Neglect, or not? I think so, ADON disagrees...

JZ_RN · Jun 27, 2012

As a nurse, if one of my aides came to me and told me to come see something (which mine frequently do, because they know I want to know about anything important and that they are my eyes and ears 'cause I don't see every inch of every patient each shift and I want to know if something is going on so we can intervene) I would go and see. If they said a leg was bending the wrong way, you better believe that I'd be calling to get an xray ASAP. At least. That's scary. Is there a possibility that in a nursing facility with staffing like the one I worked in that a patient be checked every hour? Not a chance. But at least if someone comes and says 'such and such is going on' you should go in and assess. It's hard to say if this is neglect. Some people urinate every hour and this stuff can just happen, however, if the family had gone about getting specific aides for the patient, this would have been different and the aides should discuss with the management what to do with this difficult family, they sound like they are sue happy if they "ban" certain aides then threaten legal action when something like this happens. There are only so many caregivers available at any given time for those patients and they need to realize this.

littleone25 · Jun 27, 2012

The RN on staff that night did everything she could, and while Im not a fan of the intershift blame game, It was the daytime RN's responsibility to follow up with the MD, admin, family, and mobile xray unit, and it didnt happen. I dont blame her for this, the fall itself was an accident...and I find it worse that the hospital didnt notice that both legs were broken during the course of her stay. it is true that some (okay, most at that age it seems) residents do urinate every hour, but this resident has a foley cath, so her saturation was due to a leak... My problem lies with the fact that the aide responsible for her who was banned from this residents room (the facility usually doesnt do this for the exact reason you said, but she was extenuating circumstance due to the threats from family) did not let anyone else on staff that night aware that she could not care for her..she simply let her lay there in her own urine. When an aide has had an issue with a particular resident/family member in the past, Its policy for that CNA to ensure that that resident is 'traded' for another so that they will still receive proper care. I barely got into the doorway and you could smell it, it was so strong. you dont have to go into a room to smell that much urine or see that the resident is still dressed, so to me, banned or not, theres no excuse.

JDZ344 · Jun 29, 2012

Where was the nurse who should have been made aware that an aide was banned from the room? The aide should have informed her of this STRAIGHT AWAY so she could make appropriate arrangements.

The aide who was "banned" is at fault here, absolutely, and I would say this is neglect... this resident had NOBODY to look in on her and check she was OK.

jadelpn, LPN, EMT-B · Jun 30, 2012

Wait a minute, if I am to read your post correctly-- First off, how did the resident roll off the bed and fall with the aide in the room? It shouldn't matter if the other aide went to get supplies. The bed was at chest height, and what? The aide was where exactly??? The story just doesn't make sense. This seems odd to me, and I would question why that happend to begin with. And some education on how it will not happen again. Secondly, resident comes back with a number of injuries. She was in the hospital for several days and no one noticed her other leg was broken as well? And sent her back to you? Or did this resident fall again when she came back to you all? Regardless, the resident should have been sent back to the ED on Sunday at 3am for some sort of prevenative treatment, ie: a splint, as to turn and repostion someone who has a "loose" fractured leg must have been excrutiating for the resident. And in my experience, a "leaking foley" doesn't saturate someone to the extent that you are describing. Unless the balloon was deflated, and then how did that happen? Was it more like no one bothered to empty her foley until it got so full in the bag to the tube that it backed up? There are no words....and I can't imagine how they got another foley in--the immobilizers off? Here's hoping that there were some significant pain meds on board. I don't blame this family one bit for being red hot angry. This goes beyond poor care to neglect, and needs to be reported. And the ADON is deluding herself in thinking that 3 hours is an acceptable amount of time to lapse when this patient is completely immobile, when in fact signs point to the probability it had been a heckuva lot longer than 3 hours. And do you know that 8pm was the last time the resident had any care? But no HS care as she was still in her day clothes? Leaving someone in soaked urine from one end to the other, letting someone continue with an untreated fractured leg for days, and now that there is an immobilizer on the legs no one bothers to go in and care for this resident? It makes me physically sick. There are residents who need at one time or another some priority monitoring. This would be one of those residents, and this would be one of those times. It is up to the charge nurse to delegate who would care for this patient. And if the family is "banning" aides from the room, then it is up to the charge nurse to delegate to the remaining aides who will care for this patient. With assistance from them, as the licensed person on staff has the ultimate responsibility. Epic Fail.

tamadrummer · Jun 30, 2012

6:23 am by littleone25 A member since Apr '12. Posts: 2
I am a CNA in a continuing care facility. We have both long-term and rehab residents. Recently, one of our long term residents had a nasty roll off her bed from near-chest height while with another aide...a second aide had been in the room, but had left to get some supplies. This resident was sent to the ED and was kept at the hospital for several days and came back to our facility with over 20 stitches in her face and a fractured leg, receiving hospice care. Myself and another aide that care for her on my shift (7p-7a) had told the charge nurse that her "good" leg was bending the wrong way at the knee. She did everything she could do to resolve the problem, but it was 2 more days before this resident even got an xray. It was found that her other leg was broken as well(obviously!) This is my first issue..being fully aware that legs arent supposed to bend that way, not one other nurse bothered to look at this resident, or even follow up with the MD for several days. Neither did administration. The family is threatening legal action regarding this incident, and I believe it should have been taken care of on monday at the latest (it was first discovered at 3am sunday) On to the next...I was listening to report to another aide about this resident, and when asked about her condition, the aide getting report was told, "I really have no idea how she is, Im not allowed in there." So we asked the other girls on shift who had been caring for her..everyone answered, "not me", myself included. Apparently, the 2 aides involved with her fall were banned from her room by the residents family, and the aide responsible for her that evening didnt tell anyone. So I went with another girl to check on her and we found her in bad shape...1130pm and she was still dressed in her day shirt, saturated with urine from the middle of her calves to the middle of her back(keep in mind that both legs are in stabilizers which are also saturated and cannot be removed long enough to clean and dry) due to a leaking foley. She had not been turned, changed or cared for since around 8pm. It took over an hour to clean her up, put new sheets on the bed, and assist the nurses with inserting a new catheter. The ADON called me back into work the following am to discuss it, and she says it was not neglect because it had only been 3 hours since someone had been in there. To me, that is assuming the previous aide had given care before she left at 7pm, which is assuming too much. Also, this resident had orders to be turned and checked every hour due to her condition...3 hrs minimum without any care is way more than 1. I am disgusted by this, and it made me ashamed to be associated in any way with 90% of the people I work with..CNA's, nurses, and admin. alike. I am considering reporting this to the state, but Im not sure if it really constitutes neglect. Advice anyone?

Totally neglectful behaviors. Get out of there and follow up w/an attorney. You need to be gone first. Get a different job, that place is going to ruin your career in nursing if that is your ultimate goal.

VictoriaGayle · Jul 2, 2012

Totally neglectful behaviors. Get out of there and follow up w/an attorney. You need to be gone first. Get a different job, that place is going to ruin your career in nursing if that is your ultimate goal.

I agree. Find another job and notify the apropriate agency.

There is no way that is not neglect. What state are you in? I know most states have laws requiring patients be checked every X hours if they have Y. In my state it is a violation if a depend wearing resident is not checked within certain time frame.

This whole situation is *****. I agree with Jade

BBRANRN2013, ASN, RN · Jul 2, 2012

Wow if that was one of my relatives i would be absolutely ****** as well. And Im not SUE HAPPY as someone stated! I dont think that anyone would want to see there family members in such a condition. How the heck didnt someone in the ED notice that both legs were broken or is someone not reporting another fall? I would report this immediately bc someone isnt doing there job! I would be furious!

maelstrom143 · Jul 12, 2012

Definitely neglect. Taking her history into account, the RN/LPN in charge of her care should have been made aware the CNA was not allowed to care for this patient. The patient should have been assigned to another CNA. The doctor should have been called for transfer orders to the hospital as soon as the leg anomaly was noted, as the hospital dropped the ball (they should have caught on to the leg fx during the first visit). Where was the day shift nurse? Did she ever visit this patient? I usually round on my patients during the last hour in order to ascertain their needs have been met before shift change, as otherwise they might wait an ungodly long time to get pain meds, have a full urinal emptied, have a bsc emptied...

Find yourself another job and run as fast as you can away from this situation. Definitely report it. It is beyond scary how they have treated this patient. This is not just one or two incidents. This seems to be a constant, unending barrage of failures on the caregivers' part and very few of you questioning it. Thank God for those of you who have questioned.

psu_213, BSN, RN · Jul 12, 2012

Get out of there and follow up w/an attorney.

Trying to get out of there probably isn't a bad idea, but why does the OP need to followup with an attorney? Every time a nurse or aide witnesses potential neglect (for which they are not accused) they need to pay an attorney? If that is the case, let me on that racket by the lawyers.

But, I do agree that this is neglect and if action is not taken within the facility, the OP should go out of it (to the state or the local dept. of aging, etc.).

tamadrummer · Jul 12, 2012

Trying to get out of there probably isn't a bad idea, but why does the OP need to followup with an attorney? Every time a nurse or aide witnesses potential neglect (for which they are not accused) they need to pay an attorney? If that is the case, let me on that racket by the lawyers.
But, I do agree that this is neglect and if action is not taken within the facility, the OP should go out of it (to the state or the local dept. of aging, etc.).

To cover their own behind. Seek counsel as to the appropriate way to ensure they Are Cleared of all accusatory/neglect claims. Not to sue because they have not been harmed in any way but protecting one self and ones license is rather important.