Question of The Week: Falls and Responsibility

Question:
At work today I got into trouble because one of my residents' fell. This man is independent and never needs our help. He can do his own care- showers, dressing, walking, meals, toileting...the works. As far as I know he has never fallen before. I was busy with one of my other residents who requires total cares. I was in the middle of bathing her when the nurse came in to tell me the man fell and why wasn't I with him? After I finished up with my lady's care, I was told to fill out a report which wanted to know what I COULD HAVE DONE to prevent the fall; THE LAST TIME RESIDENT WAS TOILETED; THE LAST MEAL consumed- all things that had nothing to do with this fall!!

Later, I was written up for the fall. I told the DON that everyone is responsible for ALL the residents on the hall I was working. Yes, he was assigned to me, but when I am busy with other residents, my co workers should step up and cover for me. What do you think of this?

Answer:
You should not have been written up, in my opinion.

Every resident must be assigned to a CNA. It's law. No way out of that. Every aide accepts their assignment and therefore responsibility for the residents on it. Each CNA is responsible for her assigned residents and the unit, as a whole, cannot do this.

It's tough when bad things happen to good aides, though.

Did you read the man's care plan? Are you absolutely sure he is independent in his cares? If so, did you check in with him to see if he needed any help, with anything? I think sometimes we assume these residents who are able to do their own care never need ANY help- and this isn't always the case. When doing this check in, it's always a good to ask when they're planning to get up; what they're bathing plans are and the like. This way, you can have some awareness that Mr. Smith is going to be up and about around 9am, and might need someone to just peek at him.

Of course this is where team work comes into the picture. Every time an aide is going to be tied up for awhile with residents, its always a GOOD thing to let as many peers know where you're at. And include the nurse with this info as well. If you're so inclined (and I would be) I would ask peers to keep an eye and ear out for your other residents...especially if I was going to be tied up for a longer period than usual with the other resident. A good charge nurse would make sure your other residents are covered as well. It's a balancing act though: Asking every aide to cover the others' residents every time personal care is being performed is just not practical.

As for the report: It's called an Incident Report. The questions asked do indeed have everything to do with the assessment of a fall. By asking you what you could have done to prevent this fall, the answers you provide are supposed to be helpful to prevent a repeat in the future.

Did you know most residents fall because they are trying to get to the bathroom? If they're hungry they might be trying to rush out to a meal. Usually there are other questions too on these reports- about all sorts of things. Often we don't know the prior condition of any resident when they have fallen without a witness.

It's very important for CNA's to answer these things honestly...however....when we're written up it takes away the desire for CNA's to have any respect for these reports. These things should never be used as a means for punishment. When independent residents fall, it is NOT the direct fault of the aides. It was caused by something else. It IS up to management to figure out why the fall occurred- but by placing blame on the aides they are short changing this process. This is another example of autocratic management style- which isn't helpful. And, I have to wonder if nursing homes with high fall rates have these kinds of managers.

I'm sorry you got written up. Of all the things CNA's don't have control over, the FALL tops the list. The work loads alone should tell all that it's impossible to be everywhere at the same time- or even once an hour. A good fall prevention program begins with a trusting environment where no one is disciplined for falls unseen. Once that is in place, true prevention strategies can be developed AND the CNA's are the most valuable asset to this process.

CNA's And Respect

CNA’s and respect

In the LTC setting it seems that one of the most important skills we all should have is in severe lacking: RESPECT. Respect towards our peers, leaders, people who work in other departments and residents. Without a healthy amount of respect towards others we close doors upon ourselves.

Respect towards peers- other aides- is SO important if one wants to able to work effectively and in a team like manner. It isn’t hard to respect others, it just seems so. First, we have to let go of all our old assumptions about people. Start with a fresh perspective and it is easy.

People generally:
Like to be helpful
Like to be liked
Like assistance
Like “fitting” in with others
Think better of others who use manners

People generally:
Don’t like being yelled at
Don’t like being treated as though they don’t know anything
Don’t like to be gossiped about
Don’t like being ignored
And most of all, people usually don’t respond well to others who demand things rather than ask.

Using manners in all your communications is the very first thing we can all do to improve our ability to gain respect from others. Sharing our experience in a helpful and mentoring way is another step.

Saying “Thank You” and “please” and “excuse me” are things we all learned in kindergarten or early on in life. For some reason these basic skills get lost as we grow up and become members of the workforce. I respond much better to someone who says to me- “Could you please get the door for me” vs. someone who says- after the fact- ‘Why did you slam the door in my face!?” (Usually said behind my back in some gossip session and usually I had no idea the person was right behind me and needed help!) Two good things can happen with this example: The other aide feels good because he/she got a helping hand with the door and I feel good because I was able to help. So simple yet so often not done.

Since many of us have years of valuable experience as CNA’s, we have much to share with the new CNA’s fresh out of class. Many experienced aides think it is not their responsibility to mentor new aides; they feel new aides should know everything they need to know. This might be true as far as basic skills with bed making and vital sign measuring, but NOT with the other subtle skills of getting along in a fast paced environment. Skills with speed and organization need to be talked about. The way in which we choose to teach these skills can really have an impact on our profession.

If experienced aides choose to mentor the new aides with an attitude of negativity and “Just one more thing to do”- we will fail. One has to have a positive attitude and one has to respect the position of the new CNA. Remembering what it was like when we were brand new HELPS.

Respect with leaders is a harder issue. Many nurses think that because they have a degree they automatically deserve respect. This is true only so far as the fact they got their education and degree- everyone should respect others for this. But to respect someone ONLY because of their educational status is not always possible. I firmly believe that respect MUST be earned. Nurses who treat CNA’s with respect, who use manners and who seek input from the CNA’s will manage things far better than those who “demand” respect simply due to their title. I am not advocating disrespect for nurses, but don’t give it automatically. You treat them well- with manners and dignity and hopefully they will respond the same towards you. Also, when respect is handed out without any perimeters staff tend to become like the leader. This can be both negative and positive. A leader who yells and is just miserable tends to have staff with the same attributes working for them.

So, using your manners and being polite DO go along way with respect. Sharing your knowledge and skills in a positive way also help move our profession in a good path. Not handing over respect just because someone demands it makes you a better person because you have standards for respect. What about respecting the residents?

Residents should always have our respect-unlike nurses and others- simply because they have lived long lives and because they are the paying customers within the LTC setting. They are our bosses. Without them we would not be getting a paycheck.
Residents of the Greatest Generation often fought in the world wars and lived through the Great Depression. Respect for this is expected and we should all give it! And we should be grateful. Members of this generation gave much in order that we can be as we are- they sacrificed and suffered for freedom and for American way of life. Never underestimate their sense of duty to their country.

Again, as with peers and leaders, using our manners and being sincere with our efforts will go a long way towards having good relationships with residents. This generation really expects manners and they tend to have different ideas about work ethics and how to raise children. Politics and religion are often taboo subjects with the elderly. Using correct names and titles are expected and show respect. Nicknames, although cute and becoming, should always be “Ok” with the resident and they must respond well to them.

CNA’s need to respect the values of the older generations. Currently, for example, the US is involved with military operations in Iraq. Many of the current generation (younger) feel no need to get involved with this war and are very much against it. Members of the older generation, if they know about the war, probably feel quite differently about it. They most likely feel it is the duty of every American to join the military services and serve the country. These current events can lead to hard feelings between generations. No matter how strongly one opposes war or sees a need for it, always respect how the Greatest Generation feels. Remember, they have sacrificed much more than we have.