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!

[LaneyB]

... 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?

Unless there is an emergency somewhere else than I would do it myself.

[Ruffles 1]

I wish that both techs and nurses would get report on all the patients on the floor. I think than everyone would be aware who needs help and why. We have to get to a point of team work and help everyone.

[Ruby Vee, BSN]

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.

you really need to know about the patient who has mrsa, vre, c. diff or tb so you can isolate them properly. you really don't need to know about the patient who has aids -- casual contact won't pass that one along. you're wearing gloves and adhering to universal precautions, right? that's why universal precautions were developed.

and with all due respect, you really don't get it. you clearly don't understand what nurses do on a daily basis -- and saying that we delegate what we are able to delegate to a cna is not an excuse. it's the legitimate reason we ask you to do the peri care while we're "sitting at the desk, playing on the computer" while on the phone waiting for the doctor to take us off "hold" and deal with our question. if you can show me a "patient care" task that i can help you with in the "two seconds" i have between paging the pharmacist and his returning the page, i'm happy to help you. but i cannot page the pharmacist or the doctor or the social worker or whomever, then go into a room at the far end of the hall to help you change a poopy diaper because if the person returns the page and i'm not there, i'm going to have to start all over again.

i'm getting really, really tired of cnas (even the ones who are attending or planning to attend) nursing school spouting off about what terrible nurses they work with because the nurse doesn't have time to help them do their job. you don't get it.

[LaneyB]

I guess the reason I am still not convinced on the HIV/AIDS pt. is that as a bone marrow/chemo nurse we really needed to know the blood counts of the kids, and we took even more precautions if they were immunocompromised. Yes, we always wore gloves etc, but would make sure to disinfect blood pressure cuffs, etc. (something not always done).

[ktwlpn, LPN]

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!

At our 2 local hospitals when things have gotten bad they have laid off lpn's and cna's and many units went all rn.They also got rid of alot of the r n's with many years in and then hired cheaper in-experienced nurses....

[november17, ASN, RN]

IMO- if pants are dirty or if someone needs to use the restroom- it's the job of whoever finds the situation...

I 95% disagree with this statement. What if a family member finds it? What if the director of the hospital finds it? What if a housekeeper finds it? The statement itself is illogical.

If I'm not busy with something else I'll assist a patient to use the bathroom. Otherwise I will find the aide and ask them to do it (If I'm working with one). Unfortunately, most of the time I am busy doing other things - you know, the things that CNAs can't do.

[nuwbee25]

I agree with the original post about the lack of communication as I was a Patient care assistant at 2 major hospitals and I really appreciated it when a nurse would give me report and undertsood that I do not magically know everything that he/she knows about a patient. Howeverrrrrrr now that I am a Registered nurse I understand why some of them could not have helped as much as I wanted them to while working as an aide....paperwork is very time consuming along with many other things that goes on throughout the day. You should not think of something as a certain persons job or responsiblity because in the end it is a team effort. Keeping scope of practice in mind..there are many things only a LICENSED individual can do and it is on them if those things do not get done. So I say everyone, while legally staying in their scope of practice, should pitch in and help EVERYONE. Good luck with your nursing education and furture career...you seem like you will be a great nurse!

[Equinox_93]

You don't seem to be understanding what I'm trying to get across here- I'm not talking about denture cleaning- I am talking about tasks that, if left undone, would be viewed as neglectful/abusive- such as allowing a patient to sit in their excrement "until someone gets around to it" or telling a patient that you can't help them to the restroom to urinate even though they have to GO because "it's not your job" and you're behind schedule. Dentures can wait. Baths can wait. Many things can wait. My objection is merely that MANY if not most of the tasks that CNAs do nowadays were once most definately the job of the nurses- and still are in many areas where CNAs are not employed to assist. Now- I don't doubt that there are some lazy CNAs out there that think you should be out swabbing dentures- but do understand- that is absolutely NOT what I am referring to here. :)

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.

[LaneyB]

If you leave somebody sitting in a dirty diaper that can compromise skin integrity, not to mention it is not dignified for the patient. I agree that whenever possible whoever finds it (barring emergencies) should clean it up rather than make the patient wait until the CNA is available.

[Equinox_93]

I 95% disagree with this statement. What if a family member finds it? What if the director of the hospital finds it? What if a housekeeper finds it? The statement itself is illogical.

If I'm not busy with something else I'll assist a patient to use the bathroom. Otherwise I will find the aide and ask them to do it (If I'm working with one). Unfortunately, most of the time I am busy doing other things - you know, the things that CNAs can't do.

Sorry- I was thinking in my head (and assuming it would be understood) that of those who are on the floor, employed by the facility engaged in a job that requires patient care- of THOSE people- s/he who finds it, fixes it. I certainly don't object to a nurse getting the aide- but if the aide is otherwise occupied and the patient needs to go/be cleaned- then IMO the medical professional employed by the facility and engaged in that patients care who finds the situation should fix it and not leave the patient to 'hold it' or sit in waste until someone gets around to it. Other than that- most things can wait.

And- yes- clearly there are many things that nurses are licensed to do that aides can't- but it seems to me that the nurses first and foremost concern should be for the wellbeing of their patient- and since holding it can lead to problems and sitting in waste can lead to skin breakdown- I'd think that would be a priority if no one else is available to help right then. I mean- when *aren't* we all busy with something else? I'm sure it's the rare moment when nurse *or* CNA isn't "busy with something else"- if they're doing their job.... Certainly there's no shortage of work that needs doing...

[lpnjoe60]

When crisis comes to the floor as it always will do, the CNA's AND the nurses need to work as a team to make the flloor safe for the patients.

[Lovely_RN, MSN]

I remember being so angry with a nurse when I was a CNA because I was making beds and she asked me to put a patient on a bedpan, twice. The first time she came in I ignored her and the second time when she came back I did it but I was mad as hell. I thought that if she had the time to ask me twice then she should have just gone and done it herself. I remember being totally ****** off and thinking that she thought she was too good to do it herself. Fast forward 10 years and now that I am the nurse I so understand and wish I could see that nurse now. I think that some of the CNAs I work with think the same way about me now. Here I am sitting at the nurse's station charting and asking them to toliet a resident or I go into a room to give a med or do a dressing and I don't change that resident...instead I will tell the CNA assigned to them to do it. Why do I do this? Is it because I think that I am above these tasks at this point? No not all all...it's because of time management.

You say well how long does it take to toliet or change someone 10 maybe 20 minutes?

If I stop to toliet or change 1 or 2 residents during the two hours allotted to me for med pass then I now have 1 hour and 50 or 1 hour and 40 minutes to pass my meds. Chances are I will be out of compliance. Not only that I will have my alert resident's on the call bell asking me where their meds are, calling their family members to say they didn't get their meds, and some even threaten to call the state on me for not given them their meds on time.

When I stop to do a task that I can delegate to a CNA then it puts me behind on my wound care. Maybe because I took those extra minutes trying to prove a point to the CNA the wound doesn't get done that day and then it takes even longer to heal or an infection sets in.

What if I stop for 10-20 minutes and go change that resident instead of administering a nebulizer treatment that is due and then that resident with COPD or asthma goes into respiratory distress?

What if I stop for that 10-20 minutes and change that resident instead of calling the doc or waiting for the return call regarding a critical lab value. Maybe the doc goes ballistic because it's a critical value that needs to be addressed immediately? Worse yet maybe it doesn't get done on my shift and the next nurse pushes it off and something happens to the resident because it never was addressed.

Maybe I should put off my charting and medicare notes to change that resident and then my shift ends. Should I always leave late to finish my charting (which btw management will not pay me for) or should I just not worry about all that silly paperwork since REAL patient care means cleaning up poo, making beds, and filling ice pitchers? If something happens to that resident I'm sure the BON or the judge and jury will believe me when I SAY that I did what I was supposed to do never mind all of the stupid documentation.

I'm not saying that CNAs don't have a hard job because I know from first hand experience working in a hospital and nursing home as a CNA that the job is damn hard. However don't assume that nurses have it that easy either. If the nurse has time to help the CNAs out then maybe she is having an easy day or maybe it's really costing her to spare those minutes. Some of those nurse's who try to do everything are always in trouble with administration for not getting their jobs done. They aren't leaving on time from their shifts and they are getting burned out from running around like chickens with their heads cut off. We nurses cannot do it all if we could you would be out of a job. Yes nursing is a 24 hour job but the oncoming nurse isn't going to put up with you giving them a laundry list of all that you couldn't get done during your shift every single day. Eventually they will report you to management and then management will come down on you for not getting your work done. When you tell them that you are doing tasks that can be delegated they will hit the roof and they will NOT accept it as a plausible excuse for not doing what you are licensed to do.

Sorry- I was thinking in my head (and assuming it would be understood) that of those who are on the floor, employed by the facility engaged in a job that requires patient care- of THOSE people- s/he who finds it, fixes it. I certainly don't object to a nurse getting the aide- but if the aide is otherwise occupied and the patient needs to go/be cleaned- then IMO the medical professional employed by the facility and engaged in that patients care who finds the situation should fix it and not leave the patient to 'hold it' or sit in waste until someone gets around to it. Other than that- most things can wait.

And- yes- clearly there are many things that nurses are licensed to do that aides can't- but it seems to me that the nurses first and foremost concern should be for the wellbeing of their patient- and since holding it can lead to problems and sitting in waste can lead to skin breakdown- I'd think that would be a priority if no one else is available to help right then. I mean- when *aren't* we all busy with something else? I'm sure it's the rare moment when nurse *or* CNA isn't "busy with something else"- if they're doing their job.... Certainly there's no shortage of work that needs doing...