Newbie CNA shocked "care" given by CNA co-workers!

[MidLifeChg2Nursing]

I passed the state exam and received my CNA certification about the same time I started working at my first CNA position at a LTCF - I'm only working weekends; I work during the weekdays at a very good paying job.

I'm changing career with the goal of becoming an ER nurse. I'm working the weekends as a CNA because I'll be entering an ADN or LPN program August 2015 - ADN first choice, but if I get wait-listed, it makes sene to me to go ahead with the LPN program which has no wait list, then do LPN to RN. I'm a 44 year old male and don't think I should wait any longer.

I've been working at the LTCF for 4 weekends (CNA experience - 4 weekends) and I am just appalled at the care, treatment, and/or verbal abuse given by some CNAs to the residents. My wife (yes I am a male CNA), who was a CNA a while ago and is now an MA, said I should tell the DON.

Nothing is more important to a person than his/her health. We as CNAs are entrusted to help maintain their health - that's a huge responsibility, one that I take seriously. Making up numbers on charts is crazy; a non-compliant resident wouldn't allow me to take her temperature, so I asked a seasoned CNA (33 years) to help me - she looked at the previous day's vitals and just copied it. CNAs who didn't feed an assigned resident (they feed others assigned and not assigned) when charting say "well they usually eat and drink this much", and "they usually have this many BMs" - charting what they usually do will not catch changes which may prevent something; c'mon, their health is at stake.

Providing as much comfort and dignity is the next most important thing (of course safety trumps all). Needing help near the beginning of the shift with a resident whose large BM leaked out his briefs all up his back down his leg and all over and through the sheets, the experienced CNA I asked for help said he can wait, we being the only 2 CNAs (short that night) have to distribute johnnys/bibs/pads to the wing before dinner - yeah we were short, but with 2 of us and 1 experienced it wouldn't have taken but 10 minutes to change him and the sheets, instead of him waiting in his **** for an hour - c'mon that's disgusting.

And I can't even number the verbal abuse I witnessed or that they jokingly tell me about.

Maybe because I'm a brand new, wide-eyed, idealistic, fresh, untainted CNA, I expected caring and compassionate healthcare professionals. As was taught in CNA class and re-emphasized during new employee orientation the residents at LTCF have lost all their possessions - all they have now fits in half a room; their home now resembles a hospital floor; they are dependent on others to wipe their butts, or feed them, which in their minds may be humiliating and degrading; they lost a lot of independence; so yeah, some may have a hard time with that and may be a little grumpy. Again, maybe because I'm new, but some of the residents who have "rude" behavior and language doesn't bother me.

I took my wife's advise and told the DON - I'm not trying to be a snitch or get anybody in trouble, but as I said, I take seriously my job of providing safety, care, comfort, dignity; CNAs are also advocates, standing up for them against those who bully them - that's how I see it, as much as we hear about bullies in school, these CNAs are bullying those weaker than themselves. I don't know what actions may be taken, and I am a little worried that I will be found out as the "snitch" - I do have to work with them, and hopefully will get help when asked. I keep thinking of the last 10 months of my dad's life - he was reasonably healthy and lived on his own in an apartment; but, when his body started to shut down, it was a runaway train going down a cliff. He had no major health problems for 77 years, then his health just ran away from him - he spent the last 10 months in a nursing home, and I can't help but to ask, "is this how they treated my dad?".

Treat others the way you want to be treated, and the way you would want your loved ones treated - every time I go in to work, I think of how I would have wanted my dad treated.

I don't want to be the bad guy; but when I think about it, I'm not.

[Wheels28]

This!!

It's sad society values people who contribute very little to society and overlook the people that do.

I will never understand why people are so disrespectful to healthcare workers, I know that many times people are sick and such but if you are not nice to the people trying to help them, soon they will have no one to care for them. Maybe it's because I'm disabled and have been around healthcare workers my whole life, but I have great respect and value for healthcare workers, They see and do things many people couldn't handle all just to help someone get better, that reason alone is why they should be treated with respect. I would often tell my nurse or CNA while they were preforming care, "I'm so grateful for people like you" Their face would often light up and say thank-you, I don't hear that too often. How sad is that. That's one of the reason's why I post on AN to remind Nurses, CNA's they have people who respect and admire them.

I have to also agree with alienating the ones who care, one who helps can only be knocked down so much until they say that's it your on your own, have a nice life.

[Guttercat, ASN, RN]

As always, complex problems cannot be resolved with easy solutions. This is certainly a complex problem that has plagued us for generations.

The solution will have to be at a societal, upstream level because the core of the issue is inequality. The inequality exists on several fronts. For instance, the frail elderly are socially devalued while children and younger adults are highly valued.

Also, some people are born into a disadvantaged economic rung and, due to a myriad of social reasons, never climb the ladder into middle class security. It's ironic that the devalued elderly are receiving basic care from employees, a large number of whom might be considered socially devalued due to stigma, educational level, economic status, and other issues.

My best friend worked for several years as a state caseworker who placed participants in welfare-to-workfare programs. In addition, my cousin was a participant in the welfare-to-workfare program, although she was difficult to place into job training programs due to having only an 8th grade education when many of the more attractive offerings required a HS diploma or GED.

Unfortunately, there will always be a degree of inequality in society. Due to my education, salable job skills and basic knowledge about the system, I can navigate life without bureaucrats such as caseworkers controlling my behavior, telling me what to do, and sending me to placements against my will.

However, the underprivileged woman from across town with limited education and skills and a lack of sophistry about the system will be pushed around, suffer 1000+ humiliations and get lumped into a forced workforce of caregivers for the devalued elderly.

The solution is equality, but I do not see that happening during my lifetime.

Very salient observations. Thanks for posting this.

[Guttercat, ASN, RN]

Commuter is right about the elderly being devalued, but even children's caretakers are often hanging at the bottom rung of the wage ladder. We don't value caretaking jobs in our society.

While I agree that our treatment of the elderly is reprehensible in a lot of ways in this country, you have to realize too, that we don't know the whole story of these people. I can give an example from my own life.

Last I knew about a year ago, my mother was living in a long term transitional shelter run by the Salvation Army, a state and a half away (nine hour drive). I won't write you a tome describing all the years and issues, but I will tell you that both my brother and I offered help multiple times, over the course of several years. We funded groceries, car insurance, and prescriptions trying to keep her on her feet. And she spit on all of it and cut off communication because I won't hand her cash. When she ends up in a care facility somewhere, I'm sure the people who work there will think poorly of me and my brother. They won't know she pushed us away and refused the help we were willing to give.

Yes, I think some older folks are victims of selfishness. But some are victims of their own choices. None of them deserve abusive or neglectful treatment, but sometimes they end up paying a high price for alienating the people who should've cared for them.

Another good perspective.

[Cynt87]

Omgggg I had a similar situation. I lasted 5 days at a LTC. I just became a CNA in July. I just couldn't believe it. I am now doing private duties cna work. It pays more and it am with 1 patient in the comfort of there own home. I have about 1 yr left if my LPN program so I'm gaining experience and leaving the LTC to clinicals

[firstinfamily, RN]

LTC can be a beast!!! I did not quite understand if your facility has unit managers or just the DON. Both LTC facilities where I worked either had unit managers or a ADON and a DON. If your only manager was the DON, then you did the right thing. Typically, you should go through the hierarchy ladder of management when voicing any irregular or questionable events. However, I will tell you there were times I went above the unit manager/ADON to get things done!! You absolutely did the right thing, anytime patient care/safety is being compromised it is a major issue. The verbal abuse is actually an offense that can be prosecuted, therefore those CNAs should really be let go or re-assigned to another unit. You have the responsibility to report any form of abuse and that is usually mandated by the state in which you work, you can actually be held accountable if you turn the other way knowing this is occurring. Your facility should also have a state Ombudsman---this is a representative of the state that covers various nursing homes as a representative of the residents. Anyone can call the Ombudsman and leave information anonomously. The Ombudsman will usually come out and do her/his own investigation and if they see something they will then report it accordingly. This is usually available in every LTC facility. You are an advocate for your patients and it could be the more seasoned CNAs have developed a method of ignoring what is going on, or they just do not care. What is your patient ratio? One LTC facility I worked the CNAs were expected to care for 20 patients. Now that is not doable for any one. They were so over-worked, discouraged, felt like they "got no respect" etc. They may also have gotten themselves so engrained into how they do things they cannot change their routine without some major confrontation. The CNA who insisted on setting out supplies before attending to a patient with stool is not acceptable by any means. Sometimes I think CNAs are so very task oriented they cannot see the effects of their care or lack thereof. You can be the one to say, "I think this is a priority, after-all, we do not want his skin to breakdown because of stool." Get them to think outside of their box!! I applaud you for taking on this challenging career at this point in your life. Try to not get caught up in the back-stabbing, you will find the medical field can be very pretentious at times. Somethings you just have to turn away, but this was definitely something of concern. You are already displaying those skills of critical thinking and problem solving. Keep on trucking!!!

[funtimes]

Let me give you some advice. Find employment elsewhere and enroll in LPN or ADN or go to EMT school even... ASAP. If you turn a blind eye to abuse or let it go unreported a single time you become part of the problem.

As a paramedic who worked in the tampa/st.pete area I would guess 80% of my calls were for geriatric patients. half of those were at assisted living, nursing or LTC facilities.

They are the most horrible place on earth. I worked as a correctional officer in 2 states before EMS. We take much better care of our inmates.

I have seen an LPN doing CPR on a consious patient.

I have seen multiple patients with aspiration pneumonia from being force/rapidly fed orally or through feeding tubes.

I have been called for difficulty breathing only to find the patient laying flat on their back, with no oxygen, and no nurse or CNA present.

I have seen 80% of LTC patients with toe nails yellowed and an inch long, severe bed sores, infections and rashes from laying in feces and urine.

I have smelled the overpowering smell of urine and feces in 80% of LTC i have been in.

I have run on a patient with a UTI so far gone they became septic, had a core temp of 104, a blown pupil, screaming, babbling, crying, seizure like activity, hypotension and mild hypoglycemia. SA02 @ 88%. Laying in days worth of feces and urine. basically left to die. When the screaming became unbearable the LTC called 911.

I have had nursing homes request that I begin CPR and transport a deceased patient with obvious rigor, and dependant lividity.

I have seen first hand a LTC facility make up fake 911 compalints for patients on an entire wing to have them removed so they could deep clean for a state inspection.

I have called the department of health and human services because of filthy conditions. returned a week later and found the same dirty used band-aid on the floor where it was a week earlier.

I have transported "Difficult patients" that "accidentally" fall or get dropped by staff.

I have had patients from an infamous LTC close to st.pete general hospital tell me stories of patients having to trade sexual favors just to get their food and medications. Staff allowing violent psychiatric patients to prey on the old and infirm.

In many cases ( certainly not all ) CNA's are uneducated, overworked, underpaid, understaffed. LCT facilities are in the buisness of warehousing people. They make a profit when medicare or medicaid pays. All that is required is that the residents are kept alive. The very poor or lower middle class without supplemental income or insurance are doomed to neglect if they are very lucky. Downright abuse and maltreatment very often.

The few CNA's or LPN's at nursing homes that are waiting with the patient, have a full medical history, list of meds, allergies and a good history of recent changes, signs and symptoms... I literally have hugged them and praised them for doing an amazing job. I have given my number and email out and assisted many of them into finding an affordable EMT or LPN Program.

Patient Advocacy: Speak for those that cant speak for themselves. Defend those that nobody else cares about. Always Err on the side of caution when a human life is involved.

File a complaint every single time you see a violation of patient safety, dignity, human rights, care or comfort. Meet with a patients family, encourage them to visit often and to participate in patient care.

This is the ugly side of healthcare that nobody wants to talk about.

I agree with just about everything you said, its hard to argue with it. Having said that I've worked as a CNA in LTC and worked the road as an EMT, and while both are overworked, underpaid and undertrained, I found the CNA job to be a lot harder. Yes you get your oh sh%t calls, and you get shifts where you don't even get to post its so busy, but I've also had easy shifts as an EMT. I pretty much never had an easy shift as a CNA.

I just want to mention that because I know people in EMS like to complain/joke about LTC facilities, but its hard to find many EMTs and Medics who've actually worked in one and understand what its like. Unless its someone who did it for like a week and said screw this. Obviously there's no excuse for these nightmare facilities, but even in the best of facilities the job can be brutal.

I think one solution might be to require all Nursing students to be CNAs before going to Nursing school, as some programs already do. This is how its done in EMS, with all Paramedics required to be EMTs first. This can bring a lot of quality, motivated CNAs to LTC while preparing them for the rigors of Nursing and would even improve care in hospitals, as many new RNs who've never been a CNA really suck at some aspects of patient care when they start out.

I get tired of all these Nursing students who feel they are above LTC. If you are getting into Nursing it should be because you want to help people in need, and LTC residents are in need of help. It would also reduce the glut of Nursing students and help ensure those that are really serious and motivated about the profession are left.

[kbrn2002, ADN, RN]

Welcome to LTC and nursing homes. Although some will say that all nursing homes are not like the one you experienced, In MY experiences, every single nursing home was exactly like you describe. Its so sad and disgusting, you end up crying or quitting.

Sorry for your bad experiences, but honestly not every single nursing home is like that. Places do exist where residents are treated with dignity and respect, despite staffing issues. Granted it is impossible to take 10 people to the bathroom at the same time, but to not help as soon as possible is not acceptable and would not be tolerated where I work.

[SeattleJess]

I understand what you are saying when it comes to residents who are super demanding! It is impossible to meet every resident's every need! Getting every resident's basic needs covered is of utmost importance though. You have to weigh your choices. I've had one resident scream and yell in the hallways because during a linen change, I was interrupted and had to take another resident to the bathroom and get others up for supper. Her need for wanting her bed made RIGHT NOW was put on the back burner because there were others who had more important needs that needed met. Sure, this is a really obvious example of choosing what to do. But sometimes you're faced with more difficult choices, even ones that create more work for yourself, but it's all part of the job. I've also had a resident who needed to use the bathroom to have a BM who I couldn't take right away because another resident who was a fall risk hopped up from their chair alarm and was trying to wander. I had to promote the safety for the resident who was a fall risk and couldn't get the other resident to the bathroom on time and, of course, needed to get that resident cleaned up right away once the other resident was safe. I hate having to make those kind of choices. But everyone was safe and taken care of.

There are also times when you have to assert yourself to demanding residents, particularly when their demands take away from your ability to care for others who need their needs met. Sometimes just handling everyone's most basic needs is all you have time for and then there are times you're able to go that extra mile and throw in a nice back or foot rub at the end of a shower or look at pictures of a resident's family and listen to stories about their life. Those moments are priceless!

Well said, littlemissetter! I wish those "priceless moments" could be the standard of care but from my experience, even the most caring and skilled CNAs cannot provide that level to every resident every day. It's a zero sum game in LTC where giving to one takes from another... and the outcomes look horrible to an outsider who is thinking that way instead of in terms of maximizing resources and prioritizing care.

Of course, we can't carry this reasoning to the point of abuse or neglect. Just saying that it's a gray and tricky line.

What I dislike also is the policy in my facility. If there is a family member present, riding the call light, standing in the hall waving her arms because her mother wants to be mechanically lifted into bed right at that moment, we're supposed to give the family member demand priority over other residents' toileting needs. Perception management, I believe. I can't do that in good conscious and I don't. I explained to one irrate family member I'd put on hold that I gave toileting needs priority and she could be assured that her mother would not need to sit in her own feces on my watch. I was lucky; she got it. I guess that's the upside of the high CNA turnover in LTC - if you're halfway decent at what you do, management won't like actions like that but won't fire you.

[dream'n, BSN, RN]

These were not "little" issues you witnessed. You were absolutely right in reporting it to the DON. If nothing is done, call the facilities compliance hotline or their headquarters. Also call Adult Protective Services now, if you haven't already. Next I would resign. I could not work in such a place and I know you said you have other well-paying work at the moment. You have integrity, hold your head high!

[betm, CNA]

The best thing you can do is advocate for those who can't speak for themselves. I just had to report a coworker for neglect and although it was a clear-cut case, I still felt guilty for being a "snitch." But then I remembered my residents and how they suffer from this person's actions and it made telling my Directors so much easier. Good job.

[dedicated_2b_RN]

I have worked on pre reqs for RN school for over five years I could afford one class at a time and now I'm starting CNA PROGRAM ON MONDAY 9/29/14 I want to be a good RN I am not to good to do CNA work I feel that will be the best training and will also help me in RN school

I have been an ALlnurse member since 2011 and have been reading all these horror stories all these years

I would like to know why/how all the nonsense is allowed to continue and why if all over 800 thousand of us here know about abuses in the health field why don't the proper authorities know this and do something about it like getting rid of people who don't care to do their job the way it is to be done

[TheCommuter, BSN, RN]

I would like to know why/how all the nonsense is allowed to continue

The nonsense is allowed to continue because the frail elderly are devalued in society.

why if all over 800 thousand of us here know about abuses in the health field why don't the proper authorities know this and do something about it like getting rid of people who don't care to do their job the way it is to be done

The nursing home industry is the most regulated healthcare field in existence. Therefore, nursing homes in all states receive full-book surveys, inspections and visits from state and federal surveyors regularly.

Essentially, the 'authorities' know how nursing homes are operated in this country, but money makes the world go 'round. The horrid nursing homes are constantly cited and tagged for deficiencies, but they simply pay the fines and move on.

Ridding facilities of people who don't do their jobs is more easily said than done. Many nursing homes have employee turnover rates similar to fast food restaurants, so keeping these places staffed is challenging. If everyone who performed poorly was terminated, these facilities would be critically understaffed.

Moreover, doing one's job by the book is difficult when you're a CNA with 15+ residents to shower and feed during the day, or 25+ residents to perform incontinent rounds and change bed linens on during the night.