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

cute-1 · Mar 31, 2009

Just my little observation but whenever anyone mentions "nurse" and anything relative of "lazy".Folks get in a tizzy around here.I know that nurses are busy,so are CNA's and everyone else working in healthcare.IMO,there is no way to justify leaving a patient in poop or urine.These problems will never get resolved if people don"t work as a team,if ALL of us act like the nurse is NEVER able to help with Patient care or the CNA is always busy and not on a smoke break when their patient first rang the light.We can't move on if we are not honest.Let's work on solutions in our workplaces.

Equinox_93 · Mar 31, 2009

I can understand a nurse asking an aide who she knows is right across the hall making beds (not a time sensitive issue) to hold up for a few minutes to change/toilet someone. However- if the nurse has to go hunt down the aide who is showering or toileting/changing someone else? It takes as long to hunt as it does to toilet. IMO leaving a person who has to go to hold it until someone gets around to helping them is cruel and abusive. Now if you trust that the aide is always on top of things and you know she's going to be finished with (whatever) and be right in after? Sure- it can wait- unless the person is really having to go and they don't seem to be able to wait- but in many cases they can be assisted TO the restroom (assuming they're in their right mind and you can trust that they can stay put and use a call light before getting back up) etc. While the admin. etc. may get POd because you do something that can be delegated- how POd will they be if they get a patient complaint that you were neglecting to help them when they asked/needed it especially if they name you by name?

I'm not saying nurses should be doing everything- including what CNAs should be doing. I'm just saying- the needs of the patient should IMO come first. And certainly- mid med-pass there's not much you can do- (is it even legal to leave the cart sitting out in the hall unsupervised while you closed the door to help someone? I wouldn't think so!)

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.....
......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.

Virgo_RN, BSN, RN · Mar 31, 2009

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. :)

Okay, so what do you think I should do? Assist the patient to the bathroom or attend to the patient having chest pain? Change the diaper, or attend to the patient with a CBG of 40?

And should my decision about what to do have any bearing on how busy the CNA is?

psalm, RN · Mar 31, 2009

Okay, so what do you think I should do? Assist the patient to the bathroom or attend to the patient having chest pain? Change the diaper, or attend to the patient with a CBG of 40?
And should my decision about what to do have any bearing on how busy the CNA is?

Nurses learn critical thinking and prioritization. CNAs are usually task-oriented, unless they are very concienctious and/or also nursing students. Chest pain or a blood sugar of 40 trump poop for an RN. All are important, but as uncomfortable as sitting in your excrement or urine is, and considering sitting in urine for an extra 10 minutes...it can wait.

Look at it this way: a person usually doesn't go to the ER or call an ambulance for a dirty depends, and if they did, they would be told it wasn't emergent. However, chest pain and a DKA or Hypoglycemic is an emergency. Does that help?

Lovely_RN, MSN · Mar 31, 2009

Your logic is really great but I'm telling you from experience what I know to be true. It just doesn't work the way that you think it should...supervisors and floor managers are nurses and they think like nurses.

I will tell you exactly what nursing administration would say to me if a patient complained about being left in their poop. "Where were your CNAs? Why didn't you get a CNA to change that patient." Next if I told them the CNA flounced off after telling me they were busy their next response would be "It's your job to make sure they do their job...if they give you problems write them up." Then I would be lectured about growing a pair and I would be spoken to like a two year old "Do you understand that being a nurse means DE-LE-GA-TING Ms. Stupid?" I would get a similar version of the same lecture if I told my manger that I didn't do x,y,z thing because I was changing resident's.

I'm just telling how it really is not how you would like it to be. When you become a nurse you will see for yourself. If you are able to be that super nurse and do it all kudos to you...I guess I'm just not as good as you'll be in the future.

I can understand a nurse asking an aide who she knows is right across the hall making beds (not a time sensitive issue) to hold up for a few minutes to change/toilet someone. However- if the nurse has to go hunt down the aide who is showering or toileting/changing someone else? It takes as long to hunt as it does to toilet. IMO leaving a person who has to go to hold it until someone gets around to helping them is cruel and abusive. Now if you trust that the aide is always on top of things and you know she's going to be finished with (whatever) and be right in after? Sure- it can wait- unless the person is really having to go and they don't seem to be able to wait- but in many cases they can be assisted TO the restroom (assuming they're in their right mind and you can trust that they can stay put and use a call light before getting back up) etc. While the admin. etc. may get POd because you do something that can be delegated- how POd will they be if they get a patient complaint that you were neglecting to help them when they asked/needed it especially if they name you by name?
I'm not saying nurses should be doing everything- including what CNAs should be doing. I'm just saying- the needs of the patient should IMO come first. And certainly- mid med-pass there's not much you can do- (is it even legal to leave the cart sitting out in the hall unsupervised while you closed the door to help someone? I wouldn't think so!)

Equinox_93 · Mar 31, 2009

Okay, so what do you think I should do? Assist the patient to the bathroom or attend to the patient having chest pain? Change the diaper, or attend to the patient with a CBG of 40?
And should my decision about what to do have any bearing on how busy the CNA is?

The issue has never been about putting priority on toileting/cleaning up a patient over a medical emergency. In fact- in various places, people have made it very clear that this was *barring an emergency*- which I think anyone with two brain cells to rub together would consider chest pain etc. as a medical emergency.

Now sure- one may work on a floor where these emergencies are commonplace- and if that's the case, certainly one will have a different perspective on this issue... However, for many, such is NOT the case and a patient who has to use the restroom can be accomodated with the extra minute or two it takes to assist them or offer a bedpan (and tell them to put the call light on when they are finished.) But hey- if you are comfortable with fielding the complaints and possible fall risks by those who feel they can't wait around for assistance because they have to go NOW and decide to get up and do it themselves and subsequently fall and name you in a lawsuit because you couldn't be bothered just then- then that's your license, not mine. *shrugs* Documentation would certainly cover emergencies- but would it cover charting or other non emergency issues taking precedence over that? We aren't talking here about the exceptions- I'm talking about the times when you *don't* have patients coding or other emergencies.

Equinox_93 · Mar 31, 2009

... Then perhaps rather than CNAs and nurses sniping at each other, they should get their heads together and tackle the problems with administration etc. Hmmmm? Maybe if we all worked *together* rather than griping about each other and viewing each other as "the bad guy" we'd actually be able to make our working conditions better...

Your logic is really great but I'm telling you from experience what I know to be true. It just doesn't work the way that you think it should...supervisors and floor managers are nurses and they think like nurses.
I will tell you exactly what nursing administration would say to me if a patient complained about being left in their poop. "Where were your CNAs? Why didn't you get a CNA to change that patient." Next if I told them the CNA flounced off after telling me they were busy their next response would be "It's your job to make sure they do their job...if they give you problems write them up." Then I would be lectured about growing a pair and I would be spoken to like a two year old "Do you understand that being a nurse means DE-LE-GA-TING Ms. Stupid?" I would get a similar version of the same lecture if I told my manger that I didn't do x,y,z thing because I was changing resident's.
I'm just telling how it really is not how you would like it to be. When you become a nurse you will see for yourself. If you are able to be that super nurse and do it all kudos to you...I guess I'm just not as good as you'll be in the future.

Virgo_RN, BSN, RN · Mar 31, 2009

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.

This.

lamazeteacher · Mar 31, 2009

Equinox___93:

I must disagree with you on several points concerning Isolation Techniques. First of all, I do agree that you are entitled to know the diagnosis of patients to whom you give care. However, AIDS patients do not require the use of gowns. As I said in an earlier post, the transmission of that disease occurs only when body fluids enter another person's body through a cut/break in the skin that hasn't healed, using contaminated (dirty) needles as addicts do, and having unprotected sex (no condom).

Patients need to have consistency in their caregivers, which means they may think others were wrong to have not used a gown, if you use a gown. Wasting supplies costs money. The only time you need to wear gloves when caring for them, is if there is the possibility that an exposure/exchange of blood/body fluids could occur. If you're giving someone with AIDS a bed bath, and your skin on your hands or lower arms has an opening where their body fluid could enter, you should wear them then. If their skin is intact, it's not necessary - be on the safe side, always. Since you will not be changing their dressings or giving them injections, you will not be in any danger of an exposure, then.

AIDS patients require no "extra care" or observation, and take the same time as other patients to whom you give care. If they choose to discuss their illness with you, listen, but give no opinions, as you haven't all the information you need to give them correct advice. Their condition should be treated the same as any other patient's disease, by you. Since no extra precautions are needed other than Universal/standard ones, no marker on the door is necessary, and it would breech confidentiality to put one there!

The policies and procedures of your facility must be followed, rather than doing "what you're comfortable with". They have been compiled with everyone's safety in mind. Believe me, the last thing your place of employment's administrators want, is for any employee to get a disease from a patient. Nosocomial infectious diseases are usually caused by bowel and respiratory contaminants like e coli, staphylococcus (and MRSA, which is staphylococcus that doesn't get killed by some antibiotics, and therefore needs to be identified). Those bugs get on bedding, railings, and bedpans which, when touched by staff who don't thoroughly wash their hands with soap and water or a waterless alcohol based hand washing substance, afterward, can be spread to others who touch surfaces they touch with dirty hands.

Tuberculosis (which is acquired by inhaling the bacteria coughing patients spew into the air that you could inhale) does require "droplet/respiratory precautions" which involve the use of masks. To my knowledge, NAs are not assigned to patients with TB.

I hope this mini course in the transmission of infectious diseases has been helpful for you, and that you will feel better about precautions that should be taken for them. I've been an Infection Control Nurse, and taught this stuff many times.

It's too bad that some nurses don't share some information you'd like to know more about, as that makes others feel they're considered less important, which may have led to the comment about who's fired first, due to economic downturns.

Each facility's administrators looks at staff they have, to see if some aren't needed, and make decisions based on the needs of patients, rather than how much each discipline makes. Med assistants and techs have been used to do some of the duties that take up RN and LPN's time, so they can't do all that's necessary. It is a way to lower costs, but they can't replace RNs and LPNs

Bickering about who will get fired first in this recession/depression continues bad feelings and resentment between staff. We all need to appreciate each other more, and work harmoniously to ensure that patients get the best of correct care they need.

ToxicShock · Mar 31, 2009

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?

Well, that's disappointing.

lpnflorida, LPN · Mar 31, 2009

I appreciate the original poster's perspective.

One of the things I have noticed. The nurses on our unit frequently are not only meeting the needs of their own patients , but are also helping out their fellow nurses with things they need.

Example: a nurse has tried to put in a foley or ng tube, unsuccessful so they ask a fellow nurse to try. Unable to get that lab draw, or to start an iv on someone they ask their fellow nurse to try. This goes on freely throughout a shift.

Nurse is busy so another nurse gives a prn medication to a patient. Nurse is busy, so another nurse takes report on new admit coming in. It is not only my patient's I am taking care of, I am as are my fellow nurses doing for each others patients.

My advice, cna needs help, ask a fellow cna who is in the hall to help you first if none available then ask your nurse. I love the cna's I work with, some are great at helping each other out just as the nurses do them and each other. Some do not work as collaboratively so they repeatedly ask their nurse to help when the nurse is already overwhelmed by her work load and the need to help her fellow nurses out.

This is just my own take on things . I often change patients, give baths just as I see my fellow nurses doing the same. I will quickly make up a bed if my patient is sitting in chair as I wait and observe they swallow their medication. It only takes me a few moments and I am there anyway. I would bet dollars to donuts the cna does not even remember she was not the one who made that bed up though. Nor are they aware of the times I have toileted a patient without asking or making any mention of it to them. Yet, we all hear how the nurse does not do this, but if you ask them ok, so how many times did you toilet so and so, and they will tell you 3 times, boy are they tired. Yes so am I . I toileted the other 2 times you are not aware of.

Equinox_93 · Mar 31, 2009

Thanks for the lesson- however, it's remedial here. I'm well aware of infection control methods given my own health history and my prior and current studies. However, it's always good to have the info out there. :)

Facility policies and procedures are the minimum standards. One should never do less than the P&Ps- however generally speaking there is no problem doing more- at least in relation to infection control and safety. I was taught to ALWAYS use gloves with EVERY patient- and that is what I intend to stick to. Is it always "necessary"? No. However- it makes me more comfortable. There is no "glove police". I'd assume that one would only choose to use a gown in the case of an HIV patient if they were doing something in which there were a chance- however remote- of getting their fluids onto them. Fetching ice doesn't cut it- cutting the nails on an HIV patient with Parkinsons, seizure disorder or a history of combative behaviour may, however.

Equinox___93:
I must disagree with you on several points concerning Isolation Techniques. First of all, I do agree that you are entitled to know the diagnosis of patients to whom you give care. However, AIDS patients do not require the use of gowns. As I said in an earlier post, the transmission of that disease occurs only when body fluids enter another person's body through a cut/break in the skin that hasn't healed, using contaminated (dirty) needles as addicts do, and having unprotected sex (no condom).
Patients need to have consistency in their caregivers, which means they may think others were wrong to have not used a gown, if you use a gown. Wasting supplies costs money. The only time you need to wear gloves when caring for them, is if there is the possibility that an exposure/exchange of blood/body fluids could occur. If you're giving someone with AIDS a bed bath, and your skin on your hands or lower arms has an opening where their body fluid could enter, you should wear them then. If their skin is intact, it's not necessary - be on the safe side, always. Since you will not be changing their dressings or giving them injections, you will not be in any danger of an exposure, then.
AIDS patients require no "extra care" or observation, and take the same time as other patients to whom you give care. If they choose to discuss their illness with you, listen, but give no opinions, as you haven't all the information you need to give them correct advice. Their condition should be treated the same as any other patient's disease, by you. Since no extra precautions are needed other than Universal/standard ones, no marker on the door is necessary, and it would breech confidentiality to put one there!
The policies and procedures of your facility must be followed, rather than doing "what you're comfortable with". They have been compiled with everyone's safety in mind. Believe me, the last thing your place of employment's administrators want, is for any employee to get a disease from a patient. Nosocomial infectious diseases are usually caused by bowel and respiratory contaminants like e coli, staphylococcus (and MRSA, which is staphylococcus that doesn't get killed by some antibiotics, and therefore needs to be identified). Those bugs get on bedding, railings, and bedpans which, when touched by staff who don't thoroughly wash their hands with soap and water or a waterless alcohol based hand washing substance, afterward, can be spread to others who touch surfaces they touch with dirty hands.
Tuberculosis (which is acquired by inhaling the bacteria coughing patients spew into the air that you could inhale) does require "droplet/respiratory precautions" which involve the use of masks. To my knowledge, NAs are not assigned to patients with TB.
I hope this mini course in the transmission of infectious diseases has been helpful for you, and that you will feel better about precautions that should be taken for them. I've been an Infection Control Nurse, and taught this stuff many times.
It's too bad that some nurses don't share some information you'd like to know more about, as that makes others feel they're considered less important, which may have led to the comment about who's fired first, due to economic downturns.
Each facility's administrators looks at staff they have, to see if some aren't needed, and make decisions based on the needs of patients, rather than how much each discipline makes. Med assistants and techs have been used to do some of the duties that take up RN and LPN's time, so they can't do all that's necessary. It is a way to lower costs, but they can't replace RNs and LPNs
Bickering about who will get fired first in this recession/depression continues bad feelings and resentment between staff. We all need to appreciate each other more, and work harmoniously to ensure that patients get the best of correct care they need.