Nursing Home NA nightmare

[PunkinNoir, LPN]

My work environment is beyond hostile. I am both infuriated and incredibly sad at work now. I was just wondering if anyone else is having these same issues. 

Where to begin? Covid has helped make things incredibly worse. Not sure of the rules everywhere, but you used to have to be certified to work in long term care in my state. Well, Covid made the rules bend and now I have a bunch of uncertified nursing assistants. Don’t get me wrong, some have their heart in the right place and try to do a good job. Most though? Most don’t care at all, have a terrible attitude and do NOTHING. When me, my supervisor, or other nurses write these awful workers up or inform management- nothing is done. There is a staffing crisis, after all. I work 11-7 shift. Most of my nursing assistants sit on their phones all night, and only change the patients once a shift- starting at 5am. I start my morning medication pass at 5am, so imagine how much I appreciate issues just being brought to my attention for the first time at the end of my shift. I literally just had one of my lovely NAs inform me at 6:00am, “Oh, by the way.... so-and-so has a skin tear on their arm. It happened on afternoon shift, but I guess no one addressed it.”. Seriously?! No one gets turned and positioned. How could they when they get changed once a night? Beds are left sky high in the air, fall mats are not placed on the floor, and call lights are at times purposely not given to patients. If a patient puts on their call light a few times, my NAs will threaten to take their call light away! As I have learned, this is not an empty threat. I have seen the aides clip the call light to the wall of “troublesome” patients! This has been reported, with nothing done. Oh wait, my director of nursing told the NAs not to do that, with no punishment. 

Back to the changing people once a night. When you only change the patients once a night, they will clearly be a mess. If the NA is working a double shift, they will put multiple briefs on the patients and stack blankets under them to “set themselves up”. I think the record number I’ve seen is 5 briefs and 3 bath blankets.... all soaked with urine. It’s no surprise we get a lot more wounds now. My favorite lazy NA complaint is when someone is working a single shift, and says this during their first/last round at 5am- “Look at how afternoon shift left this person!”. They even think I’ll try to get afternoon shift in trouble or write them up! Maybe they’d be in trouble if this conversation was happening at 12am, but at 5am, afternoon shift is not to blame. 

My NAs will grab random creams from the treatment cart and apply them during incontinence care. When I witnessed this, I asked the NA to please not go into the treatment cart- you can’t just put whatever cream you want on people. I then informed her that most people had zinc paste ordered for incontinence care. Her response? “Yeah, I use this and I’m going to keep doing it.” She was holding up bacitracin-zinc ointment. I told her that was not the same as plain old zinc paste, and that some people are allergic to bacitracin. She walked away with the bacitracin. I then locked the treatment cart and was called a ***. The NAs also try to do treatments. I stopped one just in time when she was about to apply a DuoDerm to someone who had no order for that. I asked where she even got the DuoDerm from, and informed her that was totally the wrong thing to use (not to mention that she was not to do treatments!). Guess who’s a *** again? 

 One of the night shift duties for nursing assistants is to pass fresh water cups. Again with the laziness.... they will only do this once a night as well. They are SUPPOSED to place the fresh cup at around midnight, then pass ice at 4am. But why do your work? They place the new cups at 4am, to only have to do the work once. If someone is out of water at the beginning of the shift, my aides will tell them they have to wait for water. That’s right, wait until 4am! Oh, and if the patient drinks all of their water after it is passed at 4am and rings for more? Again, they are out of luck. The aide will NOT give them more. “I just gave you water”, they’ll say. 

Another huge problem is the absolute refusal to take care of certain patients. If a patient says something racially inappropriate or sexual, my NAs will just flat out refuse care to this person.... forever! No incontinence care, no water, they will not step one foot into that room ever again. I mean, come on! I try to tell my aides you just have to be firm. You tell the patient that behavior is not appropriate, and that they are not to talk that way to you. I will also talk with the patient and write a behavioral note. Makes no difference. You can only imagine how many rooms my NAs refuse to go into, because I can’t even count how many times I’ve been hit on, cursed at or been called something offensive by a patient! 

The thing that broke my heart and infuriated me the most though, is the following. We had a red zone for Covid positive patients. ALL of the 11-7 aides in the entire facility refused to work that unit. I am already in charge of two units during the night. I had to be the red zone nurse, the nurse for a non-Covid unit, and the red zone CNA. The red zone was covered in trash, everyone was soaked, and no one had any water. Oh yeah, I was also the CNA for the non-Covid “offensive” rooms that the aides also refuse to go into. In all, my NA had 13 patients to care for, some of which can walk and take care of themselves. I had around 30 patients to be the nurse and CNA for, most of which had Covid at the time. The NA had the nerve to complain about how it wouldn’t be “fair” for her to have to take care of more patients, and stated that’s why she was refusing to do so. When I asked how it was fair for me to have to be the nurse and aide for all those patients, she just simply ignored me and went back to texting on her phone. 

And before I get a lecture- I worked as a CNA for years before I became a nurse. I have no problem changing people, answering call lights, etc. I DO have a problem doing all the work, while my NAs sit on their phones and flat out refuse to do anything. I try to be understanding, and realize many of my NAs never worked in healthcare before. However, when I try to teach them things, they generally don’t listen and don’t care. I get many eye rolls. The patients deserve so much better. I do change as many people as I can inbetween my medication passes/vital signs, since I know they won’t be touched otherwise until 5am. I also pass out water as early as I can. I'm exhausted and the nursing "management" does nothing. I wrote my DON a letter on how my NAs refuse to do their work and the response I got? I was rudely questioned by an employee who shouldn't have been involved about how I stated that the aides didn't even do their charting, yet the charting was done. I stated the truth, I did the CNA charting since I was the one doing the CNA work. I was even more angry, because I'm sure they saw that my initials were the ones noted on the CNA charting. 

Might I also add... some of my NAs work for staffing agencies. They get paid the same hourly wage that I do. They refuse to do their work and refuse care to the patients, while I am running around like a mad woman. We get paid the same amount and it makes my blood boil. 

[guest1171208]

I feel your pain. My unit,we have one CNA and one RN(Me) for 11 patients. They also have to get 3 patients dressed in the AM. I work 11-730. She needs help weighing patients. My thing is,I cannot pass out  meds at 0530 AND change residents. I remember a call light went off and she peeked out someone else's room and did not respond to it. 

[gemswanson90]

Yes, over the years I have had Really Fantastic CNA's/MA's/NA's to work with, and other times ~ahem~ not so fantastic.  Sometimes, it is because of the pay disparity, or it may have been a slight they felt from me, whether it was intentional or not...I have learned to try and probe/look a little bit deeper than just their surface actions.  Maybe a few people see me driving up to work in my kind of fancy car and covet my material possessions; maybe I don't like small talk and chit chat and they feel slighted if I cut a conversation short.  Maybe I declined their offer of some home-baked goods they brought in for everyone to share.  I have learned to try and see a person's actions (or inactions) from his or her point of view. I have intentionally gone out of my way to engage in more "getting to know you" type of conversations, park my car a little bit further away in order to try and avoid coming off as "Ritzy/Rich Lady", and partake in potlucks/giving of food and snacks that is fairly popular. I bring in bagels or doughnuts a few times a month, and make more of an effort to get to know my team a bit personally. I ask about kids and grandkids, spouses/partners, etc. , and try to be a good listener whenever time allows.  I also enjoy sharing personal photos of loved ones with others at work; after all, we all do have lives outside of the workplace.  I hope maybe any of this can be of help to you; take care, and Hugs from Denver.  G S, RN/Denver 

[Rogue1]

So sorry to hear of your situation.  It is not acceptable patient safety (let alone care), and it is not a sustainable work situation for you.  Not only are the patients in danger, you are at risk of loosing your license. 

I assume appeals to upper management have been met more or less with crickets.  Time to go up the food chain--probably way up.  Is there a state agency that you could contact?

(PS--I also suggest starting to write EVERYTHING down!)

[downsouthlaff, LPN]

Sorry your going through it. Sad reality is that short staffing in healthcare has caused many employers to trend toward a much more lenient approach. These are not guranteed methods but I’ll give you a few approaches. 
  Be open minded. Be polite to the CNAs even the bad ones. Try to correct and teach in a non condescending way. Pick up a little slack at times to show that you appreciate their efforts. You are the nurse and are responsible for directing assistive personell, but show them that you don’t look down on them and believe they are a valued staff member. 
  Don’t jump to conclusions on what management hasn’t done. Don’t assume because an employee wasn’t terminated because you wrote them up that nothing was done. HR won’t discuss all employee discipline with clinical staff members outside of pertinent administrative staff. The employees that you write up may not receive a raise, may not be kept past the probation period, etc. There may be things occurring that your not seeing, even tho I know the helpless and frustration when it feels like nothing is done. 
 Also, as per CMS regs, non licensed staff, or staff that are not given special permission like med aides to carry out MD orders should not have acesss to med carts or TX carts this is a major no no. Carts must stay Locked. 
  Focus on being a great nurse rather than focusing on the negatives and the drama. LTC nursing is hard, tedious, and very challenging. And lasting as a nurse in these facilities requires a great deal of patience, innovative thinking, and motivation. The energy you bring could inspire others. I know it’s frustrating but chances are you will not fix all the problems of the long term care industry , good luck to you  

[iNurs5, CNA]

On 2/5/2022 at 10:00 PM, PunkinNoir said:

ALL of the 11-7 aides in the entire facility refused to work that unit. I am already in charge of two units during the night.

 

I still had to care for those racists. I told them to use their call light. However, I made sure they got their food, snacks, and drinks. Foods and drinks are needed, not a luxury. That's their choice not to eat and drink. I don't want to sleep on my back feeling guilty. I don't have that attitude "I do it to you first before you do it to me." They don't like being discriminated against, but why starve people who are sick and helpless? What makes them different from those racists? Not their problem if those people don't eat food. If the patients strike by refusing to eat food and drink the CNAs they discriminated against who served them, then that's up to the management how to deal with this problem. Anyway, their behavior wouldn't fly with our management. They'd rather fire them and pay their nurses to help; they were four-five nurses and two CNAs for 80 patients. It worked fine.

Why can't we all get along? 

 

[Hoosier_RN, MSN]

Nothing happens because many states have mandated minimum staffing, which is a joke. If they have a warm body, and none coming through the door, they aren't going to put that warm body out, plain and simple. It's the sad state of our healthcare, all the way around 

[ComeTogether, LPN]

On 2/7/2022 at 5:00 AM, Iluvnightshift said:

I feel your pain. My unit,we have one CNA and one RN(Me) for 11 patients. They also have to get 3 patients dressed in the AM. I work 11-730. She needs help weighing patients. My thing is,I cannot p*** out  meds at 0530 AND change residents. I remember a call light went off and she peeked out someone else's room and did not respond to it. 

Was she supposed to leave the person she was with?

 

When I did 11-7 I tried to stagger my med p***.  Yes, its better to be not interupted, but you can p*** one patients meds and then go help answer lights before moving on to the next if you need to. 

So many things wrong with the situtaion OP describes, but one thing I remind all nurses about is that none of us should ever delegate out of convience. 

If you are able, and your CNA is tied up - you should not be getting them to do it for you. 

 

Im not speaking to you specifically, just in general. 

 

While there are CNAs who shouldn't be in this line of work, I think often times we underestimate how hard they work and how unrealistic we can be.  They too have multiple things happening at once.  It's always a good idea to take a moment to observe what all they are in the middle of before adding the next several things.  

We'd all do well (CNAs and Nurses alike) to view it all as one job and divide an conquer. Obviously they cant help us with all of our jobs but they can do some things we may not tend to delegate . Sometimes giving them more responsibilities like getting vitals or genuinely getting their perspective can help morale and make them feel valued - which they are. 

[FiremedicMike, RN, EMT-P]

My wife worked in nursing homes as an LPN for 15 years.  She worked in a wide range, from primarily Medicaid patients to super high end cash only places (she’s taken care of family members of local celebrities) and even worked for almost 2 years as a DON.

They were all the same.  She had the same experience as you no matter how fancy the front door looked or how much the patients were paying to be there.  She generally had a handful of aids that were amazing, but then many more that were simply terrible.  From listening to her vent over the years, seems the same was true of her nursing coworkers as well (RNs included). 

It never got better.  She’d bounce around from place to place, convinced the new place was going to be so much better.. it never was.. 

Thankfully, local hospitals started using LPNs again.  She was terrified because she thought she was going to drown going to the hospitals, but she took the leap anyway.  She’s now been working in the ER for about 6 months and couldn’t be happier, she’s also making significantly more than she was as a floor LPN in the last nursing home she worked.. 

 

[Chey McCue, BSN]

That post was a wild ride all of the way through! I am sorry that you’re being put through that and I’d be at my wits end.
 

I guess my main question is why are you continuing to put up with it? It seems like you are putting your license at risk every time you walk through the door with stuff like that happening continuously. You have to also look out for your well-being along with your patients. 
 

Regardless, I wish you the best of luck!

[delrionurse]

On 2/6/2022 at 12:00 AM, PunkinNoir said:

The thing that broke my heart and infuriated me the most though, is the following. We had a red zone for Covid positive patients. ALL of the 11-7 aides in the entire facility refused to work that unit. I am already in charge of two units during the night. I had to be the red zone nurse, the nurse for a non-Covid unit, and the red zone CNA. The red zone was covered in trash, everyone was soaked, and no one had any water. Oh yeah, I was also the CNA for the non-Covid “offensive” rooms that the aides also refuse to go into. In all, my NA had 13 patients to care for, some of which can walk and take care of themselves. I had around 30 patients to be the nurse and CNA for, most of which had Covid at the time. The NA had the nerve to complain about how it wouldn’t be “fair” for her to have to take care of more patients, and stated that’s why she was refusing to do so. When I asked how it was fair for me to have to be the nurse and aide for all those patients, she just simply ignored me and went back to texting on her phone. 

In these types of facilities, when there is extremely short staffing, and where they have to use non certified staff, CNA's get away with a lot, and the bad ones will take advantage of you. Avoid these facilities.