CNA "assessing" patients

[SaraO'Hara]

I work in a short-term rehab facility, and the majority of CNAs there are perfectly adequate, if not wonderful, to work with.

My PM shift CNA today is another thing entirely. He states to patients that he is "studying to be an RN" - not true. He gives unsolicited and wrong advice to patients about their conditions. He writes what attempt to be nursing-style notes on the back of the ADL sheet - often with inflammatory language (eg "resistant", "insistent", "combative"). He attempts to transfer non-weight-bearing patients alone. Today I found out that he tries to assess patients...

I have a patient whose last BM dates vary, depending if you ask him or the hospital record. His given date is almost a week ago (one day per hosp). With a soft abdomen, active bowel tones, and no distention or tenderness, I was inclined to believe the hospital, but gave MOM per our protocol for so many days without BM.

"Donald" came up to me during 1700 med pass.. "Mr Wombat says he hasn't had a BM in almost a week! I asked him if he was on a clear liquid diet at the hospital but he wasn't. His abdomen is really distended and I told him that he needs a Fleet's."

I asked Donald to please not give patients advice about meds or conditions; I advised him that it is outside his scope of practice. I'm not the first nurse who has spoken to the DON about him. I'm concerned because I'm a very new LVN, with a CNA whom I feel to be unsafe working under my license. I already mother-hen my patients (discreetly)... any advice?

[Daytonite, BSN, RN]

donald" came up to me during 1700 med pass.. "mr wombat says he hasn't had a bm in almost a week! i asked him if he was on a clear liquid diet at the hospital but he wasn't. his abdomen is really distended and i told him that he needs a fleet's."

i asked donald to please not give patients advice about meds or conditions; i advised him that it is outside his scope of practice. i'm not the first nurse who has spoken to the don about him. i'm concerned because i'm a very new lvn, with a cna whom i feel to be unsafe working under my license. i already mother-hen my patients (discreetly)... any advice?

respond: "thank you for telling me this, but i don't want you making suggestions about treatments to the patients. that is not part of your job." then, if it happens again, "i discussed with you before that you cannot suggest treatments to patients. if you do this again i will have no choice but to report you to the don." and, finally, "i'm writing you up. the don needs to know that i've told you twice not to suggest treatments to patients and you are still doing it."

a part of the problem here might be your don who has no followed up on the complaints. if "donald" was reported to the don and she hasn't done anything about him then its time to go a step farther. you've already told him he is doing something wrong and to stop it. next, you can either tell him that if he does this again you are going to write him up, or just do it. and, in your documentation give patient names and mention specific charting if he has recorded his wrongdoing. the don can't take disciplinary action without documentation. the longer you let "donald" go without discipline, the more he assumes he is doing right. xerox his charting and give it to the don so she is aware of what he is doing.

as a new lpn, read your facility disciplinary policy as well as the cna job description so you are familiar with both. the rules are what you have to fall back on. basically, you look "donald" in the eye and tell him he is breaking a rule, he needs to stop it and if he doesn't the consequences are. . .it is that simple. don't argue with him because it brings you down to his level. you are in charge not him. if he continues to act up--it goes to the don. the more you write him up and send him to the principles office (the don) the more likely he is to straighten up around you or quit. i learned a long time ago that working with this kind of cna is like obedience training with puppies. you have to be consistent and firm or they will be pooping all over you, barking and biting and pretty much nobody likes having them around--even the other puppies.

become the nurse whisperer.

[Batman24]

You need to start a paper trail on this matter. If the DON is aware and hasn't taken action once you put it in writing she can't deny she didn't know about the problem. This could potentially be a big liability issue for all involved. I would start writing it up and have other nurses follow suit. Today.

[arismendez_LVN]

ok so im not knocking the CNA's because i was one before i became a LVN. you have to remember that in working in a LTC facility you have an x amount of pts to see and gives meds to. you also have to talk to the MD, family members, hopice,chart, be in the dining room for meals etc. that is a lot to do. CNA's are our eyes and ears. sadly they spend more time with the residents than we do. they should know if a certain resident is not acting quite themselves. but i will say that "donald" is wrong in giving this resident advice and telling you what needs to be done. you are his "boss" and you were right in correcting him. i have a problem with telling my CNAs what to do because i am only 21 and they have been CNAs longer than i have been on this earth! there is nothing worng with putting him in his place!

[southernbeegirl, BSN, RN]

I think i've worked with this guy!

seriously, we had a male cna that was exactly like you describe! if you tell me his name is really larry, i'll die laffing. ours had been an accountant with a large company for 30 years and when company closed went into healthcare. he was in a bsn program but they had failed him out for being dangerous to the patients. when he first started he did the same things you describe. he would assess patients, offer medical advice, tell families whatever he thought he should tell them....he was the cause of many a mad families from the incorrect info.

for months i honestly thought the nurses were going to kill him. i heard them plotting it more than once.

like yours, talking to him did no good.

what did happen eventually though is that many of the nurses started just overlooking his faults and looking at his strengths. he honestly was an awesome CNA and i would to this day let him take care of me. he needed help with time management. after time, i think once he started trusting the nurses he worked with, he would bring them the issues and usually let them handle the problem. one thing they never had to worry about was not knowing every single thing happening with their patients when he worked.

he left us last year to go work as a CNA in a hospital and we still miss him. he was the most annoying person i've ever personally worked with but also one of the best cna's i've ever seen.

this doesnt help you at all, does it? lol, sorry.

might i suggest xanax?

[arismendez_LVN]

might i suggest xanax?

I second that!

[Thornbird]

I agree with others: create a paper trail. Write him up. Put the problem in writing to the DON. Depending where you live he may be violating the Nurse Practice Act, let him know it!!! It doesn't matter if the guy has good qualities, he's WAY overstepping and that can't be allowed. If you need to, try contacting your BON, they will certainly help you with this.

[RNfaster]

You might consider coaching him in a friendly way that helps him to understand that it is better for him to serve as your eyes and let you do the assessing. --You might try to serve his need to grow (he sounds frustrated with his position to me) and make him a better --and safer --teammate for you.

Explain to him about the various scopes of practice and why they are important...for CNAs, LPNs, RNs, PAs, NPs, MDs, etc. Educate him so that he works with you better. You might also encourage him to take classes and ask him how he is doing in them --in a friendly and supportive manner.

I don't think it is wise to be adversarial with him. Don't try to squash him in place. He's trying to take initiative --but in the wrong way. Help him to channel it. You might also talk to the DON about coaching him in a POSITIVE --not PUNITIVE --manner.

If the coaching doesn't work, then look at punitive measures.

Good luck.

[ktwlpn, LPN]

Just a thought, when I was a brand new RN in a LTC facility I was also 20 years old. Most of the CNAs I worked with were twice my age. Some of them had been CNAs for longer than I had been alive. I know that he acted inappropriately by giving out medical advise and by performing nursing assessments, but keep in mind that your CNAs are your eyes and ears. In LTC they are the ones who see the patients the most. I have had CNAs save my sorry butt so many times that its not even funny. I guess I say all of that just to point out that, while this particular CNA is going beyond his scope of practice, many of the CNAs you will work with are extremely experienced and will know things that will help you very much. Some of the best tricks of the trade that I know I learned from a CNA!

I don't think the OP or anyone else participating in this thread has stated or implied that good cna's are not worth their weight in gold.....In LTC they are with the residents for bigger part of the day and usually pick up on problems before the nursing staff....BUT-this guy is NOT an asset to the unit.His mis-information can seriously harm a resident.

[GOMER42]

Just a thought, when I was a brand new RN in a LTC facility I was also 20 years old. Most of the CNAs I worked with were twice my age. Some of them had been CNAs for longer than I had been alive. I know that he acted inappropriately by giving out medical advise and by performing nursing assessments, but keep in mind that your CNAs are your eyes and ears. In LTC they are the ones who see the patients the most. I have had CNAs save my sorry butt so many times that its not even funny. I guess I say all of that just to point out that, while this particular CNA is going beyond his scope of practice, many of the CNAs you will work with are extremely experienced and will know things that will help you very much. Some of the best tricks of the trade that I know I learned from a CNA!

CNAs can be a wonderful assistive tool, but this is beside the OP's point.

It doesn't matter how much they know or how well they do something if it is outside their scope of practice.

[GadgetRN71, ASN, RN]

I get the sense that this guy does care about pts and his job...I agree that someone should speak to him and tell him that legally, he cannot do these things. Maybe he should be encouraged to go to NS-it seems like he has the raw materials to make it. Looks like he has initiative, just needs to channel it appropriately.

I agree with the person that said to talk to him about it, but don't pull out the big guns just yet..if he keeps it up, then he should be discliplined. And the DON needs a slap if she's aware of the problem and is doing nothing.

Heck, as annoying as this guy may be, at least it doesn't sound like he's lazy!:)

[classicdame, MSN, EdD]

Even if he were in RN school he currently is acting out of his scope of practice and you are right to worry. Also, should he get a license it will not be his job to prescribe treatment. THIRD-this guy is a time bomb. With a license he will be even more cocky and no doubt nothing but a major risk mgt. situation will get him out of healthcare.