Aides being "nurses"

mentalhealthRN · Dec 21, 2010

I think that before you make any more assumptions you should ask to be sure. You could speak to the nurse manager. Hard to know weather or not there is "practice outside of scope" for sure seeing as they seem to have a title you are not sure of. Absolutly if they not nurses or nurse interns then by all means doing anything with the pumps --other then maybe silencing as long as they tell a nurse right away--is not okay. Communicating with the doc is not necessarily wrong. There are things they (the docs) may feel they could just as easy ask the aides providing direct care and get the info they need without bothering the busy nurse. --"Has Mr. Smith been up to the bathroom recently?" "Has Mr. Smith been sleeping much this shift?" --the doc may be there seeing the patient quickly and just want to ask a couple of simple questions that the aide would know. Not a big deal. They are a part of the team too. Not saying that those same things should not be also reported to the primary nurses but simple things can also go to the docs.

I know where I worked the aides often would silence a pump as it is loud and annoying for the patient.....and as the nurse I didn't have a problem with that as long as they came and told me that they had done this, right away so I could go and check on it if need be, change a bag, deal with air in the line, etc.

If they are doing more then silencing--and are not nurses--yeah that is a problem and should be mentioned to a manager. But start with finding out the exact role of these people.

caliotter3 · Dec 21, 2010

I worked at a facility where nursing assistants were given nursing tasks, like med administration, by the nurses. Of course this was acceptable because these individuals are nurses, in their country. At least this was their response, if asked.

raebabelvn, LVN · Dec 21, 2010

I think that before you make any more assumptions you should ask to be sure. You could speak to the nurse manager. Hard to know weather or not there is "practice outside of scope" for sure seeing as they seem to have a title you are not sure of. Absolutly if they not nurses or nurse interns then by all means doing anything with the pumps --other then maybe silencing as long as they tell a nurse right away--is not okay. Communicating with the doc is not necessarily wrong. There are things they (the docs) may feel they could just as easy ask the aides providing direct care and get the info they need without bothering the busy nurse. --"Has Mr. Smith been up to the bathroom recently?" "Has Mr. Smith been sleeping much this shift?" --the doc may be there seeing the patient quickly and just want to ask a couple of simple questions that the aide would know. Not a big deal. They are a part of the team too. Not saying that those same things should not be also reported to the primary nurses but simple things can also go to the docs.
I know where I worked the aides often would silence a pump as it is loud and annoying for the patient.....and as the nurse I didn't have a problem with that as long as they came and told me that they had done this, right away so I could go and check on it if need be, change a bag, deal with air in the line, etc.
If they are doing more then silencing--and are not nurses--yeah that is a problem and should be mentioned to a manager. But start with finding out the exact role of these people.

No no no... I didn't mean to portray that I thought that talking to the doctors was wrong, just different and odd as I've never seen it before.

As far as the unknown title, I'm 100% positive that this particular ACA is an aide. I was with grammy for 3 hours and whenever the RT or RN said they'd send the aide in, she came right in.

I agree with the silencing thing as well, as long as the nurse is notified, no harm done. But adjusting settings, flow, ect? Thats not ok with me. I would've said something, but I was shocked when she did it and didnt even think to say something. If it happens again I will.

allyourbasesare · Dec 21, 2010

Having the same trouble on my floor. The CNA in question(whose certification has expired), has incorrectly explained diagnoses to pts, pushed buttons on the ivf's, placed foleys in a non-sterile fashion, changed dressings to surgical sites, burned an elderly pt with an unapproved heating pad that she made in the microwave, refused to place a pt back on telemetry because that pt was "too feisty, riding the call light, and didnt want to wake her up" (her words). BTW, that pt coded an hour later and died. She has been told by our nurse manager twice, to not go outside her scope, and each time, does exactly that. I am reluctant to have her go into any of my rooms and prefer to do primary care because I cant trust her to do ONLY HER job and to keep her incorrect interpretations of a diagnosis or plan of care to herself. While I have spoken to the manager several times about this, it keeps happening. I understand that the manager does not have to share how she has disciplined this individual, but it is quite frustrating to observe no change in the CNA's ways. I suppose I could utilize the next step in the chain of command (my boss' supervisor) but Im sure you can guess how that will go.

klone, MSN, RN · Dec 21, 2010

I suppose I could utilize the next step in the chain of command (my boss' supervisor) but Im sure you can guess how that will go.

Actually, I think what I would do in that situation is document and then call the BON.

mentalhealthRN · Dec 21, 2010

I worked at a facility where nursing assistants were given nursing tasks, like med administration, by the nurses. Of course this was acceptable because these individuals are nurses, in their country. At least this was their response, if asked.

OMG that is sooooo scary! I would be RUNNING to the Office of professions. That is so illegal--for both the nurse delegating to unlicensed persons and to the aide practicing without a license--in this country!! It makes me sick that nurses are put into such a position where they are so over overworked and under staffed that they resort to this kind of stuff!

caliotter3 · Dec 21, 2010

OMG that is sooooo scary! I would be RUNNING to the Office of professions. That is so illegal--for both the nurse delegating to unlicensed persons and to the aide practicing without a license--in this country!! It makes me sick that nurses are put into such a position where they are so over overworked and under staffed that they resort to this kind of stuff!

The nurses did not do this because they were overworked.

freetopayattention · Dec 21, 2010

Having the same trouble on my floor. The CNA in question(whose certification has expired), has incorrectly explained diagnoses to pts, pushed buttons on the ivf's, placed foleys in a non-sterile fashion, changed dressings to surgical sites, burned an elderly pt with an unapproved heating pad that she made in the microwave, refused to place a pt back on telemetry because that pt was "too feisty, riding the call light, and didnt want to wake her up" (her words). BTW, that pt coded an hour later and died. She has been told by our nurse manager twice, to not go outside her scope, and each time, does exactly that. I am reluctant to have her go into any of my rooms and prefer to do primary care because I cant trust her to do ONLY HER job and to keep her incorrect interpretations of a diagnosis or plan of care to herself. While I have spoken to the manager several times about this, it keeps happening. I understand that the manager does not have to share how she has disciplined this individual, but it is quite frustrating to observe no change in the CNA's ways. I suppose I could utilize the next step in the chain of command (my boss' supervisor) but Im sure you can guess how that will go.

I am surprised the CNA is allowed to replace tele or was she assigned a task outside her scope? But if she can place a foley then surely she can put tele electrodes/snaps on!

mentalhealthRN · Dec 21, 2010

Having the same trouble on my floor. The CNA in question(whose certification has expired), has incorrectly explained diagnoses to pts, pushed buttons on the ivf's, placed foleys in a non-sterile fashion, changed dressings to surgical sites, burned an elderly pt with an unapproved heating pad that she made in the microwave, refused to place a pt back on telemetry because that pt was "too feisty, riding the call light, and didnt want to wake her up" (her words). BTW, that pt coded an hour later and died. She has been told by our nurse manager twice, to not go outside her scope, and each time, does exactly that. I am reluctant to have her go into any of my rooms and prefer to do primary care because I cant trust her to do ONLY HER job and to keep her incorrect interpretations of a diagnosis or plan of care to herself. While I have spoken to the manager several times about this, it keeps happening. I understand that the manager does not have to share how she has disciplined this individual, but it is quite frustrating to observe no change in the CNA's ways. I suppose I could utilize the next step in the chain of command (my boss' supervisor) but Im sure you can guess how that will go.

Yes agree with the others.....you must go to someone over your NM. The patients on your floor are at risk. I have to say I had a really bad aide on a floor and was lucky enough to have her be so mad after getting spoken to by the NM that she resigned and went back to the housekeeping dept she came from. She was really sweet most of the time but I lost it with her one day when she was walking past a patients room I was in. I had walked in and the elderly pt was trying to get the BR alone and starting to fall. I was trying to get her back to the bed and not having much luck alone as the pt got very weak and began to fall. As I stood doing everything I could to keep this pt from falling I yelled out hoping someone would be within earchot--an aid,nurse, doc..... "could I get some help in here--now!!??" She walked into the doorway and I was so releaved to see her.....she stood there and told me that her break wasn't over yet and that this was not her pt. I swear I had steam coming out of my ears. I was not so nice but got her to help--followed by my dragging her into the utility room and blasted her! I thought that would be the end of her behavior---until about a week later. I had a SOCIAL WORKER come rushing up to me and tell me she had just went in to see one of my patients and that the patient immediately reported to her that she was having chest pain. I went immediately to see what was going on and as I was getting VS and an EKG the pt tells me she had been having the pain for about 30 min. I asked why she didn't tell anyone earlier. She tells me that she had told the aide. The same aide I had blasted a week prior! She never told me or any other nurse of this pts reported CP and was like...."Oh, I forgot."--rolling her eyes. The pt ended up okay but was in acute CHF. I once again blasted her and she walked off the unit. The next day the NM told me that the aide had resigned. YEAH!! So I know its sooo frustrating. But for your patients sake you can't give up.

casi, ASN, RN · Dec 21, 2010

I agree, why dont you ask?
There were occasions when I was an aide that a nurse would ask me to add volume to a bag of IVF to give her time to hang the next bag without it beeping for 5 minutes. Certainly if an MD asks a caregiver a question about a pt like 'how was their night' an aide couldn't answer from their perspective? It sounds like you need more information about this hospitals staff and roles before going off half cocked.

As an aide I would have never increased the amount on a bag. Even when I was nurse desperately searching for a nurse job as I was still working as a CNA I wouldn't have done this. The only thing I would do with the IV pump was hit silence, "I'm going to hit he silence button and go let your nurse know that your beeping" (didn't want the patient to think that I was playing around with the pump) or with a nurses blessing i'd straighten out an arm where the IV was in the AC and hit start when the pump read distal occlusion.

To the OP ask people what they are and what their role is. When an aide touches an IV pump ask them what they are doing.

sevensonnets · Dec 21, 2010

A CNA performing tasks outside their scope of practice is NOT called teamwork.

klone, MSN, RN · Dec 21, 2010

A CNA performing tasks outside their scope of practice is NOT called teamwork.

When she said "teamwork," she was referring to talking to the physician about the patient. That is not working outside scope of practice.