Above and Beyond Scope

rn/writer, RN · Apr 19, 2008

Every CNA's mantra should be, "Communicate with the nurse. Before you do whatever."

mscsrjhm · Apr 19, 2008

If CNA #1 informed CNA #2 that the nurse had been made aware of the low blood sugar, there is no excuse for the CNA to perform any type of unauthorized intervention. A verbal reprimand or reminder is in order.

chenoaspirit, ASN, RN · Apr 22, 2008

I would want my CNA to give juice and sugar instead of waiting for me. As a diabetic I would want anyone to give me sugar if I was low-it's a horrible feeling I wouldn't want to wait for an RN to approve me having juice. I think you had a good CNA and should appreciate them taking initiative(sp?)

I agree. As long as the CNA has a background of good teamwork and is a good worker and doesnt try to go behind your back, I would definitely appreciate her helping. If she is one of those who is trying to play nurse and has a habit of doing things without informing me, that would concern me because I would wonder what else she does without my knowing. Some of our CNA's dont even bother to tell me when they do FSBS and one is low. Like one said, I would rather have one in the 200's than to have one in the 20's. Im wondering though, someone said that OJ with sugar isnt a good response. Thats what we do on our floor. Then we follow up with FSBS q 30 minutes until its stable, then q hour, then back to normal schedule.

Home Health Columnist / Guide · Apr 22, 2008

Problem with OJ and sugar combo (depending on # of sugar packets added) is often rebound hyperglycemia, then a quick drop later if protein/meal not eaten. So pt can be having yo-yo effect of hi and low blood sugars over a day --or several days, if this treatment pattern OJ + sugar repeated.

rebelgirl#1 · Apr 22, 2008

Wow,

I am surprised by how many people think that some sort of action should take place. How about education on the new ADA standard for bringing up blood sugar. Then everyone is on the same boat, and the CNA can continue following the standard of care and what is reflected in your facilities policy.

How about asking the CNA why she did that and then education, followed by verbal warning if needed. I worked for many years as a cna, followed by many years in the military. The best leaders gave a quick short explanation.

Maybe the other CNA is stirring the pot. Just a thought as I have several of those where I work now.

Medsurg Mama · May 25, 2008

While I am happy that so many of the staff quickly attended to this situation, I am also horrified by the actions of Cna #2, she may have been quick to respond to a low bs, but as a cna she has not been trained to assess the patient. She should report abnormals and respond only as instructed. My grandmother died as the result of being treated with juice and sugar as she was too lethargic to drink and aspirated, she wasn't coherent enough (bs was 21) to cough and basically drowned in a rehab center on day #2.

Atheos · May 25, 2008

Many places have a set procedure for when a patient has low blood sugar. The CNA shouldn't be given a reprimand she should be educated. While you say OJ and sugar is not recommended anymore MANY nurses still do it. The CNA may have been trying to be helpful. It would be more constructive to have an in-service and explain the proper procedure and WHY it is the procedure. If they do it again then there is cause for discipline. Also, depending on which state and what type of facility this occurred in, it may not be out of their scope.

The lesson here is that the CNA may have assumed what she was doing was correct, don't make a situation worse by assuming. Explain the situation. Lead by example. Better yet, set up a facility policy that explicitly states what the CNA is expected to do and not to do.

Sometimes people get into a routine and forget to think.