So let's give her some credit.

Well since this issue was brought up.I will not hesitate to give my opinion. You observe an abnormal behavior you kept quiet only to write about it. Her inaction is not nursing.

Most of the time young adult don't understand the profession that they are going into.Nursing responsibility is huge.So learn and grow. Florence Nightingale "Do no harm to the sick".

You should report this to your instructor ASAP. She in turn, should report to the DON. I am a DON in a nursing home and if any of my CNAs exhibited any of this type of behavior, I would personally walk them out the door. Some of this could be found to be verbal abuse and neglect. You actually are a mandated reporter. You are obligated to report this. If your instructor does not, you are able to report this on your own to OHFC.

Well since this issue was brought up.I will not hesitate to give my opinion. You observe an abnormal behavior you kept quiet only to write about it. Her inaction is not nursing.

Most of the time young adult don't understand the profession that they are going into.Nursing responsibility is huge.So learn and grow. Florence Nightingale "Do no harm to the sick".

I've literally said multiple times that I did speak up? I spoke to my instructor as soon as I had the chance and told her about what I was seeing. Or thought I was seeing. I literally was there for 6 hours, and that was the first medical experience I've ever had. Working in a nursing home and taking care of people is an entirely different world.

So you can bash me all you want, but I think I handled the situation well. I spoke to my instructor as SOON as I saw her, and I wanted to speak with her first to get an objective viewpoint on the situation before I started causing drama in the unit. Are you 100% perfect all the time?

I am NOT a bad person. I am NOT lazy, I CARE for the residents, I ASK QUESTIONS, and I am COMPETENT. But thanks for your two cents.

What you described was huge. There was no intervention mentioned.All that was written was problem.If you are not sure don't broadcast.Don't give a facility a bad name.It is not a child's play.Every facility want good reputation and it is difficult to get it back,if you are dragged to the background.Please learn rather than been defensive.

What you described was huge. There was no intervention mentioned.All that was written was problem.If you are not sure don't broadcast.Don't give a facility a bad name.It is not a child's play.Every facility want good reputation and it is difficult to get it back,if you are dragged to the background.Please learn rather than been defensive.

I didn't give a facility a bad name, in fact, multiple times I said that the rest of the staff were absolutely wonderful and were checking on the residents and taking their time with them. I also described only two things that could be completely used as objective evidence- the CNA telling the resident to go in his briefs, and the resident telling her to change her tone. You're telling me to not go and give a facility a bad name, but then you're telling me that I should've immediately stood up to the CNA within the first hour that I've ever spent in a medical facility as a student to basically put her back in her face, instead of making sure I was being objective and letting my instructor know so she, too, could look at it objectively? You're literally contradicting yourself.

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