CNA performing a newborn screen?

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The thread on fundal pressure got me thinking about the birth of my third child five years ago. The CNM instructed the nurse to use fundal pressure. It's on the tape of his birth, and I was looking up the info from my files on his birth to see if the CNM included this in her dictation of the labor & delivery report (she didn't).

Anyhow, I came across the newborn screen checklist and the discharge instruction sheet, and I noticed that they were both signed by a CNA!! The form had "RN signature" printed on it. I wasn't even a nursing student when this happened, so I wouldn't have thought anything of it, but now I'm wondering if anyone else has seen a CNA perform a newborn screen because it kind of bothers me (my son was/is fine, btw). Can the hospital train them to do this? It was a smaller, rural hospital, if that makes a difference.

Specializes in PERI OPERATIVE.

I work at a small hospital (25 beds) and our OB dept is an all RN dept. We do all of our hearing and Newborn Screening.

PS- Who ever thought of this hearing idea? (We use the Natus system with electrodes and earphones.) The things never stick right (even with skin prepping) and the babies never are deeply asleep because I have my hands on their heads trying to hold the dang things in place.

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We have OB techs which can be or don't have to be cna's also. They are allowed to do pku's and other specimen collection (ie urine catch), it's in their list of allowed responsibilites, but I haven't seen any of them do one. Us RN's are pretty protective of our babies and tend to do stuff by ourselves. Since I'm on nights we really underutilize our ob techs at night, we tend to figure "well I have to go in and assess my patient anyway why bother let the ob techs do VS, since I'll be there anyway." I try to give them things to do but mostly they sit and answer call light and the phones.

~kim

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Our lab techs do the PKU. Our CNA's can do vitals and give baths. RN's do the assessment. Sometimes when our floor is busy with med/surg patients, I take the baby to the nursery and do the bath myself - helps in truly assessing the baby anyway. We don't do hearing tests.

steph

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Wow, CNAs are really doing alot aren't they?

What do they need nurses for?

Shut my mouth......:rolleyes:

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Wow, CNAs are really doing alot aren't they?

What do they need nurses for?

Shut my mouth......:rolleyes:

Not where I work . . . although the CNA's say they used to do alot.

Don't shut your mouth .. .I was thinking the same thing. :)

steph

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I'm sure I can't be the only one who noticed, but the OP said that the CNA did the DISCHARGE TEACHING! No matter how you slice the cake, that is way out of the scope of practice of any UAP. Assessment, pt teaching, care planning; these are professional nursing responsibilities.

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I'm sure I can't be the only one who noticed, but the OP said that the CNA did the DISCHARGE TEACHING! No matter how you slice the cake, that is way out of the scope of practice of any UAP. Assessment, pt teaching, care planning; these are professional nursing responsibilities.

I noticed that, too.

Like I said, I'd better shut my mouth.

Don't even get me started.

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I'm sure I can't be the only one who noticed, but the OP said that the CNA did the DISCHARGE TEACHING! No matter how you slice the cake, that is way out of the scope of practice of any UAP. Assessment, pt teaching, care planning; these are professional nursing responsibilities.

No, I noticed . . . the RN's do the d/c teaching where I work. But our CNA's have all gone to a breastfeeding class which the hospital paid for so we would all be on the same page with advice. And that was a good thing.

steph

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

won't happen where I work. RN's do and certify their teaching. The signatures are done in the presence of the patient...no preprinted signatures are done. This seems really un-kosher to me.

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The discharge teaching is the thing that bothers me. Sure most of the baby care is common sense and a CNA could easily pick up the information needed to give PP instructions to a mom. Still though the reason we are licensed as RN's is because we have gone threw school, testing and back ground checks to make sure we understand the reasons behind the instructions we give and that we are competent to give such advise.

It's easy to memorize a script of D/C instructions but how many times do you find patients with situations that demand slight modifications to the standard instructions or in depth explanation of "why or "how". This requires a bit of assessment and some core nursing knowledge. Heck a CNA may be capable of all that but it still is outside of their scope. As an RN I wouldn't let a CNA give instructions to my patient because I would be responsible for what they said and I couldn't trust that it would be right.

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You know, I have a problem with the CNA doing the discharge teaching as well. That is the nurse's scope of practice, definitely! I mean, come on.

I've moved out of state as I now live in Cali but graduated nursing school in a southern college. One of the nurses I graduated with works in one of the tiny, rural hospitals like you referenced and said that basically the same thing happened there. She said that a CNA works in the nursery and there may be one actual RN on the floor doing the L & D/PP area, but she's also the person that "puts her RN sig on the nursery assessment". My friend said that it's not unusual for the CNAs to have up to 7 or so babies in the nursery, and that this is considered normal there. I have a problem with this (and I won't go into a long diatribe because I"m tired and I don't frankly want to go there too much BUT...) as you all know there can be a touch and go time in transition for babies that CNAs are just not trained to watch out for. IMO, that puts those babies at risk and I for one would not want my baby to be looked after only by a CNA for hours at a time as a transitional newborn.

Like I said, I could go on and on, but I'll spare you...Just had to put in a small bit as this really irks me.

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Just wanted to add that I agree completely with what you all are saying on this topic. Dayray, I think you hit the nail on the head with regards to being able to successfully explain further and refine teaching if need be, rather than merely regurgitating info by a CNA..we're not just tape recorders after all!!!

I'm so glad I work with such a smart group of people, sincerely!!!

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