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

Equinox_93 · Mar 31, 2009

If the nurses and CNAs are using the same charts, then there is a good chance they would know- assuming the nurse is documenting and the CNA is reading... :) Even if nurses and CNAs don't use the same charts at a given facility- anything pertaining to info the aide should know would be well to be documented so they can keep up on what all care the patient has received. That is an admin/facility issue that could be improved upon- not a nurse/aide issue.

I know what you mean though- if the communication isn't there- the "good" things can go unnoticed and unappreciated. And that goes both ways.

I think alot of the frustration here is that so many are taking the OPs comments to be a general commentary on "nurses" when to me it reads as specific to her facility and asking if such is "normal". There is no reason to be defensive about that particular post/line (anyone) based on a specific-facility related issue. It seems like any post that references an issue like this or shift issues turns into a nurse/aide or day/night shift war and there is no reason for it. Are some nurses and aides lazy worthless bags of flesh who coast through till paydays? Sure. Are most? No. I keep hearing excuses after excuses defending and accusing why "nurses" this or "aides" that- and yes, have engaged myself. However- the real issue comes down to mutual respect, communication and a willingness to solve the problem- collaboratively. All of the "well nurses/aides do this/that" doesn't solve the problems.

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.

lpnflorida, LPN · Mar 31, 2009

I made no excuse. It was an elaboration of what goes on which some might not be aware of. How as Nurses work together so can the Cna's.

My last comment was based on the number of times a Cna is not aware of what we have done for a patient outside of giving meds etc. Most nurses do not spend the day telling the CNA every bed they made, every patient they toileted alone, every time they turned a patient, every water pitcher they filled. Yet we do hear of the times we asked a Cna to do it when we could not.

Ruffles 1 · Mar 31, 2009

I agree with you there is so much for a nurse to do that is why we have CNA's to help us. I always try to stay and help clean patients if I can. It is usually easier with 2 people than 1. Usually after you change the bed and turn them the CNA's can take over. Teamwork is the key.

Equinox_93 · Mar 31, 2009

I didn't say you did- I was speaking generally.

I made no excuse. It was an elaboration of what goes on which some might not be aware of. How as Nurses work together so can the Cna's.
My last comment was based on the number of times a Cna is not aware of what we have done for a patient outside of giving meds etc. Most nurses do not spend the day telling the CNA every bed they made, every patient they toileted alone, every time they turned a patient, every water pitcher they filled. Yet we do hear of the times we asked a Cna to do it when we could not.

Ruffles 1 · Mar 31, 2009

I agree that the CNA's do not realize how many times we do tech stuff that they are not aware of. I also get tired of the CNA's coming up to me and telling me the patient needs pain meds, when it is to early and I have already talked to the patient. I know all they can say is "I'll tell the nurse" It takes time to call the doctor and get something else.

guest64485 · 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 have a very different experience than you do. My floor manager is a nurse but has not worked the floor in a very long time. Just because someone is a nurse doesn't mean they know/remember what it is like to be a floor nurse. My manager would be angry at me if a patient made that complaint and I did not stay with to help, regardless of how far behind I was. It would be turned around on me to say that I have poor time management skills if I could not also accomplish changing this patient along with my other duties as well as leave on time.

Now, as for the charge nurses, they work the floor daily. They are wonderful and are a whole different story. They are fantastic advocates for staff and would back us anyday.

Ruffles 1 · Mar 31, 2009

I wish we had charge nurses that would actually help with tasks. On my floor they also take patients so that they do not have to help other nurses with tasks. They apparently get paid more also. It is a shame that this happens more frequently than not.

smiletoday · Mar 31, 2009

To the original poster. It does not seem as if you are willing to listen to what the nurses are telling you. Even the nurses who worked as a CNA in the beginning of their career. Are you burnt out on your job? No longer enjoy the job you do? Just wanting to vent? This is an area where nurses would like to vent to. This is a real problem. Not every day, every unit, every hospital, nurse or CNA. However, I would like to add my two cents and vent as well. Your original post stated that you get more information from the patients than the nurses. Do you think that you may be spending to much time talking to the patients. I would like to hope that when you discuss their ailments that you are staying within your boundaries. If your nurses fail to communicate with you. Seek them out and ask about the patient. Nicely ask them if you can meet with them prior to the shift to discuss the patients needs. On our unit we use preprinted forms that list the patient name and room number. Has spaces to place diet, treatments, baths, feeding needs, ambulation, iso precautions and dx. Each nurse completes it for their patient and gives it to the CNA. You do have the power to encourage positive changes. Majority of nurses care about their patients, want to improve team work and decrease conflict. Now for my personal expierences. When I first began at my hospital. When ever a patient needed to go to the bathroom, change soil clothing, request water, juice, or blanket. You get the picture. I did it. Still do sometimes. Although this may vary per CNA on the floor. Why did I change my attitude. Certain CNA were used to me providing that care to my patients. There were several times that I spoke directly with a few CNA and stated that I have a difficult assisgnment and would need help this shift. I only wanted them to do their job. Not mine. Regardless of this early communication at the beginning of the shift. I did not get the help. When I am swamped and tell you that I am swamped. Probaly is not the time to tell my that you can't toilet a patient because you are about to go on break. Please don't tell me, "why don't you do it." Please don't tell me that you don't have time to help me boost a patient, or help me transfer a patient that requires an assist of two. This is your job responsibilites that I am asking request to help with and the CNA says that they can't. Please don't roll your eyes or shrug your shoulder while you are on the internet. That is rude, disrespectful, and unprofessional. If you want me to continue to help. We all must remember our roles and scope of practice. Also, as you progress throught nursing school you will learn and practice how to delegate responsiblity. Delegation is also part of our job discription. Nursing is about team work. Each and every one of us has a job to do that will allow for the best of care for our patients. Thank you for allowing me to vent.

nursemike, ASN, RN · Mar 31, 2009

It's tempting, reading posts like the OP's, to respond with horror stories about some of the aides I've seen, but that doesn't address the OP's concerns, and more to the point, does a disservice to the great aides I work with. So, to more directly answer the question the OP posed...no, it isn't normal, and yes, it is.

The best thing about my unit, and especially my shift, is that we have a strong team of nurses. Not all of the nurses are highly skilled--I'm no whiz, myself, though I'm getting good at some things. But we work together remarkably well, and our most experienced nurses are excellent mentors. I credit them, mainly, with setting a tone that expects us to pull together.

The next best thing is that we seem to have the best aides. They routinely team up with each other, and with the nurses. It's great that they mostly like each other, and I can't think of any I would call lazy. I know they have varied opinions of the nurses, but as flattered as I am when some say they like to work with me, I sometimes defend the ones they're more critical of. I was a nursing student who was never going to be "one of those nurses." I wasn't an aide, myself--my job before nursing was a notch on the food chain lower than the aides, and my patient-care responsibilities were limited. But I spent some of my downtime assisting the aides with baths, toileting, etc. As a nurse, I do much the same. I rarely do an unassisted bath--I don't usually have that much time, and the aides are so much more efficient. If I assist with the bath, I follow the aide's lead. I can muddle through one, if necessary, but again, they're the experts. I've always been willing to help a patient toilet. If I have two patients call out--one with 10/10 pain and one needing a bedpan, well, giving pain meds immediately won't bring immediate relief, and waiting for a bedpan is also pretty miserable, as well as likely to lead to even more time spent doing a bed change.

Still, I've learned--the hard way--to be more "that kind of nurse," than I ever thought I would, and I'm not even slightly embarrassed. I'm a better nurse for learning it. Early in my career, I was doing assessments at midnight and came out of a room to find the aide nearby, doing her round of vitals, and asked her to help the patient I'd just left to the bathroom. At the time, I told her that I didn't intend to be "that kind of nurse," indefinitely, but as I was still new, I didn't have much choice, since I was always behind on the things only I could do. She happened to be a nursing student, so I had no doubt she would know just what I meant in another year or two. These days, I rarely have to commit that same most infamous of transgressions, but if it happens, I don't apologize. I'll always help the patient toilet, if I can, and if I can't, there's a darned good reason, and if you need me to explain that we can talk when time permits.

I have absolutely no interest in bashing aides. The ones I work with are respected friends. A couple sometimes make me pull out some of the little hair I have left, from time to time, and a couple consistently make me look like a better nurse than I actually am. You can bet the latter know who they are. The former--well, they're actually pretty good, overall, so I deal with their quirks and pull my hair out in the med room. If it's feasible and remotely likely to be effective, I'll take advantage of a "teaching moment," but sometimes it's just a personality quirk and there's no point making waves that are going to accomplish nothing more than rocking a boat.

One thing I've noticed and been surprised about, and as dangerous as it is to generalize, in this case I am going to generalize, is that even very good aides aren't as good at critical thinking as I would have once expected. I am still genuinely puzzled by this, at times. I have been toying with the outrageous possibility that I may have actually learned something in nursing school. It scares me to think this, but it does fit with something else I noticed when I first graduated. When I started school, there were nurses on my unit I wouldn't have let watch my cats. By the time I finished school, there wasn't one I couldn't learn from. And no, we didn't have a lot of turnover. In particular, a couple of "those kind of nurses," turned out to be really good nurses, once I learned what they were actually doing. Plus, I've gotten better at distinguishing dog-tired from lazy. You get to be fifty-something, and after 10-11 hours of running your butt off with at least another hour to go, and it gets a lot easier to delegate to the twenty-something who just came on a couple of hours ago. Especially when the last few times you've seen them, they were laughing and joking with their buddies. (I truly don't begrudge anyone a good shift. If you can get your work done and still have some free time, good for you. I like to laugh and joke, too. But if I'm having an easy night, I'm happy to help someone who isn't, and I expect it to work both ways. Which it usually does.)

I was about to say, "But I digress..." but that would be redundant. The point I was about to make when I wandered off was that I've caught aides making some fairly goofy decisions. One teaching moment I never fail to seize is a weird custom of folding drawsheets so that they extend from a patient's upper thighs to lower back. So you lift and the patient's head goes right into the pillows. Unfolded, the sheet extends from knees to shoulders, so you can lift the patient clear off the bed, and even use four people if you need to. When I explain this, most get it, and most who maybe don't at least humor me, but it seems like a common sense thing that shouldn't need explained. Sometimes, it's clearly a case of being task-oriented. A few are so determined to get as many baths done as possible that they are often unavailable for toileting. So instead of doing the six they are supposed to, they try to do nine, and end up doing twelve because three people soiled themselves. And that's not even counting the couple of times I interrupted a med pass to get someone to the toilet.

I don't mean to rant. Honestly, I'm tickled with my aides, and even the occassional hair-loss is worth it. I'm just surprised. The people in the examples I cited, and others I don't recall, aren't stupid, or lazy, and some of them can and do teach me a thing or two from time to time. All I can conclude is that what seems like "common sense" may not be as common as I think, and I have to keep that in mind. And, of course, there are occassions when it truly is a matter of being more educated. A case of that I recall was an aide elevating the legs of a patient with +3 edema in both lower extremities, to reduce the swelling. Before I learned about cardiac pre-load, that would have made sense to me, too. (So now, at least one aide knows something she didn't, as well as thinking I might possibly know something, after all.)

I no longer have any idea where I was going with this train of thought, but I think it had something to do with the importance of remembering that even expert aides are not nurses. And, again, to the OP, I sincerely hope your experience as a CNA will make you a better nurse, but I can almost guarantee that when you are a nurse, you'll have a slightly different perspective. Which is probably as it should be, and no reason at all we can't help and repsect each other. And yes, I probably should have just said that at the beginning, but I do so love to hear myself talk and/or read myself write.

NeosynephRN · Mar 31, 2009

I wish we had charge nurses that would actually help with tasks. On my floor they also take patients so that they do not have to help other nurses with tasks. They apparently get paid more also. It is a shame that this happens more frequently than not.

So your charge nurses take patients just so they will not have to help you?! That just does not sound right...as a charge nurse, I always have patients, and usually have the rapid response phone, and respond to codes, and have a full staff and unit to help out and support...and guess what we do not even get aide, so who do you think is going room to room turning and cleaning and suctioning....we all help each other but the expectation with my director lies with me when I am in charge. Nope I sure do not desrve the extra 70 cents or whatever I get paid....

LaceyLou · Mar 31, 2009

A few statements...from an aide.

1. I love my nurses. I KNOW they would help more if they could, but they can't, that's why aides exist... Suck it up... I say that with love. :redbeathe

2. There was a misunderstanding about medication aides that I'd like to clear up. Medication aides cannot function without a nurse, it does not save money to staff medication aides, it saves a nurse from a tedious med pass when she could be spending more time with patients (new admits, skin assess, dressings, enjoying their job...), giving quality care with a clear head. There is so much medication aides can't do, it is impossible to "let nurses go", a med aide would be EXTRA staff. No G-tube meds, no PRNs, Not even tylenol-PRN, nor open wounds, no injections, no Schedule II, etc... there are many more exceptions---This is Ohio med aides.

mochabean · Apr 1, 2009

I agree that the CNA's do not realize how many times we do tech stuff that they are not aware of. I also get tired of the CNA's coming up to me and telling me the patient needs pain meds, when it is to early and I have already talked to the patient. I know all they can say is "I'll tell the nurse" It takes time to call the doctor and get something else.

I"m a nursing assistant and I have no idea what times the nurse gives out pain medications. There have been dozens of times when I told a nurse, "Patient so-and-so asked for pain meds" and the response was "Oh! I forgot! I'm so glad you reminded me!" I see no point in shooting the messenger. Just tell the patient when their pain meds are do.