Plebian who wants to be tactful

[Mirai Kangofu]

I just started a job as a CNA, and I have acknowledged that I am a plebian compared to the other CNAs who have been doing it for years. However, I've been spotting some shoddiness that I want to address, but I'm not sure how to be tactful about it.

Today I saw a CNA wiping a female resident from back to front, not even bothering to clean the front genitals first. I told her as tactfully as I could, "Wiping back to front causes urinary tract infections." She snorted, gave me a look, and kept doing it. She's been doing it for two years, and she's female, so I can't comprehend why she'd be such a Martha about it. I saw another girl not even bothering to wipe down a resident while changing her soaking wet diaper. I know that there's never time to do things as tediously as required in state testing, but there's time to at least make a few swipes. I certainly wouldn't want to be left in my stale urine or drying BM. I also see a them handling residents with the same gloves that they used during pericare, and even going on to the new residents with the dirty gloves. I'll "just happen" offer the CNA new gloves whenever I see them about to give the resident a drink while still wearing contaminated gloves, but how to actually address tha situation?

Also today, I asked another CNA if she had changed and showered one of the more severely demented residents, and she said, "No, she's violent. She's soaked and I tried to change her, but she started getting rough. I'm not going to bother." I pulled her aside and told her, "If a child is throwing a temper tantrum because he wants to play with broken glass on the sidewalk, would you avoid the racket by letting him play with it?" She told me that no, she wouldn't, because the child would know any better. I answered, "Correct. It's not wrong if you're preventing a worse situation. If you don't clean the brief or give a shower to a resident just because it's inconvenient, I can guarantee that they'll be several times more irate or require a more complex plan when they get infections. What's worse, a child can learn and remember the consequences of something, while (resident's name) can't even realize that we're removing her discomfort. It would be wrong to force residents do do things if they were in their right minds, but some of them don't know any better and are beyond communication." I then offered to hold down the resident so she could change her without getting kicked and punched, and decided to try the shower later after the resident had settled down. This CNA was also pretty new and has a much better attitude, but I'm still not sure if I was tactful. I'm trying to respect the hierarchy, but also do what is right. Help please!

[Noryn]

I wont get into a nursing home discussion here but to put it bluntly from what I have seen older people are almost forgotten. It reminds me so much of an assembly line at nursing homes. Nursing home administrators and owners want to make a profit and the government doesnt seem to want to make them do any better or pay any better. Funny how places so short staffed can still pass inspections isnt it.

My last nursing home job was about 8 years ago. At that time on evening shift there were around 4-5 aides for 40 ish patients. On night shift there were 2 for the same 40. Things have probably gotten worse.

In a perfect world, those that wouldnt show up or provide substandard care would be fired however in a nursing home they are so desperate and interested in numbers on paper that they put up with much more than they should.

One person is not going to be able to change these things however I felt as if the patients would be at least getting great care that would be a start and I feel as if you would be a postive force that could change some things. The way nursing homes are ran I guess is just different (that is a good word for me to use at this time :rotfl: )

Usually a hospital is still hard work--not as hard from what I hear but it is different work usually. There is a lot more interaction with the patients, a lot less abuse you have to take and usually you have a bit louder voice.

By all means apply to the hospitals. During your interview tell them your feelings, I think anyone would have to be crazy not to hire you. Good luck.

[gr8rnpjt, RN]

Mental note to myself---never---agree to placing any of my loved ones in a nursing home. :stone

[beannie]

the staffing scenerio you mentioned is a point of concern, though common in LTC. But with that point aside, and getting back to your original post, I think you have several qualities that are needed in the trenches of patiet care - attention to detail, advocate for patient needs/safety, accountability, and a determination to stick to high standards of care. In a new CNA, these qualities are admirable but can be viewed negatively by other staffers. I just hope that through your career you will stay true and dedicated to what your own high standards/good pt care and not wane with time or more exposure of the healthcare system. I think you have the potential to make a positive difference in that facility. You can make changes and the residents will benefit. Be a role model, careful not to correct people on a daily basis, follow the heirarchy, go the nurse first, NM next, and on up. You may discover many things by going to the nurse first and the nurse will appreciate your feedback. Also, I would try to look at the root of the problem, are supplies lacking or poorly organized? understaffed? do they feel unsupported? lacking knowledge?, just plain lazy? too long with the same residents/need a change? There are no excuses for behavior, but you may find that looking at root of problem will help you to approach the problem in a "tactful manner" Good luck!

[carolinapooh, BSN, RN]

Mental note to myself---never---agree to placing any of my loved ones in a nursing home. :stone

Sometimes you have to. Heartbreaking, but true.

My seventy year old mother could not take care of her 86 year old mother.

We researched, called the state boards and looked up complaints, actually INTERVIEWED staff, visited homes and picked one.

Granma got the best care ever.

To the OP - if it were MY mom, I'D HUG YOU MYSELF. :)

[RNSUEIA]

I also worked in a nursing home in Alvin TX for a short time when I was a cna. There were two of them there and they were the absolute worse I have ever seen. I worked my tail off and could barely walk to my car at the end of the shift for trying to do and be all for those pitiful residents. Your right the pay and work conditions are horrible. My advise to you would be go back to school and become a nurse it sounds like you are just what we need.

[Spidey's mom, ADN, BSN, RN]

Patient care comes first. I wouldn't be obnoxious about it - but there is nothing wrong with saying the patient needs to be wiped from front to back.

If you don't get any satisfaction from going peer to peer with your concerns, you have to go up to the nurse or nurse manager.

You aren't there to become popular. You are there to take care of people like my grandma.

It sounds to me like you are the type of CNA I want taking care of her.

steph

[colter517]

Patient care should ALWAYS come first. I think you are doing the right thing by advocating for residents that otherwise can't or won't speak up. You should not keep your mouth shut just because the old timers will get mad at you. I would take this to your supervisor if they continue with this type of neglect because that is what it is. You sound like my kind of CNA too.

[Jo Dirt]

^I thought so. Sigh... Should I at least offer glover to the people who should be changing gloves?

I know that I sound like a know-it-all newbie who tries to assert herself above others. Believe me, I know the kind and get annoyed by them. All the same, I doubt I'd be so shoddy as to leave excrement on their skin.

Ouch! This reminds me of the time when I worked in LTC and it somehow got reported to the DON that a CNA changed a resident's wet diaper without washing him. I remember hearing her screaming at this CNA in the hallway...I wanted to find a desk to hide under. Yes, this behavior on the DON's part was totally unprofessional (but we have virtually NO skin breakdowns in this facility, and we even use disposable diapers on these residents).