the cnas have taken over!!

[beaglemom]

Help, I'm in a situation that I really don't know what to do. I'm a new lpn, about a year and a half. I consider myself a very good nurse and very professional and very fair. However, the facility I am currently employed has a real problem.You see, the cna's think they run the floor, and no one is doing a thing about it. They have blatantly told me that these were "their residents, and they can take care of them better than I can" I have complained to the don and nothing is done about it. The other two nurses that work the floor with me have been there for years, as have most of the aids, and they have been allowed to behave like this. The other 3-ll nurses have complained also but nothing is every done. The don, I'M told is afraid of getting involved because the aids belong the a union and the nurses don't. The aids are constantly involving themselves in nursing conversations I'm having regarding care. They easedrop on conversations with nurses and doctors and family members. I think they even go through charts when no one is around. I was even told by our infection control nurse to be careful, that the aids will "report" you in a second, just to see a nurse in trouble or get fired. I was even told that the cnas had to sign off on bolus feedings, just to prove that the residents were getting their feedings. I put my foot down with that one and was called to the don's office. I now have a fellow nurse sign for them. I have never been in a facility where the cna's were so empowered. It's really scary. I'm really thinking of going into home care. Have already contacted an agency. Would appreciate some feedback with this one, Thankss.

[hogan4736, BSN, RN]

Quotes (from another thread) to illustrate my points:

"Recently, I wore my nursing cap to work several times, and people looked at me as though they were looking in awe at an "angel". Staff and patients alike even commented on how nice and professional I looked. Several patients told me they missed the nurses wearing all whites and the caps, and they felt "safe and in good hands" when a nurse in whites with the cap took care of them. I felt like I was on cloud nine and then some that entire day as well as the second time I wore it. I keep the cap in my locker just in case I get a notion to iron my only white uniform and wear it again."

First, the patients that called you an angel, were likely over 65 (old enough to remember hats on nurses)

Second, the "felt safe and in good hands" comments no doubt reinforce the feeling of superiority most RNs have (reminder, I am an RN), that help them sleep at night...

"I only had two staff (both PCTs) who said they preferred wearing scrubs. Well, since they are PCTs, they haven't earned the right to wear "the infamous nursing cap". That is a privilege ONLY nurses have earned. Anyone can wear the white uniform, but only a REAL NURSE can don the professional white nursing cap, so go ahead and don your white nursing cap if you want to, and if anyone doesn't like it, tell them you earned the right to wear that cap, and by gosh you are going to wear it as often as you want to, and you don't need their approval one way or the other. "

I wear scrubs proudly, as do the CNAs...Never have I had a patient confuse me w/ anyone else but the charge nurse.

Furthermore, I have no desire to wear whites and a hat. I like to be comfortable in XL scrubs...

If the CNAs want to wear white, after laughing at them (changing poopy diapers in all whites is a recipe for diaster), they'll have my blessing.

Here's to wearing pajamas to work!

:)

[perkines212]

Originally posted by Tory

I can't believe that CNA's are allowed to look at pts charts. According to HIPPA, we are to ask ourselves "Is this something I need to look at in order to do my job?" Does the CNA HAVE to look at the chart in order to do their job? NO! However, the RN does. It's not called teamwork,...that's called being nosey!

I am a CNA that works in a hospital as a PCT. I do not receive a report from the nurses. I get all of my info from paper. First I use the kardex for orders, code status, age, weight, admission date and the Dr(they all have their own way of doing things)

I will look @ H&P, only for medical history. Reason being is that some Dr's order ambulate on all their pts...Good for me to know that this pt is a quad. One Dr doesnt order accu checks on pts who are diabetic, and are taking oral meds...Good to know when I find them unresponsive and diaphoretic. First thing I am going to do with that guy is check his blood sugar.

We have a computer wide system for charting and I will look at pt notes to find out if they are using 1 or 2 assist, bedrest and incont.

You can call me nosey...I call it having knowledge. The more I know about my pts the better I can help the nurse.

I am able to use this info and relate to the nurses the things I see going on with pt. They are then able to take that info and use it as they need to care for the pts.

THAT SOUNDS LIKE TEAMWORK..........

[Marie_LPN, RN, LPN, RN]

Originally posted by Tory

I can't believe that CNA's are allowed to look at pts charts. According to HIPPA, we are to ask ourselves "Is this something I need to look at in order to do my job?" Does the CNA HAVE to look at the chart in order to do their job? NO! However, the RN does. It's not called teamwork,...that's called being nosey!

How the h*ll else am i supposed to find out about my pts? Rely on the nurse to tell me everything when they've got a crappile of work thrown at them as soon as they came through the door? Don't think so. They are busy, they don't always have the time to sit and TELL me that Ms. X no longer has a hip joint, etc. so it's up to me to find out.

It is a HIPPA violation if i'm blabbing about what i've read or learned. How do i know this. I asked, i read, as a cna reading my pt.'s chart, i am not violating, i am educating.

And most CNAs know the HIPPA dance anyway.

The way you phrased your post isn't very 'teamwork'y.

[ltctravelnurse]

I agree with getting out, but the board of nursing needs to be aware that CNA's are potentially being allowed to exceed their scope of practice in this facility - bottom line, like it or not, a CNA must, by law, have a licensed nurse "tell them what to do", not vise-versa!

[hogan4736, BSN, RN]

I apologize to CNAs (for Tory's and others' posts) on behalf of all intelligent nurses...

Some nurses (especially some RNs) know not what they do.

Tory is clueless

Sean

[hogan4736, BSN, RN]

Originally posted by ltctravelnurse

...but the board of nursing needs to be aware that CNA's are potentially being allowed to exceed their scope of practice in this facility - bottom line, like it or not, a CNA must, by law, have a licensed nurse "tell them what to do", not vise-versa!

no one has disagreed w/ that specific point...

it's the "holier than thou" attitude that sucks...

[ltctravelnurse]

STOP!!!! No "holier than thou" here! I have been a nursing assistant, a LPN, a RN, DON....... Everyone has a vital role in health care. No where is it more important to work as a team than in LTC. As a nurse, CNA's are my eyes, ears, hands, etc. I respect them, their opinions, their dedication! I am open to discussion r/t any resident care issue a CNA brings to my attention. I have no problem with a CNA reviewing charts (when do they have time for this?). I have no objection to CNA's rating my job performance, as long as they are knowlegdable in the total requirements of my performance.

The point of my comment was NOT to down CNA's - I could not do my job without them!

We all have a scope of practice - if I prescribe a medication, make a diagnosis, etc. I exceed my scope - that is my point!

[CoffeeRTC, BSN, RN]

In the LTC I work I used to deal with this every day. What it boils down to is scope of practice and respect for others (and people in positions of authority) Once everyone understood where I was comming from things got a little better. I was an aid before coming an RN and understood what my job scope was. I was the eyes for the nurses and reported to them. They assess and treat as needed. Not to say that as a nurse now, some of the CNAs still say " I think so and so needs this or maybe you better do this.." Never would I let them "boss" me around. but I still respect their input in the residents care and let them know that fact. Once respect for authority was established and inpowerment (sp) was there, the retention and job satisfaction of staff improved. Just my 2 cents on the issue.

[fcallicoat]

okay I say that the original concerns voiced in this are valid but take them point by point.

1) CNAs in a union. Most CNAs have to be pushed pretty hard to do this. How bad were things?

2) you are a new nurse. I hate to say this, but CNAs with years and years of experiance very frequently don't trust nurses right out of school. They see us as totally unprepared for the real world, especially in long term care. How many residents do you have and how many did you in your last clinical rotation.

3) having to sign off that a nursing treatment was done? sounds like there was way more going on there then just CNA rebellion. It isn't cost effective (god I hate saying that) to tie up 2 nurses for one treatment, especially a TF. If they had to institute it then something wasn't being done.

4) do you give your CNAs a full report everyday? More than once CNAs have been blown away because they have been caring for someone who a serious infection, fall risk etc. that they haven't been told of.

Number 3 would be my biggest reason for running for the hills. This is not a supportive enviroment for a new nurse. Some one or more have been cutting corners routinely and the staff that has been there knows it.

[hogan4736, BSN, RN]

Originally posted by hogan4736

no one has disagreed w/ that specific point...

it's the "holier than thou" attitude that sucks...

I wasn't targeting you w/ the "holier" attitude...just a reflection of many previous posters and their elitism...I agree w/ your point about CNAs shouldn't be in charge, that was all

geezsh

[renerian, BSN, RN]

I would bolt. renerian

[Nurse educator]

As a trainer of CNA's I sympathasize with the nurses. Those CNA's obviously have no manners or tact. Wonder who trained them? I would tell them to their face, you are the licensed nurse and have quite a bit more training. You have the judgement to know what is good and proper for the residents and no one owns a resident- there is something called residents rights 'they own themselves'.

Just another opinion from 'been there'

John Wayne jr