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?

[One Flew Over]

As a CNA:

I've given meds before but only under the direct supervision of an LPN. And the only reason I gave them was I take care of this very demented/combative woman, I have had her a long time and she trusts me. She often spits the medicine or flat out refuses it with the nurses, but she takes it most of the time when I offer it. Drives the nurses crazy when they try for an hour and I come in and get her to take it in 10 seconds

I'll do creams, but no patches, dressings etc. I don't mind putting on the creams/ointments but if there's any change, or I don't regularly have the patient (therefore cant tell if it has improved or gotten worse) I make sure to get the nurse to look at it.

Anyway I always ask the nurse for the cream/ointment that way she can make the decision whether to put it on or let me.

But I've had an opposite problem. I used to have a charge nurse who asked me to do dressings or even apply pain patches, all the time. I simply ignored it and went and got him anyway. Eventually he quit asking. :chuckle

[SunnyAndrsn]

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?

Our CNA's do not do dressing changes, nor would I want them to! As the nurse, I need to evaluate and chart on the progress of the wound. We are the ones who are reporting problems to the MD. CNA's are not trained to do this, and while I'd love it if they were there for an extra pair of hands, they should not be doing it alone.

As for the medications, my rule is don't leave it in the room, therefore if you need to get a BP cuff, take the med with you. If this was during your state inspection, you could get tagged for not having the med under your control...ie, BP must be take before med is given, but CNA had access to it and gave it before you could take the BP. What if the BP had been low and you should have held it? Ultimately, this is your error...

As for disguising medication in food, make sure your orders are clear for crushing, etc. I don't allow CNA's to do this for me either. Unless the CNA is a trained medication aide as well, AND I've specifically delegated the resident's med administration to them, I don't want them touching my meds.

I have had a select CNA hand a resident his medication after I got it ready, and while I was standing outside the room watching because he won't take it for me. I don't have an issue with nystatin powder or cream being administered by CNAs, but I do want to see the progress of the condition for which it's being used at some point during my shift.

[Virgo_RN, BSN, RN]

Our CNAs may perform clean dressing changes over a closed wound with no medication.