What do you expect of a CNA?

  1. Hi,

    I am currently undergoing my pre-reqs to enter nursing school. In the meantime, I am taking a CNA course so that I can work as an aide and start to gain some clinical experience.

    I have two questions:

    1. What exactly will I be allowed to do as a CNA? I am training in a LTC facility. I would probably prefer to end up working in a hospital.

    2. I have seen a lot of negative comments on the boards about CNA's not being helpful enough. Could you as an RN or LPN please describe how you would like to see an aide on your shift perform?

    Just wanting to see all sides and consider all expectations so that I can be the best that I can be!

    Hugs,

    Wendy
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  2. 22 Comments

  3. by   Rustyhammer
    A CNA has to be many things. They need to be observant to notice any change in their pts. condition. They need to be able to talk old MRS. Jones into coming into the dining room or into taking a shower. They need to be able to manage their time well' for often they will be working short and will have to do double duty that day.
    The CNA needs to be diplomatic with family and visitors. Sometimes the CNA is the ones who imforms the family how "mom" has been doing. The CNA is in it not only for the money (it should be doubled) but because they truly care.

    Hmmmm....Sounds a lot like a nurse doesn't it?
    I think you are making a good choice Wendy.
    Good luck and stick with it.
    -Russell
  4. by   BrandyBSN
    First and foremost, i do not expect a CNA to do anything that I would not do. Meaning that if theire as a really nasty mess, I do not expect her to clean it up by herself, we tackle it together.

    On the floors I have worked on, the CNAs are assigned a certain number of patients, and there are normally 2 CNAs per floor, so each gets about 10-15 patients, depending on census. They do baths, anwer call lights, and normally do the bedpans and patient transfers, but if they get swamped, we jump in and help with everything. CNAs here also take vitals, and pass food trays. They chart I&Os. I worked as a NA (not certified) for several years, and I have been on great floors, and crappy floors. On the great floors, the nurses jump in and help with code browns, vomit, bed making, baths, etc. On the worse floors I had to do all of that myself, which was not a lot of fun.

    Nurses often expect a lot from the CNA, and often have them do all the things that they feel "are above them", so just make sure that you dont let them push you too far. CNAs are important, and take a lot of stress off the nurses, but dont let them abuse you! You are an important part of the healthcare system too~!

    BrandyBSN
  5. by   Zee_RN
    A very thoughtful question. I'm thinking you'll make fine CNA and nurse just by the fact that you thought to ask.

    CNAs in LTC have different responsibilities/expectations than in hospitals. In LTC, the CNA actually has primary care of the residents...by this I mean, the CNA spends more time with them, for the most part, than do the nurses whether they be RNs or LPNs. In the LTC I worked in several years ago, the RN mostly was behind the desk doing paperwork (not always what I wanted to do but if I didn't do it, it didn't get done), the LPN was responsible for medications and treatments and the CNA did the bathing, hygiene, and feeding. They frequently obtained vital signs when they were necessary too.

    In the hospital (med-surg) the CNA also does hygiene matters, feedings and food tray distribution (dietary doesn't do it at my place), vital signs, specimen collection, restocking of unit stock items, and at times acts as "courier" for the unit. She/he also escorts patients at discharge.

    One of the most important things, in my mind, that a CNA can do is report anything she/he finds unusual in a patient to the nurse. There are times when the CNA spends more time with patients than nurses do and have better opportunity to notice when something is amiss. Please, please tell the patient's nurse. Many times it has been the CNA's comment, "She's just not herself today..." or "Her IV site is starting to look red" that has alerted staff to bigger problems or pending problems. On the other hand, there have also been times when, as a med-surg nurse, I did not get to see the vital sign sheet until later only to realize that 2 hours ago the patient had a temp 102.6!! The CNA wrote it down but never thought to actually pass this on to me...

    Personally, I would not ask a CNA to do anything that I myself wouldn't do. If my patient is in a huge "code-brown" I will either tackle it myself, grab another nurse (you can do that in ICU, there's more around), or ask the CNA to assist me--I do not tell the CNA to go in there and do it. There are those who do...
  6. by   TooterIA
    Can I please come work with you nurses? At my LTC i am a CNA and am treated like I have an IQ of 6 and the nurses would never help me in fear they would get BM on their uniform that has never been soiled.
    And that is why I am becoming a nurse, so I can treat CNA's with the respect they deserve (those of us that do deserve it anyway). I think it should be a requirement to be a CNA before becoming a nurse so you will learn what we go through. Thanks for letting me vent
    Jessica
  7. by   RNforLongTime
    Hi Wendy,

    I have spoken with you before via e-mail. I would suggest to you since you would rather work in a hospital setting that you apply to the two big hospitals in your area. They are almost always looking for good help. Get your CNA cert, first as you would have a better chance getting a hospital job. I know that the hospital I worked at in your area, they required that you be a CNA or a nurisng student.

    When I worked there, if I had a CNA that was in Nursing school, I would allow her to practice some procedures under my guidance...like NG insertions and Foley caths that sort of thing. Not all Nurses would let students TRY these things but I will..how else are you gonna learn to do this stuff?

    Good Luck!

    Kelly
  8. by   tiger
    sometimes our cnas are good and other times i would prefer to work with all liscensed. that way you have less pts. and you know what has to be done and can organize your time as such. things i do not like when working with a cna that is not so good. ignoring lights because i'm at the desk charting and you would rather finish passing water. delivering a food tray to a pt. when they are two feet down in the bed and leaving it for them to call me to pull them up. delivering a food tray without even asking the pts. of their likes so they can call me to run down to the kitchen and replace everything you left with something else. not putting condiments on the tray you deliver--i have to redo this as well. not checking incont. pts. or assisting pts. to lay down for rest periods. i will help every time when i can but sometimes it is impossible.depending how many cnas we have on and how many pts. we have. dressing a pt without his ted hose--i then have to undress the pt. and put the hose on and redress him. and many more. it's usually simple things that the cna knows need to be done but don't do in order to cut corners. it costs the nurse much time. when i do all these tasks on my own without a cna i do them right the first time cause i don't want to redo anything and waste that time. just some thoughts from the nurses point of view. and mind you--this is only with some cnas. others are a step ahead of me at all times.
  9. by   frustratedRN
    i expect a cna to WORK with me.
    work being the key word. we are a TEAM.
    at our hospital they take vitals, put in foleys, draw labs (unless its from a line) accuchecks, specimen collection, and hygiene.
    i dont expect them to do more than they are supposed to.
    i DO expect them to treat our patients and their families with respect. i do expect them to come to me and tell me what the status of our patients are. if there is anything abnormal or unusual for the patient in their vitals.
    i expect them to assist the patients in the adl's as needed.
    i would far prefer to do things with them ...like changing a patient, turning and repositioning, WITH them rather than tell them what needs done.
    i DO expect them to know what their jobs are and i DO expect them to tell me where they are. i dont care if they go outside and have a million cigarettes as long as their work is done and i know where they are.
    i dont appreciate having to look for them for hours at a time.

    yes SOME nurses have a bad attitude. ...they treat the cnas like crap and SOME cnas have a bad attitude.
    we need to stop generalizing either way.

    and i DO EXPECT MANAGEMENT TO GET RID OF INEFFECTIVE, LAZY CNAS AND NURSES....
    and here is really where our problem lies in both cases....its just not good enuff anymore to let things "skate"

    sometimes i think management encourages this division...we are supposed to ...i think....weed out our own bad so they dont have to get their hands dirty.
  10. by   teddybear
    WENDY,
    HI MY NAME IS MARIE, AND I AM A CNA.I WORK AT A NURSING HOME RIGHT NOW,BUT I TOO AM PLANNING TO GO TO LPN SCHOOL NEXT SUMMER.I WILL TELL YOU SOME THINGS WE ARE EXPECTED TO DO.WE ARE TO LISTEN TO THE REDS. CARE FOR THEM BE THERE MOTHERS AND DAUGHTERS AND THERE BEST FRIEND IF NEED TO BE.WE CNA'S KNOW MORE ABOUT THESES REDS THEN THE NURSES DO,BECUASE WE ARE WITH THEM ALL THE TIME.I CLEAN THERE BM'S IF THEY WET I CLEAN THEM UP,I ALSO CLEAN THERE BM BAGS ,THOSE WHO HAVE THEM,( I KNOW WHAT THERE CALLED ,JUST CAN'T SPELL IT......HAHA).I HOLD THERE HANDS WHEN THEY HURT ,AFRAID AND WHEN THEY ARE DYING.AND YES WE HAVE NURSES THAT WON'T DO A DANG THING BECAUSE THATS OUR JOB,NOT THERES.I THINK THATS BECAUSE ALOT OF THEM HAVE NEVER BEEN A CNA BEFORE THEY BECAME A NURSE.AND THERE ARE A LOT OF CNA'S THAT THINK THEY ARE BETTER THAN YOU AND THEY JUST WON'T DO ANYTHING TO HELP YOU BECAUSE THEY THINK THEY ARE NURSES.I DO I& O'S ,VITAL SIGNS,MEAL CHARTING,AND IF THER IS ANY SKIN BREAKDOWNS I TELL THE NURSE.I L9OVE WHAT I'M DOING,BUT IT DOES GET DISCOURGING AT TIMES.GOOD LUCK IN GETTING YOUR CNA'S LINC.
    LET ME KNOW HOW YOU DO.
    MARIE
  11. by   monkijr
    Hey Wendyd, please give us an update, how's it going?
  12. by   adrienurse
    One very important thing that I depend on CNAs to do is to notify me if they notice anything out of the ordinary. This is a big responsibility, but the realities of today's health care system is that I can go a full shift without having the chance to look at and assess everyone that I am caring for (I work in personal care). For this reason, I depend on you to be my eyes and ears. To look and listen and to develop a sense of detecting when a problem is happening.
  13. by   VivaLasViejas
    Wendyd:

    You sound like good folks to me! I was a CNA in a hospital before I got my nursing degree, and even as an RN, I still believe the best nurses are those who have been aides. I remember taking my CNA training in a LTC facility where most of the nurses wouldn't lift a finger to help the CNA if their lives depended on it. We former CNAs know what it's like out there on that floor, and we treasure good aides.

    Having said that, there are a few common practices that really trip my trigger, and again, having been there/done that makes it harder for me to tolerate:

    1) Calling in frequently (more than once a month)
    2) Smoke breaks. In my experience, aides who smoke take WAY too many breaks, and it's not fair to the non-smokers who need the breaks too and don't get them because they're busy covering for the smokers.
    3) In the same vein, I just hate it when a CNA leaves the floor without telling the charge nurse. That is unfair to the other aides who don't know they're supposed to be covering for you, and is dangerous to the residents or patients you're caring for. In fact, you can be accused of patient abandonment, and lose your certification!
    4) My pet peeve is NOT being notified right away when something is abnormal, e.g, temps, new skin issues etc. The other day I was going through my residents' vital sign list and noted a B/P of 190/126 for a resident with a recent CVA.......asked my charge nurse about it, and he hadn't even been told yet. This was in the early afternoon, and the vitals had been taken right after breakfast!!! Such an elevated B/P could easily have led to another stroke; fortunately for the resident I was able to get orders for an extra dose of blood pressure medication, and his B/P did come down, but it would have been better to know about it earlier. Don't worry about over-reporting or repeating something another CNA might have already reported; we'd rather be told 10 times about the same problem than not at all.

    Good luck, Wendyd, and let us know how it's going.
  14. by   pebbles
    I'd like to add that the tasks and mental work that are expected of you will differ depending on the unit where you are hired. Anything that isn't in your training, you'll be oriented to "on the job". Some wards in our hospital, the NA's don't empty colostomy pouches, some they do (for example). I work on a trauma unit, and I recently found out that "logrolling" technique is NOT part of the NA course here... we have to teach all the new ones on the job about how to do it and the importance, etc.

    Also some wards, you'll get more of an atmosphere of teamwork than others. Some places you'd literally be treated like a menial servant to do the tasks that nurses feel are beneath them. (Not on my unit - I was an NA before, and thats part of why I chose to work someplace else as a nurse, I like teamwork.) Your best bet is to shop around, talk to other CNA's in your area and find a work environment that suits you.

    What you'll be allowed to do, and what you'll be responsible for - that is a product of your state's nurse practice act (dictates what you have to be an RN or LPN in order to do, so some things can't be delegated to CNA's), plus your hospital's policies.

    NA's in my hospital can't do vitals or blood sugars. They do personal care and hygeine, toiletting, they help pt's mobilize as advised by the nurse (assisted walks in the hall, etc). They assist the nurses and physios with activity and mobilization. They help us get pt's on and off stretchers to go for tests. Change bed linens. They are responsible to mark down intake and output. They deliver trays, and measure what pt has eaten or had to drink. They empty and measure foley catheters, urinals and hats. Turning and changing pt's every 2 or 3 hours as needed. Plus other things that may come up, as long as it doesn't require a nurse. (Night shift NA's do a lot of restocking as well).

    My pet peeve is NA's forgetting to mark down a pt's urine output, and I have to ask them later, hoping they remember. On the whole, I love our NA's though... they are terrific with the pt's and it's a pleasure to work in a team with them.

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What do you expect of a CNA?