Tucking in new admit, I ask CNA to get water pitcher for the new pt. CNA says to me "We usually don't get them a water pitcher right away, in case they're going to a test or on a fluid restriction.". I say "Even if he is going for a cath tonight, they can have clear liquids for six hours prior, and since water is a clear liquid, he can have it.". CNA still did not get water pitcher. I ended up doing it, and getting the pt. a sandwich as well.
Later, same CNA comes up and "informs" me that I should probably call the doctor and get an order for a different kind of sleeping pill for another pt., since the one he had last night only worked for about three hours. CNA did not know that I had already discussed sleepers with the pt., who was first case for OHS the next day, and that I had already checked his PRN list and he already had two types of sleepers available. I told the CNA "I will talk to the patient about that.". CNA goes on to reiterate my need to call the doctor, because if the one type of sleeper doesn't work well, maybe a different one would.
Same CNA is pestering (yes, pestering) me about why another pt. is not on a diabetic diet. She is getting AC & HS fingersticks and SS insulin coverage, but is not on a diabetic diet. I am busy, and do not have time to delve into the matter at that moment, but I explain to said CNA that a) Different doctors have different strategies and some are more aggressive than others in treating DM, and b) This pt. is not compliant with almost every aspect of her treatment plan, and does he think she would comply with a diabetic diet anyway? (Actually, the pt. is on prednisone and is experiencing hyperglycemia related to that, which is why she is on the SS insulin.). CNA starts digging through the patient's chart for information.
I did not find the time to track down the CNA to take the opportunity to do some teaching about prednisone (we get a lot of respiratory pts on steroid therapy, so it would be good info for the CNA, since he is obviously interested in learning).
I don't mind if the CNA is interested in learning, and if I have the time, I don't mind explaining things. When I was a brand new nurse, it was a completely different story. I just wanted the CNAs to do their job and not bother me with a lot of questions. Now that I'm getting my feet on the ground, I don't mind teaching at all. But questioning me in front of the patient, discussing medications with patients, and digging through charts are all inappropriate behaviors, IMO.
I don't want to make a mountain out of a molehill, or an enemy of this CNA, by taking him aside and explaining, in retrospect, why his actions were inappropriate. I don't want to run to the NM and tattle on him. What I think I need to do is just handle each situation as it arises, showing him that I am willing to teach, but at the same time letting him know when his actions are not okay. My worry is that we are an interventional unit with lots of femoral artery sheaths and specialty drips, and what will he say/do in a sensitive situation when I am not around? I need to know I can trust him, and at this point, knowing that he is willing to question me over something as basic as water, right in front of the patient, that he discusses medications with patients, and that he will go digging through the chart to find answers rather than accepting the answer I give him, I'm not feeling too trusting here.
The other issue here is that while he is going about determining what is important for him to focus on, I am needing help with frequent toileting a LOL who is incontinent and on STRICT I&O, I need help ambulating a pt. post sheath removal, I need help feeding the new admit so I can get his med rec done and his admit orders checked off, and the CNA is not making himself available for these important things. And he is training new CNAs, who are following suit. Obviously, he is an informal leader and I need to change his behavior so that the newbies will emulate better behaviors than what I am seeing.
