Difficulty with a CNA

dmarie (GA) · Dec 31, 2006

I'm a student nurse. I was assigned a patient during clinicals recently. Her chart indicated that her vitals and BP, which was taken just an hour before by the Tech., was within normal range. When I went to assess her myself, her BP was 185/100 with bounding pulse and temp. of 101.3.

I found the RN talking and laughing with the attractive male Tech. I explained my assessment, and the RN blew me off and seemed annoyed that I --- the student --- would even comment on anything. The Tech. looked at me and then quickly downcast his eyes, as if he was guilty.

This really opened my eyes because I naively thought the Techs. actually did their jobs and that the RN's were sincerely concerned about the patients and obtaining accurate vitals. I realized this isn't always the case.

P_RN, ADN, RN · Dec 31, 2006

SO what happened with the patient with the ↑ BP and pulse? Did you get your instructor or charge nurse involved? Vitals can shoot up though not usually that rapidly. If it took say 45 minutes to get all the vitals and then they were charted at the one time, then your lady could actually have been stewing for as long as and hour or two before you caught it. SO what happened ????

chadash · Dec 31, 2006

I here you, but I am afraid it's going to get worse with the "nursing shortage"... Hopefully not. The travel assignment that I am on now, has me floating after 8 hrs, to different units throughout the hospital daily, even to the hospital down the road because they are sister hospitals. Things have calmed down since I switched to day shift, but each day I was working with a different CNA. It was very hard, because I got no continuity with them. A lot of them made me feel like an outsider no matter how nice I tried to be. Did you say you take care of up to 10 patients on days? If so that is crazy, even if you are on nights......

Yep, as many as ten when there are staffing issues, more typically 8 {this is on day shift (hospital)}. Of course, I have alot less responsibility than you as nurses. But, if I could have a 4 patient assignment, wow, my folks would be shining, happy, watered and monitored. That would be ideal. I had only five the other day, and though I was not oriented to the unit, and they were scattered a bit, it was great. Then I had to pick up 4 new ones at 3, and made some mistakes. It would be great to have continuity in my assignment, and also stick with one nurse at a time. I could get to know what kind of help she needs and expects.

dmarie (GA) · Dec 31, 2006

SO what happened with the patient with the ↑ BP and pulse? Did you get your instructor or charge nurse involved? Vitals can shoot up though not usually that rapidly. If it took say 45 minutes to get all the vitals and then they were charted at the one time, then your lady could actually have been stewing for as long as and hour or two before you caught it. SO what happened ????

When I first discovered the situation, I told my instructor. She told me to tell the RN assigned to the patient. I did. The RN blew me off. I went back to my instructor. She then assessed the patient herself and went to the RN herself. The RN called the doc. I'm not sure what happened after that because the students were dismissed shortly afterwards.

I learned that sometimes, as a nurse, it's best to get your own vitals. But I'm just a student. Maybe later down the road I'll learn to just trust the Tech or CNA with that important task?

Shiggles! · Jan 1, 2007

That's ashame you have that many patients, where I work the nursing assistants will get no more than 4-5 patients during 7-3. There is no aquity so sometimes they will get 4-5 heavy's while another CNA will get 5 walkie talkies. If I have the time, I will help with bath's, turning, so forth. I would want there help in return....

chadash · Jan 1, 2007

Wow! four to five on seven to three? That sounds heavenly!

doingourbest · Jan 1, 2007

I am an RN and I view myself and my CNA as team. Most of the time it works out... I treat the CNAs with respect. At the beginning of the shift I go over our patients with the CNA and at that time delegate appropriate tasks. I usually don't have a problem, like I said.
K back to me... I'm an easy-going nurse that has a very good sense of humor, I'm also not as good with confrontation as I should...but I start losing my sense of humor when I have to ask a certain CNA to get a BP like 5 times or if there is a scheduled task like rechecking a temperatiure or discontinuing a foley... and I ask if she has those scheduled task results... no I didn't do it. Or how about at the beginning of the shift, I tell her so and so needs to be repositioned every 2 hours and that I will help her if there isn't another CNA available. What is it that she doesn't get? I am not delegating things that are difficult or that she hasn't done a million times.
I feel like I'm constantly going over her work and either doing it since she didn't, or redoing things... She CONSTANTLY is saying "Why, I normally do it so-so way or only once a shift for vitals" to everything. I've tried to be nice about it, but I'm to the point where I want to say, "Well this is what I need done, and if it isn't, there will be problems." Of course I'm too chicken with confrontation...
I guess the point to this is, how do you deal with a nursing assistant (or even other coworkers) that deliberately does not do what I ask them to do??
Thanks in advance (o and I'm working on this communication problem of mine by reading a book)
Thanks...Jenn

You must write up this cna. Assign her some very specific tasks and write it down for her. If she doesn't do them you can easily write her up. It is unpleasant. She will be angry; but, if she wants her job she will know that you mean business when you ask her to do something. Usually, you only have to write one person up and then all of your cna's will hear it through the grapevine and know that you mean business. From there on out, you should not have a problem. If you do have a problem with the same person write them up again. Then take it to your DON. If this girl doesn't want to work, then she shouldn't be there and you will be sooo happy if she quits or gets fired and the patients will get the care they deserve.

Been there done that

jimthorp · Jan 1, 2007

That's ashame you have that many patients, where I work the nursing assistants will get no more than 4-5 patients during 7-3. There is no aquity so sometimes they will get 4-5 heavy's while another CNA will get 5 walkie talkies. If I have the time, I will help with bath's, turning, so forth. I would want there help in return....

4-5 per CNA??!! At my employer the CNA's average 12.5 on the 7-3 shift and sometimes 16.7 per CNA.

doingourbest · Jan 1, 2007

side note to this.. I am still just a student but I have seen 2 times now, different hospitals, CNA's with this same attitude and PLEASE, I beg of you , if you do get a someone like this DO YOUR OWN VITALS. One I know of got fired- she finally got caught- she wasnt doing the vitals at all, she simply looked at the charting from the previous shift and "tweaked " the numbers a bit (her words). she got caught because she told someone how "funny" it was.
The other girl- same thing, I ALWAYS do my own BP before administering any cardiac med, and her numbers were way different than mine, WAY different. So I did it twice and then got my primary to follow it thru as well. When confronted this CNA shrugged and said " Oh well, thats what I got" and walked off.
I know the majority of aides are awesome, but even with my limited experience, if I see someone acting like this, I am very careful

I have also had aids who try to fake their vitals. It is pretty easy to tell. If I suspect it I go recheck someones vitals. If it doesn't add up I ask the aid to go recheck their vitals. If they have faked them, they tend to become defensive and make some excuse as to why their vitals may have been different earlier. I don't have that problem anymore, because once they figure out you are on to them they don't dare fake them again. Although, my problem began with that by nurses not actually making the aids take the vitals and then making up vitals in the chart. Therefore when I made them take vitals and several other nurses didn't, it gave them the idea it wasn't important.

SCgirl07 · Jan 1, 2007

HI .I have been a CNA for five years. I was always told my my parents and grand parents, "No matter where you go in life, there will always be someone you have to listen to." I respect my profession very much and I really do feel where you are coming from because I also see that type of behavior from time to time. Seems like he/she does not belong in the nursing field. The way I feel is like this. You are dealing with people lives and you are going to do it correct, or not do it at all. My DON does not put up with that type of behavior. That's what I respect and love about her; she don't care if you have been there for 30 days or 30 years, the patients are always her first priority. To sum it up, you do not have to deal with that type of behavior! Good Luck!

Oh, by the way, I just got accepted into the LPN program! Bye.

lauralassie · Jan 1, 2007

Make it clear that You are the RN , she is the CNA. When she singns her name as responsible on the chart , then she can make the decision. Approach her in a professional manner, but, I've been known to put a tech in their place in front of other people by doing such things as asking them about a dx or some such thing that they will most likley not know. Some people need to be reminded why we are asking such things of them. But remember, if she's in nursing school you must be prepared to use your knowlege and one - up - her so to speak. I know that sound mean , but usually a little humility goes a long way to prevent problems in the future.

chadash · Jan 2, 2007

If I faked vital signs, I could not sleep at night! What if someone was really sick, and it was not discovered because of that?

I have the opposite problem, I take an inordinate amount of time getting my vitals because I am too careful. There must be a balance. And I do make mistakes. Sometimes I get different readings because of the difference in how each dynamap reads the vitals.

But how common is this, the faking of vitals I mean? I saw it in the nursing home because the na's sometimes just did not know how to listen for a manual bp, which was bad enough, but why would someone fake it when you can use a dynamap, easy as pie?