CNA's slow me down

LorraineCNA · Mar 1, 2005

I am a new LPN in a ltc. I have only worked three shifts thus far. I think I mentioned in an earlier thread that I feel the nurses do things the CNA's should be delegated. I gave my first med pass on my own the other night. In the middle of all my confusion and trying to stay on task, not make any mistakes, etc. a CNA asked me to help her ambulate a resident. I said I probably should not leave my cart, that i was passing meds. She asked if it was locked and it was. Then she said "well, the nurses' always help us". No problem, it is resident care. So I bit my tongue and did it. How can I finish my meds on time when interuppted and how can I say no to her without pi$$ing the aids off? Just need some advice on what and when I should say no. Oh, and I do plan on delegating certain tasks once I am done with my orientation. Thanx. :bowingpur :bowingpur :bowingpur

If you don't mind my asking, what tasks are you planning on delegating to the aides?

Where I worked (CNA) there were no tasks that the nurses did that could be delegated, the only things they did that were pt. care were things that were way out of an aide's scope of practice. It was also rare that they would help you with something like ambulating a pt. "You have to wait for another aide to help you." I can only think of two nurses that I worked with that were willing to do anything even remotely related to an aide's duty unless it was mandated. Needless to say, those two were a joy to work with.

Lorraine

CNA

almost MA

ohioipnurse · Mar 1, 2005

I have been an LPN for nearly 20 years and have done my share of work in an LTC. I gained a great deal of respect for the CNA's-they are the hardest working, lowest paid members of the healthcare team. They are also the nurses "eyes and ears" on the floor. They catch many things that a nurse may miss on an assessment.

I was able to do my job as well as help the CNA's when they needed it. We worked as a "team" and got the entire job done during our shift.

I understand being new on the job and not wanting to make any mistakes and also wanting to get finished on time, but please remember, the CNA's that you help and show respect to will be the ones to help you and respect you in return.

Just my opinion...............

Mandylpn · Mar 1, 2005

I am allowed to delegate any duty that they are trained in. They can do things like ambulate, bathe, feed, personal cares, etc. :twocents:

Lorraine, are you a nurse?

anjau · Mar 1, 2005

From my personal experience in LTC, the best way to get things done effectively and effeciently, is to give the CNAs a hand when they need it. Your staff will respect you much more if you make the playing field level and give them the impression that patient care is paramount, above meds and any paperwork. The only time I won't go to the floor to assist is if I know that person hasn't been pulling their weight in the first place. That's when I tell them that I have things to get done and I will help them when they put forth some effort. It's really nice to come in to work and have the staff be like, "oh good, you're here today! you're so easy to work with". The longer you're in nursing, the more you'll learn that you pretty much *always* run behind schedule and that you pretty much *always* have to spend an entire shift playing catch up. Whether you're in LTC, hospital, or even doctor's office, every single day is different. I don't know how many times I've been right in the middle of a med pass and a surprise admit pops in that they forgot to mention in report or even worse, someone decides to go septic right that second and you've got to send them out. Be prepared, everything will slow you down in nursing. The trick is to learn how to deal with it and get through it effeciently.

CHATSDALE · Mar 1, 2005

i have no problem lending a hand with whatever needs to be done .. but .. if you were in them middle of a med pass you should not have stopped for something like assisting with ambulation...another cna could have assisted or that cna could have done something else until you were finished...esp if you are that new you need to concentrate of the meds and what the pts look like...you have a lot of responsibility the welfare and the very lives of your patient depend on you....you should not have been told to lock your cart,,,an emergency is something else but you would know that

cursenurse · Mar 1, 2005

i agree with most of the nurses here, the cna should be directed to ask another cna for assistance. you cannot stop your med pass for every little thing. i was once told by a state surveyor who was shadowing me during med pass that the med pass takes priority over everything. i was about to stop my med pass to tend to a pt that was having a hypoglycemic reaction, and the surveyor told me to call an "extra nurse" to take care of it, that i was not to leave my cart. i don't really agree with that because i felt that was an emergency situation, but the moral of the story is to delegate pretty much everything.

lovingtheunloved, ASN, RN · Mar 1, 2005

My nurses will usually help me with anything I ask them to. But if I'm asking a nurse, it's because the other aides are busy at the moment, and it's something that really can't wait. Like yesterday I asked the nurse to help me transfer someone who was hell bent on throwing herself out of her geri chair. She locked her cart and helped me. That's time management, because she'd have been way more behind when the lady's head bounced off the floor and she had to spend her time doing neuro checks and incident reports and calling the family.

Ambulating? That's something that can wait until another aide could help.

BeenThereDoneThat74, MSN, RN · Mar 1, 2005

i have no problem lending a hand with whatever needs to be done .. but .. if you were in them middle of a med pass you should not have stopped for something like assisting with ambulation...another cna could have assisted or that cna could have done something else until you were finished...esp if you are that new you need to concentrate of the meds and what the pts look like...you have a lot of responsibility the welfare and the very lives of your patient depend on you....you should not have been told to lock your cart,,,an emergency is something else but you would know that

:yeahthat: as a new nurse, it is sometimes hard to prioritize (i'm not saying you didn't know what the priority was, i think you did). and it is also hard to convince other workers (cna's, doctors, managers, etc) that their request is not your priority. we're not talking about a pt lying in poop or vomit, or a pt lying on the floor. ambulating at that moment was not a priority, and while passing colace and mvi is not an urgent thing either, some meds are. they need to be given (close to) on time, or you'll never catch up. as a new grad, i had trouble saying no to people, and it got me into a viscious cycle of not getting my work done on time, which in turn appeared as poor prioritizing. there's a very fne line between teamwork and being taken advantage of, when it comes to ancillary staff, imho. :angryfire just remember, while you can do their job, they can't do yours. unfortunately you'll get reamed if they don't do their job, but their off scott free when you don't finish passing your meds. :twocents:

LorraineCNA · Mar 1, 2005

I am allowed to delegate any duty that they are trained in. They can do things like ambulate, bathe, feed, personal cares, etc.
Lorraine, are you a nurse?

Nope, former CNA. When you said delegate duties to the CNA's I thought you meant duties other than the things you mention above.

Where I worked the nurses for the most part didn't DO any of those duties. They were almost strictly wound care, med passes, charting...all things that would be out of scope for a CNA. So, they really couldn't delegate any of "their" duties out as they'd be out of our (CNA's) scope of practice. Does that make any sense?

:Melody: It does in my head :Melody: I just can't get it on paper... :chuckle

That's why I was asking what you'd be delegating, I didn't realize you meant CNA duties.

Lorraine

jude11142 · Mar 2, 2005

I have to agree with what others have said. I have no problem doing anything that benefits our residents and/or helps out a coworker, but there are times when you are just too busy and can't drop everything unless it is a true emergency. Assisting ambulating a pt is not one, it can wait. You have to make your med pass a priority and shouldn't be interrupted during it. You need to stay focused to prevent making a med error, plus you don't have a big window of time to finish it. With experience you will learn when you need to lock up the cart and attend to a resident.

The bottom line, I have found that you need to be able to delegate and be confident about it. When I first started, rumor went around that "I love working with her(me), she's so easy"....Not quite a compliment, I had a hard time when it came to say, vital signs, all the other nurses had theirs by a certain time and me, well, let's say that 30minutes before end of shift, I'd be running around getting them. One cna would say, I'm sorry I forgot, and I'd be like that's ok. Dinner breaks, some would be gone for over an hr and I would say nothing...Not anymore. We are all adults and we all know what is expected of us. I have become more assertive and firm in my decisions regarding assignments/breaks etc....Now, serveral yrs later, those who are still there enjoy working with me, not because "I'm easy" but because they respect me,

I am fair, not afraid to help out. Big difference. There are those who will try and take advantage of you and it is not limited to the cna's. I have had another nurse who works days, who always left the MD callboard full, treatments that should of been done that weren't etc....why? Because she knew that I would take care of it. Thank God, she is no longer there. I always pull my weight and try to make sure that at the end of my shift I completed what needed to be done. Ofcourse, sometimes you have to leave something because you had an extremely busy day, a death, a fall, somebody going to hosp etc...that is understanding. It's really about mutual respect. That goes for everyone, doesn't matter if it's a nurse, cna, housekeeper, laundry, dietary and so on. You have to give respect to earn it. Always remember that the CNA, are your eyes and ears. They often can tell you when something is just not right with Mr. Jones. The care that they give to pts allows them to notice any changes esp physically. Come on, when's the last time say, you saw Mr. Jones bottom? If your pt can't tell you, it's your cna that will come to you and say, "his bottom is starting to get reddened"......The cna's that I work with are regularlly assigned to the unit I work and let me tell you they have great skills and often have caught something early on with the pts.

I don't remember every saying, "no" to anyone at work,(take that back, I have said "NO" when asked to work 10 days in a row, lol"). You know the old saying, "one hand washes the other"........so true. It's all in how you approach others too. All of this you will learn with experience, as there is no way you can learn this in school.

JUDE

Kandee Roses · Mar 4, 2005

I was a CNA for 10 years before I became a LPN. I understand how hard the job of a CNA is and now understand how hard the job for a LPN is. I too work in LTC. I work mostly the 3p to 11p shift, so ya'll know that we have more residents to staff ratio then during the day shift. Sometimes while on my med passes, a resident might ask for assistance to the bathroom or help to get into bed. Even though I am trying to get my med pass done on time, I always try to help. Sometimes I will assist them to the toilet, make sure they know where the call light is and how to use, and then tell the CNAs that are working that particular hall that so and so resident is in the bathroom and watch for the call light to go off. It only takes a few minutes at the most to assist these residents. So, maybe sometimes my med pass may not be done on time, but I know I am not like some of those nurses that think they are above and beyond from doing the "dirty" work. I try to do the best for my residents and help out my co-workers. My CNAs do know that I have to get MY work finished, but that I will help out when and where I can.