Are most employers hypocrits?

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I have been a certified nurse's assistant for 22 yrs. For the last 9 yrs., I worked in the same place. I still maintain my CNA.

During that time my employer has always been very good about keeping us aides up to date on inservices, particularly skin care and skin integrity.

We are issued "CNA Shower Check Program" booklets and all of our showers have "Checklists" hanging in them with detailed instructions on HOW and WHAT to look for and report when showering or bed bathing. Basically a head to toe skin assessment.

We have taken this dury for granted and are happy to help our resident's and nurse's in this way.

I am also a new grad RN and altho I had my IP RN and had discussed my working there under IP RN with my D.O.N., she was leaving her job and regretfully informed me that the facility would be unable to use me as an IP RN due to a lack of available positions.

What bothers me is that even tho all of the other aides were still doing their "skin checks" as usual, the a.d.o.n. and other nurse's started to harrass me if I reported skin problems citing that I was performing assessments that were outside the scope of practice for a CNA.

I was eventually terminated by the new d.o.n. on an semi-related issue where I reported on a resident's skin integrity.

The other aides are still instructed to perform these checks.

Also, the aides have been taught that evaluating for pain is to be considered "the fifth" vital sign. We are taught to ask about location, pain scale score, nature, time, etc. Basically a pain assessment. Again, when I did it I was called out and told I was practicing outside my scope but none of the other aides ever were.

Does this seem hypocritical to anyone else? Why were my shower checks suddenly "outside my scope as a cna" but none of the other cna's were being questioned or disciplined? Should I worry that someone may report me?

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Specializes in PICU, Sedation/Radiology, PACU.

Personally I think be whole situation sounds pretty ridiculous and you should ask for a meeting with the DON to discuss it.

It's not outside the CNA's scope to tell the nurse that a resident had a red area on their back. In fact if you saw it and didn't report it, that would a bigger issue. I don't think CNA's need to do a full pain assessment (the RN will need to do one anyway) but if the resident says they are in pain, or the CNA asks, of course the CNA can tell the nurse that.

I hope that you appealed your termination so that you could at least get unemployment. From my perspective, you did nothing wrong.

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Specializes in Med/Surg, Ortho, ASC.

I have to think that there's more to this story. Did you get off on the wrong foot somehow with the new DON?

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Specializes in Critical Care.

Apply for unemployment first off and if they contest it then you will be able to explain the situation. Since they were unable or unwilling to hire you as an RN try to get an RN job elsewhere. During the interview you can explain they didn't have any open RN positions and concerns over remaining as a CNA and not being able to practice in the scope of RN.

While it sounds like you did nothing wrong, they were not comfortable with you working as a CNA while graduating as an RN. Also you got caught up in the politics of a new DON.

See if the old DON can give you a reference and who knows get you a job at the new place she is working at now? Maybe a blessing in disguise!

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Linda Whitenton, RN, MSN, and Marty Walker, ARNP. Exam Cram: CNA Certified Nursing Assistant. Pearson Education, 2010.

"Only a licensed nurse can apply prescription ointments, lotions, or other products in any form to the skin; however, you are responsible for reporting any redness, pain, tenderness (sings of inflammation), open sore, or other skin abrasion immediately to the licensed nurse." - p. 45

This same CNA text describes physical signs of pain (tachycardia, tachypnea, dyspnea, hypertension), the use of a numerical pain scale, and even goes so far as to discuss cultural differences in pain perception (p. 51,59). Why would the authors go through the trouble of explaining these details to the CNA candidate if it were not in the CNA's scope of practice to identify and report these signs to the licensed nurse?

I guess your DON has knowledge of a CNA's scope of practice that is far superior to the career nurse educators who wrote this text and to the precedents of state boards of nursing.

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Specializes in ER.
Linda Whitenton, RN, MSN, and Marty Walker, ARNP. Exam Cram: CNA Certified Nursing Assistant. Pearson Education, 2010.

"Only a licensed nurse can apply prescription ointments, lotions, or other products in any form to the skin; however, you are responsible for reporting any redness, pain, tenderness (sings of inflammation), open sore, or other skin abrasion immediately to the licensed nurse." - p. 45

This same CNA text describes physical signs of pain (tachycardia, tachypnea, dyspnea, hypertension), the use of a numerical pain scale, and even goes so far as to discuss cultural differences in pain perception (p. 51,59). Why would the authors go through the trouble of explaining these details to the CNA candidate if it were not in the CNA's scope of practice to identify and report these signs to the licensed nurse?

I guess your DON has knowledge of a CNA's scope of practice that is far superior to the career nurse educators who wrote this text and to the precedents of state boards of nursing.

While it sounds as though the OP's place of employment had a policy that CNA's report certain issues, you do no one a favor by generalizing based off a quote from a textbook.

My Nursing textbook described many things that nurses don't do in my hospital, in my state.

I perform Arterial sticks all the time, yet this was not in the scope of an RN (before I changed locations), some places it simply isn't policy for an RN to do so...it is the RT's responsibility

Hope you understand what I"m getting at...

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Are most employers hypocrits?

SIMPLY PUT...YES.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
While it sounds as though the OP's place of employment had a policy that CNA's report certain issues, you do no one a favor by generalizing based off a quote from a textbook.

My Nursing textbook described many things that nurses don't do in my hospital, in my state.

I perform Arterial sticks all the time, yet this was not in the scope of an RN (before I changed locations), some places it simply isn't policy for an RN to do so...it is the RT's responsibility

Hope you understand what I"m getting at...

People get confused ALL the time of policy versus legally forbidden.....:smokin:

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I don't think drawing a parallel between arterial sticks and noticing/reporting basic & obvious client findings is a valid comparison. While it may be quite easy to find state BONs that have varieties of rules on arterial sticks, I think you would be hard pressed to find a BON that discourages or prohibits CNAs from reporting obvious findings that indicate client injury or risk. Yes, there are subtle differences between different state's nurse practice acts. But there is still a large baseline consensus on the majority of basic issues. If that weren't the case, then the NCSBN wouldn't exist, nor would we have a standardized NCLEX or the compact states. Standard nursing & CNA texts exist and have widespread national circulation because a large consensus exists on the vast majority of issues pertaining to theory and practice.

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From my experience, employers are just a subset of the population at large and the population at large has a very high number of hypocrites ergo it can be implied that a large number of employers are hypocrites :)

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Specializes in Med Surg - Renal.

What bothers me is that even tho all of the other aides were still doing their "skin checks" as usual, the a.d.o.n. and other nurse's started to harrass me if I reported skin problems citing that I was performing assessments that were outside the scope of practice for a CNA.

That is the stupidest thing I have ever heard. CNAs are mandated reporters and MUST report skin problems found during cares. If you were documenting skin problems in the chart and signing off on them, you would be out of your scope of practice as a CNA. But reporting them to the nurse is exactly what you are supposed to do.

The nurses were harassing you because they did not want to be bothered to document skin problems.

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Specializes in ER.
I don't think drawing a parallel between arterial sticks and noticing/reporting basic & obvious client findings is a valid comparison. While it may be quite easy to find state BONs that have varieties of rules on arterial sticks, I think you would be hard pressed to find a BON that discourages or prohibits CNAs from reporting obvious findings that indicate client injury or risk. Yes, there are subtle differences between different state's nurse practice acts. But there is still a large baseline consensus on the majority of basic issues. If that weren't the case, then the NCSBN wouldn't exist, nor would we have a standardized NCLEX or the compact states. Standard nursing & CNA texts exist and have widespread national circulation because a large consensus exists on the vast majority of issues pertaining to theory and practice.

I reread my post after I got some sleep after my long night shift and I don't think I really expressed my point well.

I was not responding to the OP.

I was responding to the post that implied that because something is written in a textbook used for teaching automatically means that this HAS to be part of someone's job. I am trying to figure out how to simply put into words what I'm trying to say, but I'm too tired to try (especially after my first botched attempt)

OP obviously has a policy at work to report skin breakdown, so she should and not be penalized.

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