Is this despicable behavior?

[Nurse Beth, MSN]

Dear Nurse Beth,

I work on an ortho floor and had the displeasure of working with a CNA that is known for not pulling her weight on the floor and often found sitting on FB, online shopping, etc when she should be doing rounds. I needed help pulling an obese patient up in bed, which in this patient's case, she had a low-air loss mattress which makes sliding her up even more difficult.We positioned the bed high, put it in Trendelenburg position, and did the usual "OK on count of 3 we'll pull you up." As I began pulling and tugging at the draw sheet, I realize my CNA is barely using any muscle to pull her up, fooling me. At that point, the patient was barely pulled up and my back started hurting. I've had the past 2 days off and am still having some achy pain in my low back. Is it possible I hurt my back? I spoke to another nurse about this particular CNA and she confirmed that she had a similar experience with her as she needed help lifting someone, and she barely helped to lift, causing that nurse's shoulder to hurt for a week. Me and that nurse are going straight to manager's office about this CNA.

I am hoping she isn't upset when I refuse to ever pull another patient up with her again as I never experienced anyone ever doing that with me. 

Dear Achy Back Pain,

You very well may have injured your back. Pulling against unexpected resistance can cause muscle injury. It's also true that most back sprains go away by themselves, let's hope that's the case.

By now I'm hoping you saw your manager and reported your industrial injury and the CNA's behavior. I would hope she had you file an incident report because this is so serious on both levels. 

You say this is the second time she caused an injury to a coworker. If it had been reported by the first nurse, it may have saved you from injury.

This is extremely passive-aggressive, despicable behavior. Recognize it for what it is and don't lose a minute's energy worrying about her feelings.

Take care and best wishes,

Nurse Beth

[JKL33]

Side note: Adding my usual reminder that using 2 people for this task is not appropriate even if they both give it their all. It is likely far beyond the expected lifting/pushing/pulling your employer put in your job description. Your employer is required to provide the resources to accomplish the work that is necessary in their business. Disposable nurses who are willing to abuse their bodies is not an appropriate resource.

You will need to find a way to put your foot down about this as you are at risk for long-term injuries. Since you are already injured, it's a great time to change your MO on this issue. You won't even look like a jerk, you can just say, "I've just recovered from being injured in this exact type of scenario and I'm not doing it again." Remember, others have no problem telling you what THEY aren't going to do. Don't sacrifice yourself.

[Kitiger, RN]

Protect your back! I can't say this strongly enough! 

You mentioned that the patient was on a low air-loss mattress. That means you have to lift them up (off the mattress) while you slide them up. There is an inexpensive trick that can really help. If you don't have access to a slider sheet, use a leaf bag (or some other large plastic bag). Roll the patient and position the bag under a draw sheet. Then slide the patient up using Trendelenburg position. The draw sheet and leaf bag can easily be removed afterward.

Are you allowed to pull from the top of the bed? An average size person can often be repositioned this way.

I work private duty home health, so I seldom have someone to help me. I use whatever tricks I can. I also have access to either a Hoyer Lift or a ceiling Lift, so I can use that to reposition the patient. You should insist that the hospital provide you with this.

[hppygr8ful, ASN, RN, EMT-I]

I'm not sure despicable! It certainly seems lazy to me. By the way I was taught a long time ago that one should never "Slide" a patient when repositioning as this can cause friction and shearing injuries to the patient. Like Kitiger I say always protect your back. There are many innovative ways to safely reposition a patient and hospitals and LTC facilities need to provide appropriate equipment for the safety of both patients and staff. 

Hppy

[Kitiger, RN]

15 hours ago, hppygr8ful said:

By the way I was taught a long time ago that one should never "Slide" a patient when repositioning as this can cause friction and shearing injuries to the patient. Like Kitiger I say always protect your back. There are many innovative ways to safely reposition a patient and hospitals and LTC facilities need to provide appropriate equipment for the safety of both patients and staff. 

Hppy

I agree that sliding can cause friction and shearing injuries. That is why I want a drawsheet underneath them. A top sheet folded in half (top to bottom) makes a great drawsheet.

By the way, the drawsheet will slide on the plastic bag so well that you will have to be careful that you don't pull them up too high in the bed. You don't want to hit their head on the headboard!