CNA "assessing" patients

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Specializes in LTC, Subacute Rehab.

I work in a short-term rehab facility, and the majority of CNAs there are perfectly adequate, if not wonderful, to work with.

My PM shift CNA today is another thing entirely. He states to patients that he is "studying to be an RN" - not true. He gives unsolicited and wrong advice to patients about their conditions. He writes what attempt to be nursing-style notes on the back of the ADL sheet - often with inflammatory language (eg "resistant", "insistent", "combative"). He attempts to transfer non-weight-bearing patients alone. Today I found out that he tries to assess patients...

I have a patient whose last BM dates vary, depending if you ask him or the hospital record. His given date is almost a week ago (one day per hosp). With a soft abdomen, active bowel tones, and no distention or tenderness, I was inclined to believe the hospital, but gave MOM per our protocol for so many days without BM.

"Donald" came up to me during 1700 med pass.. "Mr Wombat says he hasn't had a BM in almost a week! I asked him if he was on a clear liquid diet at the hospital but he wasn't. His abdomen is really distended and I told him that he needs a Fleet's."

I asked Donald to please not give patients advice about meds or conditions; I advised him that it is outside his scope of practice. I'm not the first nurse who has spoken to the DON about him. I'm concerned because I'm a very new LVN, with a CNA whom I feel to be unsafe working under my license. I already mother-hen my patients (discreetly)... any advice?

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Keep correcting him, and keep documenting your corrections. The DON needs to know exactly what is going on. Keep in mind, be very specific in your documentation--no vagueness.

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Somebody needs to sit down with this guy and have a serious talk. I can see where he may think that he has learned a lot and may be picking up information from observing and working with different nurses, etc; but the fact is he is not qualified to be making these judgment calls (much less telling patients what his "assessment"s are). As a caregiver/CNA for 8 years, I feel that the CNA's role in this sort of situation is to be eyes and ears - observe, pay close attention to what is going on, relay the information to your nurse, and they should be trusted to make the appropriate judgment call. I do ask my nurses what they choose to do, not to doublecheck them (since they have had the schooling and experience and I have not!) but so that I can learn from them. I would continue to speak to the DON, charge, whoever will actually take you seriously; because he could end up making calls and taking things into his own hands...causing trouble and/or pain for more than one person.

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Specializes in ob/gyn med /surg.

this CNA needs to get a grip... he needs to be told about his charting and his assessing skills .... i would have marched him right to the DON and i would make copies of his charting and "lower the boom on him" ..

he needs to do his job and thats fine if he wants to come get you if he sees something wrong ... and thats where it ends...

i would also ask him about school.. where he goes.. what he is taking ... and how long until he graduates.... maybe thats mean of me but he brought it up ....

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Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.

Just a thought, when I was a brand new RN in a LTC facility I was also 20 years old. Most of the CNAs I worked with were twice my age. Some of them had been CNAs for longer than I had been alive. I know that he acted inappropriately by giving out medical advise and by performing nursing assessments, but keep in mind that your CNAs are your eyes and ears. In LTC they are the ones who see the patients the most. I have had CNAs save my sorry butt so many times that its not even funny. I guess I say all of that just to point out that, while this particular CNA is going beyond his scope of practice, many of the CNAs you will work with are extremely experienced and will know things that will help you very much. Some of the best tricks of the trade that I know I learned from a CNA!

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Specializes in SICU, Peds CVICU.

I'm in a whole different world that you, but I definately have an issue with CNA's overstepping their job description (just my exp. in the unit I'm working at now, in school I was privilaged to learn from CNA's that knew more then than I do now). Just because the CNA has been doing something for a long time doesn't mean they're doing it the best way, and even though I haven't been a nurse forever doesn't mean I'm pathetic and helpless and lost without them. Rant over, I promise.

Address each issue with the CNA at the moment, document that you brought it to his attention, and follow up with your supervisor. I'd also see if other nurses would be willing to do the same when they have similar situations with the CNA. :twocents:

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Specializes in LTAC, Med/Surg..

i would also ask him about school.. where he goes.. what he is taking ... and how long until he graduates.... maybe thats mean of me but he brought it up ....

OooooO! I like the way you think. Come sit by me.

:)

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Specializes in LTC/Rehab, Med Surg, Home Care.
I work in a short-term rehab facility, and the majority of CNAs there are perfectly adequate, if not wonderful, to work with.

My PM shift CNA today is another thing entirely. He states to patients that he is "studying to be an RN" - not true. He gives unsolicited and wrong advice to patients about their conditions. He writes what attempt to be nursing-style notes on the back of the ADL sheet - often with inflammatory language (eg "resistant", "insistent", "combative"). He attempts to transfer non-weight-bearing patients alone. Today I found out that he tries to assess patients...

I have a patient whose last BM dates vary, depending if you ask him or the hospital record. His given date is almost a week ago (one day per hosp). With a soft abdomen, active bowel tones, and no distention or tenderness, I was inclined to believe the hospital, but gave MOM per our protocol for so many days without BM.

"Donald" came up to me during 1700 med pass.. "Mr Wombat says he hasn't had a BM in almost a week! I asked him if he was on a clear liquid diet at the hospital but he wasn't. His abdomen is really distended and I told him that he needs a Fleet's."

I asked Donald to please not give patients advice about meds or conditions; I advised him that it is outside his scope of practice. I'm not the first nurse who has spoken to the DON about him. I'm concerned because I'm a very new LVN, with a CNA whom I feel to be unsafe working under my license. I already mother-hen my patients (discreetly)... any advice?

I would have gone further than asking Donald not to advise pts. about meds/conditions. I would have done a written disciplinary action on Donald for the following reasons:

1. Not reporting information accurately--if Mr. Wombat is independent, then it is the CNA's job to ask each shift and DOCUMENT BM activity each shift.

2. Donald has no business telling Mr. Wombat anything other than "I'll report this to the nurse". Certainly he can report anything he sees (ie, distended abd) BUT...

3. Donald should never, ever as a CNA be telling a pt. "You need xyz medication"

I've heard some of our CNA's describe behaviors in an inflammatory way as well, and it is a hard part of the job to offer them better, more appropriate language to use.

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Specializes in LTC, Subacute Rehab.

In answer to 1, Sunny, Mr Wombat was a new admit today. Per the hospital nurse in report, his last BM was yesterday. Per Mr Wombat, it was six days ago. Per my assessment findings - soft abd, active bowel tones, no tenderness or distension, Mr Wombat has periods of forgetfulness - I'm inclined to go with the hospital. But yes, CNAs should ask and document on independent patients.

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OooooO! I like the way you think. Come sit by me.

:)

...don't make me seat you boy-girl.....:chuckle

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Wow, how annoying! In my experience, many people that work in medical facilities or have even a little bit of medical experience tend to solicit advice like they have been a doctor for 20 years and know everything.

I was working as a pharm tech a while ago, and when pt's would ask me questions, I always spoke to the rph before answering.

Sometimes pts would ask "do I have to refrigerate amoxicillin after opening?" To which I would reply "yes", but if they asked me if they could take drug xyz with amox - even if I knew the answer already - I would still go ask the rph.

Its a good feeling when people come to you for help and advice that the average joe doesn't know about (ie. Medicine), but sometimes you've gotta bite the bullet and swallow that ego!

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Specializes in Labor & Delivery.

Well said ToxicShock. I work with an LPN who is a really good nurse, however she oversteps her bounds frequently(outside scope of practice). The other RN's I work with tell me thats fine because she has the ability to do the care and she's going back to RN school :confused:. Just because you can doesn't mean you should!

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