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

[GaMBA]

I've been working as a tech on a med-surg floor for about 3 months. This is my first real job as a CNA and I've been kinda surprised by a few things. Just wanted some feedback as to if these things are typical of nurses in general, or maybe it's just where I work. I work with some really sweet people--nurses and techs--I've just noticed a few things that surprised me:

1 - I didn't realize how little time nurses actually spend with their pts.

Since I do the actual pt care, of course I end up spending a ton of time with my pts, getting to know their likes/dislikes, ailments, family etc, especially when I work 2-3 days in a row and see the same pts over and over. But the nurses I work with don't seem to be nearly as familiar with the pts. In fact, oftentimes they'll seem surprised by half of the things I tell them. It seems like my pts have more trust in me since they see me most of the time. They'll let me know if something is wrong and when I say "Okay, I'll let your nurse know" I usually get a smirk and an eyeroll, like "yeah right." It's a little scary how little faith these pts sometimes have in their nurses, as if they think the nurses don't care about providing them with care/relief. Is this normal? Just a wrong perception maybe?

2 - I don't understand the lack of communication b/w the nurses and techs when it comes to pt info.

Out of all the nurses I've worked with over the past 3 months, there are only 3 who actually give me a report at the beginning of the shift about each pt. On my unit, the techs give each other report, and the nurses give each other report. It's not often that a nurse will also let a tech know what's going on with their pts. To me, this doesn't work out most of the time b/c I'm usually clueless as to labs/specimens that need to be collected (ie what, how many) as well as any diseases these pts may have. Just the other day I had a pt that had AIDS, full blown AIDS and I didn't even know it until my 3rd straight day of working with him. And I only found out from the night time tech, not the nurse I'd been working with for the previous 2 days. I have to admit that ****** me off. I asked the nurse did she know he had AIDS, she said "oh yeah, he does." Hello? Perhaps it's just me who's missing something here, but I think a nurse should let her tech know about stuff like this. I know I would.

I also find it entertaining when a nurse will ask me 1 hour before my shift is over if I collected any specimens yet. Ummm, specimens for what? How many?? I wasn't aware that I needed to get them. You never told me! Total lack of communication.

3 - I am amazed by the aversion to pt care and the lack of pt care skills that some nurses have.

A couple of the nurses I work with (and by couple, I literally mean 2) will actually do pt care for their pts. They don't wait on the tech to do everything. If they're in a room with a pt who has a dirty diaper, they change it, or they call me and together we clean up the mess. How sweet these ladies are! I understand that nurses are busy, but so are all the rest of us. And sometimes, I need help with pts, especially larger ones who I can't move by myself.

With the exception of the 2 nurses mentioned above, I have never seen a single one of the other nurses on my floor help out with pt care. They leave every single thing to the techs. There is this one nurse, bless her heart, who will at least offer, but when she attempts to help, she never knows what to do and just stands there looking at me and asking ME (the relative newbie) how to do basic things like getting a diaper under a pt or putting new sheets on an occupied bed or scooting a pt up in the med. Isn't that stuff Nursign 101?? At least this nurse OFFERs to help. I appreciate that since several of her colleagues wouldn't even think of it.

4 - I don't mind helping nurses with things that are out of my scope and part of THEIR job, but please don't expect me to do it simply b/c you ask and can't get around to doing it yourself. It's still YOUR job!

I am taking prereqs for a BSN program, so I am trying to get all the experience I can. I pimp my job to the fullest and take advantage of every opportunity for learning and exposure. I'm always there for wound cleanings, all the nasty stuff, anything that'll help me learn more, I love it and I usually don't mind doing it. But sometimes I don't have the time to indulge myself. I have this one nurse I work with who is always behind on her work. i know this because she constantly informs me of this throughtout the day, every day that I work with her. So what she does is throw as much of her work on me as she can get away with. "Can you clean so-and-so's wound?" Sure, I'm a tech and it's out of my scope of practice but I am more than happy to do it if I have time (as a tech, where I work I am supposed to only be able to apply clean dressings to a wound, not actually clean it, that's the nurse's job). "Can you look up so-and-so's lab results and tell me what they are?" Wow, sorry, Mrs. Nurse, not only do I not have the time to do that today, but I don't even know what the heck I'm looking for. No can do! "I need you to find out if there are any dr orders to d/c that foley today!" I have no clue how to even begin doing what you asked. Where do I look? What am I looking for? I'm new, I'm a tech, and this industry is new beans to me. WHat where why HUH??? I'm afraid you'll need to do that yourself sweetheart. Maybe take the time to show me next time? Thanks!

With all that said, I enjoy working with the team I work with and at this point probably wouldn't trade them for the world, but it has been an eye opening experience to say the least. I'd love to hear you all's thoughts on this!

[NRSLDT]

I am responding to your observations and it sounds like you deal with semi-cocky nurses with bad habits:down:. Before you care for a patient you should get a report. According to HIPPA, you do not need to any info on your patient except as a need to know bases. You should be able to care for any patient using universal precautions or whatever isolation ordered. If you knew the patient had AIDS would you care from them any differently? Depending on the type of nurse a person may be also depends on care. Some nurses do not like to get attached, they get tired of the frequent flyers or they do not want to become distracted with their daily assignment. Honestly, some are just witches. During your CNA experience remember what you are doing and what type of nurses you are working with- think of what kind of nurse you will be. CNAs do spend most of the time with patients learning personal info . A nurse is well capable of providing pericare and/or toileting a patient.

[BellaDestiny]

You bring up a lot of good points! As a nurse, I would really love to have more time to get to know the patients as much as my cnas do. Unforunately, with 19 patients most of my times goes toward med pass, treatments, charting, doctor calls, and such. I really do depend on my cnas to be my eyes and ears. I've helped my mother start a company teaching cnas and this is one of the first things I tell them. I also try to help out the cnas when I can, but unfortunatley, the company I work for doesn't like us to have overtime, so my time is very limited. Please keep up the good work that you do! It is appreciated by most, although I'd like to say all, nurses!

[nurse-lioness]

I just want to say that I really liked reading this topic and its comments. I learned so much and it also made me laugh because some of these stories I've actually experienced. Yes, it really does get so busy working out there in this type of work but I'm just saddened that the nurses weren't portrayed so well in the original topic. Well, nurses really are very busy most of the time. I think that's why they really can't spend so much more time with their pts than the tech would, even if they would like to. It's hard to explain all the detailys why, but anyway I think that it was just lack of effective communication on both parties. I wish the tech would open up and say how she feels about the situation with the nurse. I'm sure they can work things out better if they let each other know how they feel, then maybe they can find ways on how they can help each other.

[R*Star*RN, BSN, RN]

Where I work we have an all RN staff. That means the RNs do ADLs with the patients, toileting, feeding, etc. I don't mind doing, and I know how since I was an aide for 7 years, but there are other priorities and sometimes the basics don't get done. Patient A is having a heart attack, sorry but patient B is not going to get turned on time. Sometimes I wish we had a CNA or 2 to help out in times of need.

[Crayola]

I would have to say that your observations about some nurses (not all) and pt. care is true. I'm an RN and I'll admit that I'm not the best with basic pt. care. I used to work on a floor where we had great CNA's. I was always happy to help the CNA with patient care if they needed it. But normally I was so busy running around taking care of all my patients doing my RN duties that there wasn't time for me to cover all the basic pt care tasks. I work in the ICU now and there are no CNAs in the department at my hospital. So I have now become better at basic pt care tasks. Although, I'm still not the best at it. I still feel a little clumsy compared to some of the CNAs I've worked with.

[Farrah4, RN]

ps I know what you mean, I am a nurse and really strive to be like the "two" nurses that do pt. care too. But nursing definitely has changed since I started, acuity has increased, pt. load has increased and staffing has decreased, unfortunately I think burnout is to blame, somethings gonna give, its become a very stressful career nowadays

[EBibeault]

I agree with you. The NA's should be looking at the orders.We all have access to the same information via computer. Our change of shift report is more like lets see how loud the room can get. Really! The NA's and techs are out of the room before report is begun sometimes let alone willing to sit through and here it being given. I work on a very busy spinal cord inury unit and sometimes our patients are with us for months at a time. Some NA's do check the patients orders each day that they come in but there are those that don't. I am frustrated with the fact that Mr. X has been getting an AC & HS blood sugar for the last 6 months and when I look at the chart to see if they need insulin, there is nothing charted. When you ask the NA, I hear, "Oh he gets a finger stick??" AHHH ya, like he has for the last 6 months.

Now of course I am going to let the NA know if something has changed in the orders. I'll say, "did you see that Mr. X is now only getting his finger stick once a day?" or whatever the change is. Sometimes I think it's easier to just do it all myself. I don't want people mad and with attitudes so sometimes I just run myself ragged doing what needs done just to avoid a problem. It is about my patients, they deserve good care at all times, not just when everyone reads the orders.

[Equinox_93]

If I were caring for an HIV patient, I would take the extra precaution of using a gown as well as my gloves if I were doing anything that may result in fluid contact. Particularly if said patient had a history of seizures, combative behaviour etc. To me, this IS "need to know" information. This extra step doesn't compromise patient care, it merely gives me a greater sense of security. After you've been in a situation where you didn't expect to be in contact with someones bodily fluids, but due to other medical issues (in my experience, both seizures and combative behaviour) and you *did* have fluid contact- it makes you doubly cautious and I feel that people have the right to protect themselves to the degree that they find most appropriate. MHO.

According to HIPPA, you do not need to any info on your patient except as a need to know bases. You should be able to care for any patient using universal precautions or whatever isolation ordered. If you knew the patient had AIDS would you care from them any differently?

[Virgo_RN, BSN, RN]

If I were caring for an HIV patient, I would take the extra precaution of using a gown as well as my gloves if I were doing anything that may result in fluid contact. Particularly if said patient had a history of seizures, combative behaviour etc.

That's not an extra precaution. Using a gown when contact with certain bodily fluids is anticipated is part of Universal Precautions. The reason they're called "Universal" precautions is that you use them with everyone. Thus, you do not need to know HIV status.

http://www.cdc.gov/ncidod/dhqp/bp_universal_precautions.html

[markisrn]

It sounds like you feel a little unappreciated. I'm sorry for that, because it sure seems like you are a great CNA with her heart in the right place.

I have certainly walked a mile in your shoes. Believe it or not, when I started in healthcare, there was a hiring freeze on nursing. We had too many! So when I was in my last year of nursing school, I took a CNA job on the Med-Surg floor, so I could get my foot in the door as a nurse after graduation. I think because of this, I have always tried to be a good care partner with the techs that I worked with. I am in ambulatory care now, but when I was still in the hospital, I always prided myself with working with the CNAs making sure my total care pts were buffed and polished. I miss those days.

In defense of nurses, however, I was really surprised at how my job changed when I became a nurse, and how hard it was to get everything done before shift change. I was much different than what I did as a CNA. Our patient loads were pretty high, and I am sure haven't gotten any lower in light of the current staffing shortages.

Hang in there, and always do your best work regardless of wheter all of your co-workers appreciate you or not. I promise your patients value your attention to their care, and appreciate you, and that's what counts.

[Virgo_RN, BSN, RN]

The notion that the CNA spends more time with my patients is something that I am not experiencing. I know that I spend more time with my patients than the aides do. I like when the aide comes to report an observation about a patient that I already know about, because it tells me they have actually been in that room.

To the OP, I really can't speak to every individual nurse that you work with, but in my experience, when I am in a situation where I have to delegate patient care tasks to the CNAs, it is because I am getting my butt kicked. Some aides do have a tendency to shoot daggers at me, as if I am just being lazy or passing off work to them that I don't want to do, and I know this is because they do not have an understanding of all that I am juggling.

Just last night, I was on the phone with a cardiologist regarding a patient situation, and the CNA gave me a dirty look because I was "ignoring" a call light. I'm sorry, but I am not going to put the cardiologist that I paged at home on hold to go answer that call light. What was hilarious to me was when the aide came to me at the end of the shift to report the patient situation to me that I had been dealing with ALL NIGHT!

In my experience as a CNA, I noticed that some nurses will work you harder than others will. My suggestion is to give the nurse the benefit of the doubt. It could easily be because they are slammed and they need your support. I am sure that there are some nurses that rely too heavily on the aides for lesser reasons, but I caution you not to make assumptions that it's because the nurse just doesn't want to be bothered. I know that for me, that is just not the case, and it adds to my stress when the aides behave as if it is.

[Equinox_93]

That's not an extra precaution. Using a gown when contact with certain bodily fluids is anticipated is part of Universal Precautions. The reason they're called "Universal" precautions is that you use them with everyone. Thus, you do not need to know HIV status.

http://www.cdc.gov/ncidod/dhqp/bp_universal_precautions.html

Yes, I am aware of universal precautions, and yes- it is an "extra" precaution. For regular care, one doesn't gown up to do nail care or showers or transfers etc. The CDC states "Gowns or aprons should be worn during procedures that are likely to generate splashes of blood or body fluids requiring universal precautions." Is it LIKELY that the aforementioned tasks will generate splashes of blood/body fluids? No. So according to the CDC gowns are not necessary as part of universal precautions. However, given my life experience and having had contact where it has not been expected, I feel that such information is necessary. Gowning up for every patient would be wasting resources unnecessarily, costing the facility alot of money and myself (cumulatively) alot of time. If the status is listed and a marker is utilized (sign on door, circle marker etc.) then the same practices should apply to HIV as any other condition. If the condition is shared with the caregivers for, say, C-diff- it should be shared with HIV. If nurses are made aware of HIV or condition specific risks, CNAs should be made aware of this as well. HIPAA protects privacy, so making caregivers aware of status doesn't change that- it's just a different interpretation of who "needs to know". I'm saying that anyone providing hands on care to the patient "needs to know".