We all have stupid rules to follow that were created by people who have never seen a real resident in their entire nursing careers (if they are even in nursing at all -- Helloooooooo, Mr. CEO!). Some of my favorites:
1. No chux if they wear a brief; only use chux if they are continent. We all know how leaky briefs can be. Thus every brief change turns into a full-blown bed-and-gown-change. This ****** off the residents, ****** us off (not to mention creates more work for us), and necessitates further linens for laundry to clean because their jobs are oh-so-hard (see #6 below). And what's the point of putting chux down in the first place if a person is fully continent? There's nothing for the chux to absorb; they are just hot, uncomfortable sheets of plastic that are rubbing on the residents' skin. All. Night. Long.
2. Only 3 chux can be stocked at a time for each resident. Of course, they're not the heavy duty chux, either. They're the cheap, thin ones that do little better than if I had coated the bed in a single layer of toilet paper. If the person is a leaky, heavy wetter, multiple chux must be put down each time. So I'm supposed to make a new trip to the supply room every time they wet because I wouldn't want to exceed having 3 in the room at any given time? And another thing, if they bought the good chux in the first place, they would SAVE money because we wouldn't have to an entire package for every drop of pee.
3. A CNA must be in the dining room at all times. We don't want residents to choke. Apparently our very presence magically prevents it, whether we are 10 inches or 10 yards away from the resident. Please disregard the fact that per facility policy, CNAs are not permitted to do the Heimlich or initiate CPR. So, in the case that a resident starts choking, this means we have to run around the facility like crazy looking for a nurse, any nurse, to come and save this poor person's life. And you KNOW how long it can take to find someone (and you know we're not allowed to have walkie-talkies or cell phones). Mrs. O'Reilly, I hope you can keep that french fry from further obstructing your airway just long enough for me to go find a buddy. Like they say, "Two's a party!"
4. No clothing protectors. "They're undignified." "They make the resident look/feel like a child." "How would you like to have a bib on?" They're only undignified if you make them undignified. If they are so worried about it, why did they purchase several hundred of them that have FLOWERS on them that look ridiculous on everyone, let alone a 250-pound man? And is it "less" undignified to be wheeled around with dried, crusty drool and smeared, pureed "chicken" (I'm not sure what type of "meat" dietary prepared today -- as far as I know, they all look and taste the same) all over your shirt and pants? Really?
5. No matter how long you have worked, you still only get a 30-minute lunch break. If you work 6 hours, you get 30 minutes. If you work 16 hours, you get 30 minutes. So if I work day shift and take my lunch at 11:00 am but then graciously agree to stay and work evening shift due to a call-in (because people are tired of being worked to death), according to management, I am just "out of luck?" I'll let my unconscious, emaciated figure do the explaining for this one.
6. Each type of linen must be bagged separately upon leaving the room. Sheets, pillow cases, etc., go in one bag. Washclothes and towels go in another. Clothes go in yet another. Non-compliance to result in write-ups. All this to "make things easier for laundry" because nursing is "always making extra work" for them. I know that each department thinks they have it worse than any of the others, but really??? I have been in laundry and seen them practically having parties that would rival Jersey Shore when nobody else is around. Yes, they do have it hard.
7. Drinks must be covered when taken from the kitchen; water pitchers do not. Let's ignore the fact that regular drinks have no more than 2" diameter exposed, while water pitchers have around 4". That's only a two-fold increase in the area available to be contaminated by numerous microorganisms freely floating through the air. Shouldn't it be the other way around (if at all?)? Are malaria-infested mosquitos really going to infect the watered-down fruit punch and multiply during the 30-foot walk from dietary to the table but decide NOT to do so if I carry an open water pitcher to a resident room?
So then if someone's grandma is choking on a piece of breakfast sausage and her chart reads DNR.......do we sit there and watch her turn blue and pass away ? Probably that's a stupid question, but oh well leave it to me to ask the stupid questions.
Do Not Resuscitate does not mean "Do Not Treat." A person with a DNR that is choking can still have the Heimlich done. DNR only goes into effect if your heart stops and only refers to resuscitative measures.
A former LTC facility of mine used to make us "CNA cheat sheets." Among other things, code status was listed for quick reference.
At my current place, it's "none of our business." They just expect us to run like a bat out of **** screaming for the nurse if anyone stops breathing. Apparently our ["lack of"] education makes us incapable of comprehending such knowledge.
CNAs are permitted no access to residents' charts. As listed above, any information contained therein is "none of our business." They say charts are only read on a need-to-know basis and apparently something "simple" like taking care of someone for 40 hours a week does not fall under that category. Never mind that the information can help us do our jobs better. Why can DIETARY look at charts to plan diets but CNAs can't look at it before they ambulate a confused post-surgical resident for the first time since being admitted.
No social histories to talk to the resident about. Who cares what their former occupation was? Who cares if they have a family? Who cares if this helps us calm down a ****** off demented lady?
No MARs to look at so that we can help watch out for side effects. Who cares if Joseph falls and hits his head due to that alpha blocker-induced orthostatic hypotension?
No narrative notes to read when going to take care of a resident for the first time. Whoops, didn't mean to let that man on hip precautions bend over so far. Who cares if Fran has been *frantic* [pun intended] running around and look for her [deceased] mother every night this week.
No code status to look over. Who cares if that full-coder just keeled over? Hopefully I'll find a nurse in time to come gander at him.
Just because we may not have college degrees (well, some CNAs do) doesn't mean we are automatically irresponsible and going to abuse that information.
Do Not Resuscitate does not mean "Do Not Treat." A person with a DNR that is choking can still have the Heimlich done. DNR only goes into effect if your heart stops and only refers to resuscitative measures.
So then..... if it's not against facility policy you can apply the Heimlich maneuver to remove the offending piece of food, but if in the process they go into cardiac arrest and they are a DNR........THEN we sit there and watch them die. OK got it.
So then..... if it's not against facility policy you can apply the Heimlich maneuver to remove the offending piece of food, but if in the process they go into cardiac arrest and they are a DNR........THEN we sit there and watch them die. OK got it.
No, we can't do either. If someone starts choking, the NURSE has to come and dislodge the food from their airway. If someone falls over dead, we have to go find the nurse (good luck to us) who will then look up their code status, grab the AED and airway kit, and find the resident. Somewhere in between this, they are also supposed to call 911 (CNAs aren't supposed to use the phones). All of this should take no more than 5-10 (or more) minutes. Pity on the person who drops dead in a LTC facility.
And I don't think a DNR means you let someone choke to death on a piece of chicken.
Please correct me if I'm wrong.
I'm not talking about choking on chicken, simply about starting CPR. CPR and the Heimlich are not the same thing. CPR is only for when the heart stops, and the resident is in cardiac arrest. Of course you try to stop someone from choking.
For what it's worth, we are not allowed to feed without a nurse present in the dining room, so your scenario about choking leading to a cardiac arrest is a non-issue in my facility, as the nurse would already be present, so if the resident was a full code, CPR could be started.
I have never been in a situation like this, thankfully, because I know it'd be really hard for me to see someone (who was a no code) in cardiac arrest and know we couldn't do anything about it. But I do understand you cannot legally do CPR on an LTC resident against his/her or the family's wishes. Many residents are no codes, because of the risks involved with CPR. It can break bones and cause a lot of physical trauma on those already weakened.
Also, we have a few kids at our facility who were resuscitated (before they came to us) and are now in a vegetative state. So seeing them and how there's so little life left in them, and how it affects their families, I can now understand why someone might want to be a no code.
And while we were informed of DNR status when I worked in acute care, I've never been informed of it in any LTC setting. I don't know if that's standard or not, but it's simply what I've experienced.
I would be dead in the water if I had no access to the charts.
I work in psych and knowing my pt's past history has been crucial to how I interact with my pt.
That can apply to any aide in any setting.
Unfortunately, it is the losers of the CNA world who destroy the integrity of a fine and compassionate (and dang important) job.
This penalizes the hard-working, intelligent ones.
I'm sorry your facility views you as stupid.
We're not allowed to see the charts at my facility, either. We are only allowed to view the careplans, but even those are locked up and we have to request them from the nurses if we want to read them. It's odd to me and it does make for a challenge with some of our behavioral kids. (I work at a children's home for the developmentally disabled, so we get a wide variety of residents).
The things we're not told are astounding, sometimes. I posted on here a while back about a new resident we got. We were told nothing about him other than he could walk and talk and has Down's Syndrome. One of the nurses had to go way back in his chart to try to find some information she needed for a form and happened to find that he had lived in a group home and had been removed because they would find him in the middle of the night, stabbing mattresses with kitchen knives/sharp objects and he was physically violent with his housemates. you'd think that's the kind of thing you'd make everyone aware of when bringing him into a home of 80 disabled kids, right?
I'm not talking about choking on chicken, simply about starting CPR. CPR and the Heimlich are not the same thing. CPR is only for when the heart stops, and the resident is in cardiac arrest. Of course you try to stop someone from choking.
I'm sorry.
My post was poorly written.
I was not implying that you thought CPR and the Heimlich were the same thing.
I think everyone here knows the difference.
I'm just here trying to decompress after writing a care plan and my brain is toast.
LOL. I'm prone to the poorly-phrased posts, myself.
I thought of another stupid rule at my facility:
We are now allowed to feed two residents at a time. Somehow that is not cross contamination...but to grab both of their trays at once somehow IS cross contamination. We have to completely set up one tray, then go grab the other. Makes zero sense.
and my brain is toast.
CoffeemateCNA
903 Posts
Do Not Resuscitate does not mean "Do Not Treat." A person with a DNR that is choking can still have the Heimlich done. DNR only goes into effect if your heart stops and only refers to resuscitative measures.