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

Virgo_RN, BSN, RN · Apr 2, 2009

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.

This is so very true. While fresh ice water may not be on the top of the nurse's priority list, it is pretty high up on the patient's. They really do appreciate the attention to their needs, and often I hear positive feedback about certain CNAs who do go the extra mile to make their patients comfortable. It's amazing how far a well-timed warm blanket will go. I really enjoy doing those "little things" for my patients when I have time, but I often just do not have the time, and appreciate when the CNA can step up. That's what teamwork is.

Virgo_RN, BSN, RN · Apr 2, 2009

Using "extra" precautions for HIV positive patients is discriminatory and based on ignorance and fear. As an RN, I am a patient advocate, and I will not advocate treating the HIV+ patient any differently than I would treat anyone else.

Shaka · Apr 2, 2009

I am very grateful for this posting as it addresses the truth about what is happening to our profession. I the 37 years I have worked in the health care profession I have seen these changes happening. I have attempted to let others know of the dilemma as the standard of care is so diminished, it borders on neglect in some cases. The nurses that choose to remain in this type of work environment are slowly burning their flame of compassion to the the end of the wick.

I have attempted to let the management know the conditions that are prevailing in the workplace, at the facility I worked at and the country. I was never heard. I was asked if I had personal problems at home. I was "told" that we "should" be able to do the work loads....with a smile and all knowingness, because we were taught to do this in nursing school. I was also written up by my peers, management, pharmacy, and all if I was not able to complete all of it. Due to my years of experience this didn't happen often but I saw other newer nurses that this happened to more frequentlly. This just added to the stress of getting the routine things done, let alone the emergency problems that came up.

It is time our practice was looked at in an honest light. We are sacrificing quality for quanitity more often than not. We are sacrificing good hearted compassionate people to the idea that we should be perfect and able to do work that should be done by 2 maybe 3 people. We try to work a standard that is a lie.

In the recent years I have worked I have noticed that those who choose management do less and less to assist in the delivery of care when things get overwhelming. If you can't count on those above you, it is necessary to count on the CNA's and techs to ensure the care gets done. It is the nature of the beast. There have been too many shifts that I wouldn't have made it had I not had the goodness of the techs and CNA's to help me. I let them know how important they are and how much I appreciate their assistance. We are a team with communication and understanding that this is the reality. We are not alone in the providing of care. We are all needed.

I have always made it a priority to communicate with all those who are working with me. I also have made it a priority to learn who my patients are and what is going on with them. I do rounds on my patients every half hour on any given shift I work. Though paper work needs to be done, my patient care is my priority, always.

I have to say that after all of these years I do not look forward to going to work in this environment any longer.

The system is in need of changes yet no one wants to change. It needs a revamp totally or else we will be facing some serious ethical questions in the future. This is becoming apparent now, as evidenced by the posting and responses.

How far down must it go before we wake up this fact.

Bless us all,

Shaka

mochabean · Apr 2, 2009

Unless a patient has open wounds, TB, VRE, MRSA, or anything else, we don't wear gowns. That includes all patients, whether they have HIV/AIDS or not.

Equinox_93 · Apr 2, 2009

Using "extra" precautions for HIV positive patients is discriminatory and based on ignorance and fear. As an RN, I am a patient advocate, and I will not advocate treating the HIV+ patient any differently than I would treat anyone else.

I disagree with that. Discrimination is treating someone unfairly or negatively. Donning a gown is not treating someone unfairly or negatively. Patients question why we use gloves- and gowns are no different. Wearing a gown is not, IMO, "treating someone differently".

Does your facility not use circular stickers or signs to alert staff to infectious conditions? So long as there is an alert to a (specific mode of infection here) risk- then that's all that is required. However- I think anyone involved in direct patient care should have the same information. If the nurses have the information, so should the assistants.

The point is- each person has to assess the situation they are dealing with at the time. If I know that a patient has HIV, but also has a history of combative behaviour or seizures- I'm going to go that extra step. Much like if one knows that a patient has C-diff, they may wash their hands twice. Some have been known to use bleach as well. If I'm doing a simple ice water fetching or pillow fluffing? No. But if I'm putting myself in a situation where contact isn't *likely* but is *possible*- I'm going to take the extra step if I know that there may be a reason to. Universal precautions don't tell us to do that. But they also don't tell us that extra handwashing is necessary (many nurses and assistants wash IN the patients room, in the staff room AND in the next patients room. Is there a handwashing police? No. Is there a glove or gown police? No. :)

sicushells, RN · Apr 2, 2009

Equinox93, you state that gowning isn't discriminatory because it isn't treating someone "negatively" (summarized). I disagree based on research that's been reported that shows that patients in isolation feel negatively about their caregivers and family members having to wear gowns/gloves/masks just to touch or interact with the patient. It promotes a feeling of emotional and physical isolation. (if i find the research article i'll post a link to it or the authors' names).

With that in mind, gowning and gloving because you "might" "possibly" be splashed with body fluid in a patient who has AIDS, which is an infection with such a negative connotation in and of itself, IS discrimination. It's not necessary. Wearing gowns, even in rational circumstances, has negative effects on the patient's psychological state, so why would you do it if you didn't need to. And you really don't just to file a patient's nails or shower them.

Virgo_RN, BSN, RN · Apr 2, 2009

Does your facility not use circular stickers or signs to alert staff to infectious conditions? So long as there is an alert to a (specific mode of infection here) risk- then that's all that is required. However- I think anyone involved in direct patient care should have the same information. If the nurses have the information, so should the assistants.

We have signs that denote transmission based precautions. The specific infection is not identified, in order to protect the patient's right to privacy. With HIV, transmission based precautions are the same as universal precautions, which are to be used with every patient, so there is no need for any "extra" precautions.

You can disagree all you want, but evidence does not support your assertion.

psalm, RN · 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.

HIPAA is on a "need to know" basis. And the aides need to know. What rubbish, that nurse superviser was way out of line.

JamericanRN · Apr 2, 2009

Everyone, thanks for your responses! I will definitely heed the advice of asking the nurses to give me report and staying within my scope of practice. To the last poster, Lovehospital, I assure you I am anything but ignorant. Yes I wear gloves with my pts but it's still nice to know who has what. The nurse should've told me the guy had AIDS, plain and simple I'd think any decent nurse would. And funny you should mention MRSA b/c when I had that guy with AIDS, I also had a pt 2 doors down on isolation with MRSA. Thank God I knew about that one! (she was transferred from another room and luckily the nurse that initially had her gave me a brief rundown on her).
For those of you that say I don't understand what nurses do on a daily basis and say they could do my job but I can't do theirs, no offense but I get so tired of hearing that as an excuse on here. I KNOW nurses are super-busy (like everyone else in the hospital is!) and I KNOW I can't do their job (which is why I'm in school working my butt off so that one day I can ) but that still does not explain why some nurses don't like to help the techs or pts AT ALL! If some nurses help out, why can't others? Clearly the ones who do help out have set aside the 2 seconds it takes to lend a hand every now and then, and they STILL manage to do all the nursing stuff they have to do too, so why can't others? I'm not always able to "get another tech to help" me. They're busy too, believe it or not.

Its so funny how a CNA can take their schedule lunch, 2 fifteen mins break, and at the end of the shift puts his/her pocket book on his/her shoulder mins to the hour the shift is over and dont even notice the poor tired nurse who didn't even had time to take a 10 mins break, still passing meds, charting, writing orders, calling doctors ect. just to name a few.

I understand we have to work as a team, but I'm sorry I can't do your job and mine as a nurse. Again you were hired to do basic ADls ect, yes the nurse can help you I understand that but dont expect the nurse to be passing meds and left her med pass to help you put Ms. Jones on the toilet, get another aid to help you..

And as far as doing things out your scope of practice, you are smart enough to figure out the nurse's responsibilities, you should be smart enough to know yours... you went to school for your CNA license I would imagine, you know what your scope of practice is. One advise to you is ask your supervisor to remind you what your scope of practice is or you will find out the hard way...

Goodluck with school, we need nurses......

GaMBA · Apr 3, 2009

I've read several comments on this board about how CNAs have no problem taking their breaks and leaving on time yet nurses rarely get breaks and never leave on time. I get the impression sometimes when I read these comments that there is some resentment there. People should take their breaks. It helps you to eat, pee, and supposedly minimize burnout, whatever your job is. And people should strive to leave on time at the end of their shift, no matter where they work. There is nothing commendable or heroic IMO about staying late or missing breaks. I understand that sometimes it's unavoidable, certainly moreso with nurses, but I think it is very unfair to make it seem like people are wrong for taking their breaks and clocking out when their shift is over. I am one of those techs that takes the two 15-minute breaks I am entitled to--yes, entitled and paid--to take, and I also make sure that I get my full 30-minute lunch break every single day that I go to work. Sometimes I may forgo a short break to take care of something, and sometimes I may leave my lunch and come back to it after addressing a fire drill that comes up, but more than likely if I am on break I will simply get someone else to cover for me. On my floor this is the norm so that people CAN take their breaks uninterrupted--nurses and techs.

I have always been of the mindset that your life, your job, your whatever, is what you make it. If I were to be at a job/facility where my time was disrespected to the point that I didn't get the things I need (whether it be pay, breaks, recognition, whatever), I would leave. Life is entirely too short and way too precious to be stressed out in a bad way about a job. It's one thing to be stressed b/c of the nature of the work itself. But when you come home stressed and stay stressed b/c of things that have nothing to do with the work itself but are due to stresses like a terrible boss, horrible coworkers, no breaks, unsupportive admin, etc, then it's time to go. You can't get mad at the people who have made a choice to not let their jobs run their lives. If it ever got to the point that I was expected to miss my breaks on a consistent basis at my job in order to get my work done, I would seriously re-evaluate whether that was the right place for me.

To those that say helping a tech every now and then for 2 seconds will cause their whole entire day to be shot, I honestly don't know what to say to you. I can only hope that I will be the kind of nurse to lend a helping hand when I can. Maybe I won't be able to help every time and maybe doing those infamous "ADLs" is not my primary job, but if I can pitch in here and there to make my pts feel more comfortable I will. Bringing people back to health (healthcare!) is a team effort and I think pts appreciate having their basic needs met in a timely manner while under our care.

johnsboo · Apr 3, 2009

As a student nurse, and a working CNA, I have been one for 14 years, I can tell you that there ARE nurses out there that do ask you or should I say TELL you to do things that are NOT in our scope of practice for the plain and simple fact that we are NOT trained to do them. You know as a nurse, even an RN, if you have not had specific training in a procedure you are out of your scope of practice until you have a competency validation for that specific procedure. There are aides that have completed certain validations and are able to do certain things, just as there are aides that are not.

When I went from long term care to a hospital as an aide, I was required to take accuchecks, remove foleys, remove peripheral IV's, remove NG tubes, set up and use suction equipment, and use a bladder scanner. I worked at the hospital for 2 months before a competency validation course came up for those things. I came up against a lot of angry nurses when I had to tell them that I could not perform those duties. Many told me that I was worthless if I couldn't perform the most basic aide duties. So, unless you are sure of just what each individual aide's responsibilities and scope of practice really is, you are indeed wrong, and you can be reported to administration for trying to force someone to do something they are NOT trained to do.

Equinox_93 · Apr 3, 2009

Equinox93, you state that gowning isn't discriminatory because it isn't treating someone "negatively" (summarized). I disagree based on research that's been reported that shows that patients in isolation feel negatively about their caregivers and family members having to wear gowns/gloves/masks just to touch or interact with the patient. It promotes a feeling of emotional and physical isolation. (if i find the research article i'll post a link to it or the authors' names).
With that in mind, gowning and gloving because you "might" "possibly" be splashed with body fluid in a patient who has AIDS, which is an infection with such a negative connotation in and of itself, IS discrimination. It's not necessary. Wearing gowns, even in rational circumstances, has negative effects on the patient's psychological state, so why would you do it if you didn't need to. And you really don't just to file a patient's nails or shower them.

Patients in isolation with masks also have the added problem of only seeing people's eyes which if we're thinking of the same study- IMO makes a HUGE difference. A gown and a warm face is FAR different than a gown and only seeing a caregivers eyes. Not seeing the face masks facial expressions which *does* lead to those feelings of isolation. It's far easier to connect when one can see a persons expressions etc. So I still disagree. That's OK though- we're different people