cna's doing dressings??

[gt4everpn]

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?

[pagandeva2000, LPN]

When I used to be a CNA, I noticed that many of the nurses encouraged the CNAs to give their medications and do their dressings. I suspect that this was because it may be one nurse being responsible for administering meds to close to 60 patients. It doesn't make it right, but this shows what can happen when safe nurse:patient ratios don't exist...people will create shortcuts that are clearly not safe.

I remember a recent coversation I had with an LPN that used to work in LTC and she told me that she would never do the medications that an RN was supposed to, because she had to protect her license. And, in the same breath, she told me that she used to get the CNAs to do her dressings. I asked her what the difference was--she was also asking the CNA to work out of her scope of practice the same as the RN asked her. In other words, she was just as wrong as the RN that asked her to do something out of her scope.

It sounds like this is common practice for the CNAs at this place (not that it is right, but that some of the nurses have been doing this for a long, long time), and they don't see the implications of doing the wrong thing. Then, there are the 'wannabee nurses' who feel very priviledged to be able to say "I just gave her the pill...what is the big deal nurses complain about??". I would announce to them that I cannot control what the other nurses do, but, you are not allowed to administer my medications or do my treatments. The next time this happens, I am writing this up and reporting it.

I remember hearing a story about how a CNA did something with the tube feeding at my hospital that caused a negative outcome for the patient and the nurse was blamed (I do not know the details, only the rumor). There are some things that are really out of the nurse's control because we simply cannot be in more than one place at a time, and no one I know has eyes behind their heads. That scares me, though.

[pagandeva2000, LPN]

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?

The Patient Care Technicians, Patient Care Associates and Medical Surgical Techs are allowed to do simple dressing changes at HHC from what I last remembered. When I was trained as a PCA, that was one of our performance evals.

[Okami_CCRN, BSN, RN]

At my facility nurse's leave xenaderm,silvadine,etc at the bedside so when we clean patients we can apply a fresh coat of the prescribed ointment.

Most of us do not do dressing but if a patient does soil their sacral dressing then we will call the RN to look at it and decide if another dressing is needed.

BTW I would never give any medication to a patient unless it is a confused patient that will not take their meds with the RN, even then the RN will stand next to me as I try to get Ms. Jones to take her ativan.

[KT-Jay731]

If there is a negative outcome for the patient as a direct result from the dressing the CNA did, isn't it ultimately the RN's fault?

I don't think CNAs in our state can do ANY dressings unless they are specifically certified, and then it would be simple ones.

[pagandeva2000, LPN]

If there is a negative outcome for the patient as a direct result from the dressing the CNA did, isn't it ultimately the RN's fault?

I don't think CNAs in our state can do ANY dressings unless they are specifically certified, and then it would be simple ones.

I would think so, but what makes this scary is that many times, the RN may not know what the CNA did at all until well after the fact. The same as a CNA giving medication that the nurse doesn't know about. The example that the OP used is a perfect one. She went to get the blood pressure cuff to check before administration, and the CNA just took it upon herself to give it. Now, sure, we can say that the medication should be locked in the drawer. But, the CNA 'decided' to give the medication. And, if the nurse does not report it, and there is a negative outcome, then, sure, the nurse is ultimately responsible. Scary stuff...these are wild cards waiting to explode.

[Absolutely13]

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-

This isn't about other nurses "letting" a CNA do anything. CNA's must be fully aware of what their scope of practice is (and isn't). This is basic patient safety and we are not qualified nor trained to do anybody any favors that fall outside facility policy or state law. Specific training is an exception at some facilities.

I know this sounds like I'm knitpicking, but we have to stay on the solid side of patient safety at all times. This means much more communication with RN's and LPN's whenever in a "gray" area. After all, it's their call, not ours.

[SmileyCNAII]

In NC we can go to school to become a CNA II (2). It takes @ 8 weeks for the course and we are taught to put in Foleys , Straight Cath, oral Suctioning and trach suctioning, Do tube feedings, priming tubing and to change sterile and non sterile dressings that are over 48 hours old (no medication). If I were on a floor or in a nursing home I would dress a wound only after the nurse has looked at it and communicated to me that it is okay to dress (in the ER where I currently work CNA's do dressings all the time after the doc has done whatever he needs to do, stitch etc).

[catnip]

Where i worked as a CNA, we were expected to do dressing changes, so long as they did not envolve medication. Once we got report from the nurse that had the pt, we were told what type of wound it was, what was needed for it, and what if anything we had to come get her for in terms of changes. Cant say i agreed with it, but when arguing it with the manager results in the good old, "if you dont like it....." what can you do.

[casi, ASN, RN]

As a CNA I'm allowed to do simple sterile/clean dressing changes which amount to slapping a 4x4 on something and taping it down. It's rare that I do these, but I chart that I did them.

[pagandeva2000, LPN]

I am seeing that the scope of practice is getting wider and wider, which is causing confusion. More responsibilities are being given to unlicensed people; such as hiring medication aides, etc... Nurses, do you think that this is happening because of the nursing shortage?

[Mikey31079]

at my facility, we have a nurse that tries to pass her dressing changes off on the cna's. i told her "i'm not doing stuff like that until i get out of lpn school. doing it now would mean i was violating the nurse aide scope of practice and i do not need the state of ohio on my butt."

[NurseKatie08, MSN]

When I was a CNA, if a resident/patient had soiled a dressing, I would let the nurse know, and most often they'd let me watch while they changed it because they knew I was in nursing school.

Only time I ever changed a dressing as a CNA was after I graduated with my BSN (in fact, about one week before I was taking my boards) when the nurse told me she'd stand there and watch me do it so that she could assess the wound & she walked me through step by step.