Bad bosses busted

Years ago I worked as a state tested nurse's aide. The nursing home where I was employed was not a nice home. I wouldn't even call it a step above the county home. It was kind of a slum/sweatshop. Unaware of conditions in the home, I'd applied there because it was in my neighborhood.

I trained for three weeks, took the certification test, and was put on the floor. According to company policy, I was supposed to train another four days under the supervision of an experienced aide. That it didn't happen should have been my first clue, but I was new to the health industry. I had no idea what was coming.

Instead, I bought into the nurse's line that we were just temporarily short handed because someone had called in sick. So, on my second day, I was sort of dropped into the regular work routine, sink-or-swim. I swam, but not with a lot of confidence. However, it was left up to me to figure it out. After my third question regarding patient behavior or conditions that were not noted on their charts, the nurse got impatient and told me to shut up and do my job. That was my second missed clue.

The third was the lack of cooperation among the aides. We had been taught in class that most residents who could not stand up by themselves were "two man lifts." In other words, the person was either too heavy or too fragile to be lifted by one aide alone. When you needed to transfer a "two man lift" patient between bed and chair, you were supposed to ask another aide for help. This prevented injury to both us and the patients. I found within the first week that most aides were not willing to help the "newbies" lift. We had to seek out and ask each other. Some of the aides were lifting the "two man lift" patients by themselves, because if you didn't get your work done fast enough, you got written up. I was written up for looking for help lifting a 300 pound immobile, nearly vegetative patient. On the form, I wrote in that I felt the write-up was unjustified because I was following policy, and couldn't have lifted the guy by myself even if I had wanted to. The nurse who wrote me up threatened to write me up for insubordination because I put that in the "employee comments" section of the page, but the head nurse told him that he could not.

There were more incidents like that, but it was a month before the worst hit. One day, I was greeted beside the time-clock with a special order from my floor's nurse. Two people had called in. No one could come in to work their shifts. We had to divide their patients among us, and instead of having the legal state maximum of 14 patients, I was going to have 21. I was not to ask the nurse for any extra help, and I had to squeeze the same care for those extra 7 people into my normal shift.

I was a first shift worker. That means it was my responsibility to get the patients all out of bed, help them bathe and dress as needed, give them their breakfast trays, feed those who could not feed themselves, take the trays back to the cart on time, transfer patients to physical therapy as needed, take them to the dining hall for lunch, give them their lunch trays, feed those who could not feed themselves (again), take the trays back to the cart on time (again), and during that time, squeeze in showers for the 1 in 7 patients (three today) whose day it was to get a shower. More than half of my patients required assistance with everything. Most of them could not walk without the aid of a walker or wheelchair. During that time, I was also responsible for answering any call-button lights, in case patients needed to use the restroom. Also, any patient who was unable to move under his or her power must be moved to change the position of his or her body a minimum of every two hours, to avoid bed sores.

Getting patients up in the morning varied from patient to patient. Several of mine were unable to feed or dress themselves, so making sure I took care of all of their needs without getting behind schedule was a nearly impossible challenge. You can't just rush through these tasks. If you are not careful, you can injure your patient, or yourself.

I got through that day without any really bad incidents, but I did get written up for not being fast enough. That is not what was put on the paper, but it is the translation of what was said. Basically, another aide needed to shower a patient, but I was still in the shower room with mine. The patient had unknowingly defecated, a common occurrence. That happens enough that I never showered him without a bucket under his chair. All I had to do was carry the bucket out of the room, in to the attached bathroom, and dump it in the toilet. Unfortunately, that was going to take both hands, because it was also full of water.
My patient also required both hands. He was a fall risk, meaning that if I didn't watch him like a hawk, he'd try to get out of the arguably uncomfortable shower chair, and fall down. I could not just turn my back to clean up the mess.

I pulled the call button to ask another aide to watch him while I flushed the contents of the bucket. We waited, and no one came. My patient began to shiver under the blanket, and fidget in his seat.
I decided that I couldn't just keep him in there indefinitely. I buzzed the nurse's station, but no one answered. So, I wheeled my patient out into the hall, where I was startled to find the next aide waiting for me. I asked why she hadn't answered the call light, and she said she hadn't seen it. She was standing right under it, and it was accompanied by a repetitive, computerized tone, so I knew that was a lie.

I told her about the bucket and asked her to watch my patient for a minute while I cleaned up. I told her that was why I had turned on the light. She refused, stating instead that she needed the room now and would just clean it up herself. Behind her was another patient squirming uncomfortably in another shower chair. We were supposed to make sure the room was open before wheeling patients down the hall with nothing on but a bath blanket, and now she was impatient with me for using the time slot allotted to my patient. I wasn't even late getting him out of the shower... I was early!

I couldn't do anything about her attitude, so I just took care of my patient. Moments after I'd finished getting him dressed and settled into his favorite easy chair, the nurse called me down to the office to write me up for "leaving feces in the shower for the next aide to clean up."

I recounted to him what had happened, but he ignored it and made me sign the paper under threat of being fired.

The next week, we had more call-ins, and more illegal workloads. I went to a supervising nurse to discuss the issue. I happened to know of a temp agency that would send aides if the company would just call them. Since it was illegal for us to be that understaffed, I figured the supervisor would be glad to know where we could get help with the problem. Instead, I was reprimanded for "rocking the boat" and told "we don't do that." The supervisor threatened to fire me if I disclosed to any of the families that we were understaffed. I informed her that I was family. My grandmother was temporarily housed in one of the rooms on another ward. That did not go over well.

The nurse assumed I would not know the system for reporting violations. I did, but I was still naive enough at that point to think I could work with corporate on fixing things. I called the human resources number and talked to one of the supervisors there, telling her everything I'd witnessed at work, and how at-each-other's-throats the aides were getting. Corporate held a meeting with all of use to hear grievances related to how things were being run at the site. Afterward, they issued a finding that there were no problems, and three of the four most vocal aides were fired. I was the only one retained, and I was written up for insubordination for statements I'd made under the assurance that they would not be held against me. Again, in the comment section of the page, I wrote my opinion of the reprimand, noting that the statements had been both true and made under the assurance of confidence and impunity from corporate supervisors. The nurse took a black permanent marker and "redacted" everything I wrote.

The last straw for me was coming in that week to find that we'd had so many call-offs that I was assigned a double group. I had 28 patients to care for. The nurse told me we weren't getting anyone out of bed. One of my patients was so heartbroken about spending the day in bed "again" that she cried. I realized that this was not an issue my employer was going to be willing to address.

At the end of my shift, I went home and called the Ombudsman for the elderly. I explained the situation, giving dates for the times when we'd been illegally understaffed, and listing several other violations of our patients' rights that I had witnessed. I gave a list of the names of the people in the company who I had alerted to the problem, and explained that I'd made them aware of a temp agency where they could bring in aides to stand in for those who were ill. I described injuries I'd discovered on my patients which were consistent with carelessness and neglect. I talked to the lady on the phone for half an hour. She was appalled.

An investigation was initiated. The Ombudsman showed up without warning on a Monday, the worst day for call-offs. Her timing was perfect. Halfway through the morning, no one was out of bed. Every aide on the shift was responsible for 28 patients, and it took her nearly half an hour to find a nurse. She wrote all kinds of things in her little notebook.

The next week, the head nurse changed the schedule without warning, right in the middle of the work week. She waited until I had two days off in a row, then scheduled me to be there for one of those days. When I didn't show, they labeled me a no-call no-show. I called the Ombudsman's office and alerted her to the retaliation. She asked if I wanted to fight for my job, but I really didn't. I was only getting minimum wage, and I'd learned that aides at other nursing homes made half again as much just starting out. I just wanted to make sure she knew that the company had retaliated against the whistle-blower.

In the meantime, my family removed my grandmother from the home a month early, and made sure to tell corporate that the decision was a direct result of living conditions there. She would have her physical therapy at home.

An employee who had worked with me and survived the whole thing stopped me at the grocery months later, and told me what happened after that. The state had taken over management of the home. There was also a huge fine. Several supervisors and a few nurses had been fired, including the man who had repeatedly wrongfully written me up. There were dismissals at the corporate level. Everyone who knew about the problem and had not addressed it was fired.
Laws were meticulously enforced. A lot of changes were made at the home, including the way fall risk patients were handled. As a result, working conditions also improved. The state kept charge of that home for nearly a year before agreeing to transfer managing control back to the corporate owners. A lot of policies were changed, including the policy of not using temps to cover for sick employees. In fact, the home went to using temps as a hiring method. Instead of hiring off of the street and training aides, they would bring in temps, and if they had the right attitude, work ethic, and bedside manner, there would be a full-time job offer.

In addition, employee concerns related to how policy was being followed (or not) on site, and whether laws were being followed, increased in priority. There was now a genuinely anonymous reporting system for on-the-job safety and patient concerns. Alleged retaliation by any supervisor was grounds for an investigation, and if it was found that there was retaliation, that was grounds for dismissal.

The company had made some very expensive mistakes, but apparently corporate had learned from them.

You can't safely assume your employees are ignorant of the laws governing your industry.
You can't safely assume your employees don't know their rights.
You can't safely assume your employees won't feel a moral obligation to protect their clients, even at your expense.
Your employees will only take so much crap from you before they turn on you. Even those who don't know how to fight for themselves will back the one who does... and there will always be someone who does.
You won't get away with illegal activity or conditions indefinitely. Eventually you will be caught.
And most of all, you can't fight city hall.

In the end, it's cheaper to do things right the first time, stay within the law, and treat your employees like the human beings that they are.