Failure to Honor Resident Dignity and Physician Orders During Transfer Request
Penalty
Summary
A deficiency occurred when a resident with quadriplegia, contracture of the left hand, and chronic pain syndrome, who was fully dependent on staff for all activities of daily living and required transfer via a Hoyer lift, was not assisted out of bed for lunch as per physician's orders. The resident requested assistance from a nurse aide to be transferred to a wheelchair before lunch, but the aide refused, stating she was busy and instructed the resident to get out of bed independently, despite the resident's inability to do so due to their medical condition. The resident reported this interaction to a registered nurse supervisor, and documentation confirmed that the aide responded in a rude and disrespectful manner, failed to follow the physician's order, and was insubordinate to the supervising nurse. The clinical record did not document the negative interaction, but the aide's personnel file included a corrective action record for the incident, noting the refusal to assist the resident and the disrespectful communication. The aide had a history of multiple disciplinary actions related to care issues. Interviews with facility staff confirmed awareness of the incident and the expectation that all residents be treated with dignity and respect. The facility's policy directs that residents have the right to be treated with consideration, respect, and full recognition of their dignity and individuality.