CNA scope of practice - page 2

I was looking at one of my pt charts (paper charting) the other day and noticed one of the CNAs had charted a pain assessment on the flowsheet where they usually chart the vitals. There is a space for this allowing a numerical... Read More

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    Quote from sweetnurse63
    ...Suppose the patient is alert, and tells the cna/pct that his pain is 7/10, the cna records it, then the nurse goes to patient room, lets say in 5 mins and the patient now says the pain is 10/10. I would rather write down my own pain value, because upon assessment, there may be an emergency, that is causing pain, such as, peritonitis or small bowel obstruction or anything.
    Why can't you just chart that? Chart, "Pain reported as 7/10 to CNA staff. When patient was assessed by nursing staff/me, patient's pain is now 10/10. _____ Intervention done/med given. Recheck 30 minutes later pain reported as x/10."

    Pain scores are just numbers, easily relayed to give quick information about the subjective pain that patient is experiencing at that moment. Pain is the fifth vital sign, and as a CNA it is in my scope of practice to take and record vital signs, reporting anything abnormal to the nurse. It is reasonable for that number to change between reporting to the nurse and the nurse getting to assess the patient (just as pulse and BP and RR may change quickly - it doesn't mean not to record and report the abnormal value at the time it was taken!)...

    To me it is no different than an abnormally high or low BP - I record it and report it to the nurse - then the nurse can reassess and treat using nursing judgment.
    Last edit by juliaann on May 9, '11
    PatMac10,RN, cnabeauty, JDZ344, and 3 others like this.

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  2. 0
    I think it is okay for the CNA in a LTC to ask the patient about pain level if it is clearly written in the Policies and Procedure of the facility. However farther assessment should be done by the nurse legally. It would be different in a hospital setting because the patients are acute and need more assessment.
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    We are required to ask about pain at least every time we do the vital signs. There is a box for it on the sheet that we are required to fill in fully. We rate it 0-10. For patients who can not verbalise pain, there is an additional flow sheet that the RN is supposed to do every 2 hours, checking for non-verbal signs of pain.
    Mrs. SnowStormRN likes this.
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    I have been an EMT/CNA for almost 20 years and I have never been able to record pain in any written form, but is required to report it to a liscensed professional such as LVN/RN. I feel that as a CNA that unless there is more education added to the training we recieve we should not have to "document" things like pain due to the liability to asses what needs to be done next as far as medication or possible x-rays/lab draws/treatments. I feel that the liscensed nurses need to deal with this type of thing.
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    I agree with many of the intial posters. I've beea CNA in NC for almost a year and in my CNA ass in high school we were taught that Pain was the "extra" vital sign. At the hospital I work at we do every- other-hour rounding between the RN and CNA so when we g in we are supposed to ask if they need anything or if they are having any pain and where at. If we, as CNAs, find they do have pain the hour we round on them we report it to the RN and then chart what was said and did, in case anything concerning the legal stuff comes up.
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    reporting to the nurse is appropriate, just like taking blood sugar. What would not be appropriate is asking questions to determine the cause, intensity of the pain (assessment).

    BTW: CNA's do not have a scope of practice because they are not licensed. They have certificates and are delegated tasks by licensed individuals. Your state's health dept outlines their education and your facility SHOULD have a policy about what the CNA may do that falls within that frame of education.
    Mrs. SnowStormRN likes this.

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