I think my spirit is officially broken...

[kool-aide, RN]

Here's the deal:

The other night at work I learned that one of my friends at work(I work in a hospital) who is a CNA is in pretty deep trouble because she charted a pt's O2 flow rate via NC along with her v/s. She didn't change the flow rate or route, anything like that, just charted how much O2 the pt was on with the pt's O2 SAT and other v/s. Well, when she charted this, she backtimed it in the computer charting and somehow must have accidentally charted over the RT's charting for that time and changed the RT's charting so the RT told on her to her manager and my friend is in trouble and may lose her job for this. The manager told my friend that she is practicing out of her scope by charting the O2 flow rate because she's "assessing the pt's O2, and that's a medication." In my opinion, just charting an O2 SAT and saying the pt is on O2 doesn't tell the nurse or doctor much without knowing the L/min of O2 the pt was getting...

Also, I just received an updated list of the tasks which are in my scope of practice within my facility and a few things have been removed from my scope which isn't that big of a deal, I guess it means less for me to do, but it's just the idea that now I can't do some things that I did before to help the pts and assist the nurses..

I always try to help the nurses in the best ways I can, by trying to think like them and not just be task oriented... but I'm obviously not allowed to think, according to how my friend is getting in trouble for, in my opinion, being a good, thoughtful, helpful, and smart aide!

I'm just terrified that when I'm a nurse I'm going to be punished for thinking outside the box and not just following the all powerful doctors orders.

Opinions?

[gentlegiver, ASN, LPN, RN]

We all have scopes of practise we work under. It doesn't matter if your a CNA, LPN, or RN. My CNA's will often take vital signs for me, I always do my own O2 SATs. But either way, they give me the readings they take and I enter them onto the charts. Please do not allow this to break your spirit. I feel sorry for your friend, but, we need good people who want to take care of others, for you to give up would be very wrong. I'm sure your friend would agree.

[psu_213, BSN, RN]

I'm sorry to hear that your friend is in trouble for doing what she felt was right...

Having said that, we I started at my last job, I was told that CNAs are trained in TPR and BP, and that they could not (techinically) measure and chart sats--although on our unit, the techs did. RT was only responsible for the continous, nocternal pulse ox.

Now, the RT's logic was O2 is a med, therefore they can't chart pulse ox. At the same time, an insulin gtt is a med, yet aids will get the CBS. A cardizem gtt will affect HR and BP, both of which can be charted by an aide. In both cases, the RN monitors the infusions and the pt's status, yet the CNA can chart the VS or blood sugar.

Sounds like the RT may be getting to big for his britches.

[canchaser, BSN, RN]

Wow, I find this odd like you. It's not the Cna job to "assess" oxygen I can see that. But I would think they could chart it so doc's would know the flow rate. Why would the nurse be expected to go back in and chart the oxygen flow liters. You as the Cna is not administering the oxygen you are only charting the flow rate. I wonder why the manager is not using this as a teaching point and making your co worker the example by attempting to possibly cost the job.

[TraumaSurfer]

Our CNAs know quite a bit about the O2 devices since they do chart this info when taking an SpO2 reading. This includes knowing what the FiO2 reading is on the ventilators on tele, subacute and rehab. They also ambulate the patients on oxygen and reconnect them to O2 devices while monitoring the patient's SpO2. They know the parameters to contact an RN and/or RT to assess for anything outside of the norm just like the other vitals signs.

Recording all the data (HR, RR, FiO2 or L/m) that relates to the SpO2 is the only reasonable way to chart. Without this data it is as bad as drawing an ABG and not recording the patient's RR, O2 and SpO2 (if obtainable). In the ED they are also active in setting up the oxygen. Some don't give them the credit for what they know. It does help to work in and aroud a large teaching hospital.

[tokmom, BSN, RN]

Our CNA's know critical values as to notify the RN, and they also chart 02 sats and how many liters a pt is on.

I think a CNA losing her job is a bit extreme over an accidental charting!

What ever happened to second chances? Geez...

[rkitty198, BSN, RN]

I agree with the other posters, your friend is just charting what the oxygen was. Our cna's do that and write it in the chart.

I don't see what the big deal is. It was an accident I am assuming that she went over the RT's charting. I swear some us us in the hospital have such ego's that even a charting error is threatening. Don't let this get you down. Hugs!

[SummerGarden, BSN, MSN, RN]

yep, this kind of tattle-telling and misunderstanding happens to bedside nurses all the time. and yes, some even lose his/her job over something petty!!! so, if this event is breaking your spirits now as a cna, i think nursing by the bedside will destroy you as a person! no joke... you are witness to the tip of the crappy bedside nursing iceberg!!

as a nurse you will be told that such-and-such is no longer allowed by the rns and only the doctors are allowed to do such-and-such for whatever reason... yes, you will be told that you are crossing the line (working outside of your scope of practice) when you do something like critically think to save the life of your patient and the doctor disagrees with what you did.... (i see this a lot in the er). oh and yes, management will step in and not take your side! yes, you will have rts, techs, and other nurses tattle on you when something goes wrong or point the finger at you when minor mistake occurs even if it was not your fault (i have been accused of things when i was not even working the shift.. i know, i am magical). yes, all of this will happen, which is why many nurses have left bedside nursing for no other reason than similar events as the one you have described.... unbroken, the nurses who no longer work by the bedside contribute greatly in other capacities. i cannot wait to join them!!!

[pdrgeez]

I had to read the last post by the MBABSNRN... three times to get the full meaning.

I think what he or she means to say is that a lot of us have been broken by the ways things are done. Now we are not at the bedside because we are sick of it. And we find other things to do that do not break our spirits. I find truth in that. If that is not the meaning of it, please enlighten me!

[SummerGarden, BSN, MSN, RN]

I had to read the last post by the MBABSNRN... three times to get the full meaning.

I think what he or she means to say is that a lot of us have been broken by the ways things are done. Now we are not at the bedside because we are sick of it. And we find other things to do that do not break our spirits. I find truth in that. If that is not the meaning of it, please enlighten me!

Yes, this is my meaning... I apologize for my rambling. BTW, congrats on escaping bedside nursing.

[kool-aide, RN]

I want to thank everyone for their replies and I would like to apologize for sounding like a whiney pre-nursing student, which I did. lol I normally hate reading those whiney threads that I know we've all come across, but I guess I have to let it out sometime, right? lol

I think I just need to take a chill pill. Every profession has tattle tales and fake co-workers, and I know nursing has a great potential for those types of people, but I have also met some co-workers who are like family to me and who I know I can trust (call me foolish if you will...). I know whether or not I can make a difference everyday or not, I will make a difference in someones life, whether it be medically by saving their life, or whether it's because I comforted them in a difficult time or gave them expert care that allowed them to keep their dignity.

You know, typing out how you feel really does have a therapeutic effect! lol

Thanks again for all the replies.

[Five&Two Will Do]

Here's the deal:

The other night at work I learned that one of my friends at work(I work in a hospital) who is a CNA is in pretty deep trouble because she charted a pt's O2 flow rate via NC along with her v/s. She didn't change the flow rate or route, anything like that, just charted how much O2 the pt was on with the pt's O2 SAT and other v/s. Well, when she charted this, she backtimed it in the computer charting and somehow must have accidentally charted over the RT's charting for that time and changed the RT's charting so the RT told on her to her manager and my friend is in trouble and may lose her job for this. The manager told my friend that she is practicing out of her scope by charting the O2 flow rate because she's "assessing the pt's O2, and that's a medication." In my opinion, just charting an O2 SAT and saying the pt is on O2 doesn't tell the nurse or doctor much without knowing the L/min of O2 the pt was getting...

Also, I just received an updated list of the tasks which are in my scope of practice within my facility and a few things have been removed from my scope which isn't that big of a deal, I guess it means less for me to do, but it's just the idea that now I can't do some things that I did before to help the pts and assist the nurses..

I always try to help the nurses in the best ways I can, by trying to think like them and not just be task oriented... but I'm obviously not allowed to think, according to how my friend is getting in trouble for, in my opinion, being a good, thoughtful, helpful, and smart aide!

I'm just terrified that when I'm a nurse I'm going to be punished for thinking outside the box and not just following the all powerful doctors orders.

Opinions?

I would hardly consider looking at the monitor and recording the SPO2 and then looking at the hiflo or whatever respiratory device the patient was wearing assessment. Sounds like observation to me and that is where the CNA can certainly help the RN A LOT. I have two eyes and ears and need the help of trained personell to notice through observaion if something is not right with a patient. How else are they to notice what's wrong if they are not allowed to note what is right? Seems like the RT probably has an issue with the particular CNA. Just guessing, but sounds like a bunch of drama which I loathe!:barf01: