What would you have done?

[wbdtrt]

In the dining room last evening and resident begins to cough, could still speak and had good air exchange. Told her, "cough it up MC." She continued to cough and since it was dinner time, all staff was in the dining room and we monitored her.

Dietary aide comes along and begins to hit resident's upper back. I asked her to not hit resident on the back, explained if something was in there she (dietary aide) may lodge it even further. Dietary aide shot back at me, argumentatively mind you stating,"there's nothing in her mouth, she's not choking and I'm not going to lodge anything!" The dietary aide continued to argue with me, dining room full of residents and all staff. I firmly stated, "don't ever hit another resident on the back, thank you."

I was the ONLY licensed person in the building, entire staff witnessed this occurence.

What would you have done?

[noctanol]

I would write her up. That is not acceptable behavior.

I agree, however in nursing homes, ltc's some of the low lifes run the show, they like to question nurses judgement, most resentment is due to the fact that nurses do "nothing" and get paid three times what they gey paid. Write her up, if this doesnt deter her i suggest giving her a piece of your mind and staying firm. I had to do this to earn respect in our ltc. The aide we had picked on me time and time beacause i was new, once i settled down, i let her have it and she has not been in my face since, i see new nurses and her right there doing the same thing she used to do to me. I give them the same advice.

[Seawitch]

Do they have to do basic first aide as part of their job?

I don't think it has anything to do with pulling rank - I assume that you were in charge anyway, so she should have bloody listened to you.

I've had my fair share of crap from carers in nursing homes - usually bitter and resentful doges middle aged or close to retiring.

[andrewRN]

Say something like, "I understand that you want to help but in cases where a resident is still able to speak, we should not try to 'help'. Studies show that hitting the back can worsen the case at times. It's great to know you're worried about the resident, but he/she should be fine. I don't want you to get in trouble with management."

Keep in mind that the aide is not as educated as you. The solution to "just write her up" is incomplete and seems more like it was done just in spite. If it was done like this, how are you any better than the aide who talked back at you because he/she feels that you undermined his/her capabilities.

If you did just write her up, do you think you "taught him/her a lesson." I think not! In fact, you simply shut him/her up, but your professional relationship with that employee is broken.

I suggest that you look for that employee and have a small talk. Say something like this, "Hey Joe. Yesterday we had a little incident at the dining room. I want to say that I didn't handle the situation as well as I wanted. As a nurse, I always put the resident first and you do too. You are a good person. I did not intend to put you in a position where you would feel defensive, you know that right?"............."Anyways, if you see a resident and you're not sure if they are alright, ask them to speak up first is the best thing to do." "Are we cool now?" (I use the word cool since I'm 20).

Empathize!

[GM2RN]

Not at all about pulling rank. A dietary aide may be trained in the Heimlich per regulations, but she had no business using any sort of intervention when there was a licensed nurse already on it.

I would have done exactly as the OP did, plus maybe the fire breathing that somebody else mentioned!

That was my point. An RN is the ranking healthcare personell in this scenario. Besides, if this aide had been trained in Heimlich she should have known better.

[systoly]

This has nothing to do with pulling rank or another staff member being a low life (I was really sad when I read that). It has everything to do with protecting a pt. from further harm. Write up is not indicated due to different department. My response (and I have done this) is if you touch this resident again I will send you home or have you removed by police if necessary and later on fill out an incident report. Filling out an incident report with resident involved automatically triggered contacting the family, the Dr. and the DON - much more powerful than a write up.

[Katie5]

This has nothing to do with pulling rank or another staff member being a low life (I was really sad when I read that). It has everything to do with protecting a pt. from further harm. Write up is not indicated due to different department. My response (and I have done this) is if you touch this resident again I will send you home or have you removed by police if necessary and later on fill out an incident report. Filling out an incident report with resident involved automatically triggered contacting the family, the Dr. and the DON - much more powerful than a write up.

Excuse me? But how is yours any better? You just triggered a landslide. This was a first occurrence. The intent was not to do harm but to assist( in a totally wrong manner) superseding that RN who was already present.

Your post just pulled rank, in the WORST manner of all! A write up though ineffective due to different departments WILL have the right approach of speaking with the party(dietary aide) involved in this altercation.

How do you ignore all that and blatantly pull rank in the WORST manner of all?

[systoly]

Maybe mine was worse, maybe worst. Maybe it depends on how you interpret the OP. I happen to disagree with arguing and assisting being synonymous. I'm not going to stand by and try to explain the rationale instead of attending to the pt. and I'm not going to allow arguing in front of residents. My stance on this is in a medical emergency the highest level of care provider takes charge no matter whether the other person is an administrator, LSW, or what have you and believe me admins and LSW love to take charge and get in the way in emergency situations, but once asked to step aside or man the phone, I never had to ask twice or argue with an admin or other higher up. Correcting someone or, if you will, pulling rank on someone during an emergency does not mean I'm angry with them or won't be happy to have a discussion with them afterwards unless they have proven to be non receptive.

[Esme12, ASN, BSN, RN]

Say something like, "I understand that you want to help but in cases where a resident is still able to speak, we should not try to 'help'. Studies show that hitting the back can worsen the case at times. It's great to know you're worried about the resident, but he/she should be fine. I don't want you to get in trouble with management."

Keep in mind that the aide is not as educated as you. The solution to "just write her up" is incomplete and seems more like it was done just in spite. If it was done like this, how are you any better than the aide who talked back at you because he/she feels that you undermined his/her capabilities.

If you did just write her up, do you think you "taught him/her a lesson." I think not! In fact, you simply shut him/her up, but your professional relationship with that employee is broken.

I suggest that you look for that employee and have a small talk. Say something like this, "Hey Joe. Yesterday we had a little incident at the dining room. I want to say that I didn't handle the situation as well as I wanted. As a nurse, I always put the resident first and you do too. You are a good person. I did not intend to put you in a position where you would feel defensive, you know that right?"............."Anyways, if you see a resident and you're not sure if they are alright, ask them to speak up first is the best thing to do." "Are we cool now?" (I use the word cool since I'm 20).

Empathize!

and being 20 it is not about being "cool" it's about protecting a patient form a potential harmful intervention when you are the licensed person in the building and the only one to be held accountable if something goes wrong. If that kitchen aide had disloged a piece of food form the residents throst to lodge it in her trachea and the resident dies it's the nurse held responsible because she should have known better and stopped the harmful behavior.

I would have pulled the aide aside when the resident was nor longer coughing or choking (and called the supervisor if there was one) to tell her that she was not the one in charge of a medical emergency in the facility; and she will, in the future,do as she is instructed in a emergent MEDICAL situation and that I will be letting her immediate supervisor know the situation through the proper chain of command so that education can occur and this situation will not happen again.

You need to have clear conscise guidelines and rules when dealing with people especially when your liability and license is on the line. If this was a habitual behavior for this employee then documentation is the route to follow.

I'mm al for developing a rapport with those at work but when patient saftey is concerned the patient comes first.

[Katie5]

Maybe mine was worse, maybe worst. Maybe it depends on how you interpret the OP. I happen to disagree with arguing and assisting being synonymous. I'm not going to stand by and try to explain the rationale instead of attending to the pt. and I'm not going to allow arguing in front of residents. My stance on this is in a medical emergency the highest level of care provider takes charge no matter whether the other person is an administrator, LSW, or what have you and believe me admins and LSW love to take charge and get in the way in emergency situations, but once asked to step aside or man the phone, I never had to ask twice or argue with an admin or other higher up. Correcting someone or, if you will, pulling rank on someone during an emergency does not mean I'm angry with them or won't be happy to have a discussion with them afterwards unless they have proven to be non receptive.

Dictatorship! There is perfectly nothing wrong with asking questions- it all depends on the way you phrase it.

You did not just pull rank during an emergency(perfectly acceptable). You pulled ENORMOUS rank AFTER the emergency, when you would have had time to simmer down.

[TravelinCEN]

of course it is! the aide was doing something inappropriate that was not within her scope of duties, could potentially harm that patient, and the rn was responsible. you better believe it was about pulling rank!

just to be clear, the intervention was incorrect, not outside the dietary aides scope of practice.

my 11 year old nephew did the heimlich on a person in person who was eating dinner at a table across the room. his mother, an rn, watched as he did it.

i don't care if you serve food, mop floors for a living or just earned your boy scout first aid patch, please perform a life saving intervention if you can. that is the true message that we need to be sending to the community and our staff. you don't need a license to save a life.

but for the question "what would i do?" i would listen to the pts lungs, watch for sx of pneumonia, order a cxr if appropriate. i predict aspiration pneumonia soon.

[sunnycalifRN]

Wait, I'm confused a dietary aide has to listen to a RN? I'm not saying it to be funny...I'm just asking, it wasn't the correct behavior at all BUT is this about pulling rank?

It doesn't matter if it was a dietary aide, an MD, or the CEO of the facility . . . what that person was doing was WRONG and dangerous, and what the OP said was spot on!!

[systoly]

Dictatorship! There is perfectly nothing wrong with asking questions- it all depends on the way you phrase it.

You did not just pull rank during an emergency(perfectly acceptable). You pulled ENORMOUS rank AFTER the emergency, when you would have had time to simmer down.

Time to flee the country.