I am still a fairly new nurse, including one year of experience in Skilled Nursing, which is my current field.
One of my weaknesses is in figuring out the best way to transfer patients in difficult situations, such as after a fall. Often my CNA's have better ideas, and make better decisions, than I do about how to move the patient. It is humbling, since after all, I am in charge and the leader. (I don't mean that my CNA's don't listen to me, but rather, they figure it out before I do, and come up with a plan better than I could have.)
There have been some falls where I felt absolutely clueless about how to get a patient off the floor, and I had to rely on my CNA's to take the lead in creating a plan. But this isn't rocket science! Why am I struggling with this? I feel dumb. Maybe it's the stress and spontaneity of the whole situation that is blocking me?
Currently, I just do the best I can as a leader after a resident fall, and even when I don't feel sure what to do, I remain calm, helpful, present, communicative, and supportive to my CNA's.
How can I get better at my competency and critical thinking skills in this area?
At our facility we have a policy dictating that we have to use a vanderlift to transfer a patient after a fall. If someone has an obvious serious injury like a potential hip fracture, the paramedics transfer the patient off the floor.
It depends on the policy of your facility. It may be that your CNAs are more familiar with the policy, or maybe they're making it up as they go along - either way, you should definitely know the policy. If you're in a no-lift facility, then they should be utilizing a mechanical lift (in our facility, this is a total lift) to get a resident off of the floor. We do have a few residents that, due to psychiatric conditions, a mechanical lift would not be a good option for or may be more likely to cause additional injury, and our CNAs know which residents these are. Your role in a fall should be assessing the patient for any potential injuries and using this information to direct the activities of the CNAs (in addition to doing important things such as dialing 911, notifying the family, calling the ED to give report, etc.) I personally do not allow my CNAs to move any part of the resident until I've fully assessed them. In situations where they've severely injured themselves, I wait until EMS arrives before assisting them w/transferring the resident.
I'm an "old" nurse and there are still many situations where I struggle while the CNA's handle it efficiently.
There are great videos on YouTube that deal with nursing basics, CNA care. When I went to school it was implied that I would be the "team leader" and the CNA's would be doing the basic hands on care so I wouldn't need to know that stuff! We we're discouraged from working as CNA's because we'd have role confusion!
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