Patient Abandonment? Sorry long

[Calgon-take.me.away]

need to get this off of my chest before I go to the DON and demand that this CNA be fired. Here is the situation and let me know what you think.

I work on an acute long term care unit in a LTCF. In general, I have 10 trach/vents, g tubes, more of the serious patient population. Very demanding, but I love the challenge and do very well I am told.

I have one CNA that I am having a problem with. She is constantly leaving the floor for various reasons, disappears constantly, and generally gives very poor patient care. I have went to the DON once, told her the situation and she was reprimanded and moved to another unit. Because of staffing, she was put back on my unit. Did well for one night then back to the same old same old.

On my floor, I have a young man who is a quad due to a diving accident. Wonderful family, two daughters, wonderful wife, such a sad situation.

Has numerous wounds on his coccyx that require a wound vac, Clinitron bed, all which is a real ordeal when he needs changed, causes quite alot of pain for him.

Due to him having BM's x2 yesterday, he had to endure this twice already. Approx 7:15pm, his wife came to inform me that he had had onther BM. I informed my CNA's and told them to be careful with the vac so we did not have to change it again. Well, unfortunately we did and this is where it gets sad. Myself and two CNA went in change him and clean him up. During the procedure, with the wife in the room, this CNA sees that it is her dinner half hour and proceeds to inform us she is going to dinner NOW. She just walks out and leaves us. The patient is half cleaned up, on his side, in terrible pain and she just leaves. The wife ends up having to help the CNA and I clean him up and apply fresh wound vac sites. I kept my cool, finished the job, and continue with my med pass. I could have strangled her. But, I kept my professional nurse cap on and am not sure what to do next. I have only been at this facility for 7 weeks and do not want to get the title of snitch. What should I do next????

[locolorenzo22, BSN, RN]

I would be embarrased to associate the title CNA with this witch! Apparently, she had no clue that she needs to wait maybe a whopping 10 mins to get this done, THEN she could go to dinner...I'm a CNA...and if I was the one helping you, I would have gone to the DON myself....that's a good indicator of "Hey, would you mind helping patients? That's what you're here to do!"

Girl, if you don't go report her NOW, I'll call up for you and do it myself! Get her off that unit, before she does something really serious!

[UM Review RN, ASN, RN]

Write her up. Don't expect anything to happen, you're just starting a paper trail that will either make her straighten up or ultimately will "open the door to new employment opportunities for her elsewhere" as some of my colleagues are fond of saying.

[Brownms46]

need to get this off of my chest before I go to the DON and demand that this CNA be fired. Here is the situation and let me know what you think.

I have only been at this facility for 7 weeks and do not want to get the title of snitch. What should I do next????

First, I do not understand what your length of time at the facility has to do with reporting this person. You need to immediately report this incident, and any other incidents to your DON! Shortage of staff or not, this person has no business caring for others. Being a "snitch" would be the last thing I would be worried about.

I'm very sorry this is happening to the patients in your facility, but you and your facility needs to ensure this person does not care for patient anymore. This means calling the state board, or whomever certified her and file a report!

[Brownms46]

First, I do not understand what your length of time at the facility has to do with reporting this person. You need to immediately report this incident, and any other incidents to your DON! Shortage of staff or not, this person has no business caring for others. Being a "snitch" would be the last thing I would be worried about.

I'm very sorry this is happening to the patients in your facility, but you and your facility needs to ensure this person does not care for patient anymore. This means calling the state board, or whomever certified her and file a report!

Also this person caused your facility to violate one of this patient's rights "The right to a sufficient number of staff, including nursing assistants, to give residents quality care and the personal attention that they require."

You may want to get the mother to write a statement about this to CYA.

[RNgirlie]

i also think that when situations like this happen its best to at least 1st talk to the cna directly and privately about what happened. talking to her directly and giving rationale for why this is inappropriate behavior is a good idea. after this then you can go to supervisor.

[irishnurse67]

Also this person caused your facility to violate one of this patient's rights "The right to a sufficient number of staff, including nursing assistants, to give residents quality care and the personal attention that they require."

You may want to get the mother to write a statement about this to CYA.

Could you tell me where I could find this pt right that you quoted so that I can bring it in to work?

[Katnip, RN]

This could be construed as patient abandonment. But it's definitely insubordination. In my facility when someone refuses to do a task assigned to them by an approprate staff member, it is cause for immediate termination.

Check your employee handbook about disciplinary action, then write them up, and let HR know. Unfortunately I have a nurse I can't terminate because even though she's messed up for so long. People complain and complain but no one will write her up so there's no trail. If there isn't one on this CNA, start it nowand watch her like a hawk.

[oramar]

Most aids are excellent and go beyound the call of duty constantly. However, you do run into this type and for some reason managment is always unwilling to do something about them. However, I have watched them fire good people for strange reasons that have nothing to do patient care. I wonder if it would help if the patients wife went and complained?

[TazziRN, RN]

Don't be surprised if nothing happens from this, but you need to write this up. No documentation, no termination. Abandonment is a pretty serious issue.....you might even want to consider calling the state on this one. Even CNAs have a regulatory body to answer to.

[Ms Kylee]

*Shaking my head in disbelief* I can't tell you how many dinner breaks I've missed because I've had a lot of patients that have needed cleaned up. And I don't mind because I don't want their skin breaking down, etc. She should have waited till you were done to go to dinner, but sadly some people think it's all about me and the heck with everyone else. I have two aides that do this constantly. Management is aware, but does nothing. And then they complain about me being "slow", but golly gee... when I'm the only one doing the cleaning, rolling and changing, it's gonna take some time...

I'd write her up.

[bollweevil]

First, try to get the patient some pain meds. He needs something to alleviate his suffering. Perhaps a Pain Management consultation is in order? Maybe he needs a slow release, long-acting med, such as a Duragesic patch, plus something you can give him a little while before the dressing change, such as an IV push pain med, or even something p.o. It's scary that a quadraplegic has so much pain. His nerves are totally or near totally demolished, yet he has pain. I know some sensory nerve fibers are not destroyed in quads, so I guess that's the reason for all this pain he still feels. What a rotten shame that some motor fibers aren't also working. I pray that stem cells or nerve transplantation can someday very soon help people with severe nerve damage - quads and paras, stroke victims, MS, Parkinson's, DM neuropathy victims, and more. But do try to get him some relief.

As for your original question - yes, do talk with this young lady privately first. Try to see her in a quiet setting where you will not be interrupted. I'd like to know why she left to abruptly. Was she feeling faint? Is she diabetic or pregnant or otherwise hypoglycemic or weak? Has she no idea what it means to be a patient? Especially one who is totally, totally dependent? One whose entire life and whose family's life has been utterly shattered? The family of this quad has been forced to deal with total devastation. They see their rock, their leader, their foundation on his back like a baby, unable to earn a living (for the moment at least), unable to come home, unable to go to school functions - plays, sports, PTO, whatever; He is unable to even scratch his own nose. Give her some comprehension of his complete helplessness. Ask her how she thinks this might make him and his family feel. You'll probably not make any impression but do try.

Let her know, nicely but clearly, what she did wrong. She might genuinely not know that she did anything wrong. She might be thinking that "Hey, if I don't go right now, I'll never get to go or I'll mess up someone else getting to go to dinner." Make sure to tell her what she did wrong. Ask her how, given this new understanding of how helpless the patient is and how vital it is for staff to take care of him and how meal times can be altered, she would modify her behavior in the future. Also, you could have said something to her to stay and continue helping you at the moment that this happened. I know you don't want to start a staff squabble in front of the patient and family but you could have told her at the moment that you need her to stay another few minutes until this task was completed.

Write this incident down and inform the boss and HR. Informing HR is a gutsy move, I guess. It tells the Nursing supervisor that the jig is up and this CNA's behavior is no longer something she can personally hide or ignore. She might not be too happy about you going to HR.

I am personally trying to decide how to approach the misdeeds of one of our nurses - go to our manager? Manager and DON? Manager, DON, and HR? Manager and HR? Include Administrator? Include the one above him, too? What to do, what to do? If I go only to the Manager and the Manager doesn't act, do I then go over her head and tell DON? And if that one also takes no action, do I rat out both of them to HR? I"m thinking to notify Manager, DON, and HR all at once. But will that disrespect the Manager? The manager controls my life as far as granting days off, letting me use vacation (which expires) instead of saved holiday time (which does not expire) if I have to call off, and otherwise running my life so I really don't want to make her mad. Not that she ever answers my email or grants my requests anyway. But still, it is best not to anger her. DON never gives me the time of day, either. The nurse with whom I have the beef has been there many years, I have not. What to do, what to do? It's a really messed up situation, I know, for you and for me.

It would be great if the bad aides had to participate in an inservice in which they were made totally immobile, totally wrapped up in sheets or restraints and left alone. Unable to call for help, even, like I imagine some of your stroke survivors are, unable to get to the toilet or feed themselves or even turn over in bed. Left without a pillow, left wet or dirty, left to be unattended for hours at a time, left to see what it is really like for people to be completely at the mercy of others- others who smell bad, who smell of perfume, who talk about their love lives in the crudest terms, who have a rough touch, who don't take the time to make their patients comfortable, and so forth. I always remember and am haunted by the memory of certain staff at the facility I worked once who made fun of the quads on their floor, who complained that they needed too much care and took up too much time. I tried to get them to imagine what it must be like to be a quad but was met with derision and cruelty. "He just wants the attention. He just wants me to look at his genitals." Stuff like that. Laziness.

I wish you well and I hope you can educate this aide. That is the first step, the most preferable. Everything else is punitive and could backfire. I'm not saying don't take those other steps, just be prepared for fireworks possibly if you do.

And please get the patient some pain meds. Do they have a good social worker for the family?