Aides and Nurses - Different Outlook, Lack of Understanding

[Weeping Willow]

I find a lack of understanding on the part of some of our aides as to what the nurse's view is on certain things.

The aides think we do too many vitals, weights, I & O, rounds, etc. and decide, on their own, that they are unnecessary and do not do them. One of them was in the habit of removing IV's she thought were unnecessary. I reported her after she continued doing this after I'd told her not to. We had to stick the patient 5 times to restart his saline lock for antibiotics. Family was quite angry and I don't blame them. Another nurse told them the truth, though, which made them livid and they c/o to the DON, who fired the tech.

They want to sleep on duty while they are supposed to be watching to make sure nothing happens to mental patients and have a complete lack of understanding, apparently, that the patients will not wake them up to say, "OK, I'm going to kill myself now, or swallow scissors now, or cut myself now, stop me if you can." They do not seem to grasp that not only are they going to be fired and maybe prosecuted, blackballed, whatever if the patients suffer harm but that they are also jeopardizing my license and livelihood and ability to support my family if some investigator decides I was not properly supervising the aides - although how I am supposed to ride herd on them and still accomplish my own work is not totally clear to me.

I spend a lot of time and emotion on trying to make clear what I expect of aides, one thing being that they need to tell me if they need to leave the floor, other than for a quick potty stop. And if I say that they need to wait until their peer returns from his break, they need to wait. Some are wonderful, some get huffy, I hate all the upset and anger they toss my way at times. They do what I say, though, like it or not, as I have made it clear that I will do the write-up's that are sometimes necessary if they don't. They might not like me but I have earned their respect and they know not to cross me. Actually, I think they like me well enough and I even like them.

How about you? Do you have such troubles? Do you have the respect and cooperation of your techs? Do you like being in charge? Do you enjoy working with unlicensed staff?

[RNperdiem, RN]

I was a CNA for 4 years before I was a nurse, and the approach to the work is very different, and misunderstandings common.

As a CNA I approached my work as a series of checklists to be completed. Vitals-done, breakfast trays passed-check, baths started-check, and so on. There was not a lot of critical thinking beyond common sense, and no goals in patient care.

As an RN, I approach my patients with goals in mind. How can I move this patient forward? Can I wean that Oxygen? When was the last BM? What do these trends in vital signs tell me?

[lvlissl2ebecca]

I am now working as an LPN at the same facility I worked as a CNA for 2 years. I now supervise some of my co-workers. One of the questions on my interview to return to the facility was "Say one of the CNA's you used to work along side of did something wrong, would you have issues with reprimanding them?" I said no, but at first I felt a little out of line.. although I wasn't.

After a while it got easier I just had to keep in mind that this is for the pt. my feelings are not what matters, and eventually those feelings disappeared. I'm lucky. I work with some very very good CNAs. Although, I can say that the OP is right in that they (nor did I when a CNA) fully understand WHY THE HELL we needed alll the vitals and It was sooo frustrating when the nurse would say "Hey we need vitals every 15 minutes for the first hour on this person then every hour for the rest of the shift". My thoughts were OMG this nurse is just being anal .. the pt is clearly not hurt. Now, working as a nurse I know why, so I explain to the CNA's why each and every thing they're doing is being done.. just so they know its for a good reason.. seems to work fine, and they respect me more than just saying here.. get these vitals../end.

I also want to add that I've backspaced a lot because I keep wanting to type "My CNA's are wonderful...or w/e". I made a similar post not too long ago and got jumped on for saying My CNA's .. although we all know they are not our CNA's, they work with us. I don't feel like getting jumped on.

To the OP.. I would just continue to do your best. Perhaps discuss with your manager those you are having problems with.. state the effort you make that way if something ever did come up, someone would know about the issue. GL.

[sunnydaydream]

I've been a CNA for 9 years and just recently graduated with an ASN and will soon be working as a graduate nurse in one week... So my opinion is only that of a CNA in a LTC.

It seems that CNAs have changed a lot over the past 9 years. JMO. It use to be get the work done and get it done good and I agree with another poster as a CNA everything is a task that needs to be completed. Now though it seems that *some* of the CNAs that I work with are more concerned about how fast they can get the residents up, dressed, and to breakfast to get them out of their hair. May I repeat myself in saying *some* CNAs.

Then, though, there are the CNAs that go above and beyond. Ones that work hard to get everything done and extra so that the patients feel good.

As a CNA I have no problem doing anything that the nurse asks me to do, but sometimes the nurse doesn't realize that I'm not just walking down the hall, but I'm on a mission to do something, but if the nurse was to say I really need this done now it would make things a lot clearer. I think that the lines of communication between CNAs and nurses are often neglected and it keeps the CNA from reporting something that the nurse may find useful as an assessment as is the same for the nurse. I think the one thing that bugs me the most is when I as a CNA (pre-nursing school) saw something different in a patient and reported it to the nurse and the nurse didn't look into it. As a nurse that I have worked with said-- your CNAs are your eyes and ears to your patient because they sometimes have the ability to spend more time with the patient that that of the nurse.

I think the thing that I will try to remember when I become a nurse is what I looked for when working with a nurse. Open communication, gratitude for a job well done, and understanding that we are working together.

[Ms.RN]

to whom nurse it may concern.

dear,

i cannot believe that, after finishing chewing each other's and eating your young's, you decided to take on cna's and nursing students. that's very courageous of you. maybe the doctors are right, when they tell you that they are the ones with the big degree.:nono:

what?????? do you think she is eating her young????? :angryfire:angryfire who do you think is responsible if something happens to her patient, for example if aide take lunch break without telling a nurse and patient falls and hit head on the floor and dies because of it? this nurse can lose her license because of that!!!!! or in this case, this aide took iv catheter out because she think this patient does not need iv. what rights does she have to decide patient does not need iv? if patient becomes septic and dies because she keep pulling iv catheter out, who do you think is responsible? if this aide wants to have a right to decide this kind of things, then she need to go to nursing school.

[mianders, RN]

I worked in a very busy ER for a long time. We had a lot of problems between the nurses and the PCA's. My director at the time gave me the challenge of finding a solution to these problems. I decided to have a monthly meeting with the PCA's to discuss their issues with the nurses, and yes they did have some legitamate issues just like the nurses did. These issues were then taken back to the nursing staff and the nurses issues were taken to the PCA's. Over the next few months we worked out the problems and came up with constructive ways to resolve them. If there was a particularly hard problem that we could not find a solution that both groups felt was fair then several people from each group would have a meeting with the director and myself and the solution that was best for the dept. was used. As a nurse one of the best things I got out of this whole experience was seeing things from a different prespective. The nurses and PCA's involved in it said they did not realize how the other group actually seen things either. Sometimes we have to see things from the other side before we can solve a problem.

[longhornfan1]

Aren't we all introduced to the foundations of conflict resolution in grade school? Even as young adults and college students, we are thrust into a society that requires compromise. I bet if you researched it, you would find that those professionals with the skill and fortitude for problem solving are the same people who have similar success in their personal relationships. At work I am referred to as the "problem solver" and at home the "peace maker". If we just keep our emotions in check, respect each other and keep an open mind about alternative paths to the same goal, then most anything can be resolved. Assuming that both sides are flexible and most importantly, willing to admit fault or flaws in their plan. But as nurses, I feel, a large part of my responsibility revolves educating myself and others. I can not effectively argue a point if I am ignorant about the subject. Most problems at my job are easily solved by giving either parties knowledge about the subject and several potential resolutions.

[chadash]

Lately, I have been wondering about the use of nursing assistants in the hospital setting. Do you think it would benefit patients to have total care from a RN who has a lighter patient load?

It is true, the NA must take a task focused approach, and it is easy to lose sight of goals for individual patients. Some times there are just so many patients, so many needs, and so many details, you just feel like you have addressed only a portion of what you legitimately should. A nurse will approach and ask: "did you remember Mrs. so and so's whatchimicallit?" and I smack myself on on the head, apologize, and go do it. I go home and feel like I have neglected someone....just impossible not to, even going at a full clip.

So, I feel it would be better to have nurses with lighter loads do it all...soup to nuts...and the patient would have more personalized and better care.

[lindarn]

You are correct. That is the reason that I went into ICU. I was able to manage my own two patients, with minimal help from the CNA's that we had on the unit. I hated floating to Telemetry because we had more patients (4), and I had to depend on aides to do some of the work (V/S- etc). I would rather have my own two patients, and do it myself if I am going to have to be liable for unlicensed assistive personnel.

Lindarn, RN, BSN, CCRN

Spokane, Washington

[Virgo_RN, BSN, RN]

As a CNA I have no problem doing anything that the nurse asks me to do, but sometimes the nurse doesn't realize that I'm not just walking down the hall, but I'm on a mission to do something....

That happened to me all the time as a CNA. Likewise, it happens to me as a nurse. It seems to me that when a CNA sees me in front of a computer screen, they do not realize that this is the first time in my entire shift that I have had a chance to look up a critical lab on a patient, or that I am preparing for a med pass that I'm already an hour behind on.

The respect needs to go both ways. I can count on one finger the number of times I've been thanked for my help, yet I am always answering call lights and emptying urinals and fetching snacks and warm blankets. It seems that I am expected to do backflips of gratitude any time a CNA lifts a finger to assist me, but they do not see all the work that I am doing.

We are all on the same team, but have different perspectives on what our roles are. There are some aides that expect the nurses to stop what they're doing to help pass meal trays. They don't understand that we may be busy calculating insulin dosages and passing medications that need to be given with meals, or that this is the first window of opportunity we've had all shift to chart our assessments and that if we don't do it while we have the opportunity, we'll either be working straight through without a break, or staying late to chart. Nurses want to get out on time and go home to our loved ones just as much as the aides do. As human beings, we must take in nutrients in order to sustain life.

I'll admit, when I was a CNA, I had absolutely no clue how much the nurses really were juggling. It's downright embarrassing to think about it.

I wish I knew what the solution was. As an aide, when I tried to broach the subject, the nurses didn't want to hear it. As a nurse, if I make mention of it, the hackles go up. I'm all for open communication, but that's difficult to do when people are defensive right from the start.

I think it needs to come from the top down. We need more aides. Because we are overworking our aides, we are overworking our nurses, and everyone is demoralized. With more aides on the floor to share the workload, the nurses can provide better care as well....and maybe even take our breaks and get out on time!

[Virgo_RN, BSN, RN]

Lately, I have been wondering about the use of nursing assistants in the hospital setting. Do you think it would benefit patients to have total care from a RN who has a lighter patient load?

Maybe. But it's never gonna happen. It costs less to hire NAs than it does to hire nurses.

[jackson145]

Just try to remember how very little a tech makes when you wish they were doing more. It's very hard to make minimum wage and have a $30/hr nurse say "My job would be so much easier if you'd jump in and help me". Yeah, I bet you'd like that. Truth is, I have specific duties and so do the nurses. It takes my whole shift to complete my work and they certainly don't jump in and help me. That would be beneath them.

[Virgo_RN, BSN, RN]

That's all well and good, but I am an LPN at the bottom of the pay scale, and many of the CNAs who have been there a while, at the top of their pay scale, make more than I do. Basically, I'm earning less than many CNAs to do an RN's job.

Edited to add: I'd also like to add that when I am an RN making thirty bucks an hour, I will not be made to feel guilty! I have worked my behind off to get that degree, and have gone into debt for the rest of my life to finance it. I worked full time as a CNA while in my first year of a full time nursing program. I have sacrificed many hours of sleep, time with my loved ones, and potentially, my health (knock on wood) to get where I am now.

Becoming an RN is the hardest thing I have ever done, second to raising two children on substandard wages. I will have EARNED every single penny, and guilt does not have a place in determining whether or not I expect a CNA to do their job.