I’ve read at various online forums tales of how CNA’s literally fill in he blanks of vital sign records- without actually getting them.

just need to vent about last night at work….another cna was to take vitals on resident on unit, she is not a regular, i am new cna and also to this ltcf. been there one week still on training.
well she was to get temp and bp..resident in hallway with me…she took temp and not bp but she wrote on vital board patients bp as 120/82…..rghghhhhh it bothered me being new i hate to start trouble but this patient cannot speak…but understands.

What if we we all did this? Blew off getting the T, P, R and B/P? What if the resident has developed high B/P and because we couldn’t be bothered to be honest, it went unchecked? What if a real temp wasn’t measured for a couple days, while the resident is coming down with a infection? What if the resident is on a new medication that has a side effect of changing their respirations, but this isn’t seen because no one took the time to count them??

This is very bad. And illegal. And unethical. And most importantly, dangerous. What’s a new CNA to do? Or an experienced CNA? You stand up and advocate for the resident. You MUST not allow this to happen, when you see it, witness it, hear about it or otherwise KNOW of it.

How do you go about advocating in situations like this?

It seems pretty simple to me. Here’s what I would do (and have done many times):
1) Tell the CNA involved that she is committing fraud and that she needs to get the VS in question, right now. While you watch.

2) Report the incident to the charge nurse immediately; explain what happened and leave your personal thoughts out of this.

3) Seek the DON and report the incident to he/she as well. In writing. ASAP…Make a copy of your report to keep for your own records. Even if the charge nurse says she will make the DON aware, go to the DON yourself. You’re covering yourself by doing so. Otherwise, it could come back to haunt you in the misconception that you were aware of the incident but didn’t report it…and so on.

DON’T BE ONE OF THOSE AIDES.
The CNA who fraudulently documents care is opening themselves up to numerous problems. They could lose their job; their certification/license; their chances to work in health care as a career will most likely be ruined for good. If actual harm came to the patient/resident because we slacked off, patients and their family can pursue legal remedy. The facility and the state body in charge of regulating CNA practice can turn the “case” over to the Attorney General and hence start the criminal justice process. You get the idea.

Trust is big in health care.
Do we really think we can trust the aide who doesn’t measure vital signs but who writes in fictional numbers?

It’s not just vital signs. When an aide fills in the blanks in this one area, I question their honesty and integrity in all areas. The box is checked for the bed bath, but did the resident really get one? There are numbers in the intake and output record, but are they truthful?

Patients trust their health care providers to be skilled and honest. Our employers, the nursing homes and hospitals and assisted living centers trust that we’re using our skills and being honest as well. Our charge nurses depend upon our skill and honesty to assist with providing timely and needed treatments and medication administration. Our co workers trust that their peers are doing the right thing for their beloved residents.

The right things mean filling in the blanks with real, honesty measured/provided numbers/care. The right thing means when something isn’t done, it’s documented as not being done. We all know there are days when we can’t get IT all done and that’s the way of this work.

Experienced aides can prioritize their work- they KNOW what care or task needs to be completed vs what can wait. New aides should feel confident to ask for direction and HELP when they need it (which might be often the first couple weeks they are on the job!)

Charge nurses should always provide guidance to help sort through these issues. When it comes to actual skills- some newer aides really have trouble measuring blood pressure. The new aide should seek the help of her mentor, or the charge nurse to really learn this skill.

Paperwork overload is no excuse!
There is WAY too much paperwork in our work. Everyone knows this. Yet, facilities don’t get paid and pass inspections if the paperwork isn’t done. In the medical chart, if it isn’t documented it wasn’t done. Sadly these are facts.

The burden of documenting has become overwhelming. The original purpose of charting was to provide a clear record of a patients’ medical condition, where members of the health care team could go to see updates and alter their interventions and treatments as needed.

The chart is rarely used for this anymore. Now, it’s a place where endless pieces of paper are stored- and kept, in the event of a lawsuit. Nurses and others document on the defensive now. This is the world many have created and our little part in it has tremendous consequences. Those vital sign numbers better correlate with the sudden medical condition discovered on the next shift. When it doesn’t, red flags are spotted and questions are asked.

Maintaining Integrity Isn’t Easy In This Work
The CNA MUST ALWAYS be honest in the care and tasks they provide. We are the front line. The first to see and know. We are extremely valuable because of our place. If we don’t feel skilled enough in providing tasks/care, we need to speak up to this and ask for help. Those of us who hear the cry for help need to be willing and able to teach. We need to recognize when a peer is having a bad time, a bad day, and offer assistance. We do this not for the aide but for the patients/residents she is assigned to.

WHY IS THIS BECOMING MORE AND MORE PREVALENT?
In the past few years I have seen an increase in aides who graduate from these small medical-skills schools who don’t have (or are not taught) the same foundations of honesty and integrity. I’m not sure honesty and integrity can be taught either…we either have these ethics or we don’t. Better screening might be one solution.

The quick turnover rates of graduating “classes” of aides amazes me- and the fact they can pass the state tests tells me they know the basics. The basics aren’t good enough anymore.

It gets lost when these fast food CNA’s get on the units and are totally overwhelmed with their assignment. They feel pressured to get everything done and this is where I often see the cheating occur. I have to wonder if these schools are not doing an adequate job teaching the students everything they really need to know. I wonder if the new aides thought the job would be much easier.

When we see cheating happen we have to speak up. Loudly at times. We might even need to make a stink once in a while. Life and death decisions are sometimes made based upon our honesty. As I said, we’re the front line. Our words have HUGE impact upon everyone’s word, all of whom are above us. If we’re not honest, then neither are they. Yet we know it, and they don’t. Remember that.

We have received some emails asking us about blogging. It’s Web 2.0…Blogs are quickly replacing the standard web site as we know it.

We’d love to see more CNA’s enter the blogosphere! There aren’t any that we know of. We have an Administrator and a Nursing Home consultant and various advocacy groups who use blogs, and MANY nurses and doctors. But CNA’s? None. CNA’s could use blogs as a way to express frustrations with their work; they can share antidotes about residents; they could learn to advocate for change. Writing (posting) about work experiences, for some, is therapeutic.

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YouTube has the series on Nursing Home Reform, 20 Years Later.

Two weeks ago we wrote up 7 Habits of Highly Effective CNA’s.

Today, we’re listing up 7 habits of highly INeffective CNA’s. If you recognize yourself, change your habits.

1) She calls out often; or is late; or leaves early. A CNA cannot be effective when they are not at work.

2) She is inflexible. She won’t alter her assignment to make things fair to all; she refuses to take on extra residents without a battle; she refuses to change her routine for the residents’ benefit.

3) Teamwork: She either belongs to a clique or is a loner. The clique is negative and spends much time backstabbing other aides. The loner never smiles or offers to assist others. She isn’t helpful with new aides.

4) She is on the phone. A lot. Either her own or the facility phone. She makes calls when the nurses are busy and away from the nurses station.

5) She spend a lot of “down” time behind the nurses station. Sitting. Doing her nails or braiding her hair. Not answering call bells; ignoring requests for help. Yet she has no problem gabbing with staff from other departments.

6) She’s a gossip queen and a rumor monger. She seeks out others to spread stories and tales true and untrue.

7) She never volunteers for anything. She avoids putting any extra effort or thought into situations that require it. Residents don’t dislike her, but they don’t favor her either. She doesn’t bring on smiles to those she encounters at work.

An interesting article about dysphagia screening and assessment, and the various professions roles in this process:

Hospitals that are credentialed as stroke centers must have a screening tool for dysphagia in place, according to the American Heart Association. Furthermore, the Joint Commission states that a screen for dysphagia should be administered to patients with stroke before they are given “food, fluids and medications by mouth.”1

In compliance with these requirements, some hospitals are introducing a swallow screening procedure designed specifically for nurses. The purpose of the procedure is to enable them to screen newly admitted patients who may be at risk for aspiration and quickly determine if they are safe for oral intake.

And:

It’s important to note that the nurses who perform the screening are not performing swallow evaluations, nor are they replacing speech-language pathologists.

“My job is to perform a comprehensive evaluation on every patient. This [procedure] allows nurses to more accurately determine who needs a full evaluation and who can start their oral intake. An evaluation is far greater than that,” said Audrey Cohen, MS, CCC-SLP, of the Department of Speech, Language and Swallowing at Massachusetts General Hospital (MGH)in Boston.

Training the nurses:

Staff can access a Web-based training module via CD or the hospital Intranet. The module includes background information on the nature of dysphagia, aspiration and oral hygiene. It also differentiates between a swallow screen and a comprehensive evaluation and explains the role of the nurse in caring for patients with dysphagia.

The training module shows a demonstration of how to perform the screening appropriately, with video clips of patients exhibiting normal and abnormal responses. As part of their training, nurses must perform the screening at least five times under the supervision of a speech-language pathologist.

Where CNA’s come into this:

If a swallow evaluation is warranted by an RN, nurse practitioner or physician, the speech-language pathologist establishes the patient’s safest diet level and discusses safe swallowing techniques with nursing. All of the information is placed on a swallowing instruction sheet in a Communication Binder that the departments pass back and forth.

“We write down the patient’s diet level and any safe swallowing strategies that we feel need to be implemented with the patient during the meal,” said Repsher.

In each dining room a trained certified nursing assistant (CNA) is assigned to a supervision table and uses the information on the swallowing instruction sheet to ensure the patients eat safely. The CNA adds specific comments, such as if patients are having difficulty during the meal.

The facility offers dysphagia groups for patients. Speech-language pathologists instruct patients on compensatory strategies and safe swallowing techniques. They assess the safety of the patient’s swallow and increase the diet level as tolerated.

When appropriate, the nursing staff is given a demonstration on how to carry out these instructions.

“We show them what the patient needs to do,” said Repsher. “If the nursing assistant is in the dining room at the same time that we’re at the supervision table, we would instruct the nursing assistant on the strategies the patient needs to use.”

This information is then included in the Communication Binder.

CNA’s are on the forefront of dysphagia. We see it, hear it, watch it happen when we witness coughing, choking, strained swallowing, pocketing of food, slow or incomplete swallows. Our observations are critical to the entire process. It’s very important to share these observations with the nurses or SLP when they ask. Episodes of difficult swallowing or choking must be reported and potential illnesses watched for. The CNA is the vital link in this.

Nursing homes should have a similar plan in place for these issues. “Resident Oral Intake” Guidelines should be set up for each resident who eats.

From California:

LOS ANGELES, April 11 /PRNewswire-USNewswire/ — The California Nurses Association/National Nurses Association today condemned the Service Employees International Union for targeting CNA/NNOC leaders and members with threats and intimidation, stalking them at home and in patient care units at hospitals.

In a statement today, CNA/NNOC — the nation’s largest RN union — demanded SEIU International President Andrew Stern “immediately renounce the actions of SEIU staff and cease and desist these despicable attacks against anyone who speaks out against his pro-corporate agenda.”

“SEIU’s behavior, sending swarms of staff to threaten women in their homes, is especially disgraceful, and another illustration of their contempt for a predominantly female profession that they treat as chattel in so much of their activity, including trying to force RNs into his union,” said CNA/NNOC Executive Director Rose Ann DeMoro.

Roving bands of SEIU staff, four or five at a time, arrived on the doorsteps of at least two CNA/NNOC female Board members in Southern California Thursday, with video cameras to film their abusive exploits.

Is this what we pay dues for?

“Union membership is about collective democracy. Nurses decide they need a union and then choose the union of their choice,” Cuaresma said. “We will continue to give voice on behalf of our patients and we will never be intimidated in our struggle to defend our ratios and our hard-won benefits. Stern should rethink his strategy — he will not intimidate me or the CNA.”

Thursday’s attacks on CNA/NNOC Board members are the latest escalation by the Service Employees Union which has in internal conversations bragged about its intent to “destroy” CNA/NNOC for challenging SEIU’s practices which the RNs say compromise patient safety, erode RN standards and professional practice, and undermine workplace and union democracy.

Also on Thursday, CNA/NNOC obtained a letter from an SEIU staffer who resigned in disgust with the behavior of SEIU International and quoted a top SEIU official bragging of plans “targeting ten to fifteen C.N.A. bargaining units.”

SEIU’s corporate partnerships compromise patient safety

Perhaps the most egregious behavior of SEIU International, says CNA/NNOC are its deals with corporate hospitals and nursing homes, sacrificing patient safety for agreements to help it recruit more SEIU members.

For example, SEIU has signed pacts with nursing home operators in California and Washington state agreeing to lobby for the nursing home chains. Under the 2003 California deal, SEIU agreed to oppose legislation requiring nursing homes to provide enough staff to keep patients safe and healthy, and to not report health care violations to state regulators except when required by law.

Five years later, according to a report cited in the Los Angeles Times this week, despite increased state funding for nursing homes, the direct result of SEIU lobbying, nursing homes are spending less in California on direct patient care, and reports of patient mistreatment have shot up 38%.

Similarly, in partnership with hospital corporations, SEIU lobbied in California against the RN-to-patient minimum ratio law, and worked to erode the law after it was enacted.

Unions should work for the people who pay them to represent them. Not against them. Clearly the SEIU has held the hands of nursing home industry leaders, who have goals that are not in favor of good patient care. We might think unions are a good thing, but we should be careful consumers (that would be me and you!) when it comes to what a union really offers, AND how it operates behind closed doors.

Our very own Patti is interviewed by Elise over at the PHI web site. Go check it out!

Ahoy there! We’ve been very busy this week, WORKING tons of shifts and not having ANY spare time for this site. Next week looks less busy for us so we will resume our regular posting schedules then.

Have a good weekend.

It would seen pretty simple- at work the phone rings as you’re walking by the nurse station. The unit secretary isn’t there. You answer it. You’re polite and take messages, right?
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Check with your supervisors first, but note CPR guild lines are changing.

NEW YORK (AP) - You can skip the mouth-to-mouth breathing and just press on the chest to save a life. In a major change, the American Heart Association said Monday that hands-only CPR - rapid, deep presses on the victim’s chest until help arrives - works just as well as standard CPR for sudden cardiac arrest in adults.

Experts hope bystanders will now be more willing to jump in and help if they see someone suddenly collapse. Hands-only CPR is simpler and easier to remember and removes a big barrier for people skittish about the mouth-to-mouth breathing.

“You only have to do two things. Call 911 and push hard and fast on the middle of the person’s chest,” said Dr. Michael Sayre, an emergency medicine professor at Ohio State University who headed the committee that made the recommendation.