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.
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.
Why are people getting offended by this post? This isnt a "this is what all cnas are like" post, this is more of a "day-in-the-life/dont be that guy" post. If hes not desrcibing your work habits, dont worry about it lol. Hes obviously talking about the people he works alongside. Which sounds unfortunate, but ive seen some cnas display at least one attitude/habit that was mentioned. And ive seen some bomb digittty cnas that I loved working with. As with anything it goes both ways :)
I worked as a PCA/SNA (CNA equivalent), in acute care. I was in the house-wide float pool. Being in the float pool, depending on the institution, you get treated worse than everyone else, despite that you're the help. It was an eye opening experience.
At my first nursing job we didn't have techs (still carried 4-6 patients on days, usually at least one total care), with likely 1-2 discharges and admits. It was painful but made me grow immensely.
I have never treated the techs I have worked with in the manner I was treated in. My second nursing job I generally did some or all of my patients' vitals myself - I learned how to make it work at my first. Plus when there was 1 tech for 31 patients on nights it was nice if I could help them a little. Also - if I had to round on patients at 2300 or 0300 and they had vitals, and a neuro check due (sometimes even a med due) - I should only bother them once. I also turned, bathed and moved patients whenever it was needed but I wasn't knee deep in something else. I helped my own patients to the bathroom (and sometimes those of coworkers if I knew their activity level and the coworker and the tech were busy elsewhere). I still dealt with the PAs or NPs and physicians, lab and pharmacy as needed. I transported patients for stat scans as needed. When it was needed and I wasn't super busy I helped with meals and all kinds of stuff. I'm very happy to help, and I do have significantly more charting to do than the techs - but I'm not incapable helping to do things. Were there times I had to delegate and was unable to help? Yes. But most of the time - days, evenings or night shift (I worked a combo), I told the tech I was delegating to that if they needed help to come grab me. I tried to plan with them so that I'd be available to help (even if the other techs were busy). I rarely had anyone get upset with me about asking them to do things - because I tried to help whenever I could. Other nurses on my unit gave the techs/CNAs a list of things to do and were unavailable to help but also surprised when they perceived the techs might be unhappy with them.
As a former CNA, I totally identify with your post!
And as an RN of 15 years, after having been an LPN for 8, I hate to hear "I'm doing the same job as the RNs, even though I'm an LPN. They should pay me the same, it's not fair...etc, etc."
Great post! Unfortunately, everything you described is exactly why I hate LTC. Maybe I just had a horrible experience that left a bad taste in my mouth, but if it were my only nursing option...well....I'd do telemarketing. Fresh out of school, it was my first job. I had CNA's that would hide in resident rooms using phones, playing video games (literally hooking their Xbox into a resident's television, which burned me up, and management did nothing). They would be nowhere to be found when I asked for any sort of help, but got rude with me if I didn't stop giving meds to ambulate someone to the toilet. It was just a horrific experience. That said, I have the utmost respect for CNA's that do their jobs. I have been blessed to work with some pretty fantastic aides.
Specializes in LTC,Hospice/palliative care,acute care.
Great post! Unfortunately, everything you described is exactly why I hate LTC...
Years ago another nurse and I were reported by a family for doing our nails at the nurse's station of our small community hospital.We were reading the Tele strips....The family was crazy,they carried the complaint as far as they could.We never got an apology,no-one took the time to explain to them what we were doing.Our punishment-we were forced to give another full bed bath and SHAMPOO to their long neglected loved one..On a med surg unit....No aides.Team nursing,the RN and myself had 15 patients....
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.
As a former aide, you are exactly the type of nurse that I hated working with. Your responsibility is to your patients first. If you see that a patient is done on the bedpan or commode and you aren't busy, I would almost consider it negligent for you to delay the situation by finding an aide just so you can sit down and go on pinterest.
As a former aide, you are exactly the type of nurse that I hated working with. Your responsibility is to your patients first. If you see that a patient is done on the bedpan or commode and you aren't busy, I would almost consider it negligent for you to delay the situation by finding an aide just so you can sit down and go on pinterest.
Clearly you don't know NOADLS. You haven't been on here long enough to learn to not take things NOADLS says too seriously.
Clearly you don't know NOADLS. You haven't been on here long enough to learn to not take things NOADLS says too seriously.
The thing is that this situation is not uncommon with the newer generation of nurses; a sense of entitlement. Look back 15 years and tell me the nursing attitude hasn't changed.
There are bad eggs in every profession/job. Much like there are some crappy nurses who think a degree should separate them from having to wipe butts, there are also CNAs who assume that they have no impact on the health of the patient and can dick around for their shift without doing work.
What I'm saying is that given the situation of a nurse and CNA both being free but the nurse coming to the situation first, I find it indefensible for the nurse to leave to get the aide to do it (especially if it is their patient).
crazin01
290 Posts
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.
Well said, Camigraduate....