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

RochesterRN-BSN, BSN, RN · Mar 29, 2009

I would say there is a lot of good information already posted here....helping you to maybe understand that over all it's not that nurses don't want to help but are not able to......I thought I would throw in a couple things........first is that you say some are willing to help and others are not......when I was working on a medical/respiratory floor I found that this changed from day to day.......depending on the patients I had that day/shift. Some days I would be behind all day ready to scream...as soon as I would get close to being caught up something else would happen that took a lot of time, putting behind once again......other days I would luck out and get "easier" patients...maybe just more stabe, less meds, more independant--walkie/talkies we called them, etc. and was pretty much either caught up, or even having some down time. These days I was more available to help the CNAs, spend more time with my patients. Most of the techs would ask for help with changing/cleaning a vent patient as they were too scared they would knock off the tubing, etc. so they wanted a nurse in to monitor the vent with turning, etc.......many days this would take a lot of time and it was hard as it was a really bad day and I didn't have the time but had to make it.......

I would also have CNAs that would expect me to stop in the middle of getting meds ready to come in and help.......this is dangerous to stop me as I am checking each med against the MAR to asure I have the right med, it's the right time for it, if I need to split a pill for the correct ordered dose, and I have to check literally 27 meds for one patient. Stopping in the middle of this is dangerous......... So I think over all most nurses help when they can, depending on how their day is going.......yes I have worked with a nurse or two who will sit and shoot the s*** totally caught up then say no to a CNA who asks for help.......

As far as report.........I always thought it was important for the CNA working with my patients to get a breif report and have always tried to give one......but I have found that the majority of the CNAs seemed annoyed or disinterested. Like I was wasting their time. I like to work as a team with my CNA as much as I am able, communicating at the start of shift as well as throughout the shift and again at the end of the shift to see if they have any info to report that I may want to include in my charting.....the CNA may be the person who can tell you that the pt had 8 BMs that shift and that he /she walked the pt in the hall and how far the pt was able to ambulate,etc...things I need to report in my charting.... I have always said that a good CNA is worth their weight in gold and a bad one can be more of a hassle then a help........the ones who have an attitude, treat the patients poorly, are lazy and complain all shift. An RN or LPN and their CNA working well together, as a team is what gets the best patient care. It's kinda delicate balance! lol

LaneyB · Mar 29, 2009

I think you have some good points, and also some points that you maybe don't understand what the nurses do yet.

As a nurse you simply don't have the time to play aide to the CNA all day, helping change all the diapers and do the bedbaths, etc. Not only that, but where I worked we were specifically asked NOT to do those things regularly as that is what they paid the CNA's to do. We were expected to be doing the things the CNA couldn't do. I guess in a way we had it pretty good because the expectations of the nurse and the CNA were laid out quite clearly. Yes, if a nurse is in the room and the pt. has a dirty diaper if time permits the nurse should change it, but often time didn't permit. We were a peds onc/bmt floor and the kids were often being prepped for different tests during the day, or chemo had to be started, or blood products given.

As far as the HIV pt. is concerned, I know universal precautions should always be used but I think everyone should know if a patient has a compromised immune system so they can be even more careful. Disinfecting stethoscopes, disinfecting the blood pressure cuff, etc.

Equinox_93 · Mar 29, 2009

... What would you do with a patient that you found sitting in their own waste or who was asking you to help them to the bathroom and the CNA was busy with other patients?

Definately agree with the idea that everyone should know the status of immunocompromised patients. It's for their own protection and I'd consider that a "need to know" issue for *everyone* involved in their care.

I think you have some good points, and also some points that you maybe don't understand what the nurses do yet.
As a nurse you simply don't have the time to play aide to the CNA all day, helping change all the diapers and do the bedbaths, etc. Not only that, but where I worked we were specifically asked NOT to do those things regularly as that is what they paid the CNA's to do. We were expected to be doing the things the CNA couldn't do. I guess in a way we had it pretty good because the expectations of the nurse and the CNA were laid out quite clearly. Yes, if a nurse is in the room and the pt. has a dirty diaper if time permits the nurse should change it, but often time didn't permit. We were a peds onc/bmt floor and the kids were often being prepped for different tests during the day, or chemo had to be started, or blood products given.
As far as the HIV pt. is concerned, I know universal precautions should always be used but I think everyone should know if a patient has a compromised immune system so they can be even more careful. Disinfecting stethoscopes, disinfecting the blood pressure cuff, etc.

Virgo_RN, BSN, RN · Mar 29, 2009

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.

Yup. Whenever I pull a sheath, I'm going to be in that room for at least a half an hour. If anything goes wrong, longer. If a patient is experiencing chest pain, same thing. I am not leaving either of those patients to go help the CNA with a bed change. They *have to* find someone else. Period. Once I get out of the room, I am behind on patient care and must run like the wind to get caught up. I don't have time to do ADLs. If I have an easy group of patients and find myself all caught up, I do ADLs because I have the time. But really, I agree with someone else who said that I am not there to be the aide's aide, and that I don't have time to constantly justify to the aide why I am asking them to do their job.

Still, I find that I typically spend more time with my patients than the CNAs do. Many of them only enter the room three times; once at the beginning of the shift to update the greaseboards and get vitals if I've asked them to, once at dinner time to deliver the dinner tray (usually they don't get the person OOB for dinner either), and once at the end of the shift to tally up I&O. If the patient is on contact or droplet precautions, some of the CNAs minimize going in there, to the point that I'll go in and find the patient lying in a wrinkled mess of a bed having not even been bathed that day. What is up with that?

Equinox_93 · Mar 29, 2009

Sounds like your facility needs to up their standards on the CNAs they hire. What DO the CNA's you work with do? How many patients are they responsible for?

...some of the CNAs minimize going in there, to the point that I'll go in and find the patient lying in a wrinkled mess of a bed having not even been bathed that day. What is up with that?

Virgo_RN, BSN, RN · Mar 29, 2009

Sounds like your facility needs to up their standards on the CNAs they hire. What DO the CNA's you work with do? How many patients are they responsible for?

I typed up a big long rant, but since we're trying to fix the problem, I decided I want to stay positive.

Our CNAs "help" with routine vitals, meaning that they only get them if asked. They assist with basic ADLs like hygeine, toileting, transfer and ambulation, meal trays, etc.

Their typical load is nine patients.

The nurses on my unit help out a lot, and many of these CNAs are new and have no idea how good they've got it. Some of the older ones have been aides for a long time and are either tired and worn out, or just clueless, and the new ones follow their lead.

truern · Mar 29, 2009

Yup. Whenever I pull a sheath, I'm going to be in that room for at least a half an hour. If anything goes wrong, longer. If a patient is experiencing chest pain, same thing. I am not leaving either of those patients to go help the CNA with a bed change. They *have to* find someone else. Period. Once I get out of the room, I am behind on patient care and must run like the wind to get caught up. I don't have time to do ADLs. If I have an easy group of patients and find myself all caught up, I do ADLs because I have the time. But really, I agree with someone else who said that I am not there to be the aide's aide, and that I don't have time to constantly justify to the aide why I am asking them to do their job.
Still, I find that I typically spend more time with my patients than the CNAs do. Many of them only enter the room three times; once at the beginning of the shift to update the greaseboards and get vitals if I've asked them to, once at dinner time to deliver the dinner tray (usually they don't get the person OOB for dinner either), and once at the end of the shift to tally up I&O. If the patient is on contact or droplet precautions, some of the CNAs minimize going in there, to the point that I'll go in and find the patient lying in a wrinkled mess of a bed having not even been bathed that day. What is up with that?

Agreed!

CNA=certified nursing assistant. RN=registered nurse. CNAs are there to assist the nurses, not the other way around. While *I* can help them do their job, they can't do *my* job. If I'm busy doing my job please don't expect me to help the CNAs.

That said, I love my CNAs for the most part.

whipping girl in 07, RN · Mar 29, 2009

I worked in an ICU at my first job with no CNAs...the RNs did all the work, both "dirty" and "cerebral." When I moved here, the units I worked in had CNAs/techs who did different tasks...each unit of each hospital I worked at had a different set of expectations for which tasks were which person's responsibility...but ultimately, the responsibility falls to the RN.

I've never seen the techs have to work over...but I've worked over plenty as an RN. A few of the techs I've worked with were incredible and some were downright lazy. Most were somewhere in between. I could categorize the RNs I've worked with pretty much the same way.

I worked as a CNA on a floor where the RNs wouldn't even put the patients on a bedpan since it involved leaving the nurses' station. Those nurses assessed the patients, passed meds and sat around for the rest of the shift. I still remember the day I was teamed with a nurse who'd floated from telemetry. I walked in a room and she was getting a patient off the bedpan. I nearly died from the shock!

ITA with the poster who said the HIV status was not your business. If you use universal precautions, there shouldn't be a worry about transmission. And we should be cleaning equipment between patients anyway. If you are sick your immunity is somewhat compromised even if you are not HIV+ or on chemo. How do you think nosocomials spread?

Valerie Salva, BSN, 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.

You said it! :up: :up: :up:

Valerie Salva, BSN, RN · Mar 29, 2009

Yup. Whenever I pull a sheath, I'm going to be in that room for at least a half an hour. If anything goes wrong, longer. If a patient is experiencing chest pain, same thing. I am not leaving either of those patients to go help the CNA with a bed change. They *have to* find someone else. Period. Once I get out of the room, I am behind on patient care and must run like the wind to get caught up. I don't have time to do ADLs. If I have an easy group of patients and find myself all caught up, I do ADLs because I have the time. But really, I agree with someone else who said that I am not there to be the aide's aide, and that I don't have time to constantly justify to the aide why I am asking them to do their job.
Still, I find that I typically spend more time with my patients than the CNAs do. Many of them only enter the room three times; once at the beginning of the shift to update the greaseboards and get vitals if I've asked them to, once at dinner time to deliver the dinner tray (usually they don't get the person OOB for dinner either), and once at the end of the shift to tally up I&O. If the patient is on contact or droplet precautions, some of the CNAs minimize going in there, to the point that I'll go in and find the patient lying in a wrinkled mess of a bed having not even been bathed that day. What is up with that?

Exactly!

lamazeteacher · Mar 29, 2009

I sympathize with all the facts you shared, and it's impressive to see how well you write. Are you a new tech or CNA? I've never worked with techs, but from threads I read here, they're a new addition to stretch nurses' staffing; and they have less educational preparation than Nurse's Aides do.

However, I think all staff should receive a print-out of the patients they will have. That contains the diagnosis, secondary conditions, meds, tests, etc.

In report, you should follow along better, having that and especially with 24 hour urine tests, be able to keep them going.

Blondy2061h gave you correct info about universal precautions, and as a former Infection Control Nurse, I appreciated seeing her post. However, I suspect that you knew about that, and felt out of the loop......am I right? I've worked with NAs who become very nervous about patients with full blown AIDs, as they have some misconceptions about its mode of transmission. They may have a false idea about how they could get it (only with direct exposure to blood/body fluids through an open wound they have, themselves - like a needlestick). It's quite rare that healthcare workers get real exposures, and then have the disease. Lab workers have the highest percent of acquiring AIDs at work. Even in the OR when a scalpel slips and goes into a co-worker's hand, there's less transmission if the patient on the table has AIDs, than was previously and widely thought.

These days, early reporting of a possible occupational exposure assures free lifelong treatment; and the newer and better treatments, though inconvenient, time consuming and uncomfortable (if/when nasusea accompanies them), can assure someone of practically a normal, yet more prevention encumbered lifespan. HepC is another matter....... It's become more prevalent and dangerous than AIDs. Your Infection Control Nurse should provide you with Inservices regularly about communicable diseases and Isolation measures. Frequently those who aren't mandated for NAs to attend them, so they don't go to them, and that's a big mistake (for their own relief from anxiety about those conditions).

Your observations are well taken, and should probably be sent to your facility's administration. They need to be aware of how their staffing criteria leaves little time for R.N.s to know their patients well enough. Nurses who aren't proficient with nursing care measures, probably had little clinical experience in their schooling. That's a real pity! You can only imagine the extent of M.D. knowledge deficits about their patients, as they spend even less time with them.

Thank you for your contribution that should heighten nurses' awareness of how they appear to their patients and other members of the health care team.

Equinox_93 · Mar 29, 2009

... If you're in a position to have a say- you might try setting a meeting between the nurses and the CNAs to have a real discussion about this. The newbies may really have no idea if their precepting CNAs are as clueless and burnt out as all that... Sounds like morale may be quite low- and if you can get communication going and raise morale- there may be a good chance of improvement in the situation.... If you're as frustrated with them, chances are they're equally frustrated with the nurses... I tend to think that communication often weeds out alot of that- and if not- it's time to hire new staff.... GOOD LUCK!!!

I typed up a big long rant, but since we're trying to fix the problem, I decided I want to stay positive.
Our CNAs "help" with routine vitals, meaning that they only get them if asked. They assist with basic ADLs like hygeine, toileting, transfer and ambulation, meal trays, etc.
Their typical load is nine patients.
The nurses on my unit help out a lot, and many of these CNAs are new and have no idea how good they've got it. Some of the older ones have been aides for a long time and are either tired and worn out, or just clueless, and the new ones follow their lead.