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!

[Equinox_93]

IMO- if pants are dirty or if someone needs to use the restroom- it's the job of whoever finds the situation... If it's something that's not pressing and the aide can do- then it's their job. (If all the aides patients/residents have messed themselves at the same time- a patient/resident could feasibly spend an hour or more sitting around in their own waste- something most would consider neglectful- thus my "s/he who finds it, cleans it" mantra. That's far less about helping the aide than it is helping the patient/resident- which IS clearly the nurses job... ) My point of contention is that alot of tasks that are "CNA work" are really just the parts of the nurses job that the CNA is trained to do. Yes- "CNAs are there to assist the nurses"- which means taking some of the load off the nurses by doing the nurses job- the parts of it that they have been certified to "assist" with. That doesn't mean that certain tasks are no longer considered the nurses work- it just means that CNAs are there to assist with it.

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.

[Equinox_93]

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?

IMO anyone involved in the direct care of the patient/resident should be aware of that information. Those who are caring for the patient/resident are bound by HIPAA- so it's confidential and therefore should not be a concern that they know- but *could* be valuable information both for the extra care they may take, as well as the extra attention to detail that they should be paying to observing the patient/resident's condition. Caregivers should also in those cases have the right to choose to use extra PPE if they feel more comfortable doing so. (Such as a gown with the gloves they should be wearing anyway). If a facility uses door markers etc. for other infectious diseases and conditions- HIV should be treated no differently and like any other condition- caregivers should be made aware of what the patient has so they can determine what level of PPE they are most comfortable with. Further- while one should definately be using standard precautions regardless- one might want to take *extra* precautions above and beyond that or if an accidental exposure does occur- take more extensive corrective action and more rapidly.

[ktwlpn, LPN]

In my experience during my years in acute care we usually only had 1 or 2 cna's for the entire unit and their duties were always hotly contested.Some nurses seemed to "hog" the cna's time-others never saw the cna...It sounds like this facilty has a similar problem-the job description needs to be narrowly defined.And when budget cuts hit hard the lesser educated staff are the first to go....

[wannabesedated]

And when budget cuts hit hard the lesser educated staff are the first to go....

Really? I always thought the staff that cost the most were the ones to be cut and "replaced" with lesser educated staff. Isn't that where nurse tech/med aide roles came from? Please correct me if I am wrong!

[truern]

IMO- if pants are dirty or if someone needs to use the restroom- it's the job of whoever finds the situation... If it's something that's not pressing and the aide can do- then it's their job. (If all the aides patients/residents have messed themselves at the same time- a patient/resident could feasibly spend an hour or more sitting around in their own waste- something most would consider neglectful- thus my "s/he who finds it, cleans it" mantra. That's far less about helping the aide than it is helping the patient/resident- which IS clearly the nurses job... ) My point of contention is that alot of tasks that are "CNA work" are really just the parts of the nurses job that the CNA is trained to do. Yes- "CNAs are there to assist the nurses"- which means taking some of the load off the nurses by doing the nurses job- the parts of it that they have been certified to "assist" with. That doesn't mean that certain tasks are no longer considered the nurses work- it just means that CNAs are there to assist with it.

You're welcome to your opinion.

[Equinox_93]

You're welcome to your opinion.

As are you.

[mochabean]

This is a good thread and I'm glad you brought this up, Gamba.

I believe a lot of this depends on what type of unit you're on, how many people you'll be working with, and *who* you'll be working with. I work in a hospital where RN/LPN and nursing assistants are being pulled to other units all the time. I'm on a step down unit and we have 35 patients. Sometimes there will be 4 nursing assisants and sometimes there will only be two, or even one!

1) When it comes to nurses spending time with their patients, that depends on the nurse. I know a nurse who spends 15-20 minutes with the patient. She usually has 5-6 patients and she rotates all day, so her patients see her constantly. She's very attentive and is one of the best nurses on the unit.

2) The nurses on my unit don't give nursing assisants reports. We have to give each other a report in the morning and we always go on the Cardex to see the patients diagnosis, medical hx, diet, and to also see if there are specimens that are needed to be collected, accuchecks that need to be done, I&Od, or special vitals. I always double check with the nurse to see if s/he has the same information, because sometimes it's not updated in the computer. I agree that all patients should be treated as contaminated, and I wear/change gloves and wash my hands constantly, but it doesn't hurt to be extra careful. Just as long as everyone's treated with respect.

3) Once again this depends on the nurses you're working with. I've worked with nurses who'll barely ask me for anything and nurses who will partner with me. Then there are other with nurses who are CONSTANTLY asking me to do things, some which is riciculous and would only take at least 5 minutes to do, like getting a picture of water or putting a patients socks on when the nurse was just in the room. It doesn't matter what day it is, how many patients are on floor, how many RN or nursing assisants there are, it's all the time. My unit was short on nursing assistants today, so when a patient had a soiled brief and needed a boost in bed, two nurses had to clean her up. One day when you become a nurse, there maybe no nursing assisants on the floor. Or maybe there will be a nursing assisant, but s/he has a bad attitude.

4) I agree that you should never do anything outside of your job description. You don't want to be the scapegoat for whatever goes wrong.

I work with a lot of nurses and they're still human beings. After getting to them I know which one's I enjoy working with and others I wouldn't want to bake cookies with. I'm sure they feel the same way about the nursing assisants. I already know what type of nurse I'm going to be.

[Virgo_RN, BSN, RN]

IMO- if pants are dirty or if someone needs to use the restroom- it's the job of whoever finds the situation... If it's something that's not pressing and the aide can do- then it's their job. (If all the aides patients/residents have messed themselves at the same time- a patient/resident could feasibly spend an hour or more sitting around in their own waste- something most would consider neglectful- thus my "s/he who finds it, cleans it" mantra.

If your CNAs have a work ethic, then this is fair. The problem is that this kind of thinking can enable the lazy ones to simply avoid going into rooms where they know they are likely to find a mess. The nurses *have to* go into the room to assess, give meds, etc., but the CNAs can easily avoid going into the room, especially if the patient never puts on their call light. Many patients will just wait until the nurse comes in to mention that they have a wet undergarment or soiled bedding. If the CNA never goes in there to check, then the CNA never finds it, and never has to do it.

[Equinox_93]

If your CNAs have a work ethic, then this is fair. The problem is that this kind of thinking can enable the lazy ones to simply avoid going into rooms where they know they are likely to find a mess. The nurses *have to* go into the room to assess, give meds, etc., but the CNAs can easily avoid going into the room, especially if the patient never puts on their call light. Many patients will just wait until the nurse comes in to mention that they have a wet undergarment or soiled bedding. If the CNA never goes in there to check, then the CNA never finds it, and never has to do it.

The same can be said of nurses who go in and who try to pass the buck "Oh, the CNA will be in as soon as she's done" or "Oh- I didn't see/smell anything" nevermind that the CNA is currently showering a patient and then has to get the patient into bed, and then there is the high fall risk she has to field on the way to/from... If EVERYONE- including nurses- had a good work ethic- maybe this wouldn't be such a point of contention between the two "factions". I think there are good nurses and bad nurses. Good CNAs and bad CNAs. If everyone would just work together and realize that it doesn't do anyone any good to claim "It's not MY job- it's THEIR job" and just DO the job if you're the one who finds it needs doing- and be sure to be doing the job you were hired on to do- then I think everyone might get along better...

[Virgo_RN, BSN, RN]

I agree that if the nurse is not busy with more critical tasks, then there is nothing wrong with the expectation that they perform basic patient care tasks.

The thing is, if the CNA finds a patient's blood pressure is 210/100, they can't "just do the job" and deal with it. If the CNA finds the patient is in rapid afib, they can't start a diltiazem drip. If the patient is having chest pain, the CNA can't give Nitro.

If I, as you say "try to pass the buck" and tell a patient (who I happen to be medicating two hours late because I've been turning and toileting and cleaning all of my own patients as it is) that the CNA will come in and help them clean their dentures, I am simply delegating what I can so that I can do the critical nursing tasks that I cannot delegate.

I remember when I was a CNA, there were several nurses who I thought must have had broken arms. It was if they couldn't do anything for their patients, and were always asking me to do the simplest things that in my mind, they could have just done since they were right there.

Now that I am the nurse, I know better, and quite frankly, am embarrassed by some of the misperceptions that I had.

[Kiki36]

While I was replying to the original poster my message went away???? So sorry if this comes up twice, and incomplete??!!

I have never posted before but I felt compelled to reply to the original poster. I have been an RN for about four years on a busy med-surg/oncology floor. I have 5-6 pt's on day shift with my CNA partner.

To me, you seem like a really new CNA that does not understand the scope of the RN practice. As an RN, we can do an initial assessment on the pt quickly. It may not seem like we are in the pt room that long or that often but after our assessment (and check of the pt hx, labs, vitals, i&o, md orders,etc) ........we determine what the priority is for the pt that day. For us, the priority is not getting the pt showered. It is making sure the pt is stable and that RN interventions are implemented.

I always give report to the CNA I am working with regarding the pt's condition and I expect her to do the same for me.(For example, if the pt has a low urine output 4 hours into the shift.) As I am the doctors "eyes and ears," the CNA is my "eyes and ears."

You complain about the RN not "helping you" with things such as changing dirty pants. Believe me, RN's don't want pts sitting in their own waste for one second, but.....if the pt next door is having trouble breathing or has a hct of 22 we need to deal with that first. We learn all about priortizing in nursing school...you haven't been there yet.

It seems from your post that you want the RN to help you but you won't go look up a lab result to help her.....If you want to be helpful, and want the best for the pt, it seems like you should learn how to do this. The CNA I work with knows how to print labs, order diets, do ekg's, and soooooo much more. She comes and gets me to look at a pts skin or if she thinks a pt does not "look right."

So my advice to you is to trust the RN, work hard, and learn learn learn. There is much you don't know yet and after a few years as an RN I bet you will understand better what you are dealing with.

[psalm, RN]

Reminds me of when I worked on OB before I had given birth...I would get impatient with the patients who cried out or seemed wimpy to me. After all, women had been giving birth for centuries without epidurals or demerol.

Then I had 24 hours of back labor with my first child with only a pudental (by my choice). The pain was indescribable...and after it was over and I had time to take in and enjoy my newborn, I wished I had been more understanding of my laboring patients...how I wish I could meet them and apologise for my impatient attitude (that I hoped didn't show at the time).

Live and learn. Hugs