Negligent CNA?

[halerac88]

I was transferring a resident to bed as a one person ext. that I had been transferring for months and followed all the right steps when I noticed that the bed frame of the bed had caused a very large skin tear on the residents leg. I immediately got the attention of my supervising nurse and she got our Charge nurse and they began to assist the resident. I was then informed that the resident had been a two person ext. and that I had to have a write up for not following the care plan even though I was not aware that the care plan had been changed. I was than informed the next day by DNS that the incident had to reported to the state because it was negligence. This incident has happened before several months ago when the resident was transferred as a two person but the DNS believed it was another issue that caused the injury and not the bed frame. The DNS said that it was my transfer that caused the injury yet that same day she had the bed replaced in the residents room. I am also confused because for almost a year I have been charting that I have been transferring the resident as a one person and the MDS never questioned me or asked why I was transferring the resident incorrectly. I am scared that I am going to lose my license, I am a good CNA and all of my coworkers and residents love me. Even the resident who got injured stated that she believes it was the bed that caused both injuries and doesn't believe me to be at fault. Does anyone have any advice on what I should do?

[Hygiene Queen]

I'm sorry this happened to you.

How do changes in the careplan get communicated? How is it you didn't know? Did you not know because you did not take it upon yourself to check, or was your information source never updated?

Why you "didn't know" is important because that needs to be fixed.

I have no clue why your continued charting that the resident was transferred as a 1 assist was repeatedly overlooked.

I have no clue why the bed or rail wasn't replaced after the first incident (I remember a few old old beds we used to call "meat slicers" )

I do suspect that the ball was dropped in several areas and you do bear some responsibility in this as well... but it sounds like they did too and are happy to throw you under the bus.

Besides all that, sometimes doo-doo happens. Sometimes, as careful as we are, someone is going to get a skin tear. I am sick of TPTB acting like these things can never ever happen! That's bogus.

Also, someone fill me in because I have no clue: would something like this really get reported to the state? I'm thinking in this case it would be rather stupid to do. The charting would surely bear that the aide was transferring as a 1 assist and no one ever stopped them until there was an injury!

Is this "reporting to the state" an oft-used scare tactic, or what?

OP: I don't think you'll lose your certification for this. Just make sure you do what you can to make sure you keep yourself up-to-date on any changes.

[NurseOnAMotorcycle, ASN, RN]

I agree with Hygiene Queen. I don't think you'll lose your certification over it, either. I think the are throwing you in so they don't get looked at.

editing to add:

BTW: if something happens to a pt while a cna is assisting a nurse, it's on the nurse.

[TheCommuter, BSN, RN]

Unfortunately, CNAs frequently become the scapegoats for issues that become problematic at many LTC facilities. I concur with previous respondents who mentioned the need for a system to communicate care planning changes.

[bluegeegoo2, LPN]

Hygiene Queen:

I think it has to be reported to state because it was a piece of equipment that caused the injury, not the transfer itself. I wouldn't quote me on that as I'm not entirely sure.

[halerac88]

The careplan was updated several months ago but its still wrong. Like this particular resident eats in the activity room because they need more assistance yet on her care plan it says she eats in the independent dining area. I told this to my DNS and she said it didn't matter, but if it's wrong on several areas of the care plan how can I know if it's up to date?

[Julius Seizure]

The careplan was updated several months ago but its still wrong. Like this particular resident eats in the activity room because they need more assistance yet on her care plan it says she eats in the independent dining area. I told this to my DNS and she said it didn't matter, but if it's wrong on several areas of the care plan how can I know if it's up to date?

I would encourage you to have a written record of all communication regarding this, for your own interests. Either communicate by email so that you can have a record of what was said, or if it is an important verbal conversations with the DON or something, then immediately afterward, you can go to your email and write up notes about the conversation to save for yourself (include date and time if you really arent able to do it promptly). By sending it via email to yourself, it will sort of timestamp it AND help keep everything in one place. If you want, you can send a copy to the person that you spoke with and say "Just reviewing what we discussed" to be sure that you are all in agreement and understanding....if they dont write back and clarify then they are essentially agreeing that your summary was accurate. May come in handy if this becomes a he said/she said where you are being thrown under the bus.

[LockportRN]

I am sorry that this happened both to you and to your resident.

As others have said, it appears as though there is a facility-wide lack of communication. For this reason, it would appear as though you may be scape-goated. Like another poster said, do document all communication regarding this incident with management in an email to yourself. If there is a paper 'write-up', make sure that you ask for a copy.

Now the report to the state should not be considered a punishment. This is what the facility is mandated to do. Well, at least in Illinois it is. All incident or accidents must be reported. If your manager and administrator are smart, they will start a POC (Plan of Action) immediately and that should include getting all Care Plans up-to-date, and instituting a better way for staff to know about pertinent changes promptly. Under most circumstances you will not loose your certificate unless the facility can prove that you were aware of the proper transfer technique but refused to comply. Even then, it would seem as though you would be given proper training. I wouldn't think that a one-time incident could get you punished by the state.

From what you say about this, it sounds like an internal communication problem. If you are formally 'written-up' I would ask for guidance (in writing) what you should do on a daily bases PRIOR to shift start, to ensure that you are made aware of any changes (for nurses, we give each other a report). There are many many ways this could be done for you, but these are usually facility specific.

Try to breath, take responsibility KNOWING that accidents do happen (many of our elders have tissue paper for skin...heck, I am getting close to that myself!), and often skin tears can't be helped. It was good that you immediately got her help. Hopefully, you can be a part of changing what sounds like a faulty communication system so that these things will happen less often.

Best of luck to you.

[CapeCodMermaid, RN]

I wouldn't report this unless it was done with malice. People make mistakes

[withasmilelpn]

We just do education. Silly that they reported it as negligence. Doubt that anything will come of this unless it's a serious injury.

[ttt4271]

In some states it is required to be reported; in my state we have to report incidents in which our investigation shows that staff could be guilty of neglect, which includes failure to follow the careplan. When we report the incident we also tell the state of our plan of correction-in this case your writeup would be part of the plan- and often the state accepts that plan without coming out to investigate and that is the end of it. If I were you I would find out how to make sure you are always transferring residents correctly, and if the state does come out and investigate be honest about the fact that you did not know you were doing anything wrong. In my experience it is very unlikely that any action would be placed against you by a surveyor; they are much more likely to cite the facility for failure to train you adequately if they do come out and investigate.