1st job, need advice working with CNAs and/or dementia patients

Cheekylpn · Jun 2, 2011

hi I understand how you feel I've ben an lpn for a year and some cnas are overly pushy for people to get their meds. I worked on a lock down dementia unit for 7 months.Some residents you can tell a head of time if you work evenings if a resident is going to have added anxiety or agitation, usually its the ones who sundown bad or when its a full moon or close to one. On these occasions I would make sure that they recived their prns, on that unit the residents fed off of each others agitation ,callingout, spitting what have you.its not always easy but you'll get it sometimes the cnas who've been around can give you a heads up if someones getting agitated, and some just don't wanna be bothered to take time for people. And just keep in mind that alot of behavior meds don't work if their to agitated. Good luck

Poi Dog · Jun 2, 2011

I read our post as saying that CNAs are the same as dementia patients...

Yes, I have a warped sense of humor. :smokin:

:lol2: :lol2:

Abby4031 · Jun 2, 2011

Thanks Cheekylpn, it's a relief to get some advice and understanding. I have noticed that it is really hit or miss whether the Ativan works or not, and one nurse thinks the pt is delusional as well as dementia so it needs to be treated differently. I guess I need to study up on these disorders to understand them more fully.

Cheekylpn · Jun 2, 2011

I'm glad to help its not fun when nurses you work with don't help you out or tell you dont use a med because they feel its not helping. If the resident is hallucinating or is delusional see if maybe tje md will give an order for haldol just make sure that you have documentation that ativan does not always help, some drs wont write an order without documentation

**canoehead, BSN, RN** · Jun 2, 2011

The CNAs really don't have time. If you have time, that's wonderful. There are so many issues that you could spend extra time and energy on that I would recommend giving the prns they ask you too until you know your staff and patients very well. If you ask the CNA to do 1-1. S/he may feel you have disregarded the real issue, and may need to neglect other patients to complete the task. Staff that aren't good at verbally calming are going to ask for more sedation, and you want to really play to the positive during your first six months or so.

Abby4031 · Jun 2, 2011

Canoehead, I hear what you are saying and appreciate the advice. I really need the CNAs to be on my side, so understand what you are saying. But at the same time, I don't want to medicate for convenience.

This is a great facility, CNAs only have 6 or 7 patients each, most are usually in bed for the night by 8:30p. Also, the CNA was sitting at the nurses station eating at 4:30p (shift started at 3p) when I asked her to sit with the patient. Maybe most CNAs don't have the time, but at this facility I think it is reasonable for her to do a little one on one, which I have seen other CNAs do on previous nights.

However, you are totally correct that some will be more comfortable than others doing it, and I need to learn patience and get to know the patients and the staff. There is a weight coming straight out of school to always do the right thing, and I don't want to lose that either.

littlewingrn · Jun 2, 2011

Please don't flame me.....But, isn't giving a PRN medication when not indicated a chemical restraint? I fully understand if a CNA (or other personnel) advises that a resident is behaving this way or that way out of the norm, but isn't having someone just flatly say, medicate them without assessing the need for the medication a violation? It is the nurses responsibility to assess that resident to ensure the proper med is giving. WHY is the resident showing increased agitation? Are they in pain? Are they near another resident that possibly agitates them? Some other reason? I firmly believe in medication when indicated, but the situation must always be assessed so the proper interventions can be carried out by the nurse who is caring for that resident (and who is caring for their license). If a resident is always receiving PRN medications for the same reasons and indications, then the doc should be notified in case that resident would benefit from a routine order. :confused:

ktwlpn, LPN · Jun 2, 2011

I am a recent LPN grad on my first job at a LTC facilty with a few dementia patients. One in particular has a prn order for Ativan when she is agitated, although there aren't totally clear guidelines on when to give it to her and I have had problems getting a clear picture from the other nurses. A couple of times CNAs have just come up to me to tell me to medicate patients right when I come on shift, before I have even had time to see the patient myself. This happened last night so I went to see the patient and she wasn't that bad, saying "mama" over and over, but she does that, and she wasn't screaming it or trying to undress. So, I sat with her a bit, held her hand, gave her some pudding and she seemed okay. I asked the CNA to please try sitting with the patient one on one and she told me she didn't have time and it wasn't her job. I explained that prn meds, such as Ativan, are only to be given after trying other measures first, not as a preventative, or convenience to the healthcare workers. Later that night I saw the same CNA ask a patient if her knees hurt and did she want Tylenol? This is totally out of her scope of practice! Most of us got into nursing to help patients be the most independent as possible and live the fullest lives they can, not to be managers. At least I didn't get into this to be a manager. I deeply value the input and work the CNAs do, and could not do my job without them. Any advice for working better witih CNAs or to facilitate team work? Or even advice on working with dementia patients?

My advice for facilitating teamwork ( which you are already doing) is to listen to the cna's and then go and assess the resident as soon as you can. You will decide to give the med or not. After you have been there for awhile you will get to know your residents, their triggers and which interventions are effective for each particular resident.

You certainly can remind a cna that sitting 1 to 1 for a few minutes when you request she do so IS her job.Sometimes when you are a new nurse in LTC you 'll come across and aide or two who may try to test you.You will have to make your expectations clear from the start and follow through.If you tell someone to do something and they refuse to do it you'll have a problem if you permit it to continue.

As for the tylenol issue-I don't see a problem with any staff member asking a resident if they have pain. I don't believe that is out of the scope of practice. It's not different then asking if they are thirsty or hungry.The cna's know the residents best in LTC and sometimes the resident won't complain to the nurse.

I am a big believer in tylenol/motrin etc in the afternoon especially with the dementia residents.You'll soon learn to address basic needs first when a resident has increased agitiation (hunger,thirst,pain,toileting) That is often all you'll need to do. Their is a thread on here dealing with alzheimer's pateints -it's full of tips and tricks for dealing with behaviors.Do a search-it's a "not to be missed "thread. Good luck.

Abby4031 · Jun 2, 2011

I totally agree that it is a chemical restraint without assessing and trying alternatives, like ktwlpn said, of looking to basic needs and pain first.

Thanks ktwlpn I will look that resource up tonight.

Abby4031 · Jun 2, 2011

ktwlpn--thanks for the advice, I will look that up tonight

ktwlpn, LPN · Jun 2, 2011

The thread is a "sticky" in the Geriatric Nurses and LTC Nursing specialty forum and it's the second thread-"redirecting tips for Alzheimer's/dementia pts"