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The CNA decides what nurse can visit. . . huh? (long)

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  • The CNA decides what nurse can visit. . . huh? (long)

    I'm putting this under Sightings because the customer is the patient, and the patient wasn't the one who was sucky (heck, she never even woke up), nor was the family. So it doesn't seem to fit as a Sucky Customer.

    This happened to me a couple of weeks ago. BG I work part time for one of our local Hospice organizations doing telephone triage. One of our nurses who does visits was on light duty from a back injury, so we swapped roles for the weekend. I didn't mind, I like doing visits as long as it is during the day (I don't see well at night and hate trying to find places in the dark). /BG

    Cast:
    Me:
    J: Triage nurse
    CNA: bitch caregiver for the patient.
    Boss: my immediate supervisor
    Big Boss: well, you get the idea.

    So J calls me to send me on a visit to a lady we often get calls about after office hours. The patient has a 24 hour live in CNA. I knew the name, as we get a lot of calls about this patient, however, I'd never gotten one as triage. Moreover, this was my first visit to the home. J tells me that the CNA was reporting the patient was "gasping for air" and on the verge of dying. The CNA wanted a nurse to visit. "She's crazy," J tells me. "We have all kinds of problems with her." Well, after 8 years in the ER, and 3 years working in a jail, I figure I can handle anything.

    I get to the home and find the CNA sitting on the front step, talking on the phone. She is crying, and there are tissues scattered all over the front porch. She hangs up the phone when I get there. I smile and say, "Let's go see how she [the patient] is doing?" The CNA started on about how she was close, and she'd called the nephew who was POA to come right away.

    Well, to make a long story short (this really isn't about the patient), the patient was stable. Nothing wrong. Nothing at all. Simply sound asleep.

    "Great," I say. "You're doing everything right. She just needs to be repositioned, and the snoring will stop. Just let her sleep. She's doing fine."

    "The other nurse was here last night and told me she had days," the CNA said.

    Well, I didn't see it. The patient was as stable as could be; eating drinking, making urine. She wasn't anywhere near actively dying, and I told the CNA so. I could see she was pissed. I ignored the behaviors and went back to my car to make my next visit. While I was programming my GPS, the nephew and his wife drove up. So, I get out of my car, introduced myself and let them know everything was OK. The nephew and his wife were wonderful, gracious, and pleasant . . .relieved that things were OK after all.

    Next Monday, my boss calls me to tell me the CNA was filing a HIPPA complaint because I talked to the family. According to her, I had no right to discuss patient information with them. I told my boss what happened, and she agreed I'd done nothing improper and not to worry about it.

    A couple of days ago, the boss came into the office while I was there picking up my computer for my next shift. She told me the Big Boss had called the home, which is what she always does when there's a complaint, basically to kiss ass "we're sorry you were not satisfied with the service, etc etc without admitting the employee did anything wrong."

    So, the CNA says, "well, I don't want Panacea back out here again."
    Big Boss: Well, if Panacea is the nurse making visits, she may indeed have to visit again.
    CNA: I don't want her here. I'm the caregiver, and I don't want Panacea in this house.
    Big Boss: Are you a relative?
    CNA: I'm the 24 hour caregiver and I don't want her here!
    Big Boss: But are you related to the patient.
    CNA, indignant: I'm a family friend!
    Big Boss: I'm very sorry, but since you are not related, you cannot tell us who is not allowed to visit the patient.

    Not that I'd want to deal with this CNA again, but I was surprised the Big Boss didn't cave.
    Last edited by Sapphire Silk; 09-06-2010, 03:11 PM. Reason: Left out something
    They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.

  • #2
    Someones too big for her britches.

    Do you know who she works for? Im thinking a complaint needs to be made with her employer b/c thats just ridiculous.

    Also, did you say she mistook snoring for agonal breaths!?

    Comment


    • #3
      she's pulling a "HIPPA card" for you telling the relative that the patient is fine?

      does this CNA have legal documents that prove she has sole legal rights to the patient?

      if not... ... i'm wondering what else she's pulling.
      (i.e. possible elder abuse if she's trying to dictate who can and cannot visit).


      and... is it just me or would "zi" fit perfectly after this caregiver's name?

      Comment


      • #4
        Quoth Amina516 View Post
        Someones too big for her britches.

        Do you know who she works for? Im thinking a complaint needs to be made with her employer b/c thats just ridiculous.

        Also, did you say she mistook snoring for agonal breaths!?
        She works privately for the family. I'd have to report her to the Department of Health and Human Services, I suppose. But I'm not sure I could make it stick. CNA's don't assess, and she did call the 24 hour help line. Personal obnoxiousness isn't covered by the regs.

        But yeah, she mistook snoring for agonal breathing. Sad thing is, for every good CNA who's on her game, there are at least 2 who shouldn't be allow anywhere near sick people. Until facilities get rid of the "any warm body will do" mentality, this will continue to be around.

        As for the elder abuse thing. . . well, I did think of that. Other than being obnoxious, though, the patient seems well cared for. The place was neat and clean, and so was the patient.

        Probably just full of herself.
        They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.

        Comment


        • #5
          not all abuse is physical however
          it could be emotional or psychological abuse - control issues.

          Comment


          • #6
            Good point. This woman definitely has control issues. I talked to the primary RN recently, who tells me she has a lot of problems with this CNA. But the patient sleeps most of the time, so mental abuse will be hard to prove. But apparently, the primary RN had the same thought you did and is looking out for it.
            They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.

            Comment


            • #7
              I've heard some pretty bad snoring...

              But seriously, I wonder if the caregiver isn't just very stressed out. I don't think she'd be sitting there crying her eyes out, thinking the patient was dying, if she was abusing her (unless of course she was stealing from her and thought she was about to lose her source of free money). She called the relatives to come over, and they may have been very gracious, but are they ever around any other time, or is this CNA the only person who's ever there?

              Just wondering because I know how very stressful caregiving can be.
              When you start at zero, everything's progress.

              Comment


              • #8
                Quoth MoonCat View Post
                I've heard some pretty bad snoring...

                But seriously, I wonder if the caregiver isn't just very stressed out. I don't think she'd be sitting there crying her eyes out, thinking the patient was dying, if she was abusing her (unless of course she was stealing from her and thought she was about to lose her source of free money). She called the relatives to come over, and they may have been very gracious, but are they ever around any other time, or is this CNA the only person who's ever there?

                Just wondering because I know how very stressful caregiving can be.
                The patient lives in her own home. I honestly don't know how involved they are, but based on the expressions of relief on their faces when I told them everything is OK, I think they genuinely care.

                And sure, this gal probably is stressed out caring for this lady. But if she's that stressed out, she should admit it and get someone else to pick up the slack so she can get some respite. Her anger at the situation didn't make any sense; she was angry because I didn't agree things were going down hill. I think she was embarrassed because she over reacted, and took it out on me because she could.
                They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.

                Comment


                • #9
                  Lordy I'm afraid to ask, but what is agonal breathing exactly?
                  https://www.youtube.com/user/HedgeTV
                  Great YouTube channel check it out!

                  Comment


                  • #10
                    Quoth telecom_goddess View Post
                    Lordy I'm afraid to ask, but what is agonal breathing exactly?
                    http://en.wikipedia.org/wiki/Agonal_respiration

                    Comment


                    • #11
                      Quoth telecom_goddess View Post
                      Lordy I'm afraid to ask, but what is agonal breathing exactly?
                      Agonal breathing is periods of apnea (no breathing) interspaced with a series of gasping breathes, or simply shallow gasps of air. We see this prior to death, though some patients will do this for hours, even days. The proper term for apnea with rapid gasping breaths is Cheyne-Stokes (pronounced "chain-stokes") respirations.

                      Another term is "guppy breathing." As in like a fish out of water.
                      They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.

                      Comment


                      • #12
                        I feel that this

                        Quoth Panacea View Post

                        Next Monday, my boss calls me to tell me the CNA was filing a HIPPA complaint because I talked to the family. According to her, I had no right to discuss patient information with them. I told my boss what happened, and she agreed I'd done nothing improper and not to worry about it.
                        And this

                        So, the CNA says, "well, I don't want Panacea back out here again."
                        Big Boss: Well, if Panacea is the nurse making visits, she may indeed have to visit again.
                        CNA: I don't want her here. I'm the caregiver, and I don't want Panacea in this house.
                        Big Boss: Are you a relative?
                        CNA: I'm the 24 hour caregiver and I don't want her here!
                        Big Boss: But are you related to the patient.
                        CNA, indignant: I'm a family friend!
                        Big Boss: I'm very sorry, but since you are not related, you cannot tell us who is not allowed to visit the patient.
                        Shows that she likes being in control more than she cares for the patient. Maybe this is her own convoluted way of "caring" but she has issues she needs worked out. Her needs do not trump the patients' or their family, who obviously had no issue with the care Panacea provided.

                        Comment


                        • #13
                          Thanks for the info on the breathing thing...I guess LOL. Now I know what it is but am regretting that I know at the same time.
                          https://www.youtube.com/user/HedgeTV
                          Great YouTube channel check it out!

                          Comment


                          • #14
                            Quoth telecom_goddess View Post
                            Thanks for the info on the breathing thing...I guess LOL. Now I know what it is but am regretting that I know at the same time.
                            LOL! Its not that bad. Just when you come across someone doing that, please call 911.

                            Comment


                            • #15
                              Quoth telecom_goddess View Post
                              Thanks for the info on the breathing thing...I guess LOL. Now I know what it is but am regretting that I know at the same time.
                              I know . . . my friends are always telling me TMI, TMI.
                              They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.

                              Comment

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