Are we overworking the CNA's or are we lacking teamwork?

[abbaking]

Being a former CNA I understand the back-breaking hard work that the assistive staff preform on a daily basis. I am lucky to work with fantastic CNA's but I have noticed some alarming trends both on the floor and during staff meetings.

Sometimes there is only 1 CNA for the 20-bed tele/med/surg unit. Our CNA staff do vital signs, assist with bathroom needs, admissions, transfers, feeding patients and other important duties. Some of my co-workers seem to take advantage of this and request the CNA to monitor the surgical drains output (JP's, Hemovac). BIG NO NO! That is a nursing responsibility and In my opinion it is not something the CNA staff should be responsible for. Its a great learning experience to observe the RN and ask questions but its not something that I feel the CNA staff should preform.

The CNA's have told me that when its terribly busy during the start of shift and the RN's can't be found to tell them about abnormal vitals, the CNA gets reprimanded for with-holding information. This is a big issue on our unit but I side with the CNA's. Look at it from their perspective - they have 20 patients vital signs to do (with outdated equipment mind you). Call lights are going off left and right (which the unit clerk pretends is not going off - god forbid she actually have to answer it). Patient need help to the bathroom. Patients are dirty and need to be cleaned up. Post op patients are arriving on the unit and need assistance into bed and routine post op care. Patients need to be fed and some patients need to be transfered for tests. AND ITS ALL EQUAL. That would put anyone behind in their duties. The argument is always communication and teamwork - but depending on who your working with as a CNA, an RN can mean either a Registered Nurse or Real Nutcase.

My manager told the CNA's that if vital signs are abnormal and the RN can't be found, the CNA's are to stop what they are doing and document on the computer in real time the vital signs. I saw one of the CNA's doing just that the other day and the charge nurse told him to get off the computer and work and answer call lights. Thankfully this guy has balls and told the charge to do it herself - your still a nurse here and being a charge nurse doesn't mean your the queen of england - LOVE THAT GUY! I feel for the CNA staff tremendously. I will do my vital signs and help them out whenever I can

What do you guys think?

Is this crazy or is it just me?

[Jules A, MSN]

Personally I think they are overworked and underpaid, that said there are many that go above and beyond as well as the few that don't. If it were a better paying position we would expect more across the board and while most of my team would be worth it there are a few that are just dead weight. But wait that goes for the nurses also, lol.

[Poi Dog]

@ RN (real nutcase). At my place RN stands for Registered Nutcase

[HouTx, BSN, MSN, EdD]

One way to absolutely guarantee that a job is impossible and soul-crushing is to have multiple "bosses", right? There is no way to plan and organize your work because each of them is expecting you to prioritize their needs & respond immdiately when they holler - arrrrggghhhh! But this is the way that our CNA's have to work all the time. They waste a lot of their time just bouncing back and forth between 'bosses'. It's no wonder they get frustrated and start to act out by simply making themselves scarce or refusing tasks. Why do we allow this to continue?

In my experience, the most satisfied/productive CNAs are working in a one-on-one arrangement with an nurse or as a member of a small team caring for a specific group of patients. Communication is clearer, work is more equitable and meaningful.

[deemalt, BSN, RN]

One CNA for 20 pts is crazy. I don't see how this is remotely safe. Your facility is asking for trouble such as patient falls, pressure wounds, and missed abnormal vitals. You have to approach this carefully though because some facilities will just try to pawn off more work on the RNs rather than hire more CNAs. Best way is to encourage pt's and their families to complain in writing to mgmt.

Keep us posted!

[strength4unityRN]

I agree with you! The CNA's work just as hard as the nurse if not harder. The way I look at my job as a nurse is I have a bunch of different duties to do, and I need to pull my team together and delegate each task according based on who can do what. Not based on what I don't want to do.

For example I can't answer every call light, help patients to the bathroom, etc, cause I may have to call the doctor or I might be dealing with a crashing patient. I also can't ask the CNA's to go into the chart and figure out why my labs are trending this direction. I am the only person who can do this.

Answering call lights, turns, baths assisting with patient care are something I can do too, when my time is freed up ('freed up time' we know how that works lol). But I still believe that should not be all the CNA's responsibility. They help us, we should help them too.

Bottom lines is its not about being a CNA, or a RN, its about taking care of the patient. When everyone works together it makes a world of difference.

[K nurse-one-day]

The only thing I want to address is the issue with the drains. Im a cna and I assure you I'm perfectly competent and capable of emptying a drain and measuring the output. It doesn't take a rocket scientist.

Other than that, I appreciate your post a lot. Its always nice to be recognized

[guest42010]

For what it's worth, I'm a tech (CNA) on a post-surgical unit, and we have a max of 12 patients on a circular (not a long hallway) unit. I manage I/Os for them, including JPs, Hemovacs, Foley catheters, pull CBGs on an AC/HS, Q6 (NPO protocol) or BID schedule, and vital signs on post-op, Q4, or Q6 schedule.

I have great nurses who do some of these things for me, and I'm expected to chart as I go, which means that even if I can't find the nurse right away, s/he has any abnormal vitals available on the computer.

In Oregon, we have a CNA-2 (Acute Care) certification which teaches us about JPs, Hemovacs, and a number of other skills, which means we can be a little more versatile and useful. I agree that these are "Nursing Tasks", but so is every other skill I perform. In fact, on an unrelated note, I think CNA work should be prerequisite to nursing school. So many of the things I do seem so basic to nursing that I don't think I would want to start without the base I have.

:)

[ChristineN, BSN, RN]

I'm an RN and have worked as a CNA and will say that everywhere I worked as a tech emptying surgical drains was withing a CNA's scope.

However, I do feel like your CNA's are being overworked. 20 pt's from one tech is way too much. How many pt's do the nurses have?

[Reese2012]

I was a CNA for a year at a hospital in chicago. I was working the 3-11:30pm shift and came on the floor hoping to have a good night. Turns out the other CNA that was supposed to work with me called in sick. I was the only one on the floor with 24 pts. Thankfully I had some nice nurses to help me out with the call lights, because if I had to do it all by myself, I think I would have quit that night.

Another situation I was in, which actually made me quit the job as a CNA was when I was at a suburban hospital and the nurses there thought they were GOD. It was me and another CNA, we had 12 pts each, working on a meg/sug/oncology floor (this place was always crazy). When I worked here I was in charge of taking vitals, charting (I & O's), feeding, discharging, admitting, and removing IV's, along with giving baths, changing linens (every day), and answering all of my call lights. The one nurse I was working with called me on my phone when I was in an isolation room changing a pt. She was screaming and asking why I was not in room *** because she needed help putting a person on the commode. I explained that I was busy at the moment and when I am done I would come help her. Obvisouly that was not good enough and she wrote me up for not doing my job. How is one person supposed to be in two places at once?

I must admit, I do miss being a CNA, but I am worried to go back to a place where the nurses do not respect you at all

[mama_d, BSN, RN]

Unfortunately on my floor recently we've been running with one tech for 25 pts on a somewhat regular basis. And we have a few nurses who still act like we're full staffed.

To make up for it, I try to do as much care as is possible on my patients, including vitals and blood draws and cleaning up the pts who I can by myself. While the "queen of England" types have time to sit on the internet b/c they have hogged the tech and therefore have free time. I've started to get nasty with some of them..."I'm done with the vitals machine. It's your turn for it." I've also gone to our direct management about the lack of teamwork from those individuals b/c I know most of the techs won't b/c they don't want to rock the boat. But our floor is known throughout the hospital for its teamwork, and I'm not going to stand idly by while a couple of newcomers jack things up.

The easy answer to the vitals dilemma...make the nurses get their own. That way they'll know immediately if they're not WNL, and the CNA won't be wasting time hunting people down.

[Flo., BSN, RN]

I think the easy answer would be for the CNAs to tell the charge RN if the pts primary is unavailable. Having the RNS check vitals is taking away a major job responsibility of the CNAs and unnecessarily contributing to the RNs work load.

On another note all CNA activities are not equal. Prioritization must be used, I always tell my CNAs to ask me if they are having trouble deciding what is the most important task.

I love my CNAs and I do think they are overworked and underpaid, just like the nursing staff. We all have less than ideal pt ratios