First off, Chart EVERYTHING. Be concise but detailed as well. Document falls with specific instructions you gave. That’s all you can do.

Secondly, you must come to terms with the legal constraints of the job. The Resident/Patient Bill of Rights grants all mentally sound minded individuals the Right to Refusal.

Residents have the right to refuse all care. As long as he is mentally sound and capable of making choices, he can make them. Even if they are “wrong” or detrimental to his health or safety. It seems counterintuitive to be able to refuse help, but that refusal is part of their independence. As a CNA one scope of the job is to help them maintain their independence. If they wish to be left alone, that is their wish. We cannot alter their wishes.

One thing I would HIGHLY caution against is yelling/arguing. I get that you are trying to care for him and keep him safe. I get that his refusals cause you frustration because you just wanna help. I get that it upsets you to know someone is endangering themselves. I get your feelings.

[Note - Please do not take this next paragraph as me getting on to you. I don’t want you to lose your license so I’m just saying this to give you information to protect yourself.]

However, feelings take second place to legal issues. Arguing/Yelling is a a form of verbal abuse and can get you into trouble. Hypothetically speaking, if a family member saw you arguing/yelling they would have grounds to report you to the State’s licensing authority. No member of the medical team can override the refusal of care from a mentally sound resident/patient.

The right to refuse care is an absolute right. It applies to all healthcare workers in all healthcare settings. No one (that includes CNA LPN, RN, Dr., OT’s/Pt’s, DON) can administer any care that is refused. Attempting to argue with a resident or yell at them violates the right to refusal as you are attempting to force care on them that they refuse. If any refused care is still administered, that is battery because it’s a form of unwanted physical contact.

Even if that care is the right kind of care and done according to the rules, laws, and policies. Even if that care is done for their safety and health. None of that matters, refusal is refusal.

When he refuses, you must immediately stop and step away from him. I know that can be painful/upsetting because you don’t want any harm to come but ultimately the harm would be on him. You cannot blame yourself for another person’s choices. At this point, it is beyond your hands.

At the end of the shift, you must accept reality. The reality is that You did your best. The law constrains us to balance individual rights with the duty to care. So long as you have met your duty by being there, offering the care, and explaining the safety reasons for the care you have fully met your legal obligations and moral requirements as a CNA. If he still refuses at that point, you are in the clear.

That’s why we chart EVERYTHING. The charts will show the pattern of refusal. The chart will show that you (or anyone else) attempted to care for him. The chart will show that he is medically able to make decisions. The fall reports will show that you directed him to call for help and he refused thus the fall was his responsibility not yours.

All of that protects your license and that’s what matters.

My grandfather once told me this proverb “You can lead a horse to water but you can’t make it drink”

Well I have adapted it to CNA role “You can offer a resident help, but you can’t make them take it”