In St. Louis, the Labor Department has recovered more than $1.7 million in back wages for 4,000 employees of hospitals and clinics operated by SSM Health Care, a Roman Catholic system.

In Boston, the Partners HealthCare System agreed to pay 700 employees more than $2.7 million in overtime back wages to resolve a lawsuit by the department alleging violations of the Fair Labor Standards Act.

And under the proposed settlement of a class-action lawsuit in California, Kaiser Permanente would pay $7.25 million to hundreds of registered nurse coordinators, case managers and other medical workers. The employees said they had been denied overtime pay because they were improperly classified as exempt.

This is when they classify nurses as supervisors. They are, but they usually do not meet the federal standards for being exempt.

Nursing assistants, licensed practical nurses, janitors and cooks “are particularly vulnerable to wage violations,” Mr. Stripling said.

In many cases, employees say they were not paid for work performed during meal breaks.

“Most nurses put the patient first,” said Charles D. Boal, a registered nurse who worked in the critical care unit of The Western Pennsylvania Hospital in Monroeville, near Pittsburgh.

“We often gave up lunch breaks to see that a patient was taken care of properly,” he said. “If you brought your lunch from home or got food in the cafeteria and took it to the nursing unit, you would be interrupted by phone calls, by physicians and family members who wanted to talk to you. We really did not have an uninterrupted meal break.”

How many of us have given up a break, or shortened one, because of patient/resident care demands? I know I have. Multiple times. We need to MAKE sure we are being paid for those minutes given off our breaks. Don’t let the facility management con you into believing they don’t HAVE to pay you because a supervisor/other did not ASK you to give up break times.

Previously here, we posted an article for nursing assistants:
Getting Paid For Every Minute You Work

On Christmas Eve last year, the staff at Woodland Oaks Healthcare Center in Ashland failed to perform CPR on a dying resident, a state citation alleges, even though the resident had signed an order asking for resuscitation.

In February 2008, John Karem said, he arrived at Jefferson Manor Nursing Home in Louisville to find an emergency medical technician performing CPR on his 95-year-old mother, Eva. This was done, her son says, even though the nursing home had do-not-resuscitate — or DNR— orders on file.

Can you imagine? Either way, the wishes are not followed and it could have been prevented. How really easy this is to prevent, too!

The two alleged incidents point to a gap in Kentucky law that can lead to errors at the bedside of the dying: There is no uniform regulation about how to denote a patient’s wishes regarding resuscitation in a long-term care facility or a hospital, according to Sadiqa Reynolds, inspector general for the Cabinet for Health and Family Services.
[...]
Federal and state laws require that hospitals and nursing homes keep do-not-resuscitate orders in a patient’s chart. But when it comes to how those orders are carried out at the bedside, it is up to the facility. Some use color-coded wrist bands, colored tape on residents’ doors or stickers on their charts.

How do you know resident DNR status? Do you think you should know? How is this information passed onto you? Do you know the status of your assigned residents, or ALL the residents?

Since 2007, the state Attorney General’s Office has charged more than 50 nursing home workers, including five in the Rochester area, for kicking, neglecting, tying up, stealing from or sexually abusing residents.

Most were fired after abuse was reported. But in at least several cases, accused workers in Rochester homes found jobs at other area facilities shortly after their former employers reported abuse to the state. Among them, a certified nurse’s aide accused of kicking an 87-year-old resident, and another convicted of stealing patients’ Social Security numbers.

Oversight of nursing home hiring practices hinges on a careful balance between protecting employees from wrongful accusations and guarding vulnerable residents against mistreatment that’s found in local facilities.

The gap between reporting of abuse, and the investigation and conclusion, is where the problem lies.
This is a problem in most states, and there are no simple answers. However, it seems to me that anyone accused of abuse or neglect, should immediately have their certifications placed on HOLD, pending investigation. Facilities who are hiring can look up names in a database, and make hiring decisions based upon this as well as background checks. It might seem unfair to the aide being investigated- and this should not be about just aides, but nurses as well. Protecting our residents is the most important factor.

These are Residents Rights, with info and guidelines for CNA’s to follow when caring for residents after the first few.

The right to be fully informed—by word and in writing—of the policies and procedures that protect the person’s other rights

All of the rights of citizenship the person has in the United States
This includes voting in all elections.

The right to know all of the services available at the facility, including whether it is certified for Medicare or Medicaid residents, and the right to assistance in applying for those benefits

The right to be fully informed about the person’s own health condition
Believe or not, some residents do not know what their medical conditions are. Some families wish to keep this from the resident. Or, residents are not informed of disease progress (such as a cancer spreading). While the CNA should never disclose this information to ANYONE, we need to be extra careful when discussing it at the Nurses’ Station and other not-so-private areas.

The right to choose one’s own physician

The right to refuse medication, treatment, or care
Indeed. A resident can refuse to be medicated, to have dressings changed, to be weighed, bathed, fed, dressed- we cannot force them to do these tasks or allow us to assist them. When we do, against their wish, we are violating their rights and in some cases it would be considered abuse. It is very important to document these instances. Make sure the nurse is aware of the refusals.

The right not to be forced to perform therapeutic activities
These include PT or OT sessions, activities, special baths and the like.

The right to be free from punishment and involuntary isolation
THIS IS A BIG PROBLEM. CNA’s often take it upon themselves to remove residents from dining and other rooms and place the resident in their room. This is involuntary seclusion and in some cases is considered abuse. Don’t do it. Wait for the nurse to direct you on this. It is never within the scope of a CNA’s practice to make decisions like this. Withholding food, drinks, delaying care, when used to punish a resident is abuse.

The right to be free from verbal, physical, sexual, and mental abuse
For some residents, the sweet little nicknames we have for them is a form of verbal abuse. Others love to tease and tell jokes- but for some this is mental abuse.Yelling includes raising your voice. Or using short, sharp words- it’s all verbal abuse. Many aides don’t understand the varieties and the subjectivity of this. If it offends a resident, often it can be called some form of abuse.

The right to be free from chemical or physical restraints except on a doctor’s order and as a last resort for the person’s safety
This includes being put to bed against the will. It also includes placing residents into recliners and other furniture that they cannot freely get up from. Being tucked into a table so close movement is not possible is a restraint as well.

The right to be treated with courtesy and respect
Manners. Use them. All the time. Please, Thank you, Excuse Me, I’n Sorry. Referring to Sally Smith as Mrs. Smith until she asks you to use another name…

The right to privacy when receiving treatment or personal care

The right to get and send mail and to make and receive phone calls without anyone else’s interfering

The right to associate with anyone the resident chooses, in private if the resident requests privacy

The right not to be sent to a new room without a good reason, advance notice, and sufficient preparation

The right to keep medical and personal records confidential (except as needed to evaluate the facility and follow up on complaints about your care)

The right not to be transferred or discharged without good cause, advance notice, a discharge or transfer plan, and the right to a hearing to stop the proposed change

The right to make suggestions and complaints and to have the staff act promptly in response, and the right to be free from retaliation of any kind for making complaints or suggestions

The right to inspect the person’s own records, and the right to purchase copies of all records

The right to participate in any social, religious or community activity the person chooses

The right to keep and use personal clothing and belongings, as space permits, and to have lockable storage space for personal belongings

The right to be reimbursed for belongings lost or stolen by facility employees

The right not to sign any contract or agreement that claims the person agrees to give up any of these rights

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.

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

CNA’s develop long term relationships with those we are charged to care for. We grow to love them and will do all the little “extras” for them. Usually this doesn’t present a problem for anyone. But there are times when our relationships become unhealthy- for us, for the resident, for the other residents we’re assigned to; to our peers and to the facility we work for.

Over Attachment
In nursing homes, CNA’s can become too attached to a certain resident, in different ways. The CNA will be very upset if they are not assigned to care for this resident, or, will use their relationship with this resident as an excuse for being exempted from floating to other units. The CNA might spend inordinate amounts of time with this resident, and therefore shortchange the others assigned to him/her. The aide will always cater to this residents’ every whim before all others. This resident will have more needs than all others as well- and these “needs” will increase as times moves along.

Sometimes, the resident develops a fondness for an aide that isn’t healthy. The resident becomes dependent upon the aide’s presence to be happy. He or she refuses to allow other aides to work with him/her. Residents have “bad” days when their favorite aide isn’t at work. I have seen residents who believe they are “in love” with their favorite aides, especially those with mild dementia. I’ve also seen aides who care for patients in short term rehab centers develop “crushes” on these patients. The age difference between patient and aide isn’t that far apart.

Other assigned residents are neglected. Often. Or, the needs of these residents are tended to by the CNA’s peers. This creates a problem for everyone. Resentment sets in and working relationships suffer.

Being Objective
A huge problem with this arrangement, as it’s often called, is when the aide loses his or her ability to be objective. This is a serious concern. We must be able to truthfully report the conditions of our residents. This includes, but isn’t limited to, the residents progress or decline in all areas: Ability to speak, bath, dress, feed self, walk- are all very important. The CNA who is too close to certain residents isn’t able to accurately describe the resident’s true abilities.

This effects the resident directly: A resident who cannot really dress herself can be assessed as being able to do so. This might end up in a care plan…and other aides who work with this poor resident will get frustrated at THEIR ability to motivate this resident. Families are told their loved one can still dress herself when in fact she cannot, and hasn’t been able to perform this task for awhile.

We have professional boundaries
CNA’s are considered to be the professionals in the care giver-patient relationship. A CNA is expected to maintain a therapeutic relationship and not anything else. We have the upper hand because of our knowledge and skills. We are responsible for the care we deliver. Within the ethical discussions on this subject, the care giver always has power over the patient. Many times these relationships are for the benefit of the care giver and not the patient.

When the care becomes intertwined with personal friendships and over-advocacy, it’s not healthy. What is OVER ADVOCACY? It’s when we demand residents be given care, therapies and attention they don’t truly need. This is often where over attachment to a resident’s family starts. This is another whole problem- and the legal implications are high.

Ask yourself these questions. And be honest. If you can answer more than two of these with a YES, then YOU are crossing the professional boundaries. And setting yourself up for a lot of trouble.

* Have you ever spent off-duty time with a patient/family?

* Do you keep secrets with patients/family?

* Do you become defensive when someone questions your interaction with a patient/family?

* Have you ever given gifts to or received them from a patient/family?

* Have you felt possessive of a patient/family, thinking that only you could provide the care the patient needs?

* Have you ever flirted with a patient?

* Have you chosen sides with a patient against his or her family and other staff?

If you find that you’re overly attached, how to manage that? It’s not easy. The first step is recognizing you have a problem. Then, its a matter of distancing yourself from the resident. For some aides this is best done gradually. For others, a total cut off is appropriate. Many times, when the bosses see these problems, they’ll assign the aide to another unit altogether, effectively ending the relationship. I don’t think this is a good way to do this.

A CNA can ask for a change with their assignment. Being open and honest about this will almost always result in getting the changes you seek. Part of being PROFESSIONAL means keeping staffing issues to yourself. The urge to tell the resident, or the family, a change has taken place might be very high. Its best to leave these discussions with the nurse. And, after the resident and/or their family is informed, THEY will prod the CNA for information. Again, professional boundaries must take precedent over individual staff needs.

A note about being attached to resident families.

It’s not as common as resident-CNA friendships. But its much more dangerous. And, many times these relationships are initiated by the CNA.

Often times:
A family will block out all others in the facility and depend upon the aide for all communication. The aide will be put into situations they are not trained and educated to handle. Every word the aide speaks will be heard and recalled. If the aide doesn’t have the right information, or misspeaks, a lot of trouble can arise, legally.

The aide will become a spy, for the family. CNA’s are privy to some information that is private and confidential. The levels of care for other residents is an example. When we have over bearing families seeking information from aides who are all to willing to share, it creates huge management problems. It sets the stage for a turbulent relationship between the FACILITY and the family.
Some aides like to think families have some super power over a facility. This is simply not true. Government regulation and oversight have “power”; as do legal standards.

Other aides will use the family in an effort to be assigned to the resident they want. From my experience, these residents are almost always the ones who are considered “easy to do”– and the aide is simply seeking a guarantee of being assigned to this resident. There has been some evidence of aides seeking permanent assignment to certain residents in hopes of getting some monetary award. These situations are always unethical. The aides involved in this should be terminated from employment and barred from working as aides ever again. They are opportunists.

No matter whether a CNA is overly attached to a resident or their family, it’s not usually healthy. Most times the only way to stop the problems associated with these relationships is to separate the aide and resident. Perhaps, consistent staffing would better serve all if the assignments changed every so often. A couple times a year and all aides would be required to change no matter what family requests are. We all want what is best for the residents. Sometimes though, in order to insure this is happening equally across the board, we have to make adjustments and changes.

Seasoned aides can also make use of a small notebook. They’re cheap, can be bought almost anywhere and come in so handy for CNA’s. A great resource, the little notebook.

I have one…pocket size that fits nicely in my scrub pockets. What do I do with it? A lot. When the nurse asks for VS on a resident/patient, I have paper to record the results. When a weight is needed; when a height is needed; when intake and output need to be recorded- these little pads come in real handy.

At the top of the page I write the date…day, month, year and shift I am working.

*I record the times I clock in and out- so if there is a discrepancy in my pay I can go back and check.

*I record what unit I’m working on, and the initials of the staff working with me. Even the nurses. And I note who is agency.

*I record my assignment- residents names. No need for more info; names are enough.

*Any falls or other incidents are recorded in my notebook as well…the vital stats are documented. Who. What. When. Where. Witnesses.

Some aides will go to the effort to write in certain info about their residents: BM’s, voids, showers, turning and the like.

Many aides use their assignment sheets to record all this info…and that’s fine. But I like to keep a personal record of these things. It can help you keep a clear record of your daily work and one never knows when this information can become necessary to defend one’s actions. Some aides prefer to write notes about their workday at home, away from prying eyes and nosy bosses. No matter where you do this, it’s pretty important to DO IT.

The legal environment in today’s nursing homes demand we keep clear records of the care we give. Most nursing home management can be trusted to not alter records, but not all. Aides can and have gotten into seriously hot water over issues and incidents that were not properly documented; flow sheets have been “corrected” to suit the best looking picture. Since aides are the lowest people in the chain of command, it’s way to easy to blame us for problems, issues, accidents and the like.

Who hasn’t been called at home, by the DON, demanding to know details about some incident that occurred last week? And who among us has a truly clear recollection of the events? If we had written down all the details, it would certainly help us during this call.

A little notebook can keep a lot of vital information. I wouldn’t go around telling everyone I have one though…management often doesn’t take well to such things. And we have to be extremely careful to respect HIPAA rules, but it is within our right to keep notes about our workday. I strongly advise all aides to do this.

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.

A federal grand jury has indicted 17 people, most native Kenyans, for allegedly stealing the identities of hundreds of nursing-home residents and filing false tax returns in their names.

The conspiracy, which began in February 2005, sought more than $13.1 million in fraudulent returns from the federal government and 27 states, U.S. Attorney John Wood said Thursday at a news conference.

The defendants allegedly stole the identities of more than 300 people, most from the Kansas City area.

“Identity thieves are using more complex and sophisticated methods to commit their crimes,” Wood said.

Some involved in the conspiracy used their positions as certified nursing assistants to gather personal information, which they passed to others who prepared the returns, authorities said.

“It’s not hard to get identity information in an institutional setting,” said Assistant U.S. Attorney Curt Bohling. “They might have a chart with their name and Social Security number on it, which is all you need.”

The grand jury Wednesday returned the 18-count indictment under seal. Federal agents Thursday arrested 10 of the defendants. Officials said three others were believed to be in Kenya, and four remained fugitives in the United States.

Those charged include: Loretta Wavinya, 30; Ervin Somba, 26; Edwin Nyumu Sila, 25; Lillian Nzongi, 26; Moses Ndubai, 33; and Bernard Nyemba, 39, all of Kansas City; Vincent Niagwara Ogega, 23, of Independence; Aaron Mutavi, 28, of Overland Park; Kenneth Njagi, 31, of Lenexa; Mary Gitiha, 25, of San Francisco; Ernest Kangara, 40, of Santa Rosa, Calif.; Paul Kilungya Nyumu, 41, address unknown; and Karingithi Gotonga Kamau, whose age and address were unknown to prosecutors.

No commentary needed on this. It’s wrong. And we need to think about ways to keep SSN’s and other pertinent info out of the hands of those who might have reason to steal the name of someone else.

Horizontal Violence

A Call For Action

Being Professional: Guide For CNA’s

CNA’s & Respect

Workplace Culture: CNA’s can make it or break it

Shift Wars

Tips & Timesavers For CNA’s

Legal Issues For CNA’s

The Nursing Process & CNA’s

Observation Skills For CNA’s

Continuing Ed For CNA’s: Just Another Inservice?

Email us for a TEXT or WORD version of these materials.

In the near future we have several more posts that will be up for grabs:

Falls: The CNA’s Role in Assessment and Prevention

Mentoring: A SKILL for CNA’s