cna's doing dressings??

KarynicaRN · May 30, 2008

in my state of Illinois where I teach nursing assistant classes, nurse assistants are not allowed to do dressing changes unless it is a simple dressing with no medication involved. They cannot give medications, cannot put medication in patient/residents food.

This would make me very upset as a registered nurse working on the floor. I would remind the cna's that it is not their job. Also you as the nurse must look at the wound and make sure it is healing.. They may think they are helping out, but they know what they can and cannot do. In my classses I make it very clear what a cna can and can't do. If they are trying to overstep their bounds, it could be consider beyond their scope of practice. Sounds to me like the cna's at your place of work need a really good in-service meeting on what they can and cannot do.

Laught3r · May 30, 2008

My concern is that if the CNA is so comfortable with doing dressing changes and giving medications are other nurses allowing or even encouraging this type of behavior. When I was a aide many nurses would try to get me to give medications or "put this ointment on Mrs. Brown after her bath and cover it for me" Of course I always said no. I also know of nurses who think that allowing aides to give Tylenol of Motrin is harmless or mixing the medication in the food during meals is OK.

al7139, ASN, RN · May 30, 2008

Yikes!

Any assistant doing things like giving meds, changing dressings, etc. in my hospital would be writen up or fired.

Yes, the assistants are a huge help to the nurses, but they are not qualified to perform these duties.

Before I became a nurse, I was a CNA. We were taught to do basic dressings (why I'll never know...mabye for home health care?), but on the unit I worked on we never did dressing changes ourselves, the nurses did them so they could assess the wound. It was out of our scope of practice on a hospital unit. Never did we give meds!

Scary...you should report this to mgt., and go higher if you need to.

You are ultimately responsible for any problems resulting from the CNA's actions.

Amy

catlynLPN · May 30, 2008

If the aides are doing the dressings, then who is assessing the wound?

I would not have left medication at the bedside, while I left the room.

Now, what if her b/p was really low and it needed to be held?

You have no control over what happens to the medication while it is not under your supervision, or in a locked cart.

Sorry to point that out, I guess I'm just too afraid of something going wrong.

TrickieTam · May 30, 2008

I worked at an assisted living facility that had these tyes of Aides. None of the aides were certified byt they all felt as if they were smarter than the nurse. Even the administrator felt like she knew more. If a resident got a skin tear some would dress the wound themselves. I had one aide to take it upon herself to contact a resident sponsor after an incident which resulted in a small skin tear and alert them of the incident. Mind you I was very upset and let her know, and also let my administrator know when I would be working out a notice to leave her facility.

littlebitark · May 30, 2008

I am a CNA and I bet other nurses are letting them do it. Pull that CNA aiside and explain how you would prefer to do your own dressings and give your own medications-

TazziRN, RN · May 30, 2008

Meds: why did the CNA have access to that BP pill? When you left the room it should have been in your possession still. This was very wrong on her part, but if anyone were to write her up for it, you would be on the hot seat too.

Dressings: if they are allowed to do dressing changes in your facility, there should be strict guidelines for them to follow: no recent changes in the orders, stable and healing wound, simple dressing. And just because she already did it, you as the supervising nurse have the right to remove it to check on the wound for documentation. If the CNAs are not allowed to do dressing changes but they're doing it anyway, then things need to change before the state finds out.

Atheos · May 30, 2008

There have been times where someone has a small wound or red spot and the nurse would look at it and then give us the cream to put on. I also worked at a home where the nurses were so short staffed, they would lead us around inspect the wounds and have us dress them. Even stage 2 or 3s. While I wasn't comfortable doing it and it could have cost me my certification, I was competent to do it and the nurse already did their thing. After a nurse inspects a skin tear and/or other injury it becomes basic first aid. Some states allow a CNA to do this, and some don't. Some facilities do and some don't. I would never do anything without going to the nurse first however.

classicdame, MSN, EdD · May 30, 2008

may depend on the policies of your facility as well as state law. In my state CNA's are allowed to do non-sterile dressing changes w/o medication. But nurses need to assess the wound so does this really save you time?

RNDreamer · May 30, 2008

When I was hired at an HHC (city hospital) last year as a CNA, one of the tasks on my "Job Duties" list was changing simple dressings. Maybe your facility allows this?

At the ltc where I work some cna's do resident's dressings. Sometimes when I go to do a dressing the cna says '' I did it already'' most of the other cna's call me or the other nurse to do the dressing change when they see that the resident soiled the diaper and the dressing on the sacrum gets soiled as well. It may sound strange but even though the cna's think their doin the nurses a favor and saving themselves the trouble of hunting down the already busy nurses it makes me uncomfortable that the cna's do this . Dressing changes are more than slapping medicated cream unto someones skin what if the doc has special orders or changes the order etc... I even once worked with a cna who gave a BP pill to a patient when I walked out of the room for 2 second to get the BP machine . when I came back in the room with the machine to take the pressure before I gave the drug the cna told me she gave the lady already! some cna's will even come to me and ask for so and so's medicine so they can put it in the persons food .These cna' may think their helping but this type of stuff makes me uncomfortable being that as the nurse I'm liable for each resident. I believe that the craziest things happen at the most unexpected times. what do u all think nurses and cna's alike?

Ms Kylee · May 30, 2008

At my hospital, nursing assistants cannot do dressing changes. Patient Care Techs (one step above NA, but still below Nurse) can do more advanced things like pulling IV's when patients are discharged, inserting Foleys and straight caths, EKGs, enemas, and simple dressing changes. Simple meaning covering with gauze and putting tape over it. We were are not permitted to pass any medications. In some nursing homes in my state, there are CNA's that have taken a course in medications, are trained, and I believe they are supervised by a nurse when they are passing. I never got the whole story there.