Not following care plan

Inquisitive one · Aug 3, 2007

We strongly adhere to following the careplans. Resident safety is a priority and I will write up any CNA who doesn't when it pertains to transferring. Three write ups pertaining to safety and you are out of a job. Resident injuries are reportable to DPH (the state) and I have know CNA's that have not only lost their jobs but thier CNA certification because they did not transfer according to the care plan and an injury resulted. Take the time to do it right and ALWAYS think resident safety.

buildingmyfaith57 · Aug 4, 2007

amanda have you ever check the registry in your state and see how many people are put on that list each month for misconduct ? alot of cna are losing their certication because of not following the care plan. but than i notice that not all health care facility are not going by state laws either. here is my question why is it so easy for health care and agency people to cause cna or license to lose their cna or license when not all health facility has those rules?

CapeCodMermaid, RN · Aug 5, 2007

You must follow your facility's policy. Most facilities required the use of gait belts for those patients who need assist with ambulation unless they have had abdominal surgery or a g-tube.

The care plans are there for a reason. They indicate what is the best plan of care for a particular resident and can end up 'saving' the staff if something does happen. We had a woman fall while she was with a CNA. The family was irate because they thought she should have had 2 people helping her. At the time of the fall, her care plan (and MDS) clearly stated she was a 1 person assist. The CNA felt terrible about the fall, and honestly it wasn't her fault, but she was following the care plan.

Management doesn't make up these rules to give people more work. I have CNAs who are insulted if I have to investigate an allegation of abuse or if the patient says they are too rough. Regulations about investigating aside, much of this is for the protection of the CNA and their reputation. If there isn't a thorough investigation with a conclusion, there might always be a doubt about the allegation.

(Sorry for going on so....4 cups of coffee so far today!)

pumpkin92356 · Aug 6, 2007

I just had to reply to this one! I am a cna and let me tell you this care plan issue is one that we should all follow. But, the majority of LTC I have worked in have persons doing the care plans that really have not ever worked with the resident. I'm not saying that this is true for all nursing homes there is also the issues of staffing . Most homes try to work you with anywhere from 8 to 12 residents on day shift and sometimes these will be total care. Teamwork is the key to this problem and there are some aides who dont know what that means. They come to work and only answer their lites and tell a resident who wants help "I'm not your nurse today" I find it very hard to believe that you have followed the care plans to the letter. Situations arise that you are forced into that are beyond your own personal control concerning resident care. I'm not saying that you are not being honest just that it just sounds to good to be true.

buildingmyfaith57 · Aug 6, 2007

I just had to reply to this one! I am a cna and let me tell you this care plan issue is one that we should all follow. But, the majority of LTC I have worked in have persons doing the care plans that really have not ever worked with the resident. I'm not saying that this is true for all nursing homes there is also the issues of staffing . Most homes try to work you with anywhere from 8 to 12 residents on day shift and sometimes these will be total care. Teamwork is the key to this problem and there are some aides who dont know what that means. They come to work and only answer their lites and tell a resident who wants help "I'm not your nurse today" I find it very hard to believe that you have followed the care plans to the letter. Situations arise that you are forced into that are beyond your own personal control concerning resident care. I'm not saying that you are not being honest just that it just sounds to good to be true.

pumpkin i agree with you about the team work. answering their own lites and than tell the residents im not your nurse today. if that was me saying that i be written up or sent home.

amanda1229 · Aug 6, 2007

I just had to reply to this one! I am a cna and let me tell you this care plan issue is one that we should all follow. But, the majority of LTC I have worked in have persons doing the care plans that really have not ever worked with the resident. I'm not saying that this is true for all nursing homes there is also the issues of staffing . Most homes try to work you with anywhere from 8 to 12 residents on day shift and sometimes these will be total care. Teamwork is the key to this problem and there are some aides who dont know what that means. They come to work and only answer their lites and tell a resident who wants help "I'm not your nurse today" I find it very hard to believe that you have followed the care plans to the letter. Situations arise that you are forced into that are beyond your own personal control concerning resident care. I'm not saying that you are not being honest just that it just sounds to good to be true.

First of all, at our facility, saying that we can't help someone because we're not assigned to them would never fly. We have three wings at my LTCF and since the Alzheimer's wing is always locked, B and C wing aides and nurses are always there for each other if something comes up. If anyone went up to a resident, on my wing or not and said that, I would assist that resident and then promptly report that stupid behavior to a superior. What an insult!

Secondly, our MDS coordinator is great. She asks the aides, not the nurses, what it's like to care for certain residents. Her office is accessible, and she wants us to come and talk about the residents with her. Every MDS should be like this, I believe. If I notice that Mrs. So-and-so is getting too heavy for a one-assist, I let her know right a way, or if another is losing his ability to stand. It's a great system.

Third, on a typical day where I work, myself and another aide are assigned to a wing with twenty-four residents. Eleven are one-assists, three are two-assists, four are Hoyers, and the rest are independent (it's so much better than it used to be, we used to have nine Hoyers and, like, three independent). I have yet to break a rule. Obviously situations come up, like if someone is falling and I have to do what I can to get them safe -- we had a woman who was just beginning to decline but CP still read one-assist as it had only been a few days. She had the gait belt on getting up from the toilet, but started to buckle -- I acted on instinct and just "chicken-winged" her and through her back on the toilet. I gave her some light bruising under the arm for that one, but she would have hit her head on the edge of the toilet, and her knees on the bars of her wheelchair. That's a situation where I'm not going to worry about sticking my fingers into that snug belt in a pretty immediate situation.

I can't speak for anyone else in the facility, but I prefer to follow the rules. It's the same when someone doesn't show up and I'm alone on my wing. I'll get the one-assists and the independents up and moving for a meal, but I sure won't be doing the Hoyers and two-assists by myself. I'll wait patiently for a nurse or another wing's aide to come help me. That's the teamwork at our facility, and it pretty much has to work. We have aides that are stressed because they do everyone on one side and then have to come over to do seven more, but what can I say? I'm not about to be a hypocrite and let it be okay to break rules, and neither should they. It's not like any other job where you can skip a step and fly by -- I deal with fragile people on a daily basis, I'm not going to be responsible for a bruise, broken hip, or a death on the floor because I'm in too much of a hurry to get to supper.

mercy1975 · Aug 9, 2007

Just out of curiosity, how many of you LTCFs out there stick faithfully to a resident's care plan? I will be posting this on the CNA board as well, since aides see most of it, but I wanted to get the nurse perspective of it as well.
When nurses help with transfers, do you use gait belts without question? Is there always two to a Hoyer transfer? Are two-assists ALWAYS two, or does the one big guy handle them all by himself? I am one of those aides, I do everything to the care plan faithfully because I am not the strongest person, for the safety of the resident, and I don't want to lose my job. But so many of my coworkers are NOT the same way -- in fact, come to think of it, I don't know if anyone is like me that I know of.
One of our strongest workers, an older male, recently lifted a two-assist by himself and fractured her hip in the process. She will now be a Hoyer and has been in and out of the hospital for decline. He has been fired since for transferring another two-assist resident by himself. So our LTCF has really been cracking down on it, I'm surprised more people aren't religiously sticking to that gait belt, and other transfer rules!
What is the situation like at your facilities?

How wonderful it is to hear that facilities will follow the care plan in the posts. In this situation where a fractured occurred and the care plan was not followed could and probably would result in a high level of deficiency by the federal and state inspectors. This could result in a high fine and other serious issues such as not being able to take new residents. If this problem and others are widespread it could result in losing the state and federal moneies which would cause the facility to close.

This doesn't even begin to address the pain this poor resident has sufferred.

Daytonite, BSN, RN · Aug 11, 2007

amanda1229. . .i recently did a paper on lifting laws which both the states of texas and washington have enacted. california, as well as several other states, has been trying to enact similar laws. there are a number of reasons behind them. primary is the number of workman's comp claims that are paid out for back-related injuries of nursing personnel as well as days of work lost. osha is very interested in getting national laws relating to the safety of lifting and moving patients enacted and applied nationally. i would imagine that in the years to come you are going to see this issue brought up more and more.

what you have seen is the result of what can happen to a patient. this male worker you mentioned was practicing very foolishly. he put not only the patient, but himself at risk of injury as well. he and the facility will be very lucky not to be sued by the patient for the injuries she sustained as a result of his negligence. the facility will be liable because they did not supervise him adequately and enforce their own policy and procedures.

you have pointed out another very important concept. . .we are each responsible for our own actions. you are going to see a lot of ways people handle responsibility. people can be told the rules, but it is their choice to follow or not follow them. supervisors and managers are also responsible for enforcing them. people who observe others not following policies and procedures have a duty to make these transgressions known to their supervisors. we have to all work together for it all to work to all our benefit. as lifting laws are passed by lawmakers and facilities impose policies and procedures upon us, those who do not follow them, become injured as a result, or injure another as a result will find no help with the expenses they incur due to their negligence and refusal to follow the rules. these are the consequences of living in a free society where we have freedom of choice. what you are really posing is an ethical dilemma we each face every time a patient asks for help to be moved. part of the decision we make involves not only knowing what is on the patient's care plan, but the laws and what is good nursing practice.

Dixiecup · Aug 20, 2007

I'm the ADON at a LTC facility. One of my resonsibilities is assessing and assigning the amount of and type of transfer the resident needs and to update as needed.

I totally rely on my CNA's for input as they work with the residents every day and know them much better than I do. Almost all of the CNA's at our facility are excellent and I trust their judgement.

We enforce the policy strictly but it's hard to keep an eye on everyone all the time. Luckily we have responsible staff that genuinly care about the residents.

First of all, at our facility, saying that we can't help someone because we're not assigned to them would never fly. We have three wings at my LTCF and since the Alzheimer's wing is always locked, B and C wing aides and nurses are always there for each other if something comes up. If anyone went up to a resident, on my wing or not and said that, I would assist that resident and then promptly report that stupid behavior to a superior. What an insult!
Secondly, our MDS coordinator is great. She asks the aides, not the nurses, what it's like to care for certain residents. Her office is accessible, and she wants us to come and talk about the residents with her. Every MDS should be like this, I believe. If I notice that Mrs. So-and-so is getting too heavy for a one-assist, I let her know right a way, or if another is losing his ability to stand. It's a great system.
Third, on a typical day where I work, myself and another aide are assigned to a wing with twenty-four residents. Eleven are one-assists, three are two-assists, four are Hoyers, and the rest are independent (it's so much better than it used to be, we used to have nine Hoyers and, like, three independent). I have yet to break a rule. Obviously situations come up, like if someone is falling and I have to do what I can to get them safe -- we had a woman who was just beginning to decline but CP still read one-assist as it had only been a few days. She had the gait belt on getting up from the toilet, but started to buckle -- I acted on instinct and just "chicken-winged" her and through her back on the toilet. I gave her some light bruising under the arm for that one, but she would have hit her head on the edge of the toilet, and her knees on the bars of her wheelchair. That's a situation where I'm not going to worry about sticking my fingers into that snug belt in a pretty immediate situation.
I can't speak for anyone else in the facility, but I prefer to follow the rules. It's the same when someone doesn't show up and I'm alone on my wing. I'll get the one-assists and the independents up and moving for a meal, but I sure won't be doing the Hoyers and two-assists by myself. I'll wait patiently for a nurse or another wing's aide to come help me. That's the teamwork at our facility, and it pretty much has to work. We have aides that are stressed because they do everyone on one side and then have to come over to do seven more, but what can I say? I'm not about to be a hypocrite and let it be okay to break rules, and neither should they. It's not like any other job where you can skip a step and fly by -- I deal with fragile people on a daily basis, I'm not going to be responsible for a bruise, broken hip, or a death on the floor because I'm in too much of a hurry to get to supper.