Need help re: resident transfer policies and possible resident and CNA consequences

[johnbwight]

I am a very experienced CNA, so I should have known better as to how I handled what I am about to tell you about. I'm asking for advice, but at the same time, I'll share some good advice.

Experienced CNA's know how it is. For example, I work evening shift and have 12 residents to put to bed between the end of dinnertime and 10:00 pm. 3 of those require hoyer lifts, 2 require a sit to stand machine, and 1 is a 2 person transfer. In addition, my partner has her 12 residents with a similar mix. I think most facilities require 2 people to do a hoyer transfer, many require 2 for a sit to stand (but mine doesn't), and they require 2 people for a 2 person transfer. Plus gait belts and proper transfer procedures must be used.

Realistically, we feel we don't have time for all that, and perhaps it is true. So we do a hoyer transfer or a 2 person transfer by ourselves. But...

Here is my situation.

I've actually been thinking about this a while before this personally affected me. Others in my facility will do a hoyer transfer by themselves, fortunately they do it very safely. However, one day, a particular female hoyer transfer had a large bruise on her leg. I was glad to have been assisted by another person to do the hoyer transfer the evening before I found out about this bruise. That way I had a witness with me that could vouch that we had performed a safe transfer. This resident is not mobile at all. So any bruises would have to come from consequences of our care, or any possible medication conditions, and bruises can be caused by a medical condition.

Then the other day, another resident had a large bruise on her left side and on her breast. When I put this resident to bed that evening, she did not have this bruise. I recall this clearly. She is a 2 person transfer, but not bearing weight very well. It was busy, so I did not get help. The transfer went OK, but could have been better, I don't recall anything that could have caused such a bruise. I'm extremly careful to do a safe transfer in all cases, if I'm not sure that I can, I'll get help. I'm extra careful with a gait belt (admittedly, if I use one) and I do anything I can to avoid pressure under the arms and around that area, including providing back support and support under the bottom, as needed according to the condition of the resident. Due to my years of lifting, my arms are strong enough and safe transfers are second nature to me. I imagine many of you are similarly experienced.

But the next afternoon I came to work, and I found out the resident did have this bruise. I know some CNA's complain about this or otherwise don't quite understand, but nursing staff and administration do have to investigate all bruises, for reasons related to state and federal law, particulary to rule out abuse and neglect.

So I truthfully told the nurse on the floor and the nursing supervisor what happened, that is, I performed a 2 person transfer by myself and that nothing out of the ordinary happened and that it was very safe. The nurse on the floor thought it was caused by a gait belt. This couldn't be, I would not put a gait belt near the breast. When used, it is only for a back up for my transfers, this resident is also very immobile, no way will I allow a gait belt to slide up in such a case. A CNA and this nurse and I also speculated with each other that it was an under the arms transfer that did this. Not so in my case anyway, as for such an immobile resident, I would provide support at the back and under the bottom for such a resident (I don't recommend this for everyone, only if you are sure you can do it safely).

Another side to this is that bruises are a common problem on this unit and lots of very new CNA's come and go. Experienced CNA's know that when new CNA's start transferring residents by themselves, anything can happen, for example, a resident or a hoyer may fall during a resident transfer, or an under the arm transfer is done causing bruises, or a gait belt does cause injury because of improper use, etc. Other possible causes for such a bruise may be related to how they are turned in bed. Even peri care is difficult for this resident due to her physical condition, so a bruise could be caused by spreading the legs to do this.

In my case, I was told by the nursing supervisor that a write up would be coming and next time would be termination, I see this as somewhat fair, the only reason I say somewhat is that one, many were transferring this resident by themselves, and two, I've only been a few months at this facility, and consequences have not been clearly communicated, I did not know the consequence until this write up situation. The nursing supervisor did express that she did not think I did this deliberately. Also, the resident was immediately changed to a hoyer transfer.

But I haven't recieved the write up yet, so I suspect further investigation might be done, and the nursing supervisor might be consulting with her supervisor, as this happened over the weekend. I happened to be off today (Monday), on again tomorrow, so I may recieve the write up then. This is all normal and proper in the conduction of nursing home business. I do worry a bit as it's hard to say what they might find, or if they might believe my story or not, from what the nurse on the floor and the supervisor said, it sounds like they feel it was due to my transfer, as it was first noted by the day shift CNA, a new CNA, although being new may or may not have any bearing on this, I've worked with new CNA's that do great work. I don't get along especially well with these nurses, for example, they feel I should be able to get all 12 residents to bed properly before 10:00 pm while doing transfers per policy, which I do, except in the case of this one resident, all need complete care, for either mental reasons, physical reasons, or a combination of both. Experienced CNA's understand this may or may not be possible, especially with mental conditions in the mix, unpredictable bowel eliminations, difficult residents, etc. In short, it seems they think that my transfer was the cause. But I do not think so.

My advice to you, if a resident requires assistance for a transfer for any reason, always get assistance, even if you are able to safely transfer the resident. That way if some unexplained injury occurs to a resident, you have a witness that can say you performed a safe transfer. Injuries will happen, the facility's concern is to rule out abuse, this is required by law. If an injury does happen, you probably won't get in trouble for it, unless, for example, you transfer a resident by yourself that requires assistance, or you have a pattern of unsafe transfers. Any other CNA could be caring for the resident since the last time that you did, and anything could have happened, whether or not the CNA is truthful about the matter is another story (one CNA I talked to about this said I should have lied).

That is my story, what is your input on this? I've never been written up in my 20 years as a CNA, so I'm not sure what to expect. I do know the facility is required to take action, could be reorientation to safe transfers, or disciplinary action or termination. The nursing supervisor did tell me the consequences, but that is subject to change, as I haven't received the write up yet, that could be in my favor or not, I can accept the write up, as from now on, I will do transfers according to care plan. Is the facility being too harsh because many other CNA's aren't doing transfers according to policy? What do you think?

[One Flew Over]

Just as an aside. If they all don't care what time they go to bed, couldn't you and the other aide just take a half hour or so and just transfer all of those hoyers/two persons? Then you can each go your own way and start getting them ready in their beds? Then move on to your other residents? I mean it sounds like the 2 persons are pretty compromised so they'd probably benefit from being in bed a little earlier. At least then they'd be comfortable while they are waiting.

[fuzzywuzzy, CNA]

^That's what we do with total care residents. It doesn't work with people who are mentally alright and set in their ways though!