Not following care plan

Nursing Students CNA/MA

Published

Just out of curiosity, how many of you LTCFs out there stick faithfully to a resident's care plan? I posted this on the regular Geriatric/LTC nursing board, too for a nurse's perspective, but since CNAs do pretty much all the transferring work, it pretty much belongs over here!

When doing 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?

Specializes in Community Health, Med-Surg, Home Health.

Thanks for clarifying how things are run in your facility. Now, the last question; did their lack of following the care plan get reported to the state? And if so, was their certification revolked? I read here in all nurses somewhere that a CNA mentioned their certificate was revolked and wanted to know what happened. Thanks again!

Specializes in LTC.

I believe that posting a care plan within plain sight is a hipaa violation. Having that kind of information in sight of every visitor that drops by is a huge dignity issue. I’ve seen care plans hidden in LTC closets in order to be more hipaa compliant, in Assisted Living we keep them locked in the residents med drawers, in the MARs (CNAs pass meds), and in the hospital they are in a book at the nursing station. The hospital does have little alerts that they put on doors, but they are all in code. Such as a tree with falling leaves to show that someone is a fall risk.

It really does seem odd though that someone would be fired for their first offense of transferring someone the wrong way. I’m curious what your staffing is like. I know at at least one of the facilities I worked a CNA had to do A LOT wrong to get fired because a warm working body was seen as a big perk.

Specializes in Community Health, Med-Surg, Home Health.
I believe that posting a care plan within plain sight is a hipaa violation. Having that kind of information in sight of every visitor that drops by is a huge dignity issue. I've seen care plans hidden in LTC closets in order to be more hipaa compliant, in Assisted Living we keep them locked in the residents med drawers, in the MARs (CNAs pass meds), and in the hospital they are in a book at the nursing station. The hospital does have little alerts that they put on doors, but they are all in code. Such as a tree with falling leaves to show that someone is a fall risk.

It really does seem odd though that someone would be fired for their first offense of transferring someone the wrong way. I'm curious what your staffing is like. I know at at least one of the facilities I worked a CNA had to do A LOT wrong to get fired because a warm working body was seen as a big perk.

I think that the tree thing is a cute code. Posting any sort of information within view can be considered as a HIPPA violation in some of the nursing homes based on nurses I have spoken to in other places. My hospital has color coded bracelets for the clients; red for allergies, blue for DNR and green for fall precautions. In a med-surg unit, I am assuming there is no time to make signs, the hospital stays are so short. I work in a clinic, so, when a person who is handicapped visits, we can identify them because they have green clinic cards. Those will usually be the priority to have them see their provider sooner because the transportation department closes by 6:00pm.

I guess each state has their own requirements to deem that HIPPA has been broken.

Specializes in LTC.

I like the different colored bracelet idea. I think the red allergy bracelet is pretty universal, but I haven't paid enough attention to any other bracelets for DNR or falls risk. At the hospital DNRs alerts are placed on the telemonitor next to the persons name.

In assisted living DNRs are on our assignment sheets, but if something goes wrong we can never find the DNR forms which has caused some problems in the past.

But I'm getting off the subject.

The problem with colored name bands and cute little pictures is (1) you'd never get a nursing home resident to keep a bracelet on. (2) Nursing home residents pick up on our little codes so the minute Mr. Smith gets a picture of a tree put on his door, Mrs. Anderson and Mrs. Johnson will be found gossiping in a recreational area that Mr. Smith fell again...

Specializes in LTC.
I believe that posting a care plan within plain sight is a hipaa violation. Having that kind of information in sight of every visitor that drops by is a huge dignity issue. I’ve seen care plans hidden in LTC closets in order to be more hipaa compliant, in Assisted Living we keep them locked in the residents med drawers, in the MARs (CNAs pass meds), and in the hospital they are in a book at the nursing station. The hospital does have little alerts that they put on doors, but they are all in code. Such as a tree with falling leaves to show that someone is a fall risk.

It really does seem odd though that someone would be fired for their first offense of transferring someone the wrong way. I’m curious what your staffing is like. I know at at least one of the facilities I worked a CNA had to do A LOT wrong to get fired because a warm working body was seen as a big perk.

I don't know if it is or not here, because I've never heard anything about it. I can see where everyone is coming from but I don't know why we've been allowed to have them up. And, haha, some of our old fall risk signs are still around (we don't have much anymore) but they have shooting stars that say "I'm a falling star!" It seems really corny and obvious compared to the tree/leaves one your hospital has!

I don't know, in my opinion, it's just like breaking another rule. At ANY job, why should you get a second chance if you didn't care about your first to begin with? Everyone's warned, everyone's told, and like I said, at our facility the CPs are up for all to see, plain as day. And updated often, so you can't really come and say, "I didn't know that person was a two!" Because you'll just get in trouble for not checking the CP daily like you're supposed to do. I guess it just matters on the facility -- obviously it's going to be a lot different if the LTCF doesn't do as much extensive work with their CP program, like not having it available to see or updating it once a year.

have any of you ever check the registry in your state and see how many people are put on that list each month for misconduct or for abuse and negigent 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?

Specializes in Community Health, Med-Surg, Home Health.

The key thing to me is the emphasis placed on it from day one. In nursing school, we discussed and created care plans, so, the nurse is aware of the importance. The reason why I am having a bit of difficulty with this is because while I was in CNA school years ago, NOT ONE TIME was a care plan discussed, nor have they shown us many assistive devices. They showed us the hoyer lift, restraints, mittens, geri-chairs and such, but I was amazed of how many devices existed without me knowing about them from classes.

As I mentioned previously, I didn't know one existed until a patient fell and I was written up. Nothing became of it, but, still, I didn't know of the importance of following them or knowing that a CNA has actually had their certification pulled because of not following it until now. We were not educated about them in orientation. If I had not become a nurse and decided to go back into the field as a CNA, I would have probably taken the exams again (certification expired because I worked in a hospital most of my life) then, I would have probably walked into a similar situation now. If the facility is strongly emphasizing this fact, then, I would say that the employee was fairly warned. But, I do know that there are MANY facilities in New York that have not followed this and that is a disadvantage to the CNA that plans to work elsewhere.

Anyway, I am glad to see that this place is giving everyone fair notice.

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

This is just my humble opinion, but I think care plans are the most worthless invention ever. They are worth less than the paper on which they are printed. I believe that care plans are used as more of a CYA (cover your a**) mechanism than anything.

Specializes in Community Health, Med-Surg, Home Health.
This is just my humble opinion, but I think care plans are the most worthless invention ever. They are worth less than the paper on which they are printed. I believe that care plans are used as more of a CYA (cover your a**) mechanism than anything.

I must also mention humbly that I think that the careplans are the dumbest thing ever for the nurses. When I was in school and would look at the NANDA diagnoses, I would laugh and wonder what fool actually thinks that this makes nursing more professional?? It is a waste of time and paper as you stated. I think there should just be a booklet on the floor spelling out the disorder and how nurses treat the response to that disorder and that is it.

I hated making care plans in school, had a great book that spoke of the medical disorder and then the possible nursing diagnoses that may be applied to that disorder. I hated thinking for myself because it was a waste of time and brain power. Just venting...

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