A few observations about the nurses I work with from a new CNA...

psalm, RN · Apr 1, 2009

Kind of off-topic, but related, lol. I had a doctor come in at the end of my shift and tell me "this should have been done hours ago; why wasn't this done; how come this hasn't been done?"

I agreed with him and told him I could only answer for the time I came on at 2300...that if he wanted to know specifically why A, B, C, D etc. wasn't done he'd have to ask the nurses before me. BUT then I said: " You know, Dr., this is a very busy floor and each nurse has 7-8 patients and most are high acuity. This isn't ICU where we have 1-2 patients. If things weren't done, there must be a good reason, let's look at the MAR; when the orders were written and when they were noted & reviewed."

I got the stuff I needed and it turns out that some of the orders he wrote in the chart were staggered...He ordered one antibiotic specifcally before the 2nd. Turns out the 1st antibiotic wasn't sent up until hours after the 2nd was ordered so the nurse before me went by his orders and was waiting for the 1st drug to come up.

But the kicker was his orders...turns out this doc had possession of the patient chart for about 3 hours. I pointed this out to him...it shows here that you wrote these orders...but there is no sign-off between the orders so the unit clerk or nurse wasn't alerted to some of these orders til hours after you wrote them becuase you had the chart.

This was something this doctor was known for, hoarding his patient charts and then sometimes even forgetting to put them on the rack for the unit clerk...we'd find charts all over the nurses station and even pt. rooms!

So we all have to work together for the patient.

Aquamarine · Apr 1, 2009

with my last pregnancy at age 40, i was hospitalized for 12.5 days due to severe preeclampsia... as a former patient i have to say the nurses who took care of me inspired me to go back to school (i'm a pre-nursing student at the age of 42). the cnas were wonderful too... but when no one was "watching" it would be my nurses who would "pop-in" just to see how i was doing after their shifts were over...
everywhere you go you'll find people who don't like their jobs... even some nurse... but the most important thing you have to remember is the job you are doing :) you sound like a wonderful cna and because of your life experience as a tech you are going to be an awesome nurse!!
good luck to you :wink2:

it is exactly that kind of appreciation that is our real reason for taking care of people. what keeps us going when it isn't so easy. thanks for that.

LelaRN · Apr 1, 2009

OK.....I'm gonna try to keep this short, but I had to speak up, I was a CNA in both Nursing Homes and Hospitals, prior to becoming an RN, I know both sides of this well. In general I've found that bottom line, nursing can be a hard job, you can literally give it your all for 12 hrs, and somebody will still find something to complain about. I show respect for my techs by giving report and helping with hands on care, after all -that patient is MY RESPONSIBILITY. I manage my time so that I can be at my pt.'s bedside as much as possible. RN's, LPN's, Tech's-- you notice we are always going at each other, but you will NEVER EVER, see the Dr.'s complain and bicker about each other the way some of us do......hmmm.....food for thought. That's just my 2 cents:twocents:

Equinox_93 · Apr 1, 2009

I hope no one takes offense to this but I feel I must say it. Techs are there to help support the nurses NOT the other way around. Nurses are the ones putting their licenses on the line when they delegate.

... And CNAs are putting their certification on the line if they accept delegation outside of their scope of practice. Unfortunately that happens fairly frequently. What was the point there?

Yes- this is true- that aides and techs are there to assist, but you see- the nursing assistant is there to assist the nurse in her nursing duties. Therefore- if a nurse is assisting the aide in HER duties, all the nurse is actually doing is picking back up the duties that are already her own. Once upon a time, the duties carried out by the CNA were the responsibility of the nurse. The position of CNA was created to better use the nurses time. The issue of prioritization demands that the nurse attend to the duties that ONLY she can do FIRST- but if those are done or there is a lapse between, the duties that the aide is performing are still the nurses duties- she just has someone else (the aide) to *assist* with them. The simple fact is- there is alot that needs doing- and both nurses and aides have a very hard job, are overworked and underpaid, and both are busier than they probably should be in many cases. Think about it- if the "little things" aren't done in a timely manner- (with assistance when assistance is needed by whomever is available) things can back log and affect more than just that patient/aide/nurse. Also- the "assisting the assistant" bit isn't nearly as much about assistance to the aide as it is keeping the patient comfortable and cared for. If everyone is doing their jobs- this shouldn't be an issue for *anyone*- to be able to help if one is able to. No one is suggesting that nurses drop everything to play fetch- but IF THEY ARE ABLE- then it seems fitting that they do. IF everyone IS doing their job- and the nurses are run ragged and the aides are needing assistance that isn't there- then there is a problem (and hey- we probably all can agree that there IS...) So- rather than biting back and forth between nurses/aides- all healthcare workers should focus the attention and frustration where it is due, and express the problems to administration and to the State and work together to find effective solutions. If we're sitting here complaining back and forth to each other- we're not getting anywhere. Let's start taking that time/energy and focusing it on the *real* problems (such as unreasonable expectations, staffing, etc.). MHO. One poster already commented that they were inspired to start giving report to the aides on their unit. Good for them! :) I hope that poster will come back and update in a few months to let us all know how that experiment is working out for them! If it is successful- perhaps they will take those findings to others up the line and a facility wide change will be implemented. Maybe others will follow suit. THAT is constructive. :)

FixThebody · Apr 2, 2009

i have always believed that to be a good nurse you must be selfless. only the patient counts after all,,, that is the pledge we take. no, i always put the patient first. i never go home without communicating regardless of my kids. i made arrangements for the kids.

sure it makes some people mad including some doctors but i refuse to compromise my morals and as a professional my morals make the patient my number one priority while at work. i have never and will never do it for the sake of capitalism or the legal beagles. the rest is their problem to deal with as they wish. i only work for the patient. the paycheck is secondary but i sure can use it.

Aquamarine · Apr 2, 2009

of course but you still have to follow the "rules of the house" ...I didn't one night and took care of the man that needed to be cathed, the lady with the weeping wounds, the anxious lady who was crawling over the rails, etc. I had 10 patients, no clerk, no one but me and one other nurse and 10 pts each, it was horrid. there was a doct that came back from Disneyland with her kids walked on the floor after dinner time and wrote new orders for everysingle patient. I gave meds late because it was impossible to get all those orders to pharmacy, etc. And I got written up. Also got written up for giving Tylenol 30 min too early. When we had blackouts here and they couldn't get a Rn to go to work, I brought my dog to safety, brought candy (the only food left in the stores) extra clothes, shoes, and whatever I had to help, and worked on the floors to help out, waded through water in the parking lot, etc. Do you think they gave me a good referral? I don't know how some people live with themselves. I would do it again I guess...but would never work for the Catholic Health System again. They can say all the prayers over the loud speaker that they want, but they don't respect their nurses in this area.

kbnocturna · Apr 2, 2009

I haven't read all 12 pages of comments, so I'm sorry if I'm repeating something someone else has already said.

I completely understand where you're coming from. I have worked with some wonderful nurses, who will go out of their way to do their job, regardless of the distinction between tech work and nurse work. It's about the patient. And then I have worked with other nurses, who seem completely helpless without a tech. My favorite in recent memory is the nurse who went up and down the hallway for at least a minute, calling my name, because she wanted me to get a sign for a patient's door stating that they were a daily weight. Never mind that I was in a patient's room, fully-decked in isolation garb, helping my patient with C.diff who had had yet another bout of diarrhea in her bed. It's my general observation that people who complain about being behind all the time, would have plenty of time get caught up if they stopped running their mouths, and just got to work (sorry, soapbox rant over).

I've developed a strategy for taking care of my patients as best I can, and still covering my you-know-what: after I get report from the preceding tech, as soon as I am able, I approach each nurse, and ask them what specifics for patient care they need me to know for the shift. I have found that this

1) keeps me in the nurse's mind more, (s)he is more likely to inform me of what i need to know, or help me with patient care, throughout the shift,

2) helps me understand the nurse's perspective better, I can see who's having a bad day, who might need a little extra help, etc,

3) improves communication, which allows both of us to take care of the patients better, and

4) in the rare event that the nurse is just a crappy nurse, who can't do her job, and/or wants to try to blame stuff on me, I am covered, because I tried my best to communicate with her; and in the end, it's not my license.

Stoney52 · Apr 2, 2009

Welcome to the world of nursing! :nurse:

LelaRN · Apr 2, 2009

i had 10 patients, no clerk, no one but me and one other nurse and 10 pts each, it was horrid. there was a doct that came back from disneyland with her kids walked on the floor after dinner time and wrote new orders for everysingle patient. i gave meds late because it was impossible to get all those orders to pharmacy, etc. and i got written up.

see that's what i mean, this entire healthcare system is overwhelming in some areas. why should you be written up for caring for 10 pts. when there should be a national law that no nurse should have to care for more that 5-6 pts. (depending on acuity) we are liable for everything we do, whether we have tech or not.

johnsboo · Apr 2, 2009

In reply to the last post, I can tell you why the aides at the hospital where I work don't check the kardex. It's because the nurse supervisor caught one aide doing just that, and terminated her for hipaa violation. She claimed that it was not in our scope of practice to be looking at patient information meant only for licensed nurses. After the aide was terminated she held an inservice to inform the rest of us about this. She then stated that we are to get report from each other only, and if the nurse has information for us, it is up to the nurse to decide what is appropriate. So in this case, in seems to me that the nurse supervisor is actually making more work for her nurses, but she is also making sure that the aides "know their place". In doing this, she has made us all feel like we are worthless, and has given some of the nurses (a small number) more reason to treat us like second class citizens.

I don't know what the ruling is in your state on nursing practices, but it may be that the cna is not allowed to look at the information on the nurses kardex.

just thought it might answer some questions.

steve40 · Apr 2, 2009

I can relate to alot of what is being said. I was a CNA for 20 years, a medication assistant for 1 year, a lpn for 5 and have recently become a RN.

I think that the old verbage about "walking a miles in someone else's shoes" says more than most people realize. I try my best to always explain to and inform nursing assistants of what is happending with our patients, in addition to assisting them whenever possible. I think my attitude stems primarily from experiencing pretty much every spectrum of the nursing field first hand.

Valerie Salva, BSN, RN · Apr 2, 2009

I remember being so angry with a nurse when I was a CNA because I was making beds and she asked me to put a patient on a bedpan, twice. The first time she came in I ignored her and the second time when she came back I did it but I was mad as hell. I thought that if she had the time to ask me twice then she should have just gone and done it herself. I remember being totally ****** off and thinking that she thought she was too good to do it herself. Fast forward 10 years and now that I am the nurse I so understand and wish I could see that nurse now. I think that some of the CNAs I work with think the same way about me now. Here I am sitting at the nurse's station charting and asking them to toliet a resident or I go into a room to give a med or do a dressing and I don't change that resident...instead I will tell the CNA assigned to them to do it. Why do I do this? Is it because I think that I am above these tasks at this point? No not all all...it's because of time management.
You say well how long does it take to toliet or change someone 10 maybe 20 minutes?
If I stop to toliet or change 1 or 2 residents during the two hours allotted to me for med pass then I now have 1 hour and 50 or 1 hour and 40 minutes to pass my meds. Chances are I will be out of compliance. Not only that I will have my alert resident's on the call bell asking me where their meds are, calling their family members to say they didn't get their meds, and some even threaten to call the state on me for not given them their meds on time.
When I stop to do a task that I can delegate to a CNA then it puts me behind on my wound care. Maybe because I took those extra minutes trying to prove a point to the CNA the wound doesn't get done that day and then it takes even longer to heal or an infection sets in.
What if I stop for 10-20 minutes and go change that resident instead of administering a nebulizer treatment that is due and then that resident with COPD or asthma goes into respiratory distress?
What if I stop for that 10-20 minutes and change that resident instead of calling the doc or waiting for the return call regarding a critical lab value. Maybe the doc goes ballistic because it's a critical value that needs to be addressed immediately? Worse yet maybe it doesn't get done on my shift and the next nurse pushes it off and something happens to the resident because it never was addressed.
Maybe I should put off my charting and medicare notes to change that resident and then my shift ends. Should I always leave late to finish my charting (which btw management will not pay me for) or should I just not worry about all that silly paperwork since REAL patient care means cleaning up poo, making beds, and filling ice pitchers? If something happens to that resident I'm sure the BON or the judge and jury will believe me when I SAY that I did what I was supposed to do never mind all of the stupid documentation.
I'm not saying that CNAs don't have a hard job because I know from first hand experience working in a hospital and nursing home as a CNA that the job is damn hard. However don't assume that nurses have it that easy either. If the nurse has time to help the CNAs out then maybe she is having an easy day or maybe it's really costing her to spare those minutes. Some of those nurse's who try to do everything are always in trouble with administration for not getting their jobs done. They aren't leaving on time from their shifts and they are getting burned out from running around like chickens with their heads cut off. We nurses cannot do it all if we could you would be out of a job. Yes nursing is a 24 hour job but the oncoming nurse isn't going to put up with you giving them a laundry list of all that you couldn't get done during your shift every single day. Eventually they will report you to management and then management will come down on you for not getting your work done. When you tell them that you are doing tasks that can be delegated they will hit the roof and they will NOT accept it as a plausible excuse for not doing what you are licensed to do.

:yeah: :yeah: :yeah: :up: :up: :up: :yeahthat::yeahthat::yeahthat:

I too, was an CNA and am now an RN. I know exactly where you are coming from.