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

Equinox_93 · Apr 3, 2009

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.

Interesting- in most facilities I am familar with (granted not a large number- but more than a couple)- the specific infection is shared with those providing hands on care- nurses and assistants- as it is determined to be a "need to know" issue since they are in contact with said infectious condition. Evidence is interpreted by different people to mean different things. You interpret it your way- I'll interpret it mine. The "evidence" doesn't say that it is harmful, nor does it say that it is advised against. The study mentioned previously if I am thinking of the same one mentioned the issue of full PPE- including a mask- the psychological effects that hiding the full expressions and communicative benefits of seeing the caregivers entire face is a far different issue than just donning a gown. There is also no "need" to wash ones hands multiple times, or to wear gloves doing tasks that one isn't likely to be exposing themselves to contact, or to do a number of other things that nurses, assistants, doctors and other medical professionals do. But doing them makes some of us more comfortable so we will continue to do them- evidence or no evidence. So long as it isn't harming the patient, anyone who has a problem with that can take their "PPE police" badge and put it.... away :)

nursemike, ASN, RN · 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.

As I've noted previously, I'm fortunate to work with a very good group of aides, and we get along pretty well. But that has not always been the case, I've seen several who weren't particularly good, and a couple who were just terrible. No work ethic, no respect for patients, nurses, or peers, no business, IMHO, anywhere near a hospital.

If it isn't already clear, I don't believe the OP is one of those. However, in the course of the thread the OP has, inadvertantly, I assume, quoted some of the worst aides I've seen. For example, the assertion that aides do most of the patient care. It just isn't true. Handing someone a pill is patient care. Gathering several medications, evaluating whether they are appropriate to be given at this time, explaining what they are and what they are for, verifying five rights, and administering medications is patient care. (Most of my real-life med passes are somewhere between those two extremes--I don't have to do a dissertation on metoprolol every time I give one, but rarely do I get to just hand someone a pill, either.) Doing assessments is patient care. The formal, head-to-toe assessments I do as ordered are patient care, and so is sticking my head in the door to see how you're doing.

Even stupid $%&&**!!! charting is a form of patient care, albeit and indirect and sucky one. The nights I don't do much patient care are boring as heck, and rare as hen's teeth.

Differences in scope of practice are not an excuse. Legally, I have just as much right to do a bath or toilet a patient, or set up a dinner tray, as the aide does. But if I'm doing those things instead of the things only I can do, I'm negligent, and if I'm able to routinely do both, I don't need an aide. Personally, I am sometimes able to help out with some of those things and still get "my" work done on time. Sometimes I really can't spare the time, but I do anyway, because it's important, so I end up making for it doing some my work--usually that blasted charting--after reporting off to my relief. And I have--very, very rarely--had to do it myself because the worth-less aide flatly refused to his/her job. Oh, and the quickest job I've ever helped an aide with--pulling a patient up in bed--took more than 2 seconds. (OK, maybe 4 seconds, but still, and most have taken several minutes, at least.)

On a typical night, I'm pretty busy, most of the time, except when I'm charting. And I think charting should also count as being busy, since it a.) has to be done, and b.)sucks every ounce of joy right out of my soul. Being a nurse is both physically and mentally demanding, and usually, the physical demands are the easy part. Which brings me to an important point: Working as an aide can be physically more demanding than working as a nurse.

My previous, unlicensed job as a transporter/housekeeper/gopher/whatever else nobody else wanted to do was often more physically demanding than my present job as a nurse. But I've worked with a number of nurses who had jobs like mine, or worked as aides, before becoming nurses, and to a person we agree, being a nurse is harder. Because it is. Not every nurse works harder than every aide, and being a good aide is hard work. But being a good nurse is harder. Much harder. Also pays much better. That's not a coincidence. Don't believe the hype about "respected professional." Nurses make moderately decent money because they earn it. At least, most of us do. Don't get me wrong--most aides deserve more than they get, but they shouldn't imagine they have any sort of monopoly on being underpaid and underappreciated.

The OP wondered why some nurses are more helpful than others. I'll help when I can, or when I need to. I'll help an aide with a patient assigned to another nurse, usually because the other nurse is too busy. Sometimes the other nurse is busier because she/he wound up with a tougher assignment. Sometimes the assignments are balanced, but the other nurse is less experienced and having a hard time keeping up. Sometimes I just happen to be closer, or the aide may ask me because they like working with me. Whatever. As I said, I work with good aides, and I respect good aides.

I extend that respect to the OP, but also recognize that the OP is new. It's possible the OP works with a crappy bunch of nurses. It's possible--likely, even--that the OP doesn't realize how hard nurses actually work. Some are so good, they make it look easy. Some are so poor, they make it easy by skipping large chunks of it. Most of us are doing the best we can and respect our coworkers who are doing the best they can. But Jamerican isn't wrong. It's human nature that we are all most keenly aware of how hard our own jobs are, and that's okay, but by far and away, the worst aides are least respectful to nurses, no doubt because they don't respect themselves.

I'm not saying I believe that applies to the OP. But I'm giving some benefit of the doubt, here, because I know for sure I'm not the only nurse who has heard some of these same comments from aides who were useless.

catshowlady · Apr 3, 2009

and find the means to get over it.
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. [\quote]
cna suggests the nurse is "lazy" because nurse isn't doing enough pt care/adl's, whatever. nurse thinks, "how can i be lazy? i've not peed, eaten, or drank in 9 hours because i have been working. someone who has taken 2 breaks and a lunch has the nerve to suggest i'm lazy? grrr..."
as far as not taking breaks goes, we are taught to put our pts first. if my pt needs care (meds, tx, tests, whatever), i'm professionally and ethically bound to provide care. so i put my pts before myself, and give them care before i give myself care.
moreover, we are under a lot of pressure from all sides. pts may require a lot of hands-on care (e.g., c-diff pts w/ isolation garb and diarrhea). other pts/families are just plain demanding, and keep coming out to the desk where i am trying to chart off meds every five minutes until i get ice water for the pt. pts on my floor (icu) may be very sick and needs constant care to titrate drips. i am under pressure from the pts/families to provide "excellent" care (right now!), under pressure from management (gotta keep those press-ganey scores up), under pressure from staffing (you gotta take this 3rd pt, and we need to make room for him by transferring out another of your pts right now), under pressure from the drs. (why isn't this pt's ct done yet?), and, with some aides, under pressure from the aides (why can't you do that?).
nurses really do try and do our best to please everyone. some days, everything is important, and needs to be done now, and before you know it, it's 1500, and you've not sat down for more than a minute, let alone had a break.
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. [\quote]
except that, with a few exceptions that are very far between indeed, nursing jobs are high-stress. there is rarely support from the boss (who is stuck between the staff and admin), from coworkers (who are working just as frenetically as you are), from admin (more worried about profit margin).
add to that the current economy, it's not as easy to find another job that would be better right now.
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.
truthfully, i have had a day or two where helping a tech for anything other than a boost when i'm already in the room would be too much. did all my charting after my shift was over, and left 2 hours after the end my shift. normally, though, i will help whenever i'm asked (and even when i'm not asked), even if i am behind on my work.
i think it would benefit everybody if we could just all give each other the benefit of the doubt from time to time. i am currently reading the book "crucial confrontations." i left it at work (to read during lunch), so i don't have it at hand to quote, unfortunately. one of the early chapters talks about how we often tell ourselves stories that attribute malicious intentions to other people's actions, when in reality, those malicious intentions are non-existent.
gamba, you seem like you really care about your pts, and how to better serve them. i think this will help make you a good nurse someday. most of us try very hard to be good nurses too, try and give us the benefit of the doubt occasionally. :)

steve40 · Apr 3, 2009

Something I wanted to add that one of my instructors said to me and it has stuck in my head ever since. Putting aside working with every discipline in the nursing process, ask yourself if you are treating your patients as you would treat a guest in your own home. Also, as "simple" as it may sound, try to always be your patient's advocate in any given situation. This can be considerably difficult particuarly when we as nurses always have our own set of values and beliefs to live by.

Virgo_RN, BSN, RN · Apr 3, 2009

Interesting- in most facilities I am familar with (granted not a large number- but more than a couple)- the specific infection is shared with those providing hands on care- nurses and assistants- as it is determined to be a "need to know" issue since they are in contact with said infectious condition. Evidence is interpreted by different people to mean different things. You interpret it your way- I'll interpret it mine. The "evidence" doesn't say that it is harmful, nor does it say that it is advised against.

You misunderstand. Of course those who need to know have access to the medical record, and thus to that information. The signs on the doors do not specify the organism, just the method of transmission.

And no, you do not have a legal "right to know". The person with HIV has a right to keep their HIV status confidential. Healthcare providers (i.e. physician or nurse practitioner) have a need to know so they can provide appropriate care, and health care workers (i.e. paramedic, nurse, CNA) have a right to know only if there has been exposure with significant risk for transmission. At least, that's what most State HIV Confidentialiy laws state. They do vary from state to state.

When it comes to taking "extra" precautions with people who are HIV+, the evidence says that it is unnecessary. Since it is unnecessary, and you are only taking those precautions for people infected with HIV, it is therefore discriminatory behavior.

Lovely_RN, MSN · Apr 3, 2009

It seems to me that no matter how much the nurses try to explain their perspective that some of the CNAs just don't get it so I give up. It's like no matter what you say they truly do not think that there is anything difficult about your job and want to believe that many of us are just lazy and mean. Also why is it that we have to keep explaining ourselves anyway? We work with dietitians...respiratory therapists...PT/OT...SLPs...MDs....PAs...housekeeping....SWs (the list goes on and and on) I don't have to ask those people to do their job and I don't have to justify what I do to any of them.

Why do I have to expend so much energy thanking the CNAs for doing the job that that have chosen to do and apologizing for not being able to help them more? I really wish that CNAs had a license instead of a certificate so that they would be held accountable for their own practice and then when they didn't do what is required of them they could worry about having their license stripped. :banghead:

RN1982 · Apr 3, 2009

I agree with Valerie. I didn't realize that nurses worked like dogs until I was a nurse.

lpnflorida, LPN · Apr 3, 2009

I sat here thinking how can a CNA fully appreciate all the nurses do as they have never had to do all that they do. How can I an LPN fully appreciate all that an RN does as I am not responsibile for the multitude of things only they can do which I can not.

I believe this is the point of this thread realizing we all work hard, the CNA, the LPN and gosh knows the RN .

Each of us are to do the best for the patient within our own Scopes of Practice. I do for the patient that which a CNA and an LPN can do. I do for the patient and the RN that which helps the RN as she helps me with that I can not do.

Think about it where does the buck stop.

**LaurelRN, MSN · Apr 3, 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.

okay-so I get that you are incredibly frustrated and feel the need to be an advocate for both yourself and your patients but here's a little insight from someone who has worked in every clinical job of nursing.

As a CNA- I always said- why do nurses do so little for the patients and I do everything- but THEY make the money??

As a monitor tech/HUC- I always said- god why are these nurses/techs so lazy that they can't go put a pt back on the monitor/get that urine sample/get this pt some pain meds..etc.

As a tech I always said- wWhy can't that monitor tech give me five minutes to get this pt cleaned so I can put that other pt back on the monitor/why can't that nurse get up off her butt to help me with this 350 lb pt/ why do I have to do all the running to make sure these pts are on the monitor/safely in the BR/answer that call light etc..

AS A RN I SAY- every person on this unit has a job. Every person on this unit has individual skills that another may not be able to do. I am overwhelmed with the amount of strictly RN needs pts have that NO ONE but me can do.

I have walked in your shoes and have to tell you that I am one of the nurses that help out when a CNA/tech/MT/HUC need something done...........but here's the cost of that. MANY times I go home at 8/8:30/9:00- when EVERYONE else has gone home. Yes I get paid to stay late, but when i am working three very busy day shifts in a row- trust me going home at 9 is not something I want to do. As many before me have stated- there are always those people in a workplace that will defer their work to others if they can get away with it--BUT unless you know all that is going on in someone else's job- don't assume that just because they aren't doing something that a tech is able to do, that its just because they don't want to.

Just my :twocents:

Laurel CNA/MT/CHUC/RN

abbaking · Apr 3, 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.

I had a similar experience with this when i was a cna. The nurse manager said the the kardex was sensitive patient information and not within our scope of practice. I pointed out to her that the computer charting "exposes" the cna staff to dx/demographics/insurance info/medications and so on. She didnt have a good answer. Its a power play from power-tripping nurses and uptight management. If you are caring for patients, you are a professional who should have access to this important information so to provide appropriate care and assist the nursing team with patient interventions. The cna should be informed of a patients 4 JP drains, midline incision, and wound vac. Plan of care should include ALL nursing team members with concise and proper communication. PATIENTS LIVES ARE THE BOTTOM LINE

Equinox_93 · Apr 3, 2009

We're just rehashing at this point. You have your opinion- I have mine. We'll agree to disagree.

You misunderstand. Of course those who need to know have access to the medical record, and thus to that information. The signs on the doors do not specify the organism, just the method of transmission.
And no, you do not have a legal "right to know". The person with HIV has a right to keep their HIV status confidential. Healthcare providers (i.e. physician or nurse practitioner) have a need to know so they can provide appropriate care, and health care workers (i.e. paramedic, nurse, CNA) have a right to know only if there has been exposure with significant risk for transmission. At least, that's what most State HIV Confidentialiy laws state. They do vary from state to state.
When it comes to taking "extra" precautions with people who are HIV+, the evidence says that it is unnecessary. Since it is unnecessary, and you are only taking those precautions for people infected with HIV, it is therefore discriminatory behavior.

Equinox_93 · Apr 3, 2009

They do. It's called a certification, but that certification can be stripped just like a nursing license and accountability is required under that certification...

While I agree that people shouldn't have to be thanked just for doing their job, part of being in a supervisory/management position over others (or- part of being a "good" manager) is showing them due appreciation, respect, offering good communication and generally setting a positive example that raises morale, not lowers it. (Which admittedly is difficult to do when one is overworked, overstressed and frustrated). Part of it also is constructively correcting poor behaviour, setting clear expectations and making sure the communication is there to support them doing their jobs to your satisfaction/expectation. :)

It seems to me that no matter how much the nurses try to explain their perspective that some of the CNAs just don't get it so I give up. It's like no matter what you say they truly do not think that there is anything difficult about your job and want to believe that many of us are just lazy and mean. Also why is it that we have to keep explaining ourselves anyway? We work with dietitians...respiratory therapists...PT/OT...SLPs...MDs....PAs...housekeeping....SWs (the list goes on and and on) I don't have to ask those people to do their job and I don't have to justify what I do to any of them.
Why do I have to expend so much energy thanking the CNAs for doing the job that that have chosen to do and apologizing for not being able to help them more? I really wish that CNAs had a license instead of a certificate so that they would be held accountable for their own practice and then when they didn't do what is required of them they could worry about having their license stripped.