Helping with Rounds

[HisTreasure, BSN, RN]

I went to a facility the other night through my agency. I was put on a very small unit (13 residents) with one CNA. It was implied that the nurse would help with rounds on the 13 residents which was fine with me. I asked the CNA, the regular on the unit, what time she normally did rounds. She stated between 2:15 and 2:30.

The night progressed slowly and we were able to watch some TV and chit chat. A staff member from another unit came over and we all chatted; she was going to school for business admin at the same school that I attend. She said she had to get out of nursing and I agreed that I, too, had to get out of bedside nursing due to my shoulder injury and the lack of opportunities I have had the past few weeks. My coworker asked why I hadn't mentioned it to her before and I told her that I didn't feel it was relevant as long as we worked together for the rounds. She assured me we would and that was that.

About 1:15 a disruptive resident started in on the call light. He had been in pain earlier but I had given him his PRN. He had fallen asleep but woken up and was at it again. His only other PRN was a 2mg Ativan injection, however there wasn't an appropriate needle on the unit. I told my coworker I would be back (I left her watching Plastic Surgery Before & After) and started with the neighboring unit and kept going until I could find the right size. On the last unit I checked I ran into a nursing school buddy and we chatted for a few minutes on her unit. I told her I had to get back. She walked me back to my unit. When it was all said and done I had been gone approximately 9 minutes.

The CNA was not sitting at the desk anymore but I didn't question where she was. My concern was getting the resident some medication and comfort. Went into his room and waited for him to get out of the bathroom. I administered the medication, helped him get situated in bed, found him a suitable channel to watch, peeled a banana for him and on my way out the door noticed his foot was out of the sheet. In tucking his foot back in, I noticed how dry they were. I donned gloves and applied the lotion on his nightstand. Went back to the med room to wash my hands and grab his chart to make a note and came out to find my coworker pushing the cart. I told her, "Oh, you started early. I'll be there to help you in just a sec." I noted the VS and made a note in the resident's chart, returned the chart to the corral and went into the room with my coworker. She turned out the light and gently pushed me back out into the hall saying "I'm all done." The time was now 1:49. I know because Plastic Surgery was still on and I had just noted the time in the chart.

I apologized for not helping (wondering HTH she did it so fast?!) and told her that I would help next time. 3 AM I had a BG to do on a chronic hypo and her tube feeding. Notice the resident is on her way down and start interventions. Somewhere in the hustle and bustle of getting her sugar up and donning and undonning gloves I lose my wedding ring. I don't notice until a little later in the shift. I spend the rest of the time looking for my ring up until it was time to start morning rounds.

CNA tells me that she has a shower that she does first and then she does rounds. So I do my very small med pass and BGs, checking and changing the briefs of the few residents I have to give meds to. I go back to check on my hypo resident who is now stable and I am back to looking for my ring. I am in and out of resident rooms and in none of the rooms do I see the CNA, which is fine since I had changed those residents already.

Now I am frantic. I sit at the station to gather my thoughts and the early arriving day staff start to trickle in. I am telling them how I lost my ring and to please be on the lookout. CNA says, "Well, we checked the few beds she went in. She didn't help me with rounds so we didn't have many places to look...":uhoh21: I let the comment go until I noticed she kept making the same statement, just different ways. Finally I excused myself because in spite of being quite frustrated with losing my ring, I wasn't about to take it out on her by rightly defending myself and my actions.

She started rounds early 1st round and did 2nd rounds on her time. She never once told me WHEN she was actually going to do them either instance, and I did round 5 residents:madface:. GRRRRRR.... now I bet all the CNAs there think I'm some lazy do-nothing nurse that thinks she's too good to help out and that couldn't be further from the truth.

[jjjoy, LPN]

Could you have pulled the CNA aside and addressed the issue? Perhaps by saying "I heard you say that I hadn't helped with rounds. I was expecting to help and then you told me you were finished already. Did you try to find me prior to starting?" Or something like that? This is often easier said than done, especially if there is already tension between you and/or you feel upset & defensive. If you can, step back and try to address it as some kind of miscommunication. If the person continues to say things that misrepresent your work, then she probably does that routinely and others should know not to take her too seriously. And of course, your performance and attitude should speak for itself. When other CNAs work with you, they can judge for themselves how they like to work with you.