What CNAs need to tell the nurse - page 4

in a postop, i want to hear about: pain level (could indicate compartment syndrome or that dose needs adjusting) c/o nausea/vomiting (could indicate an ileus) bp over 140/80 or under... Read More

  1. by   groverslisa
    If it is anything out of the ordinary! Write it down on a paper towel or just come come get me! Rather sooner than later. CNA's are the eyes for the nurses. They should be praised for that, so that they feel like they can come to the nurse even if it turns out to be nothing.
  2. by   texas_lvn
    Quote from Angie O'Plasty, RN
    Your post shocked me with its angry attitude. I would not want to work with you because apparently you've lost sight of the reason that you're taking the vitals in the first place--to identify patients who need intervention.

    This is not an intrusion into your schedule--this is your job.

    Had you read the whole thread, one previous poster asked "What more can I do?" and that was my answer.

    PS

    Don't try to "find" me if a patient has chest pain and you can't reach me on my pager. The stupid thing doesn't work right half the time anyway and the battery's probably dead from phone calls from family, pharmacy, lab, doctors, and the desk. It's a wonder I get any assessments done at all, but then again, why I get paid "the big bucks."

    (Not sure whether to laugh or cry at that last quote. ) Regardless, back to the chest pain patient:

    Turn on the bathroom light, hit the Code button, yell down the hall, I don't care how you do it, but alert me STAT because after a patient has c/o chest pain, we all have exactly one hour to get all the aforementioned stuff done--or you could lose your job, I could lose my license, and the hospital could lose accreditation.

    Not to mention that the poor patient could lose heart tissue and potentially his/her life.
    Angie, I would not worry about this poster. If you read some of their other posts, you would see it appears they are just hostile about their situation. She even started a thread that appears hostile to begin with.
  3. by   MT RN
    Quote from kurosawa
    Yeah. So you collect the big bucks for assessment, care planning, and delegation--and you expect the CNA to do it for you.

    Get a grip.

    You know why you don't get abnormal data ASAP in the middle of the CNA taking vitals?

    Because it takes 15 minutes to find you which she can't afford even when she's only vitaling half the floor, let alone the whole floor by herself, and you're not helping by not carrying your pager.

    Because every other RN on the floor is hollering for (1) their vitals and (2) come here NOW and help me/do this/do that.

    Because she's WAY overloaded before anyone starts hollering: if you took total care of your pts, you'd find yourself spending half your night on changing, cleaning, and bathing, yet with 5 RNs for 1 aide, you expect all that done "and where are my vitals and I's and O's?"

    Because she knows what normal is, and not only that but what floor policy is, but so many times she's gone hunting for an RN with data that's out of limits and been told, oh I don't worry until it's X or Y or Z, or, did you really have to wake up the pt for a BP and anyway that's normal for him -or- leave him alone, he's dying.

    But mostly she doesn't do your assessments, plan your care, do critical thinking, and do your delegations because she doesn't have RN training.

    Wow, this is a frightening post!! Kurosowa, I was a CNA while in nursing school so I feel qualified to speak from both ends of the spectrum. First and foremost though, IT'S YOUR JOB to do vitals, I&O's baths, etc., as well as to report to the nurse any abnormalities. And yes, being a CNA is often a thankless job with lousy pay and too much work, but believe me, so is nursing.

    I can actually remember thinking as a CNA/student that life will be so much better when I'm a nurse and only have a few patients as opposed to the whole floor, but boy was I wrong! You obviously have NO idea how much more work is required as a nurse. Yes, it does pay much better but it's also a lot more demanding.

    I have no idea if you ever plan to be a nurse, but if you are it would be interesting to see your perspective of things once you've been a nurse for a while.
  4. by   anonymurse
    When something goes wrong with one of my pts, *everyone* knows, like it or not. What we are looking for is ways to bulletproof things in the general interface between RNs and sitters. RNs, not aides, manage sitters, so it falls to them to ensure reliability. How many RNs assess their sitters for competency? Brief them on expectations? Or just say, oh good, there's a sitter in the room, then take off for hours. That's scary. Yeah, I'm dead paranoid about falling asleep and betraying my trust, but I've seen many asleep and know some even plan to sleep. Hostile? Seething is more like it. Monitoring and maintenance of UAPs is awful. Do you know if the aides on your unit always mark axials AX when they chart? Do you look in the basket on the vital signs machine that an aide is rolling down the hallway and say something if know you have an obese pt down the hall and you see only one size of cuff in the basket? Even if floor policy tells 'em to notify the primary when temp's 100.4 or over, do they know what it means when a 90-year-old hits 99? Dismiss it all as hostility, that's the ticket.
  5. by   UM Review RN
    Quote from kurosawa
    What we are looking for is ways to bulletproof things in the general interface between RNs and sitters.
    A sitter is not necessarily a CNA and this thread is not about what the sitter needs to tell the nurse. Most sitters may not take vitals or do the tasks that a CNA is trained and certified to do.

    I have no idea what your problem with nurses is to cause such hostility and anger, but you need to get it resolved. Patients are highly intuitive of their caregivers' emotions and patients don't do well with unhappy, frustrated, hostile caregivers.

    This is my last post to you on the subject, since there is no contribution to the topic of the thread at this point.
  6. by   chadash
    Dear Angie,
    Sorry you got discouraged by this thread. Your imput is invaluable. CNAs who are also nursing students have alot of insight into what is important, what is a real urgent sign and what is normal in some circumstances. For those of us who are first and last CNAs, we do pick up a lot from experience, but in my case my experience did not fully prepare me for hospital work. So your list of warnings and suggestions really was informative to me. Thanks again.
  7. by   UM Review RN
    Quote from chadash
    Dear Angie,
    Sorry you got discouraged by this thread. Your imput is invaluable. CNAs who are also nursing students have alot of insight into what is important, what is a real urgent sign and what is normal in some circumstances. For those of us who are first and last CNAs, we do pick up a lot from experience, but in my case my experience did not fully prepare me for hospital work. So your list of warnings and suggestions really was informative to me. Thanks again.
    Chad, I'm glad that you found the information useful. I'm not discouraged at all over the thread; quite the contrary, I think that there's a lot of very useful information here. I enjoy teaching and working with CNAs having been one myself once as well as working both with and without CNAs on the job.

    A good CNA is gold but I'd really rather work by myself than with a CNA who doesn't see that the patient's wellbeing is the real Big Picture.

    May all of your assignments be manageable, and may you have a peaceful shift once a week!

    ~AngieO
  8. by   MidnightTang
    Quote from Angie O'Plasty, RN
    A good CNA is gold but I'd really rather work by myself than with a CNA who doesn't see that the patient's wellbeing is the real Big Picture.
    If only everyone involved in patient care would see the "Big Picture" from the housekeeping staff to the neurosurgeons what a wonderful world this would be. The hospital and all its employees exist for the sole purpose of CARING for patients and their families.
  9. by   hjwdancer
    I am a nursing student (grad- Dec 2006-hooray) who has worked for the past 11 months as nurse extern- which covers training and working as CNA, unit secretary, and telemetry monitor tech. My tips that I have learned from my experiences are:

    Before starting your shift, have a routine or schedule mapped out for the day. Always find and speak with your nurses for the day within the first hour and ask them if there are any specials things to watch for or need to be done today.

    Organization is the key to a smooth day.
    Ex:
    0700, get ice bags filled, get linen cart or washcloths prepared with extra soap/toothpaste/etc, do VS, toilet, wash hands face, FSBS and distribute ice bags. Turn Q2 pts. Chart VS/FSBS/Q2 and tell nurse/conference. If possible fit in one bath.
    0800 Distribute breakfast trays. If no pts need feeding assistance and you have an NPO pt or two then bathe them. Pick up trays.
    0900 Turn Q2s and chart brkft%/turn. More baths and take your first 15 min break-recharge your batteries and let your feet rest.

    Stick your head in pts rooms as you walk past for a quick check- this will help reduce your running time and will help you stay alert to pts.

    If you notice something new with a patient, tell the nurse even if it seems small. I always call for the nurse when I notice a red spot or a new wound, etc. This saves the patient the aggravation of rolling again in 15 min and helps the nurse assess the area.

    If a finger stick blood sugar is sky high or really low, stick the patient again using a new site (preferably fingers of the other arm).

    For low bloodsugar, get juice and a pack of crackers to patient immediately then find nurse (if this is acceptable at your agency and obviously if pt is not npo or confused, etc).

    Roll with the nurses- some act as if you are an idiot, some treat you with respect. Don't let this affect the attentive care you provide for your patient and whether or not you will report an abnormal value.

    If you don't know how to do something, get help. You should never fly solo on a maiden voyage.

    :smilecoffeecup:

    Good Luck!
    Last edit by hjwdancer on Nov 22, '06 : Reason: Got a little wordy in previous post :)
  10. by   KLYx0327
    I'm getting CNA certified sometime in the middle of Feb. 07. Thanks for this thread--- I'd like to get as much input as possible about what the nurses I am going to be working with are probably expecting of me.

    Happy Thanksgiving everyone!!
  11. by   Marie_LPN, RN
    Let us know if a bandage has fallen off or needs retaped.

    If the IV beeps for a new bag and you're the first to notice it, don't just hit 'silent' and not say anything. Inform the nurse that a new bag is needed.

    If you find any pills in the sheets, on the floor, etc. tell the nurse. Those pills could be for cardiac or BP reasons, and may make a huge difference n the vital signs, and may explain why a BP is elevated.

    On a post-op hysterectomy pt., if you help change their peri-pad, inform the nurse of how much blood on the pad and what it looked like (or better yet, keep it in the trashcan where the nurse can see it if necessary). This may be part of the documentation, plus if the pad is soaked, it's an indicator that the pt. might need to go back to the OR.

    If the pt. pees, the nurse needs to know, and how much.
  12. by   Marie_LPN, RN
    Patients are highly intuitive of their caregivers' emotions and patients don't do well with unhappy, frustrated, hostile caregivers.
    I second this. And pts. will either feel like a burden (i.e. may not report the smallest problems, or ask for anything), or angry.
  13. by   UM Review RN
    When you feed someone, if you notice the patient constantly clearing the throat, coughing, sudden nasal drainage while eating, pocketing food, or not moving the food back easily, please stop feeding the patient immediately, clear the food, and tell the nurse asap.

    This could mean that there's some weakness or paralysis of the mouth and throat and the patient may need thickened liquids or pureed meals.

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