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.

In this article, I want to present a concept that should be well understood by all CNA’s. Here, we’re going to discuss what can happen when we become overly attached to a resident, or their family and the implications this has upon the facility.

One of the better changes for some LTC facilities is consistent staffing. However, this staffing model has created some unintended consequences.

Read the rest of this entry »

Often we hear the terms Restorative Nursing and Rehabilitation Nursing- the two terms are confused and intermixed in conversations and services. While similar, there are a few major differences between the two:

Rehab is a higher level of skilled care. Services are always provided by licensed staff- physical and occupational therapists and their assistants; Speech-Language Professionals, Nurses and others. Services are billed for by the hour. Government and insurance plans will only reimburse services delivered by licensed professionals. The use of CNA’s in Rehab is limited- and any care they provide is not “billable”. This means services provided by a CNA are not paid for. In Rehab, the CNA is not considered a professional.

Restorative care, on the other hand, is provided by nursing staff, including CNA’s. It is provided 24 hours a day, 7 days a week. Nurses can assess residents for needs and create special programs designed to restore or maintain the residents’ current and previous levels of physical health.

Read the rest of this entry »

Continuing on the theme of online resources for CNA’s, Patti gathered several links to sites that offer continuing education opportunities. These are not free and pricing is a bit prohibitive for individual CNA’s. Facilities can certainly afford some of this though.

Read the rest of this entry »

The National Association of Health Care Assistants has been around for many years; it’s an excellent CNA advocacy group and offers individual and facility memberships. Through this group, CNA’s have an opportunity to engage in a professional course designed to further their knowledge and skills with caring for the elderly.

Description
The Geriatric Care Specialist Program is a 10-module correspondence study course for certified nursing assistants. This course is designed to assist nursing assistants with enhancing their knowledge and skills in the field of geriatric care. The certification expires annually. To maintain certification, submit annual verification that 12 hours of in-service have been completed, along with $5 renewal fee.

————————————
Syllabus

Module One
Anatomy and Physiology

Module Two
Age Related Disorders

Module Three
Geriatric Urinary Incontinence

Module Four
Pressure Ulcers, Wound Healing, and Skin Care

Module Five
Caring for Residents with Dementia

Module Six
Psycho-Social Needs of the Geriatric Resident

Module Seven
Communicating in Long Term Care

Module Eight
Restorative Care

Module Nine
Observation, Reporting, and Documentation

Module Ten
Survey Process and Federal Regulations
————————————

Go HERE for more details.

If you’re looking for prepared programs to further you’re knowledge as a CNA, this site has a comprehensive listing of courses. For LTC facilities mostly, this site offers online classes that staff can participate in through their employer.

Academy of Certified Health Professionals

ACHP Educational Programs

A revolutionary continuing education program designed to meet the complete needs of health care providers. Programs are geared to real life educational needs based on feedback from nursing assistants, charge nurses, administrators, staff development coordinators, CNAs and nursing directors.

A sample list of course titles:
—————————————————-
Skin Integrity Management
Course Number 150
Professional Point Value 10
Level of Difficulty
Description: This course details the anatomy and physiology of the integumentary system, age related changes, and preventive care to maintain skin integrity.

Pressure Ulcer Prevention
Course Number 250
Professional Point Value 15
Level of Difficulty
Description: Knowing that prevention is the best treatment of pressure ulcers, this module outlines the risk factors identified for skin breakdown, causes of skin breakdown and caregiver implications related to pressure ulcer prevention.

Weight Loss Management and Intervention
Course Number 350
Professional Point Value 15
Level of Difficulty
Description: Adequate nutritional intake is imperative for skin integrity and wound healing. Unplanned weight loss puts the frail and elderly at risk for pressure ulcer development and impaired wound healing. This course defines the necessary nutrients, vitamins and minerals for optimal health, plus caregiver methods to reduce unplanned weight loss and optimize nutritional intake.

Wound Healing in the Elderly Individual
Course Number 450
Professional Point Value 20
Level of Difficulty
Description: Building on the material presented in Courses 150, 250, and 350, this module provides, in great detail, the phases of wound healing, the ideal environment to promote wound healing, and how the CNA can positively impact wound healing.

Developing and Implementing Resident Safety Protocols
Course Number 160
Professional Point Value 10
Level of Difficulty
Description: Nursing assistants are the first line of defense against resident accidents and injuries. This course will explore realistic and hands-on techniques to ensure the safest environment and care for the frail, elderly and disabled needing assistance.

Infection Control for the Nursing Assistant
Course Number 260
Professional Point Value 15
Level of Difficulty
Description: Because even the mildest of infections can be life threatening to the frail, elderly and disabled, it is imperative the CNA have a good working knowledge of the chain of infection and how to prevent the transmission of infection to those in their care. This course will cover those topics, plus other techniques to reduce the risk of infection both to residents and staff alike.
—————————————————-

There are MANY others.

Also, this service offers a CAREER LADDER PROGRAM based on the completion of the courses. This would be geared for facilities and not individual CNA’s.

Nursing Home Magazine does it again: AN excellent article about dysphagia and swallowing problems, some of which is aimed at CNA’s:

Dysphagia is not unusual among older adults living in long-term care facilities. One study recorded the presence of mealtime difficulties in nursing home residents and found that nearly 90% had impairments that included dysphagia, poor oral intake, positioning problems, or challenging behaviors. Furthermore, 68% of the residents experienced dysphagia, compromising their ability to enjoy meals, let alone consume the necessary calories to meet nutritional requirements. Dysphagia can lead to aspiration, choking, dehydration, malnutrition, and pneumonia. In fact, aspiration pneumonia is the fifth leading cause of death in people over 60 years of age and the third leading cause of death in people over 80. Clearly, food intake is crucial to many residents’ health and quality of life.

Residents with dysphagia often require modified diet consistencies, such as thickened liquids or pureed foods. In addition, nursing assistants must often comply with specialized feeding techniques, such as placing food in the non-impaired side of the mouth, limiting the use of straws, or facilitating the use of adaptive feeding equipment. In the dining room, nursing assistants who provide help to, monitor, or feed residents must follow the techniques for the residents’ safety and nutritional health. Failure to successfully comply with swallowing and feeding recommendations can cause inadequate hydration and nutrition and unsafe feeding.

More:

Through therapy, a speech-language pathologist can help many residents with dysphagia learn compensatory swallowing techniques. Researchers have found that poor staff training and a lack of understanding about feeding recommendations can cause malnutrition and dehydration in long-term care. McGillivray and Marland conducted a review of the literature on assisting people with dementia during meals. Their review found that mealtime assistance is often stressful for residents and staff because feeding becomes task centered and staff have not been sufficiently educated or trained.

I think ALL staff could use more training.

Did you know?

Signs and Symptoms of Dysphagia
Some signs and symptoms of dysphagia are not commonly known. For example, did you know that a persistent low-grade fever might be a sign of dysphagia? Did you know that if a resident is spitting food at meals, he or she might have oral phase dysphagia and might be unable to chew properly? Review the list below with your staff. Residents displaying the following signs and symptoms of dysphagia should be seen by a speech-language pathologist:

* Having trouble recognizing food
* Difficulty placing food in mouth
* Drooling or spitting
* Food falling out of mouth
* Pocketing of food in mouth
* Rocking tongue back and forth while chewing
* Food left in mouth after the swallow
* Chewing for a long time
* Coughing before, during, or after the swallow
* Delayed or absent rise of the larynx during the swallow
* Requiring 3–4 swallows after each bite
* Continuous throat clearing during or after the meal
* Wet or hoarse voice
* Complaining of something caught in throat
* Refusing to eat or very slow eater
* Lasting low-grade fever
* Unplanned weight loss or unexplained loss of appetite
* Pneumonia
* Malnutrition or dehydration

This article provides an excellent review of swallowing problems for nursing home residents and would be a timely and good resource for an in service.

Why it’s so important to maintain professional relationships with residents.

OLYMPIA — A 20-year-old woman has lost her nursing assistant’s license after being accused of accepting $145,000 in gifts — including jewelry, a car, a stock portfolio and a trip to Disneyland — from an elderly man before he died at an Olympia assisted-living facility in 2006.

Lila Guzman collected the gifts from Damiano Buffone from 2004 to 2006, starting when she was 18 and Buffone was a resident of Merrill Gardens on Lilly Road, according court records and a statement of administrative charges filed by the state Department of Health against Guzman this year.
[...]
According to the civil suit filed by Buffone’s daughter:

“Over a period of time from November, 2004 to May, 2006, defendant received approximately $145,000 from the decedent in the form of checks. Additionally, shares of stock managed by Merrill Lynch was transferred to the defendant.”

The suit alleges that before Buffone’s death June 6, 2006, Guzman “coerced” him into giving her stock and money while she worked at Merrill Gardens. Horn’s attorneys were able to freeze Guzman’s stock holdings, as well as at least one of her bank accounts, after Buffone’s death, the complaint states.

Now, Guzman is broke, unable to pay the money she has been ordered to give Horn as part of the judgment, Benjamin said.

“She has no money because all of her assets were frozen and taken away,” he said.

An post over at the WSJ Health Blog caught my eye:

Nurses are beaten and abused, pinched and punched by deranged and demented patients.

The rough treatment of nurses by some of the people they care for isn’t an issue that gets much attention, but it should, Illinois doc Ben Brewer writes this his WSJ.com column. “Nurses get assaulted all the time at work,” he writes. “They get assaulted in small and large ways at every hospital and nursing home in the country.”

The subject comes up occasionally in the medical literature (see this study, for example), but for the most part everybody assumes it happens and there’s not much to do about it. Nurses are the infantry of the health-care system.

Brewer rolls out one example after another. The young nurse with the long scar on her forearm, where the surgeon went in to fix tendon damage after a patient violently twisted her hand and bent back her fingers. The ICU nurse with a deformed finger and nerve damage from a patient’s bite. The nurse who got punched in the ear.

He notes that patients are restrained less often than they used to be, but he suggests that more frequent use of restraints probably wouldn’t do any good. “Usually it’s the one you don’t see coming that gets you,” he writes.

Yea? Let’s talk about this rough treatment:

Nurses and aides are:
Hit
Punched
Kicked
Bitten
Pinched
Held semi captive by hair pulling
Picked up and thrown
Targets of objects being hauled across rooms- everything from a simple hair brush to entire hospital beds.

…and otherwise roughened up and abused by our patients.

On a daily basis.

Read the rest of this entry »

Proposal For The Nursing Shortage:

(CBS) CHICAGO An Illinois senator introduced some new legislation this week. The plan is to improve the current nursing shortage by providing better career incentives, as CBS 2’s Suzanne Le Mignot reports.

Norene Brown says she’s worked as a certified nursing assistant for 11 years. Brown says she’s always wanted to be a registered nurse and Senator Dick Durbin’s new legislation, can make her dream a reality.

“What it would do is enable me to advance myself into the next level of nursing, without having to worry about how I’m going to pay for it,” Brown said.

Brown says using the Nurse Training and Retention Act of 2007, would provide her with scholarship money to become a nurse and after 10 years, any loans she took out, would disappear. She says this would be life changing for her.

“With this $8.50 that I’m earning, it’s disrespectful – it really is,” Brown said. “Because I shouldn’t have to worry about how I’m going to pay my bills; I shouldn’t be living from paycheck to paycheck.”

Sen. Durbin says the legislation he introduced earlier this week is aimed at easing the nation’s nursing shortage.

“In just six or seven years, we’re going to be one million nurses short of what America needs – one million nurses,” he said.

Durbin says through the legislation, grants are given to organizations who work with their employees to improve their skills to become nurses. Durbin added, hospitals will be charged $1,500 for each nurse they bring in from overseas.

“We need their help,” Durbin said. “We obviously have this nursing shortage, but we’re going to have a fee attached to bringing these nurses in to provide scholarship funds for home grown American nurses.”

Durbin also says qualified nursing school applicants are being turned away because there are not enough faculty to teach them. A program allowing retired military nurses to pursue graduate degrees to become nursing faculty just won state approval. The senator says the program will help ease the shortage of nursing teachers at universities.

I only wish we had more details. Overall this sounds good but many questions remain unanswered. It’s a great policy directive, but we need the nuts and bolts as well.