But all the Nurse is doing is sitting down. Why cant the help?

Nurses General Nursing

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Im an LTC Floor Nurse/Charge Nurse. Im an LPN and i have 41 patients on a brutally busy 3pm-11pm shift in a busy rural nursing home. But i wasnt always....

For nearly four years, from the ripe age of 16 and a half to the age of 20, i was a Male CNA in the LTC Enviroment. I remember all the demands and physically exhausting shifts of turning, changing , getting endless vitals on heavy patients. Feeding patients. Working short. Low pay. Broken back. Little respect. CNAs i get you. Ive been there. I understand. But what do i miss? 2pm-10pm met 2pm-10pm. In between rounds i was able to sit down, eat, socialize with co workers and basically have little emotiomal stress. There was no staying 2-3 hours over.

Flashforward! Im a 20 year old male Nurse who is still considered a kid by most residents. Recently at one of the CNA staff meetings one of the Aides made the comment. Of why cant the Nurse help ? All they do is pass meds for two hours and sit on there lazy butt for 6? That burned me up. CNAs in LTC, you must understand! Being a Nurse means!

1. We are responsible for these residents well being and life, and have a professional license bound by the board of nursing to protect. When residents fall, or get injured because of your carelessness, we have to stay 30 minutes over to complete a thorough incident report to cover our own behind. I know its not always your fault but when your sitting on the hall reading fifty shades of gray, and the fall risk bed is 10 feet high in the air, the bed alarm is turned off, well heck ?

2. Upon clocking in for our shift, us Nurses already have about 8 hours and 15 minutes of work cut out for us. That is without anything extra that may come up, like an incident, new physician orders, or god forbid a 2 hour complex full 3-11 LTC Admit.

We have to complete about 2 hpurs worth of time consuming Medication Admin Record on computer. Roughly about 10-12 Narrative Nurses Notes that determines whether or not the facility will get paid for the services they provide. On 3-11 a Treatment record. We have to chart on active incident reports. Notify family members of changes. Reorder medications. Handle facility conflicts. The list goes on and on. Its a mentally draining and exhausting overwhelmong kind of fatigue that no CNA will ever understand unless there sitting behind that nurses station as a Licensed Nurse having to make mentally draining independent decisions. And yes we are sitting down. But this does not mean that we are not slammed and drowning trying to complete very important documentation.

3. Management. We are all being scolded about overtime. A Nurse needs every free moment he or she can to even take a stab at finishing in 8 hours. Very rarely do CNAs work for eight straight hours without breakinh and clock out more than 15 minutes after shift change. So when a Nurse teels you to hold on there very busy, they more than likely are. And you must understand that while flying out the building after 8 hours the nurse may be staying anothet hour or two or heck even three to finish up crucial documentation, and them get accused of just riding the clock by management.

Message to CNAs from a used to be turned nurse. When a Nurse delegates to you , and you feel rudely interupted from reading your book, or socializing with co workers, dont roll your eyes, stump your feet, mouth off , becuse you think the nurse is just being lazy. I can tell you as an ex CNA now Nurse, you truly have no way to understand what the nurse is going through and workload and responsibilty placed on Floor Nurses in LTC. So dont judge. Just do, you will still have plenty time to socialize and clock out on time.

But we truly thank you CNAs for what you do. And the help you provide us. Without you guys we would be responsible for the total care of 40 patients. I dont even wanna see that dark day.

Specializes in hospice.
For me the problem is when I'm given an attitude, like I'm a jerk, because the cna had to do her job. Just like most other people have said I am happy to help when I have time to. But when I'm busting my butt to care for my patients I really can not accept being scolded by the cna. Which did happen to me recently. She took me aside to ask me why I hadn't cleaned a room and she had to do it. Let me mention that this CNA took a postion as a housekeeper on the unit and no longer even does pt care. The pt's iv site bleed after being removed and she dripped some blood on the floor. I did use a towel and wipe it up but according to this cna I missed some. I must have apologized at least five times. "I'm sorry. I really thought I got it all" and so on. I got the eye roll and told that I'm a jerk because she would never leave a room that way. Not cool. What happened to professionalism and doing your job.

What the? Dear Lord, that little piece of work needs an attitude tune up. I can't imagine any workplace that supports behavior like that. If yours does, I'm truly sorry for you. I refused to speak like that to a nurse even when a wussy charge nurse told me to. All I could think was, "Honey....that's why they pay YOU the big bucks. I live in the bottom of the valley and I know where crap rolls."

Have you talked to anyone in authority about this? She should not be allowed to continue that behavior.

I know this feeling, and I've been on both sides of it. Point blank, being an aide/CNA sucks, hard. I basically got paid a dollar more than minimum wage to clean up all forms of grossness, toilet people, and be responsible for 10-20 (depending on if I was alone or had a helper) baths and bed changes daily. After breakfast, lunch, and dinner (all of which were eaten on the 7a-7p shift), there'd be at least half of the patients on the floor needing to all go use the bathroom at the same time. Understandable, but very stressful, especially when most of them are elderly, so they can't hold it long and failure to get them there on time meant a very soiled occupied bed change + patient cleanup. Even ten sets of vital signs can take more than 2 hours to get when so many of the patients need you to help them use the bathroom while you're in the room or get them a coke or call so and so or any other number of things relegated to the aides.

As a nurse, I still don't feel I get paid well enough to do all the things expected of me. As an aide, I really didn't feel like I was compensated well enough. I would never have made a career out of that. It would've physically broken me down to do it; my back, knees, and feet hurt every day after going home because all I did was haul people around all day, change beds, and give baths. I'd be the one not getting my breaks, while the nurses, who were only responsible for five patients versus my ten or twenty, often got theirs.

So yes, I know both sides of the coin, and I keep it humble. I help the CNAs when I can. I also don't put up with any attitude because I know exactly what it's like to be in those shoes, so it's easier to realize when I should cut slack vs. call one of them out on their crap. I think we'd all benefit from that kind of perspective.

I am lucky to have a lot of supportive CNAs on my floor. Everyone tells me that I always lend a hand and am always there when I need to be. They often bash the other nurses on other floors for always sitting behind the desk.

What they don't understand is that as a salaried employee I don't feel rushed and I know that if I clock out a little late it's no big deal. (I don't even punch in so I guess I mean when I LEAVE late it's not a big deal.) But for that half hour I spend with that resident with dementia who broke her arm and doesn't want grandma to leave is another half hour later I stay. I have no children and my husband works an our away so he's not home for another two or so hours after I am. But the other nurses have children and other obligations and are sick of sacrificing so much time for a company. Yes, nursing is a calling but it's still a job.

I help so much because I used to be an aide. But now that I'm on the other side I find it very difficult to help as much as I used to. The more experience I gain, the more I know I need to do in a day. I used to be a substitute and not understand how the care plans and CNA instructions needed to tie together. I didn't realize that for every skin tear or fall I need to do a fall assessment or skin risk assessment. I need to make sure certain things are documented because for every dollar they make I need to make sure there's proper documentation that allows the company to gain that dollar for them.

Mrs. T fell? I have to stop what I am doing, assess, call the MD and family, fill out the report, fill out the assessment form, fill out the investigative form, change the care plan ( and I HAVE to add an intervention so yes you need to do 15 min checks), and if it was unwitnessed I have to get everyone on the unit in the past 24 hours to sign the form. Depending on what's wrong it can take 20 minutes or an hour.

And yes, I may be sitting at that desk 90% of the day, but I have to do all my work with screaming residents, constant phone calls, and constant alarms going off. What would take me an hour with no interruptions could end up being 3 hours for me!

I do understand though. When your back is hurting and you're covered in sweat and you're getting beat up and spit on and have your hands in human waste all day. And you look over at the desk and the nurse is sitting there smiling and chatting with someone. I've been there and it sucks.

But I make an effort every day to do something that's "a CNA job" like trim someone's nails or toilet someone. Maybe clean up a room or make a few beds. Hand out some nourishments. A small thing on a bad day can make a difference in everyone's attitudes.

Specializes in tele, ICU, CVICU.

It most definitely depends on your teammates. They alone will make or break the shift.

Once a travel LPN (no offense to anybody, I've travelled, been a CNA) who was 'hiding' in the corner, on a internet site, CLEARLY not work related. I was 3 feet from her, pouring meds. One of her patients' call light went on, right in front of her and her portable phone was going so the lite was going for over 90 seconds by then. She got up, walked into the room, I heard her say "what do you need?" patient replies, bedside commode. I had just given her IV Lasix for this LPN. I hear the nurse say "Ok, I'll go find the aide." And walk out of the room. Granted, this was about 2145, and she gets to leave at 2330, what does she care if the bed is soaked?

I always try to be objective and ask what would I do? in such a situation, bite my tongue in a work setting, but I tore her a new one. That was way over the top, and thank god far from the norm.

There is always a 'perception' of CNA's to nurses, nurses to aides, etc. And, sometimes, we get to experience said perception.

Specializes in LTC, SNF, Rehab, Hospice.

Once a travel LPN (no offense to anybody, I've travelled, been a CNA) who was 'hiding' in the corner, on a internet site, CLEARLY not work related. I was 3 feet from her, pouring meds. One of her patients' call light went on, right in front of her and her portable phone was going so the lite was going for over 90 seconds by then. She got up, walked into the room, I heard her say "what do you need?" patient replies, bedside commode. I had just given her IV Lasix for this LPN. I hear the nurse say "Ok, I'll go find the aide.".

I don't see a problem with this on any basis, but that is me being on my extreme. In a more reasonable case, if both the LPN and aide had downtime, I really don't see any reason for the LPN to face any scrutiny for delegating this to the CNA.

Specializes in Intake, Home Care.
I don't see a problem with this on any basis, but that is me being on my extreme. In a more reasonable case, if both the LPN and aide had downtime, I really don't see any reason for the LPN to face any scrutiny for delegating this to the CNA.

But if they both had downtime couldn't the LPN put the patient on the bedpan and delegate to the CNA to take her off? Teamwork? (I've been a CNA and RN, I say this as a disclaimer!)

A little background: I worked LTC and acute care as a CNA and have only done acute care as an RN. I have never worked as an LPN, just worked with them on a team and taught clinicals for them.

As a CNA, I had no idea how hard being a nurse is. I generally don't have time to do my job and the CNA's job, too, which I know is not as hard as the CNA thinks it is. It sounds awful, but it's true. I didn't realize how much easier the CNA role is until I became a nurse. I would rather take stressful physical work over stressful mental + physical work any day. Sometimes I miss being a CNA and being able to say, "I'll ask your nurse." It's a good idea to keep in mind that the CNAs have no clue what you are going through, so give them a little slack, and educate rather than berate. It's outside the range of their experience, entirely.

I love giving baths, but it is very low on my priority list. My main concerns are keeping the patient's heart, lungs, and brain working, while making sure the vitals are stable. There are a ton of interventions that are outside the scope of practice of a CNA that I have to do while meeting these concerns.

Yes, I can do what the CNA does, but the CNA cannot do most of what I do. So if the CNA is behind and I'm not, I'll help out and do vitals, glucose checks, turns, brief changes, whatever. What is the CNA going to do for me when I get behind? Most of the ones I have worked with have been very good and have at least answered call lights when I have been slammed, but that's about all they can do for me.

The CNA can't call the doc about the condition change, or assess the patient to see if the LOC change is real or they're just sleeping, or give meds for that blood pressure that's 210/120.

I also don't believe in passing stuff off that's just as easy for me to do, though. So, if I'm passing meds and the patient wants the bedpan, I put them on the bedpan. I don't have time to wait around and take them off, though, so I delegate that to the CNA. If the patient wants a cup of juice, it's faster for me to run over to the kitchenette and grab it than track down the aide and ask them to do it. But if the patient wants to ambulate during the 9am med pass, it's either wait for the aide or it's not happening.

I think one of the problems is that CNAs are taught that nurses do ADLs, but they AREN'T taught prioritization. So, to a nurse, prioritization is all about the ABC's and getting/keeping the person stable. To a CNA, who is not guaranteed to have any knowledge of A&P, each task is equally important, with the tasks the CNA is supposed to chart on getting first priority. This doesn't mesh at all with the nursing view of patient care, hence the clash between roles.

I have had to pull aides aside and tell them exactly why I can't help them. I actually had one aide who thought that every time I sat down, I was surfing on the internet, until I showed her I had three screens of patient info up and was charting. I pulled up the detailed physical assessment that I had just saved with its dozen or so tabs and compared it to the 5 field ADL form she was used to using. I think the light bulb turned on for her at that moment.

Specializes in SICU, trauma, neuro.

Sigh... I was a CNA for 5 yrs--3.5 in LTC. It never would have occurred to me to give a nurse attitude for being asked to do the job I was hired to do. The one time I gave a nurse what could be called "attitude" was while on a night shift w/ an RN and another CNA and the CNA was on break. I had 3 call lights ringing at once. I said to the RN that she needs to help b/c I'm not able to be in 3 rooms at once. What was she busy doing, you might ask? 3 hr med pass? Nope. Post fall protocol? Nope. An admission? Nope. Cross stitch. With her feet up on a chair. Oh yes she did.

I've never worked in LTC as an RN, but I saw all the time how they busted their tails and how stressful it was for them. I saw that they were always busy even while sitting (well, except Cross Stitch Nurse.) I can just imagine how lit up I'd feel if another staff member said those things about me and my work ethic.

Specializes in LTC,Hospice/palliative care,acute care.

I get the OP completely.We can do the cna's job,they can't do ours.As an inexperienced nurse I fell into the trap of trying to do it all...Many shifts the cna's got their breaks and punched out on time and I got neither...Had to learn to delegate and take care of myself as well.And sometimes you can bend over backwards to do it all and it's still not enough.When you are hustling your bum off and walk into a room and the whole crew of cna's are sitting on the beds eating potato chips hit kind of makes an impact....Or hear a snarky comment because the docs made rounds and you had to ask someone to do their job...It's tough...

I don't think you meant it in a harsh way, but all care is important from turning every 2 hours to charting assessments.

I agree - all care is important. Realistically, the ADL care is MORE important to a patient's health and well-being than all but the most essential charting.

But I don't have time to do it all, and I can delegate the ADLs. I can't delegate the charting or the med pass.

Specializes in Registered Nurse.

There were little pieces of the thought that a LTC Nurse (who is doing meds, treatments, and documentation, etc. or some combination of those) might help the CNA with hygiene/rounds...If I were that LTC Nurse, and they told me I'd have to help daily/regularly with hygiene/rounds, I'd be looking for another job. It's just too much.

Add - I was a CNA for about 6 months prior to becoming a LPN and then a LPN for many years before becoming a RN.

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