CNA scope of practice issue on my unit

[nurseredd]

I am a LTC charge nurse on a psych/behavioral unit. CNA from another floor was moved to my floor as a regular. One patient has a foley, so she gets a leg bag during the day, then a larger bag at night for bedside. CNA last night refuses to change the bag from leg to bedside, stating it is "not in my scope of practice and I do not know how to do it". I'm big on education, so I told her I would gladly teach her how to do it, but she continued to refuse stating its not in her scope. Ultimately, she did watch me do it, but continued to repeat herself. Now, I've been a nurse for several years and this is the first time I have ever had a CNA tell me changing a foley bag isn't in their scope, this is not a skilled procedure. My supervisor agreed it is in the CNA scope. I have emailed my states BON to get scope clarification as I could not find any reliable information via the internet. Currently I am awaiting a response. CNA is aware I emailed the BON, however, she still is adamant she will not change the bag even if they say she can because "I googled it and google says I can't". Very frustrating!

Nevertheless, any other nurses had this issue with CNAs? Any advice?! I typically have a good rapport with my CNAs and this is honestly the first time I've had an issue like this. I will involve my supervisor if I must, but I prefer to handle things on my unit independently, especially petty issues.

[AutumnApple]

I am always confused by the use of "CNA scope of practice." It is my understanding that "scope of practice" refers only to one who holds a professional license. At least in my state, CNA's do not hold a license. Perhaps it is different in other states.

I guess what I would do in your place is give the CNA x days to produce said scope of practice to bolster her position. If she can't/won't produce that and continues to decline your delegation, then I think you have a simple matter of refusal to perform her delegated assignment, whatever the ramifications of that would be.

If I, as an RN working on a Med/Surg floor, declined (out of fear of making a mistake) to give IV push medications, and always had to bother others to push meds for me, I couldn't get away with claiming "outside my scope of practice."

"Certified" Nursing Assistant. Yes, CNAs most definitely have a scope of practice. Education on what is in their scope of practice is one of the biggest differences between CNAs and nursing assistants who learn on the job.

We throw the term CNA around a lot and use it as a blanket statement for all nursing assistants. Most in hospitals are just assistants, not certified. Some employers require them to get certified though. This is much more common in LTC (yeah, it goes against the grain of most LTC practices, to require a higher standard) but some hospitals seeking magnet status will require it too.

The theory is, hospitals avoid making their assistants get certified because they (the hospital admin) believe CNA's are more likely to unionize if they are all certified.

Anyway, as far as the CNA of this topic goes: Never try to rationalize with someone whose intention is to misinterpret you.

CNAs will try to be passively insubordinate by throwing out the "It's not in my scope of practice" line when they don't like something. As you found out, whether that is true or not is of no significance to them. They're telling you "no" in a way they feel you can't write up.

I have to agree with Been there, done that on this one. Contacting the BON was not the proper follow up to this CNA challenging you.

I've dealt with this exact issue too many times to beat around the bush with it. Educating and "lifting up our coworkers" is not what this situation calls for. They challenged you to make them do the task, and you either call them out on it or don't. You have to draw the line and make it clear that saying "no" with more words and some technical lingo is still saying "no".

In my experience, the best way to respond is to get clarification first: "To be clear, are you refusing to............(empty the urine cath in your case)" then write it up if they continue with the song and dance.

[KRVRN, BSN, RN]

Heck if I know, I had to google what changing a urinary catheter bag is.

[pebblebeach, BSN, RN]

Wow. Emptying foley bags is definitely in the CNA scope of practice and at my job we empty them twice a shift. Something sounds fishy about this particular CNA if she isn't willing to learn.

[BuckyBadgerRN, ASN, RN]

The op was about changing the entire bag

Wow. Emptying foley bags is definitely in the CNA scope of practice and at my job we empty them twice a shift. Something sounds fishy about this particular CNA if she isn't willing to learn.

[pebblebeach, BSN, RN]

The op was about changing the entire bag

Ah. Read it too fast. Pretty sure that's in the CNA "scope" as well at my hospital.

[MunoRN, RN]

To be fair, allowing CNA's to change foley bags is not a universal rule. At every place I've worked CNA's are not allowed to change foley bags, and if asked to do so by the nurse they are expected to say "no". The OP mentioned that CNA had come over from another unit, and while this might be normal practice in "well patient" environments such as psych or LTC care, it's not a given that CNA's are always allowed to do this by facility rules.

[OpinionatedCNA, CNA]

I feel bad because sometimes I think it is confusing sometimes as a CNA, especially if you're new to a facility. As long as you tell her that she's supposed to be doing it and offer to teach her how to do it then it will probably be something the supervisor will have to handle. If she keeps refusing after that then it's a bad sign for her.

Maybe she does think she's not allowed too, stuff like that can be weird. I'm a cna in a ltc right now what we're allowed and not allowed to do doesn't make any sense to me. We're allowed to change the foley bags to leg bag and allowed to empty/change the ileostomy pouches but we're not allowed to give residents Ensure because it's considered medicine. It doesn't make any sense but nothing the management decides ever does.

[heinz57]

Thank you all so much for your responses :) As the charge nurse I do have the authority to discipline & write the CNA up, which I will be doing tomorrow when I see her. Additionally, state BON responded, of course stating CNA's can most certainly change leg bag to bedside bag.

Feeling the power?

What the BON says and what the actual policy of your facility might be very different. The BON says RNs can intubate but it is doubtful a lot of facilities extend that skill to all of their nurses.

If the CNA had to "google" something then maybe your facility's P&Ps are not clear or readily available. What about her skill check off list? For goodness sakes you had to email the BON instead of looking in your own policies. Never assume something in your own workplace until you check the written policy. Heck some assume the advice on this anonymous internet forum must be the word of policy for all.

Maybe instead of flexing your "authority", you should gather up the facility's CNA job description and skill checkout sheet. This might have been the first time she has heard of changing the bag as her skill. CNA is an entry level job with very little training or education. Don't expect them to know everything the first time not matter how menial the task is to you.

This stuff of "I'm writing you up na na nah" over what seems to be a conflict in information should not come into this playground.

[heinz57]

Are you licensed? You don't have a "scope of practice" unless you are...

That is incorrect. In the OP's state if her profile is correct, it is referred to as "scope of practice". The same reference is in my state as well. EMTs and some Paramedics are certified and have a scope of practice as do phlebotomists. Medical Assistants are also defined loosely by a scope of practice although their certification process is somewhat of a mystery to me but I say that with respect.