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

lovehospital · Mar 28, 2009

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!

I see a lot of bull crap going on the medical floor too,with that said I also believe this is the most underestimated,hard and stressful unit out of all.About the patient with AIDS,sorry but you seem a little bit of ignorant....arent you wearing gloves with all patients anyway.Give me an Aids patient over MRSA one any time.

I had nurses who forgot to mention that the patient has MRSA and didnt put him in the isolation,see I dont worry I will get sick (cause I know better,that usually is the immosuppresed people who are at risk) but I dont want to pass it to others and directly contribute to nosocomial infection rates.

Also I'm tired of hearing people questioning nurses skills,ok do you know how to perform any of them?

GaMBA · Mar 28, 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.

truern · Mar 28, 2009

I see a lot of bull crap going on the medical floor too,with that said I also believe this is the most underestimated,hard and stressful unit out of all.About the patient with AIDS,sorry but you seem a little bit of ignorant....arent you wearing gloves with all patients anyway.Give me an Aids patient over MRSA one any time.
I had nurses who forgot to mention that the patient has MRSA and didnt put him in the isolation,see I dont worry I will get sick (cause I know better,that usually is the immosuppresed people who are at risk) but I dont want to pass it to others and directly contribute to nosocomial infection rates.
Also I'm tired of hearing people questioning nurses skills,ok do you know how to perform any of them?

Which is it, you're running around like a chicken with your head cut off with only two patients or you're the expert at nursing now??

OP, you have some legitimate complaints about the nurses you work with, but please know that all nurses don't avoid patient care/contact. Some of the very things you complain about may be your own "fault" (for lack of a better word) because you're willing to go outside your scope of practice. NOT a good idea, btw.

wannabesedated · Mar 29, 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).

The chances of being infected with HIV at the workplace are extremely low, especially when using standard precautions and with the safer injection equipment in place. You will come in contact with patients who are HIV+ but are undiagnosed. It's unrealistic to assume you will always know which patients have an infection. This is where gloving with every patient becomes important. When it comes to HIV, I just protect myself as if everyone is contaminated, as another poster mentioned. :wink2:

Good luck with your BSN, it is good to see a future nurse who cares about her patients and her own safety.

chevyv, BSN, RN · Mar 29, 2009

When I was a cna, we were only told a pt's hiv status if they were in hospital specifically related to hiv or aids. If they were in for anything else, we would know this pt as what they were hospitalized for. I never agreed with that because if a pt had cancer, we would know about it.

I didn't want to know so that I could avoid the pt, I wanted to know what each of my pts had going on so that I could be aware of any changes so that I could let my rn know what I was seeing. Many staff members would tell us on the sligh, but that was it.

As far as nurses not beign around. I hear you. I'm a lpn now and just finishing rn school. I hate that I don't have time to spend with my residents. I run all night long and rarely get to do anything for my residents. Charting takes up so much of my time. When my cna's leave, you can bet that I'll be staying at least an hour over just to finish up. I sometimes wish I didn't have the added responsibility that comes with my nursing license. There are so many times I would like to get people up and going, help them eat, and even get them toileted. Instead, I'm pushing pills down their throat and trying to say hi as I run out of the room to the next person. I legally have only so much time to get those pills passed and then I do it all over again with the next med pass. It is not easier.

I am so grateful for cna's! You are my eyes and ears now that I've gone deaf and blind. Thank you, thank you, thank you!!!!

Equinox_93 · Mar 29, 2009

In some states at least, if a nurse delegates the task, even if it is outside the CNA's scope of practice, the CNA can do the task. The nurse must explain, demonstrate and follow the states rules of delegation for this to be "ok". I'd assume this is what she's talking about- because yes- acting outside of ones scope of practice without being formally delegated a task is asking for trouble.

It was sort of like that on the med/surg unit I worked on too...the techs reported to each other, and the RNs to each other, with very little communication between the groups, until something happened to a patient that was a direct result of poor communication. The manager's solution was to have one tech sit in on our reports and then provide report to the others.
I didn't like that because I felt the information passed hands too many times. Why not let everybody that was oncoming just sit in? I don't work there anymore (thank the gods LOL) so I dunno what they're doing now.
You'll want to think carefully about doing things that you KNOW are outside your scope of practice. Should something happen to the patient, everyone including you will be held accountable for it. If the nurse is supposed to be doing the dressings, then if I were you I wouldn't hesitate to let her know. Anyhow, how can she chart how it looks if she doesn't physically assess it??
You sound like a wonderfully caring person and you're gonna make a great nurse! Best of luck in your career!!

Pierrette · Mar 29, 2009

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.

You think that any "decent" nurse would tell you that the guy has AIDS?

Two questions:

(1) Is it necessary that you get that information in order for you to do your job properly?

(2) Might patient care suffer if you don't get the information?

If you can accurately answer "yes" to either of the above two questions then you need the information. Otherwise, you legally cannot receive the information.

http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/minimumnecessary.html

Virgo_RN, BSN, RN · Mar 29, 2009

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.

I am one of those nurses that does a lot for my patients, and in doing so, I get behind on my assessments, my med passes, analyzing their rhythms, looking at their charts, reading their H&Ps, following up on their labs and imaging results, doing medication and procedure and discharge teaching, charting, etc. I need to do these things, and do them in a timely fashion. It is not optional. In order to do so, I must prioritize these tasks and rely on the aides to do the ADLs. This doesn't mean I'm unwilling to help or feel above the tasks, or don't want to get my hands dirty.

If any one of my patients has a change in condition, then any routine I might have had goes completely down the tubes. Even worse is if two or three of them have immediate issues requiring immediate intervention.

Oh, and BTW, I was an aide for three years before becoming a nurse.

Valerie Salva, BSN, RN · Mar 29, 2009

I was a CNA for three years also, and imo, being a nurse is far more stressful and far harder than being an aid is.

Aids and techs complain that nurses don't help them but you can see them climbing over each other to see who can clock out and go home the fastest- and the nurse is still there with a pile of work left to do.

I am a charge nurse, and mgmt is always telling me I spend too much time w/ pts, too much time on the floor and too much time helping other staff.

november17, ASN, RN · Mar 29, 2009

The CNA is my eyes and ears.

No, I don't have that much time to spend with patients because I'm too busy managing their care. Sorry. There are many factors involved besides basic care. That's what CNAs are there for.

Sorry that you think I have an aversion to direct patient care. I don't. As a matter of fact, I'd do it all day long if I could. I'd happily accept my higher wage to do the job that a CNA could do. I was a CNA for much longer than I've been an RN. I long for those simple days sometimes. Unfortunately the hospital I work for expects me to do things only a person licensed as an RN can do. I'm sure if anyone else could do it for cheaper (like say, a CNA), they'd probably have a CNA do my job. Thanks to the BON, that's not happenin. So here I am.

My only aversion to patient care is the fact that I'm probably neck deep in the more "cerebral" side of care, and just because I'm appearing to not be doing anything or sitting down doesn't mean I'm not managing some sort of a problem.

Where I work we have a 5-1 ratio (with a CNA), without a CNA we are 4-1. Oftentimes we don't have a CNA and I do everything by myself. I promise I would run circles around any CNA on my floor.

As far as "report" goes. The first thing CNAs do when we get to work is run off to start baths/vitals/etc. I understand that, its good time management. But at the same time if they want a decent report then they better make a second to do it, because if I have to hunt them down and they arent available then they won't get it (because I also hit the floor running and have assessments and other things to do). 99% of the CNAs where I work are very good about looking at the kardexes and figuring it out for themselves though, so this isn't really a problem at all.

Don't get me wrong, I love the CNAs I work with. They are integral to the team!!! love you

Also, about some nurses having time and others not having time.....time management/prioritization is a skill that some RNs just don't really ever master. Ever read some of the threads around here? Just type in "I'm drowning" in the search bar I'll guarantee you get about 10 gazillion hits.

ktwlpn, LPN · Mar 29, 2009

[quoteWhich is it, you're running around like a chicken with your head cut off with only two patients or you're the expert at nursing now??

:yeah: :yeah::chuckle

ktwlpn, LPN · Mar 29, 2009

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.
2 - I don't understand the lack of communication b/w the nurses and techs when it comes to pt info.
3 - I am amazed by the aversion to pt care and the lack of pt care skills that some nurses have.
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 have seen these things,too..The cna can spend more time at the bedside actually assisting with the adl's on a stable patient then the nurse will.But the nurse may be with an unstable patient for quite some time.I have worked with nurses that would not even give a patient a bedpan.Nursing programs can't offer enough clinical hours-I think all nurses should be cna's first to familiarize themselves with direct patient care.Don't EVER do anything outside of your scope of practice-some nurses will try to take advantage of you.Don't let them... Aspire to be the kind of RN that you wish you worked with now.