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!

[sicushells, RN]

I don't have a lot to add that hasn't already been said, and probably better than I could say it, by nurses and unlicensed assistive personnel (regardless of actual job title)with more experience than me, but I do want to say that anytime you get on a nurses forum and start talking about how nurses are lazy and don't want to do patient care... you're going to get some grumpy nurses. Yes, there are lazy People in the world, but most of them don't go into bedside nursing (in my opinion) because it's HARD FREAKING WORK!!! If somehow they stumble into the insanity that is bedside nursing, they certainly don't stay for long.

A) I'm absolutely interested in what you think after you FINISH nursing school (yes clinicals are experience, but no... they don't make you a nurse)

B) To the CNAs who think that toileting a patient comes before all "nonemergent" situations... Just wait until the first time as a nurse you end up staying two hours late finishing charting, completing all the orders that the doc wanted throughout the night, and trying to survive the death-stares the oncoming nurse is shooting you because your laundry list of things to do is a mile long. Also, that saying "an ounce of prevention is worth a pound of cure"... yeah that. Most (not all, but most) emergent situations really can be potentially prevented with a good set of eyes and ears. Hypothetical example... If I don't give my patient the IV metoprolol they're scheduled and they convert into A fib with RVR, pass a clot, have a PE and die... well at least I was helping you change linen. Since there wasn't an "emergency" going on at the time, you know. I'm afraid I sound condescending, and I'm not trying to, but there are reasons for why I prioritize the way I do, and it's not based on a dislike of hard work or distaste for the smellier parts of nursing. We don't end up all saying "No, i don't mind helping/cleaning up if I have time. But i don't have time" because we want to catch up on American Idol. It's because we don't have time. And when you've been a nurse for 6 months, you can come back and tell us how you feel about prioritization of changing linen/poop-pee patrol vs. every single other thing we do.

Alright, ramble/grouch fest over. I still ended up typing a book (sorry!)

[GaMBA]

It's interesting what this thread had turned into. I've been called ignorant, burned out, told I "don't get it", and a couple of other ridiculous things. I see that tact and respect in a discussion is a total lost art for some. The ability to read and reading comprehension seems to be a struggle for a select few as well.

With that said, I do appreciate the constructive and respectful comments that gave me insight and good feedback. When I go into work tomorrow I will educate myself on what a Kardex is and how to find/use it. I'm also going to make sure to leave the eager-beaver part of me at home and stay within my scope of practice, no matter how tempting the task looks (for some reason, I have become obsessed with wound care!).

During lunch the other day I asked a nurse (she's a relatively new one, I think about 6 months) what her typical day is like. She started talking about how she had to clear up a medication error that wasn't even her fault and told me that it seems like a large part of her job is being a coordinator of sorts between different groups of people--doctors, the pharmacy, other nurses, and so on. I was actually surprised. We ended up laughing about it though b/c after 30 minutes at lunch, she had only managed to tell me about this one aspect of that one pt, much less the other 5 or 6 she had to take care of that day. I can only imagine all that she does during the day. But our convo did give me some perspective on what a nurse's day is like on our floor.

One of the posters mentioned that I should be doing more, like EKGs and brain surgery :-) During my orientation I was trained to do a bit of phlebotomy and dry dressing changes and I can take out a foley and an INT, but beyond that I'm pretty much used as your typical tech is. Mainly CNA-type duties. We have a phlebotomy team, we have people that do the EKG stuff. I do plan to get as much diversified training as I can at my job, but it does take time. I've been at this job and in this industry for roughly 3 months now. There's no way I'd already know how to do everything (though I am trying to learn, believe me! lol)

[GaMBA]

Also, and I feel I have to spell this out because some people either just don't read the OP or they like adding words to the stuff they read, but not once have I called the nurses I work with "lazy." I've never implied it either. What I have said is that some of them seem to have an aversion to doing pt care or helping out with it. No, I don't see what every nurse does every single minute of every day, but I have worked with most if not all of the ones on the day shift on my floor at some point or another, and this is simply one of my observations. I understand the prioritization and delegation stuff that has been mentioned on here repeatedly, I understand that after I go through NS I will "get it", but at the moment I'm simply telling how I see things. Maybe they don't have an aversion to pt care. I don't know. But what I do know is that as a tech, I don't ask for a whole lot of help. In fact, it's rare that I even ask a nurse to help me with anything b/c I know how busy they usually are. In the event that I do need some help, my first resort is typically to ask another tech. But sometimes they're busy as well or the nurse is already in the room. I have literally only needed a nurse (who was already in the room with me) to hold a pt on their side for 3 seconds while I slipped a brief underneath the pt and have been told to go find another tech to help me. It is behavior like this that I do not understand. I don't know what kind of delegation skills are learned in nursing school that would tell a nurse to do such a thing. I may get flamed for that comment but it is what it is. I'm not asking for help every minute of my 12-hr shift, nor am I asking you to do everything for my pts. I'm not even asking you to toilet them or change sheets or whatever (I didn't realize techs asked for help with that one!). In fact, chances are that during a typical day I won't need any help from a nurse. It's only once in a blue moon that I actively seek help from a nurse and even then, like I said, it's for something really super quick. All I'm saying is if you happen to be in the room when I'm in there and I ask you very kindly if you can help me pull the pt back up in the bed, or if you can hold them while I slip a brief underneath, I'd really appreciate it.

[psalm, RN]

Concerning toileting a pt. before they do it themselves and fall: Most facilities want nurses and aides to make hourly rounds to see that everyone is okay. This is a good time to ask if someone needs assist to the BSC or toilet.

Time management and managers putting the blame on the nurse or aide...that is a "catch-22" we will probably all have to live with.

[nursemike, ASN, RN]

During nursing school, a friend who worked as an aide was contemplating nursing school, but hesitating because she was afraid nurses spent more time charting than caring for patients. Being much more knowledgeable then than I was after nursing school, I assured her that the ones who spent most of the shift charting were the ones who wanted to. The nurses we both most admired spent plenty of time with their patients.

I've had to eat those words many times. What I didn't see was that the most patient-centered nurses were the ones still charting 30min-an hour past their shift. Lacking their time-management skills, I've gone as late as 10-10:30 after an 11-7 shift, though lately I'm doing better. I've also seen that none of the nurses I work with spend all of their time charting. And I don't think any prefer it. I once remarked that I'd rather do colostomy care than chart. Then I actually got a pt with a colostomy (rare on our unit). As I was doing his care, it suddenly occurred to me that yes, by golly, this was more fun than charting.

It occurs to me that in my previous post, I said in effect that my aides were ignorant. I hope that didn't come across as perjorative. I only meant that most have typically not studied anatomy and pathophysiology and pharmacology and all that other important crap, so as smart as they may be, it's important (for me) to remember which of us is the nurse. But they are very smart within the scope, and I'm smart enough to listen to my aides.

To me, the time I spend with my patients is food for my soul. As a beginning nurse, I was very task-oriented, because I had to be. Over time, I've learned to manage my time and set my priorities more effectively. One patient once asked me (he'd been a CNA in his prior life) whether I was leaving his assessment for last because he liked to talk so much. I admitted I had been (all of my patients, that night, were fairly low acuity, so there wasn't much need to worry about seeing the sickest first). He was grateful, and I enjoyed our gab sessions as much as he did. More recently, I've faced choices like a patient with pepcid and colace due at ten vs a patient who learned she had a brain tumor at 9:55. So, hey, pepcid and colace aren't that time-critical, and if it doesn't get passed until 10:45, I'm not reporting it as a med error. Pretty much all of the nurses I work with would agree, but I suppose there might be a few in the world who'd be appalled.

There have been numerous threads in the past about lazy nurses, lazy aides, nurses who were "too posh to wash," etc. Nurse vs. CNA is a horse that seems pretty sickly, if not dead, to many long-term members. Of course, anyone who doesn't care to discuss it doesn't have to respond, but it's a bit inevitable that some of us will bring some baggage from previous threads.

I looked over the original post, again, and notice the OP has been a tech for 3 months. The situation she describes is not the situation on my unit. We have a good team, all around. Some of the newer aides do need more help, more often, than the more experienced ones, but I'll take the OP at her word that she rarely needs help. I wonder how many of the nurses are also fairly new.

Someone mentioned the charge nurse helping out. I've just recently done three nights as CN. I was free-charge (no pts of my own) for nearly all of those nights (two nights I had to pick up the last admission of the night at 0600 or so, so I was virtually free. I haven't been able to be as helpful to my coworkers as I would like, or as other CNs are. The other night, a friend needed an IV at the same time I was doing the next day's assignments. If the IV doesn't get done, dayshift can get it. Not ideal, but not unheard of. If the assignment board isn't done, the whole day is screwed up before it starts. If I were better, I could do both, but for now, I do the one that has to be done.

So, anyway, while I do sympathize with the OP's plight, I know from my own experience that there may be two sides to the story, and I hope she'll keep an open mind to that. That, and stay within your scope. I've never heard of it actually happening, but it is possible to lose your license before you ever get one.

[darrell]

Been there, done that. I was a tech in a respiratory ward for 18 months during nursing school. I saw all you describe. There are many different reasons for the problems, but the main driver is poor systems design. A little more structure supporting integration might go a long way.

I am an RN in a psych unit now. Our techs and nurses all sit together for report. We talk together throughout the day as equals with differing scopes. This is partly the design of the system (joint report, for instance) and partly the culture of the unit. Both can be modified to achieve this end.

Continue in good faith. Remember patients come first - never let them suffer over some disagreement with a coworker. You are giving your own career a huge boost by working as a tech. Observe, ask questions, find out why when you can, build your own model of the kind of nurse you wish to be.

To this day I am incredibly grateful I decided to take a tech job during school.

D

[amshockley]

Well I can see both sides since I have worked every aspect of most of the nursing roles. I understand how the CNA can feel rejected, slighted or even ignored and how the nurses push off problems of the patients because they are overwhelmed. I have watched nurses do that for years (being a nurse). I am a hospice nurse and go into nursing homes, hospitals and patient's homes. I think its inexcusable honestly and I don't like it one bit. If you don't get any response from the nurse you should take it above her head. I have done that as a CNA way back when I just got into nursing myself. Just because you are an aide doesnt mean you cannot write that nurse up either. There is a flip side to this as well. Nurses have a lot of calls, paperwork, crossing all the T's and dotting all the I's. I can see how being over several patients can be overwhelming, but it is part of the job and thats what you get when you signed up, so to speak. Sorry for your troubles and the best way to remedy this is to further your education and become a loving nurse, one that won't neglect her patients.

~be happy in life...

Angie..RN

Hospice Nursing

Tulsa, Oklahoma

[l150]

Sorry, I have been on both sides. Let's admit it nurses. There some of us that are just to lazy and don't want to help the aide even IF they have time. I have heard several colleges say that pt. care is not thier job. Even though this fundamentals I have been told that's not what they went to school for. I'm sorry, and many of you won't like to hear this buit it is true. It is EVERYONE'S job. They refuse to do any of the "dirty" work. I've seen it time and time again. They talk down to the aides, ignore them if they present any pt. concerns, and some won't recognize an aide at all unless they need something. I am a nurse and yes we are overworked, but so are your aides. Think about that next time. Also, what you think is pertinent to you might not always be for the aide. For example you might have poopy diaper in 126a , but 130b is confused,pulling out I.Vs, etc, but the family refuses to have that pt. on chemical or physical restraints ( yes this has actually happened ). What do think it more important to that aide or the other nurse taking care of that pt? Just remember that. Also not giving a report to the aide only hinders yourself. If you let them know what is needed, most of the time it gets done. There are unexpected things that happen from both sides, so telling aides at the last minute is not feasable. At least if something comes up you can work your way around it. Yes , you should let your aide know what is going on with your pts. Someone posted will it affect pt care. Most likely it will, Remember, the aides see your pt. more than you. There are certain things that aides have and can be trained for ( there are different levels of education to aides ,also, bet you didn't know that )You should have good communication.This cuts back on resentment and confusion. You shopuld treat your aide/tech how you would want to be treated. Every human being deserves respect. A degree might make you the supervisor over them, but it doesn't make you a better person than them. When you clock out and walk out those doors, we are all the same.If you think otherwise, then you really need a reality check.

[FixThebody]

As an RN myself I also find many RN's to be just plain LAZY ! I must mention that paperwork has made more and more nurses nothing more than paper pushers. Many are finding less and less time to be the educated and capable patient contact staff of the past. For some, their poor paperwork skills, robs from their valuable patient care time. The ever increasing ratio of patients to nurses is also making the pile of paperwork for each RN mountain of paperwork.

However, you are right, I can always identify a few that just like to sit on their butts. It makes for an easy shift which reserves energy for multiple shifts or extended hours. This makes for a bigger paycheck.

The biggest issue I have is that many just guess, guess, guess on the paperwork. Not spending any time with the patient keeps them from having the first hand knowledge to truthfully fill out the paperwork. Sure the answers are educated guesses, however, the problem is that they are not necessarily acurate answers. The answers which can ONLY be obtained though time "SPENT" with the patients.

Anyway,,, Hang in there ! I don't see it getting any better. Just learn to live with it. It is not always the RN's fault.

[starfire33]

First of all.... ROCK ON! CNAs who care about what they are doing make my job a MILLION times easier! Secondly, you are right - when I got on the floor I had NO medical background except school and really didn't know how to clean up a patient efficiently, but instead of just shooing me out of the room and saying "I'll do it" while rolling their eyes one or two CNAs were cool enough to gently point out some tips and help me until I got the hang of it. There are so many CNAs AND RNs/LPNs that are a bit slack in their job that each group is super sensitive to what the other may/may not be doing. Luckily, I have found open communication and time helps. Because over time, my co-workers will realize if I DO have the time, I will do ANY task and communicate, teach, talk, and spend with my patients as much as I can. And if I am suddenly calling sixteen times to ask for help with X, Y, and Z then you will know something is going horribly, horribly wrong and maybe work with me so we can both make sure everyone is taken care of. Teamwork is awesome. :) Thank you so much for the idea of giving report to my CNA co-workers! Like your unit, nurses give report to nurses and CNAs to CNAs, I never though about how much could get miscommunicated or lost in the cracks between the two, I will try that on my unit and see how it is received. I already know some people will be irritated, and some overjoyed, but as you stated it is rarely that "over-communication" happens.

[amshockley]

I have to agree with fixthebody. You CANNOT assess a patient from your chair at the nurses station. C'mon nurses! Get up and go to the rooms. Sit and take time to really know your patients and actively chart what is really going on with them. Open communication is key with your CNAs. I travel around a fairly large city. Who do you think calls me when one of my patients is declining or is having difficulty? Can we just tell them what to do..? No we drive there ourselves to see what is going on. I cant just sit in the office or sit at home and chart. Its no different than sitting on at the nurses station. We do depend on the CNA to keep them comfortable until we arrive. My CHHA's are my eyes and ears, not my hands. Face it nurses! Without the assistance of the CNAs our job would be virtually impossible. Be kind to your angels in scrubs and let them know how much you appreciate them on a daily basis and show them the same respect you would want yourself.

Angie

Hospice Nursing :redpinkhe

Tulsa, Oklahoma

[mochabean]

I know on the unit I work on we frequently get call offs, so there are bad days when there are only 2 nursing assisants or even 1. I've spoken with other NAs and pretty much everyone is frustrated and are planning to leave or change their status to part-time or casual. The NAs who are even in nursing school find the job frustrating as well but still do a good job. The one's who don't like coming to work usually disappear or claim they are "busy"- anything to get out of doing work, which makes it harder for other NAs. On the days there are 2 nursing assisants (with 30-35 patients on the unit), we don't get much help at all from the nurses who are constantly asking us to do things. It's one thing right on top of the other. One person can only do one thing at a time! But I agree, I don't see it getting any better unless. Nursing assisant jobs are very physical and the pay is not enough considering the amount of work we do. This position has a high turnover rate.