Patient claims of Abuse

BostonTerrierLover, BSN, RN · Apr 27, 2012

I would never document any NEGATIVE action or assessment without applying what I done to address it through the nursing process, basically. If there is a notation of something negative and no counteractive measures with short and longterm goals, then evaluation/reassessment, that sticks out like a sore thumb.

It sends shivers up my spine for the Joint Commission Rep to say, "I see here Ms. Doe has a new red area to her coccyx on 04-25-2012 @ 0023, but nothing here was done after that assessment that I can see. Am I missing something?"

My Point: Do the right thing ALWAYS, but if you chart a problem, follow-up with appropriate measures. On this issue, it is going to be a Policy and Procedure Issue vs. Laws. I am only a Nurse, If I was an attorney I would be in my BMW anyway right now on Route 1 in California, so wouldn't have any LEGAL advice either way.

If YOU feel it is abuse, report it. If they find no weight, no harm done. I would rather someone report me, and it be a false claim, than to miss me doing harm. I would also keep a very keen eye out for this CNA.

As the CNA stated earlier who thinks ALL nurses think CNAs are stupid, poorly paid, and morons- You choose your job, first off. MOST nurses don't think that way. And, We are responsible for the care you give just as if WE gave it. I hate GENERALIZATIONs and STERIOTYPING- they are usually wrong. I know everyjob I have ever had (and the first few were NO WHERE NEAR nursing salary!!!!!, by showing up, I AGREED to the poor salary.

Always assume the worst, and hope for the best. Always be SAFE!

Just a few thoughts,

:redbeatheBoston

Nascar nurse, ASN, RN · Apr 27, 2012

F0225 The facility must not employ individuals who

have been found guilty of abusing, neglecting,

or mistreating residents by a court of law; or

have had a finding entered into the State

nurse aide registry concerning abuse, neglect,

mistreatment of residents or misappropriation

of their property; and report any knowledge it

has of actions by a court of law against an

employee, which would indicate unfitness for

service as a nurse aide or other facility staff to

the State nurse aide registry or licensing

authorities.

The facility must ensure that all alleged

violations involving mistreatment, neglect, or

abuse, including injuries of unknown source

and misappropriation of resident property are

reported immediately to the administrator of

the facility and to other officials in accordance

with State law through established procedures

(including to the State survey and certification

agency).

The facility must have evidence that all

alleged violations are thoroughly investigated,

and must prevent further potential abuse while

the investigation is in progress.

The results of all investigations must be

reported to the administrator or his designated

With all due respect - most responses are incorrect. The above is the actual federal requirements to remain in regulatory compliance. Note that it does include mistreatment and more importantly, cursing at a resident IS verbal abuse. Any resident that alledges mistreatment or abuse must be immediately be taken seriously. The nurse is obligated to immediately remove the staff member from the schedule until an investigation is completed. (In every facility I have worked at it is the policy that the staff member will be paid for the time suspended if they are found "innocent").

Now, with that said, I also 100% agree that not all elderly residents are the sweet, cookie baking, Grandma's that we would all love to envision that they are. Some of them can be mean, nasty, manipulative old beings. Doesn't matter....still gotta play by the rules outlined and it is even more important to play by the book when dealing with the bad ones. It is the only way to keep yourself and the facility out of serious hot water.

My most recent state survey: An attention seeking lady tells state survey that someone was to rough with her "a few weeks ago". Couldn't really tell the surveyor who was rough...couldn't really define what she meant by rough...couldn't even be certain when it actually happened... stated she told someone at the time but couldn't really remember who she told, but she kept to her story to all 3 surveyors who actually interviewed her individually. We took 2 federal survey tags as a result of this nonsense. We failed to keep her "safe" and we failed to report the episode (how in the heck could we report what we had never heard about until this episode).

My own personal episode a couple of years ago: Had a cognitive but crazy old lady that targeted me personally to spew hatred towards. She personally went directly to a state surveyor and told them I was abusive towards her. As the ADON I was immediately suspended just like any other employee (see nguyency77 - it's not just the aides). Let me tell you - I was enraged and incredibly hurt that any old coot could put my license in jeopardy in that way (I actually considered suing for defamation of character). Luckily this lady also gave such an outlandish story of me putting her and spouse in the basement for days at a time without food - whipping them with chains - etc....of course our building was on a concrete slab with no basement present. Surveyors did point this fact out to her and she said I had a secret door, blah, blah, blah. Long story short I won. In the end I got paid to sit at home while survey was going on - lucky me ha ha. After survey she continued to make threats towards me and I told the facility it's me or her but one of us will go and they actually did find her different placement.

To the OP: You absolute must follow your facility policy - it is the only way to protect yourself. Find that policy and commit it to memory. Call the administrator at the first indication of trouble. It doesn't mean the staff is even necessarily wrong but a quick and complete investigation is often the best way to protect them from the problem residents.

(This may be the longest post I've ever made. Can you feel the passion)

jadelpn, LPN, EMT-B · Apr 27, 2012

Part of your daily assessment is also cognitive/behavioral. If the patient shows signs of being passive/agressive, gamey, paranoid, etc. that needs to be documented--which would support attention getting behaviors. My personal favorite "prefers patient directed care". Let's forget for a minute the specific "CNA was rude to me" statement. What makes this seem unrealistic to me is that patient has now said something untrue about you, as well as your duty to act if asked to by a patient regarding her perception. In the future, I would say something along the lines of "well let me get my charge nurse, and you can speak with her about your specific complaint." Document doing the same. If no charge nurse, I would say to Mrs. So and So--"we take these complaints very, very seriously, and of course I need to speak with the person involved in this. For tonight, you will have an alternate CNA, I will have a discussion with CNA #1, and lets see if we can get to the bottom of this complaint." If she still says "don't do it"--"well, it must have been important for you to bring to my attention. What is your ideal solution for this?" THEN you can get to the root of the "complaint". Remember, some complaints stem from what the patient thinks should happen ie: I do NOT want to get out of bed and you can't make me, CNA #2 doesn't make me.... types of situations. If the CNA used bad language (and really, how can that be proved) then reminders about language should be given. CNA's spend an extraordinary amount of time with patients. Perceived "insults" are not uncommon. If you have any reason to suspect that this is a valid complaint, then you do have a duty to act on it. And I DO NOT, under any circumstances, condone any caregiver's abuse--verbal or otherwise--but you know your patient population, and that you did not act on it and kept her complaint under wraps would tell me that you questioned the validity. But make sure you do have documentation to back it up.

Merlyn · Apr 27, 2012

Just report the whole incident to your supervisor and be done with it. patient could be:

(A) a loony tune.

(B) telling that " you said you are going to9 take care of this." for something to hold over you.

Take it to your supervisor. Don't fall for any tears.

Nascar nurse, ASN, RN · Apr 27, 2012

Hi. I'm a CNA and if I may, I would like to share my humble opinion with you. First of all, I think a good nurse does NOT jump to conclusions or make assumptions about the situation. You need to understand what happened before you go crying to management about elder abuse that may/may not have really happened. A good nurse is objective.
I'm tired of people thinking that we CNAs are all abusive, uneducated morons who are bitter because we get paid so little. I'm standing up for those of us that do a lot of dirty work for some of you nurses, yet only get mistrusted and patronized in return. Don't get me wrong; I have a profound respect for the nurses I work with. But I don't like that all you're concerned about is your own butt, and not the safety of the patient or resident. The first priority is that the resident wasn't actually hurt, and that no abuse took place.

And you need a better understanding of the law. By following the policy I am protecting my butt...I'm also protecting your butt....I'm also making sure the resident really is safe from actual abusive situations. It has NOTHING to do with your perception of being a "uneducated moron". I have some of the best CNA's and they are absolutely priceless. I got started in this industry as a CNA. You don't know what you don't know.

BostonTerrierLover, BSN, RN · Apr 27, 2012

I can tell I would get a kick out of working with "Merlyn!":cool:

I like it when you never have to wonder what someone is really thinking, and today's times that's a rarity.

Keep it up Merlyn! Kudos from the Deep South!!

P.S. Send us a cool front!!!!

:redbeatheBoston

Silverlight2010 · Apr 27, 2012

We document physical assessments twice a day (maybe more) where I work, depending on acuity in addition to computerized charting of ordered treatments and medications. It makes me grateful that I have a decent patient ratio so I have a little time to document any interventions, assessments, treatments, or patient concerns. I can understand the Joint Commision Rep situation, for me it's the occasional demanding patient that wants it their way, ignores the unit rules, complains often about little to nothing, and my personal favorite, tells stories about the time they told "this one nurse" if they didn't do what they were told they were going to call their lawyer. (I document big time on them). It's why I'm a big believer in documenting complaints, makes it more difficult for people to change the story later or say nothing was done.

Dazglue, ADN, BSN, MSN, RN · Apr 28, 2012

you should write up the patient for being manipulative to staff and causing disruptive behavior!

i wish this was possible. i work in a snf as well. we had an incident about 2 weeks ago where a cna was accused of being "rude" because "she had a deep voice". and the daughter said because of this she feared for her mom's life. so we have a "complaint" protocol we have to follow. so, what did our don do? she kissed the family behind and turned the cna into the state for abuse and she is currently being investigated and had to take a customer service class. not one time was the patient verbally, physical, or emotionally abused. the patient's family later admitted to one of the nurses that she really didn't want any black people to take care of her. i wish she would have said that instead of claiming abuse. i understand following up on any claim but being manipulative and putting other people jobs in jepoardy really p*sses me off! i can't wait until my scholarship contract is over so i can transfer!

Silverlight2010 · Apr 29, 2012

Not one time was the patient verbally, physical, or emotionally abused. The patient's family later admitted to one of the nurses that she really didn't want any black people to take care of her. I wish she would have said that instead of claiming abuse.

Hope someone brought that to managements attention. Not sure about legal stuff but isn't that slander or defamation of character?

Lynx25, LPN · Apr 29, 2012

Hope someone brought that to managements attention. Not sure about legal stuff but isn't that slander or defamation of character?

It's freaking terrible, is what it is.

I have several people in our LTC who act this way, very crafty, manipulative little things. It is up to the nurse to look into alleged 'abuse' IMMEDIATELY and not leave it until a day or so later when someone else can take care of it. This will just lead to greater issues, and if the patient is just being nasty, there's no way you can figure that out 'later'.

I had an issue yesterday where a patient claimed the two CNAs that were delivering meals took his leg and "tossed it all around and cussed at everything". Turns out he just didn't want to be woken up early and was mad they brought breakfast.

We had another CNA fired when he tripped in a crowded room (with two bariatric beds, two of those XL wheelchairs and all the other nonsense that comes with that) and banged his shin on a bed. The resident claimed the aide kicked the bed, and was rude. The same resident would never allow his light on at night. The management took the side of the resident- and promply fired one of their best aides.

Dazglue, ADN, BSN, MSN, RN · Apr 30, 2012

Hope someone brought that to managements attention. Not sure about legal stuff but isn't that slander or defamation of character?

It was, but waht did management say? "Because she said abuse, we have to turn this over to the state.". The CNA is still being investigated. Managment told her to make the pitch of her voice higher when she speaks to people? Ummm, didn't know you could do that. I know you can fix your tone, but not the pitch. She justs naturally has a very deep voice. Sweet as can be and one the best CNA's I know!

nguyency77, CNA · Apr 30, 2012

OP,

Did you ask the CNA what happened? Every story has two sides. I'm not saying the OP shouldn't follow facility procedures on reporting, NASCAR, but that she needs to be more thorough. In my state, the documentation needs to be thorough in accordance with our whistle blower protection. We can't report without reasonable suspicion, but we have a duty to report should something be wrong.

The resident isn't always right, the way Corporate thinks they should be because they're "customers." I'm just saying it's wrong how only one side of the story was heard, and the OP already wants to go report it without hearing the other side. It's odd how the resident doesn't want the nurse to talk to the CNA about it, because that way the alleged abuse would stop and that CNA would get fired. Meanwhile the resident is receiving attention from this ordeal. From what the OP said the resident's story wasn't consistent, either.