Need advice,Problem CNA

[stillwant2banurse]

I am a nursing student in school, and I am currently working on my preq reqs. My question is this, my mother in law is in ESR (End Stage Renal Failure) and my spouse is trying to assist his mom in anyway possible. The CNA that is taking care of her is becoming unapproachable to the point that everytime we ask her a question she assumes that I am after her job and instead of just speaking with me about her condition she runs back to our father in law and tells him that we undermine her and we think she dosnt know what she is doing.

Let me first state I do not want her job, I am too busy with school and my own job at a local hospital, but it has now gotten to the point that my mom (in law) was placed on too much meds her bp was dropping and she was rushed to the hospital on several occassion almost having a heart attack. When I went to look at her meds I continued to try and point out to her that her medication was incorrect, but instead of trying to look at the problem she was more concern with her job then her patient.

Now she has had these medications in her system for so long, the doctor is convince her health is warranty Hospice and my spouse dad is confused and do not want her on all these meds (being that the meds are 4-5 different psych. meds) and she is not combative in anyway.

I cant get past why this CNA is so protective about her job, to the point that she dosnt want to share information with her family members which is us?

When going to school, or obtaining your RN, did any of you guys experience this before?

If so how did you handle it?

I have not said anything to my spouse because I dont want to complicate things more, but it makes me wonder sometimes what is she hiding if anything.

I should also mention, that I believe my mother really can benefit from a RN doing quaterly vist and assesments to prevent this, but when she meets anyone she introduces herself as "her nurse" and she is not a nurse! and this impression is hindering her from receiving or asking for the appropiate care.

[elizabert49]

Please, please, please be pro-active about this and do something quickly! As previous posters said, check your state laws, and if she is not within her scope of practice and, as I understand from your post, has actually harmed your MIL by working outside of her scope, pursue a legal avenue. ESRF is a complicated, fragile condition that requires a delicate balance of medications, diet, and lifestyle to manage. While a CNA may be able to help your mother in many ways, this probably requires an experienced RN to truly manage her medications. Even as an RN, ESRF makes me nervous because of all of the intricacies that goes into managing it. Good luck with your situation!

[BabyLady, BSN, RN]

Personally, I don't understand why this is such a problem.

If the CNA is not taking care of your mother, and is not listening to your needs, the simple thing to do is request that the CNA not be assigned to your mother.

You have a right to refuse care for your mother's behalf, if you think the care is not being given.

[stillwant2banurse]

it sounds like your mil is being cared for at home. if the cna is a certified medication aide (which we do have in my state) then in regards to the medications for bp, the bp must be taken as well as the pulse and you need to discuss with the primary physician about a hold for the meds if the bp/pulse is below a certain number.

if she's not, then her duties are simply vitals and adl's period. if she is not qualified to give the meds, then someone in your family needs to be administering these meds.

lastly, it seems like the situation is hostile. this is not a good situation for your mil.

in nursing school, i've found some cna's are wonderful and see us as assets on the floor, we lighten their loads considerably, and there are some who resent nursing students. i've always gotten along well with almost all of the staff from the housekeepers to the cna's and the nurses, but sometimes there are those who you just cannot make get along with you as a member of the healthcare team whether it be in the hospital or as part of the team with your family in the care with your loved one. if this is in your loved ones home, then another care giver with more respect to their responsibilities and their patients might be in order. as a cna, she should be under the supervision of a licensed nurse even if not on site, you should speak to her supervising nurse.

thank you all i thought for a moment this was just me, but now i can see it is not. being this is my mil, i really do not have any of the say so in her care. my spouse is constantly asking about her and cant get a straight answer. when my husband asked her how his mother is doing, or even try and find out about getting a rn for her, she runs back to my father in law and threatens to quite saying that my husband dosnt trust her. my inlaws are in there 70's and i really do not believe he understands the scope of practice for a cna. she works for an agency and he even pays her extra to do things like cook meals and take her to doctors appt's. i have explain to my husband this is her job, but then again you cant tell my father in law too much either.

[pers]

Cooking meals and taking your MIL to the doctor may not be part of her job. Aside from clinicals in school I only did home health one summer but those tasks were not included in basic care. If those services were included for a particular patient it did cost extra.

I appreciate that this is your MIL and you may feel a need to tread lightly here. How involved are you and your husband in her care? Is this something you even have a say in? Have you or your spouse tried talking with your FIL directly? It's easy for us to suggest you simply replace this person but that may not be an option for you.

Again, I'm not very familiar with home health but a friend of mine is wading through the ins and outs of home health with her mother and I know for her family a lot depends on her mom's insurance and what Medicare will cover. They are eligible for a HHA but not for an RN (unless they pay out of pocket). I would imagine your MIL qualifies for RN visits with ESRF but I can't say for sure.

With regards to meds, it's very dependent on which state you are in if it's even in the scope of a HHA. Though if she is permitted to administer meds, I would imagine (but don't know as I have no experience with this) that without very specific guidelines (BP or pulse above or below a certain number) it is not within her scope to hold medications.

Beyond all that, what exactly do you want the CNA to share with you? It really does seem like medication questions should be directed to the doctor not the CNA. If you have questions regarding the very basics the CNA should be able to tell you about it (how she's moving, eating, etc). Then again, those are things I would imagine your FIL could tell you as well. How does he feel about the CNA? What does your MIL think of her? Have you discussed an RN with them?

[stillwant2banurse]

Cooking meals and taking your MIL to the doctor may not be part of her job. Aside from clinicals in school I only did home health one summer but those tasks were not included in basic care. If those services were included for a particular patient it did cost extra.

Beyond all that, what exactly do you want the CNA to share with you? It really does seem like medication questions should be directed to the doctor not the CNA. If you have questions regarding the very basics the CNA should be able to tell you about it (how she's moving, eating, etc).

Normally from my past experience HHA would be required to cook meals and take the client to some doctor appointments. One of the questions that is general asked when applying for the job is do you have a driver lisc. and we need to see a copy of your vechicle insurance car.

I feel that as a CNA she should be assisting with ADL's and not interjecting herself with her medication and how much she should have so forth and so on. I also feel like if my spouse ask's about how his mother is doing she should answer the question. Ex. There has been several occassions when my spouse would call to see if mom was having a good day or a bad day, and instead of simply answering the questions, she would say something like I need to call you back, she would hang up the phone and call my dad (inlaw) and say things like, your son thinks I dont know my job and he is always second guessing me - and its like what are you talking about I was simply asking a question - How is my mother doing?

Also, when we are at the house she will do things like, leave something running and get my dad (inlaw) all upset, then go behind my back and say I did that. When my husband tries to explain that his mother needs a RN, to make an assessment of her care, she gets angry and calls herself the my MIL nurse- which to me is crazy, I cont. to explain to my husband, that she is not a nurse, but trying to get this through my FIL head is like

and it really is sad because my hands are tied but she really needs a RN to come in and give her an assesment that the CNA could follow. If I make an attempt to help, I am not helping I am trying to take her job- and it has gotten to the point that I tell my spouse not to mention me around her, maybe this will convince her I am not trying to take her job, but if you tell me, she cares more about her job than her patient.

[stillwant2banurse]

Personally, I don't understand why this is such a problem.

If the CNA is not taking care of your mother, and is not listening to your needs, the simple thing to do is request that the CNA not be assigned to your mother.

You have a right to refuse care for your mother's behalf, if you think the care is not being given.

BabyLady I agree with you 110% if she was my mom and not my MIL, that would be my suggestion as well, however, this is not the case, it becomes hard to sit back and see something wrong but not be able to speak freely about the matter because it is making my MIL miss the opportunity of care that she really can benefit from and needs.

[Virgo_RN, BSN, RN]

Is this CNA working through and agency, or is she private duty?

If she is working through an agency, there must be a written plan of care. You and your spouse do not have the right to see this plan of care. You and your spouse do not have the right to ask for medical information regarding his mother. This is protected health information, and the CNA is correct not to be sharing her client's private information with anyone except for those who are authorized to know.

Your FIL is the person that should be handling this, and the CNA is correct to take her concerns to him and not discuss them with you or your spouse.

It is your FIL that your spouse needs to have a heart to heart with about this situation, not the CNA.

There may be financial complexities involved here; for example, if this CNA is private duty, it may be because your MIL's insurance will not cover home health nursing services, and this is what your FIL can afford. If this CNA is working through an agency, then an RN or LPN has to come evaluate your MIL at some point, which would be a good time for your FIL to bring up any concerns, or he can call the agency if his concerns cannot wait for the nurse to come around.

All in all, I think you need to butt out. It sounds like this CNA does a good job other than the medications, which need to be prescribed by a doctor and the CNA has nothing to do with that. If the medications need to be adjusted, your MIL's MD needs to be contacted, not the CNA. Your FIL needs to contact the MD, not you or your spouse. Therefore, the person you need to maintain a cooperative relationship with is your FIL. Let the CNA take care of your MIL, and as long as your MIL is clean, dry, warm, and comfortable, then the CNA is doing her job.

[stillwant2banurse]

Is this CNA working through and agency, or is she private duty?

If she is working through an agency, there must be a written plan of care. You and your spouse do not have the right to see this plan of care. You and your spouse do not have the right to ask for medical information regarding his mother. This is protected health information, and the CNA is correct not to be sharing her client's private information with anyone except for those who are authorized to know.

Your FIL is the person that should be handling this, and the CNA is correct to take her concerns to him and not discuss them with you or your spouse.

It is your FIL that your spouse needs to have a heart to heart with about this situation, not the CNA.

There may be financial complexities involved here; for example, if this CNA is private duty, it may be because your MIL's insurance will not cover home health nursing services, and this is what your FIL can afford. If this CNA is working through an agency, then an RN or LPN has to come evaluate your MIL at some point, which would be a good time for your FIL to bring up any concerns, or he can call the agency if his concerns cannot wait for the nurse to come around.

All in all, I think you need to butt out. It sounds like this CNA does a good job other than the medications, which need to be prescribed by a doctor and the CNA has nothing to do with that. If the medications need to be adjusted, your MIL's MD needs to be contacted, not the CNA. Your FIL needs to contact the MD, not you or your spouse. Therefore, the person you need to maintain a cooperative relationship with is your FIL. Let the CNA take care of your MIL, and as long as your MIL is clean, dry, warm, and comfortable, then the CNA is doing her job.

To come back and tell me to butt out of my own MIL health, is out of line, she is my MIL and I have ever right to know how her progress is. Second of all, the lack of a care plan is the problem if you was reading the post. The care plan needs to be made by the RN, and everyone knows that family members are a part of that team that will assist her in reaching the goals of her care plan.

Understand me I am not saying this is not a good CNA, but I am saying she is just that a CNA and not a RN, or LPN. She works and gets paid through an agency, so you are correct we know she needs a RN or LPN to come in and to do an assesment, but each time we make this suggestion we are getting blamed for thinking she is incompentent, and we are being told she is my MIL nurse and she knows what she needs so now she is worst off and that is the problem. I am a CNA and I work with several RN's, however, I stay in my scope of practice, I dont make it appear to my patients that I am something I am not. Now to say we cant ask any information about her is crazy, if you took your love one to the hospital and you visted them on a regular basis, and asked the nurse how is she doing and the nurse told you to butt out- exactly what would you think of that RN?

I really hope I misunderstood you on that one or that you misunderstood me, also we do have the legal right to ask these questions because we are the health proxy for her.

Also, I do agree with the fact my FIL needs to bring these things to her attention, and according to the concerns he has stress to us, he has, but we you have someone telling you I am a nurse and this is your wifes condition it is extermely misleading. I think that we should all be who we are - in other words let the CNA be that and we will be her family and things could run more smoothly.

[pers]

I really hope I misunderstood you on that one or that you misunderstood me, also we do have the legal right to ask these questions because we are the health proxy for her.

If decisions regarding your MIL's care are up to you and your spouse and you are not happy with the care she is getting then contact the agency directly and ask for an RN and a replacement for the current CNA. I don't understand the problem?

[stillwant2banurse]

If decisions regarding your MIL's care are up to you and your spouse and you are not happy with the care she is getting then contact the agency directly and ask for an RN and a replacement for the current CNA. I don't understand the problem?

she has been my MIL CNA for a very long time so it would really hurt to see her go, and I really dont think she is a bad CNA, but I do think she should stay in her scope of practice and understand that we each have a part to play in seeing my MIL get to where she needs to be. Why be so eager to think someone is out to get you? I guess I am venting and at the same time trying to find options to be able to talk this through with her and adress that concern that someone is trying to take her job because it truely is not the case, I have one of thoes

[pers]

Considering the number of us who felt the solution was to fire her (I just mistakenly thought this may be up to your FIL not you and your spouse) based on what you had posted I don't think it's all that unreasonable for her to feel her job is threatened. Not necessarily because you will replace her but because you have the ability to take it away and are obviously not satisfied with her, make sense?

You seem really unhappy with her and it doesn't sound like she's open to discussing your MIL's care with you. How is this a good situation for anyone when you and your spouse are the ones making the decisions regarding her care?

Even if you want to keep the CNA, contact the agency and ask about getting an RN. While you are talking to them, ask about the doctor visits and meals as well since you believe it should be included. The CNA doesn't need to be involved with your decision to bring in an RN as it's not up to her--you don't even have to tell her you're doing it.

[stillwant2banurse]

Thank you pers

So in other words just contact the agency directly and request that my MIL have a RN come to do an assessment of her, that makes complete sense to me.

I am general not a confrontational person, but I find that I need to be in some cases such as this. I never looked at things from the point of view that maybe she feels I want her job because I have access to it. I really do not want the job, I am extermely press with school and working myself and I like it very much at my current employement in that I learn so much and I am exposed to so much.

Thank you again I believe I will give this a go, when you are on the inside you dont get the chance to see the outside point of view from others like this, so thanks again to everyone