CNA's and Fire Power

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Hello to fellow nurses who have been stung by the CNA wasp. After I got off a 3-11p shift on New Years Eve, I sat at the dining room table telling my boyfriend that I felt very uneasy about what occured at work that night and they have the power to get a nurse fired. When I got off the hall at 10:45 I discovered the vital signs sheet for my Medicare people were not where they are usually placed toward the end of the shift. When I discovered they weren't done, I asked the CNA if she could get them for me so I could do my charting and I really appreciate it. She told me I should have hand carried them to the end of the hall and given them to her personally even though they were in plain view sitting on the counter of the nurses station. All other employees pick them up and promptly proceed on to get the VS done. In the end I finally recieved them slapped on the counter with a rude smirk "there, is this what you want?" I told my boyfriend that me indicating that I couldn't get my charting done because she held me up is gonna come back on me or get me fired. Sure enough, this morning the DON gets me in her office and says she got reports that I made a stink and attituded up on the poor CNA and was told they have to LET ME GO. Folks who don't witness the balance we nurses have to keep with them and the tightrope we walk to keep our jobs. If CNA"S collaborate together to badmouth a nurse who simply needed what she needed to do her job if only they did theirs, and they succeeded. That is too much power lording over the licensed nurse. Has this happened to you or someone you know? People don't believe me that they can get you fired. :cry:

Specializes in med surg ltc psych.

On bug out's reply, I was following exact protocol for THAT facility. What I described in a "normal" 8 hr shift is how I am expected to chart on the Medicare Part A residents. Yes they do require the nurses (at this facility) to enter the VS on the very first entry line of documentation and time they were taken. Are you really thinking that no other vital signs are taken throughout my night shift? If I have 3 med passes in that 8 hr shift I am constantly reassessing and as I stated in the paraphased area that you included in your reply, that I do RE-TAKE all cardio med residents VS also. You angled me as some kind of incompetent individual. Medicare does not require vital signs for charting? Perhaps not where you work but they sure are entered in a documentation/charting book for Medicare residents. and I missed the entire purpose of the Medicare requirements? Are you SURE I did that? My vital signs are done throughout the shift, and the 9 that I requested are the last set of the night done by the CNA and those were the ones that were not done by the CNA and my requesting them as usual was met with defiance and disrespect. That was the nature of my original post regarding me being terminated because they sided with a lazy CNA who evidently didn't care enough about he residents she was assigned to, to provide what I consider very important. You missed the issue at hand completely by insinuating I caused or created this and deserved what I got. I will assume you are a hands on kind of nurse, and don't read the content of text very well.

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Specializes in Geriatrics, WCC.

This is not the place to take out your anger on someone just making suggestions to you. Bug Out made her own observations and she is not the reason you were terminated. I have never terminated for just "one" action unless it was a gross infraction of nursing care. I believe that is what she was trying to point out. Let's keep this forum professional and not start throwing darts.

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Specializes in VA-BC, CRNI.
On bug out's reply, I was following exact protocol for THAT facility. What I described in a "normal" 8 hr shift is how I am expected to chart on the Medicare Part A residents. Yes they do require the nurses (at this facility) to enter the VS on the very first entry line of documentation and time they were taken. Are you really thinking that no other vital signs are taken throughout my night shift? If I have 3 med passes in that 8 hr shift I am constantly reassessing and as I stated in the paraphased area that you included in your reply, that I do RE-TAKE all cardio med residents VS also. You angled me as some kind of incompetent individual. Medicare does not require vital signs for charting? Perhaps not where you work but they sure are entered in a documentation/charting book for Medicare residents. and I missed the entire purpose of the Medicare requirements? Are you SURE I did that? My vital signs are done throughout the shift, and the 9 that I requested are the last set of the night done by the CNA and those were the ones that were not done by the CNA and my requesting them as usual was met with defiance and disrespect. That was the nature of my original post regarding me being terminated because they sided with a lazy CNA who evidently didn't care enough about he residents she was assigned to, to provide what I consider very important. You missed the issue at hand completely by insinuating I caused or created this and deserved what I got. I will assume you are a hands on kind of nurse, and don't read the content of text very well.

I repeat, you missed the point of the Medicare regs. THEY DO NOT CARE ABOUT VS FOR CHARTING! They want VS because that is the MINIMAL standard of Nursing practice, you document to prove that you accomplished the MINIMAL standard of Nursing practice.

Well maybe I missed something. Yes I understand you get VS for the meds. Do you look at VS for the sake of assessing your pts?

Those 9 pts, did you see VS, complete VS before starting your med pass? Or do those 9 only matter once your shift is done and you're charting?

If my aids do not have VS for me after my report I will personally go out and get those VS myself. Many times I only have to get 1 or 2 VS before the aid catches up to me but I ensure they get done. All the Nurses I work with do the same thing. After report we go and assess our pts, including looking at their complete VS even if we have to get them ourselves.

The CNA does not work alone, their failure is your failure to supervise/delegate/educate.

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Specializes in VA-BC, CRNI.

Look, I am not trying to be mean about this.

I just observed a possible weak point in your methods, take it as you may. I do not think you are incompetent, just inexperienced. EVERY NURSE makes mistakes and EVERY NURSE needs to sit down and reevaluate their practice to see where the weak spots are.

Hell I am corrected daily by CNAs, LPNs, New Grad Nurses on little things that I can do better. I welcome the critiscm, better to be verbally corrected by staff then reprimanded by the BON you know what I mean? I am no better than the lowliest gardner, transporter or CNA on my floor. I make mistakes.

To speak more on the topic of CNAs.

When one of my aids drops a pt is that their fault?

No, it is 100% my fault.

Why?

1. I failed to adequately supervise that CNA.

2. I failed to appropriately delegate a task to the CNA that they could accomplish safely.

3. I failed to educate the CNA on proper transfering methods.

4. I failed to assess my patient's transfering needs.

etc

etc

etc

If your aid does not do something you are obligated to ensure that it gets done, period. It sucks being the leader of the healthcare team because you are responsible for everyone but it is the sacrifice Nurses make.

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If there were no other issues at play here and you were let go solely from this issue they did you a big favor in the end. If they took the side of the CNA who didn't do their job and didn't even think that perhaps the CNA was covering their own butt versus even hearing you out then you have the inmates running the asylum. Bad business.

APPLY FOR UNEMPLOYMENT IMMEDIATELY. Many think when they are fired they aren't eligible when in fact they are. Write down exactly what happened on the unemployment forms. Don't be afraid to apply.

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Yo, Bug Out, I have 44 residents on my unit. None are unstable, none are likely to go south on a moment's notice and I depend on the floor nurses and aides to work together. There have been three occasions in the past two weeks on which residents were sent out to the hospital and each and every time it was because a vigilant and dedicated aide noticed, during AM care, that the resident was sick and took it upon herself to get a temp and report it to me so I could further assess and contact the PCP.

Vitals in LTC are not monitored the way they are in the ICU or even med/surg.

Is there more to this story? Probably. Is it possible the OP needed to be let go? Sure. Was she treated right? No way, and she has a right to be hurt and angry.

I was in one place in which the aides were directly insubordinate, rude, and abusive. When I wrote one up I was lectured about my "approach." I ended up let go on an excuse - I was definitely a bad fit for that place, which says good things about me - when a bad thing happened caused by the ADON's DIL but they certainly weren't going to throw her under the bus, and the aide I wrote up was later fired for documented abuse.

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Specializes in VA-BC, CRNI.

I know what your saying Sue but my contention are the Med A patients. These are not LTC patients, they are SNF/Rehab patients.

Unless my Med A patients in Arizona are different from everyone elses my SNF/Rehab patients require attention, alot of attention. Most of my Med A people are sick people, IV meds, PICC lines, post Ops, active infections/resp infections etc, chemo etc.

Now some of them do turn from Med A to LTC patients but those requiring Medicare charting are classed as Med A short term Rehab patients.

I have 64 patients on my floor, 14 are Med A. 10 of those people are sick people that need close monitoring, the other 4 are close to being DCd from PT/OT and are relatively stable, but they still need close monitoring.

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Gotcha.

We have some sub-acute, but they are not, frankly, unstable. They're old and sick, but it's usually PN and the hospital kicks them out before they're ready. Gotta love DRGs.

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Specializes in LTC.

I caught an aide sleeping in our charting room a few weeks ago wrote her up and handed it over to mgmt who then suspended investigAted and fired her. She called state on us who showed up the other day and nothing was found to substantiate her claims of wrongful termination. The stAte people went thru all my assignment sheets and the schedules I do the aide. Assignments the don does the scheduling. I knew it was.coming just didn't know when. I agree that some aides can ruin a nurse if enough stick together and I also have just witnessed a single aide turn 3 nurses against each other by spreading gossip and heresay to them. I had to step in and tell all 3 that we have to stick together and not let loose lips ruin our work relationships as the aides rarely have the facts about what nurses do and don't do and the legalities we face as nurses. In my state you can be let go without reason or explanation

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Specializes in Emergency Nursing.

I have read all of these posts and I have found them really interesting. I think that when we talk about "CNAs ruling the roost" this is definitely something that is more predominant in a LTC setting like a nursing home and definitely not the case in the acute care hospital setting where CNAs are just one level of patient care and by no means "rule the roost". I do believe that in the LTC setting the CNAs far outnumber the nurses and so there is a definite possibility of ganging up on nurses and other staff members. As a CNA I have reported a nurse that I believe was purposely trying to hurt a patient. What happened was, I was standing with the nurse at the IV cart and when she pulled out the largest venipuncture needle in our cart I asked her why she was choosing that size (since I have been a phlebotomist I don't normally use that size on pediatric patients, adults sure but not children) and she said that she didn't like the patient and thought that they should not be in the ED so she was picking the largest needle possible to "cause the patient more pain". She could have said that the patient had large veins that could easily tolerate the larger needle or nothing at all but she made a point of saying matter-of-factly that she didn't like the patient and didn't believe they should be in the ED and so she was going to cause the patient some more pain. I reported this to the charge nurse at the time it occurred and sat with her while she wrote the e-mail to our clinical manager. To my knowledge (and the charge nurse's knowledge) nothing has happened to this nurse and I was never questioned about what happened by my clinical manager. I immediately lost all respect for this nurse and have minimal contact with her but I will do what I need to do for my job. So while in some settings CNAs may "rule the roost" as you say, in others their voices are lost amongst the masses.

!Chris :specs:

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