Does anyone have trouble with CNA's?

  1. I am working as an extern on an Ortho/Neurovascular floor and I am working under a preceptor/RN license. I was a CNA prior to being in nursing school for 5 years on a cardiovascular floor and floated all throughout the hospital and as a CNA at a nursing home for 2 years, anytime there was something abnormal whether it be a temp, blood pressure, attitude change(LOC change) i ALWAYS reported these things to my RN. The CNA's that are on the floor where I work don't report back low B/P's, elevated temps which seems to happen a lot in our postsurgical hip/knee population. Some are trained to take blood glucose testing with meters and do not report back what the blood sugar is. It is frusterating to say the least on having to track these people down for these things when you have insulin to draw up, wonder if you can give the diuretic and blood pressure med that are both due at 1600, never mind the fact that report let out 15 minutes ago and the family would like to talk to you in detail about "grandma's constipation" when she returned from surgery at 1400 and describe in length about their own bump, no maybe it's a mole or could it be cancer? on my inner thigh and proceed to hike up their shorts in the middle of the crowded hall so I can take a "look-see"!! I really don't mind the questions and the rat-race that can sometimes accompany the 8 hours I get to work, but it would just be a lot easier if I didn't always feel like I am doing 2 jobs instead of 1. I looked my CNA square in the eyes and told her I needed this info if there were spiked temps, low B/P's in front of the RN whose license I was working under and it still wasn't done. I really do have a lot of patience and I don't believe in rudeness so I said it in a very polite way, the only reason I made eye contact with her was so that I knew she heard me. I just don't understand it??? I asked the RN that I was working with how I could have said it any better so that my requests were respected and followed through with, she didn't have an answer for me. Have any of you had similar situations/progress/solutions? I would appreciate any feedback-thank you very much and I hope you all are doing well--thanks for all the welcomes to my previous post
    Leah
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  2. 9 Comments

  3. by   GPatty
    Maybe it's that they are perceiving you as being "bigger than your britches". I know it makes no sense when it's peoples lives, but I am currently a CNA (until my boards coming up soon) and I see this activity every day. Some CNA's for some reason just don't want to give the info that's needed...
    On the other hand, I've also seen some nurses who won't listen and act as if the CNA isn't even standing there, they just keep on with their personal conversations....
    I think I would....to remedy the situation.....might make more work for myself, but the patient would be alright.....
    do the glucose testing myself......and do vitals myself.....
    That way I would know what my patient is doing......

    Either way, good luck to you and I hope you find a better way to get them to listen to what needs to be done!
  4. by   Gator,SN
    Decembergrad,
    Not exactly sure what the problem may be with your particular situation, but I was wandering........
    Could it be possible that the CNA's that you mentioned do not know/understand glucose levels or sliding scales? Or that they may not have be trained to understand changes in vital signs, only take them?
    As a student and a CNA myself, I know that their have been numerous times when, had I not been a student, I would have missed serious/subtle changes in patient status. You seem to have more experience then some others, in that you worked in a hospital before. Do the assistants at your facility attend report at change of shift. They don't at mine. I asked about this one time and was told, "you don't need to for what you do." It is impossible for me to know the baselines or condition of the patient and so it goes....

    Also, watch how the nurses respond to the assistants. I have one nurse who snaps and growls every time someone goes to her with information about one of her patients and one nurse who rudely questions everything that you tell her. It makes it hard for the CNA's to keep going back for abuse like this.

    These are the exceptions. Most of the nurses appreciate it when we tell them something or go to them with questions. They take us seriously and go check it out.
    Talk to the nursing assistants, tell them that you appreciate them and when they do a good job. Tell them exactly what you want and why. This will go a long way in bridging the gap between you. They are the eyes and ears sometimes when the nurse is busy in another room or talking with a family.

    Most nursing assistants want to feel like they are part of the health care team......not just the tail end.

    Good Luck to you!
    Gator

    To all the nurses who take the time to be good to your CNA's......thank you, it means a lot. We really want to help you!!
  5. by   Ortho_RN
    OK.. I agree with Julie.... I am working as a PCA, and I do report things to the nurses, but when you tell them half the time, they say OK and continue their conversation about something else.. And as far as the CBG thing goes, we chart the value on the MAR and the nurse can check herself what the rate was, when she goes to pull up meds; however if it is abnormally high I will personally tell them.. Then again they don't always listen to what you say... So I think it is a TWO way street... But if you come across like you are the BIG dog.. Then I guess you should expect a lil attitude.. You being a former CNA should understand what it feels like when a RN comes up to you with an attitude that isn't called for.... There is a PROFESSIONAL and COURTEOUS (sp) way to do things...

    Good Luck with handling your CNA's
  6. by   darby1
    My opinion is that Miss Leah has already done the CNA job and knows how it should be done. She is probably like myself in that she took her job seriously as a CNA, and reported everything, ON TIME. I know exactly what you're talking about. There's always these slack a$$ people on any job you go to. These CNA's you're talking about are probably the ones that "just need a C to pass this course" type. I'm going into ADN school this fall, and I'll have to keep my manners, for a while. When I become a RN, these slack people will not like me! If they can't do their job, I'll find someone who can! I hear a lot of whiners everywhere I go and I'm tired of slackers. Build a fire under their a$$ Leah, or tell your supervisors to get rid of this dead weight. That's my .02 cents. You guys have a nice day.
  7. by   decembergrad
    Thank you for all your replies to this situation. I guess I should have been a bit more specific on my attitude and personality before I posted this message. I am in no way thinking that I am "Bigger" than anyone else. For the 7 years I was a CNA I loved my job and I loved the RN's/LPN's I worked with. Only once did I not get along with one RN but I kept that to myself. The charge nurse on my unit described me as "not being a chatty cat" and "I have no doubt that if she doesn't know something she will ask her RN and not do it just because she has a new title". I repect the fact that I am working under someone elses license and one day I might be in the same situation and I would hope that extern would appreciate and respect that as well. I know only too well what it is like to be dumped on by other CNA's and RN's but that really never "angered" me because I have a lot of patience and I am doing my job ultimately for the patient's and that is why I am in nursing. As far as the comment about treating CNA's with respect..... I do and I always say thank you for what they have done for me that night....I agree most of the time that does get missed. I also do remember though that the RN's I used to work under as a CNA expected the things from me and I never questioned them or not did them. As far as the training goes to do blood sugars, I went through the same training that these CNA's did and parameters are given, that goes for blood pressure as well. The CNA's are trained on our floor to report O2 sat's less than 90% is a reportable finding to the RN and any blood pressure less than 100/60 is also a reportable finding due to the blood loss in these orthovascular surgeries. The pt I was describing to you had an O2 sat of 86% on 3 liters of O2, a blood pressure of 86/44 and was receiving two units of autoblood and had received cellsaver blood from the orthopat machine in surgery/PACU. The CNA's are required to listen to report with the externs and the RN's and the RN's/extern's highlight specifics that need to be done for that shift, so I find it baffling when they just don't do the things that are asked of them. I do not just go about my business when a CNA tells me something, I am not that type of person, I do believe respect is a two way street and I don't take the job that CNA's do for granted, I ws there and I do know how it feels. I have been doing my own blood sugars when they aren't done on time and as far as blood pressures it only took once for me to get "burned" on that, i alays have a blood pressure cuff in my pocket. I just don't feel I should have to do 2 jobs for 1 and it does take away from the time where I could be learning new skills. That is the reason I took the extern position, so that when I do graduate in December I will spend less time on orientation and more time doing what I've wanted to do since I was 5 years old! LOL!! Thanks for all the replies!! Leah
  8. by   Ortho_RN
    Well if the CNA's just aren't doing what they are suppose to, then they do need to be corrected... Especially if these are CNA's that know what to do.. I myself have encountered people who are just their to make a $$$, but I feel most are really there because they enjoy the patients and the medical field... Also I don't know the Patient Ratios on your floor.. But I also work on an Ortho floor, and me as a PCA, can have up to 15 pts to myself... Usually no less than 10... And the RN's only have 4-5pts each... So that needs to be take in to account.... If things aren't done RIGHT when the nurse orders... I feel as long as you remember where you started and always treat people with respect things will be fine.. But then again, don't let people get away with improper care....

    Heck I a few weeks had to turn in a LPN for giving the wrong pt insulin and not doing anything about it.. Just pretending it didn't happen... Luckily the pt was fine.. But regardless of our titles we are there for the patients, so we do what we must for them..
  9. by   GPatty
    You know...I do have to agree with doing 2 jobs for 1 person. Have you talked with the nursing supervisor about it?
    If they don't do anything....then I would still do my own glucometer checks and vitals...
    I guess I just wouldn't want to rely on someone else to tell me something about my patient.
    But the patient you described.....something should be done about that CNA. That's just wrong to NOT report something like that....

    Good Luck to you!
    Julie
  10. by   Love-A-Nurse
    i do my own vital signs for the patients when it is something i need to know "now".
  11. by   Fgr8Out
    Leah,

    Continue to assert yourself and report to your CNA those items you need to know about your patient's status. Make sure you give a time frame, "I'm concerned about Mrs. So-N-So's blood pressure (temp, pulse, etc...). Would you please let me know what they are as soon as you've taken them?", or something similar that shows you see yourselves as a team in the care of this patient. If the CNA doesn't follow through, be certain to remind them, "Do you have the vital signs for Mrs. So-N-So?"

    We have a few primadonna types on our Unit... (Rn, LPN and CNA's alike)... who seem to take issue with being given instructions... seems they feel as if they are being ordered around. Let's not forget folks... there is a chain of command and each and everyone of us has a role in that chain. If your job is to take vital signs, you're obligated to report these to the LPN/RN just as an LPN/RN is obligated to report changes in a patient's status to the Physician.

    Make sure, Leah, that you take time to talk one on one with whoever is responsible for vitals, etc with your patient's. Let them know what your expectations of them are and hold them accountable for their actions. If they aren't meeting these expectations and if the RN you're working under isn't offering you assistance in making this CNA accountable, take it to the next level and direct your questions to your Supervisor/Manager.

    We're a team, people... and everyone has to do their part to keep things running smoothly.

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