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.
Like it or not, CNAs, too, are COworkers. I will get from them that which I put INTO them. A little appreciation goes a long, long way.
This is the attitude of the 10 nurses i work with on my shift, and this is why i can't sing their praises enough on how great of a job they do.
They treat me with respect, and i in turn do the same. Whatever little thing i can do for them, i do it. I see that a pt's IV bag is low, i get another one of the same bag, after checking the orders to make sure that the solution is not to change to another formula. That way the bag has already been put in the charge book, and sitting at the nurse's desk ready to go. A big time saver, and for something that small i always get a 'thank you' for.
Same thing that if a pt. on QS vitals rings for pain medicine, the nurse usually takes the Datascope with her(him) and gets that pt.'s vitals while they're awake. And i REALLY appreciate that!
This is the attitude of the 10 nurses i work with on my shift, and this is why i can't sing their praises enough on how great of a job they do.
They treat me with respect, and i in turn do the same. Whatever little thing i can do for them, i do it. I see that a pt's IV bag is low, i get another one of the same bag, after checking the orders to make sure that the solution is not to change to another formula. That way the bag has already been put in the charge book, and sitting at the nurse's desk ready to go. A big time saver, and for something that small i always get a 'thank you' for.
Same thing that if a pt. on QS vitals rings for pain medicine, the nurse usually takes the Datascope with her(him) and gets that pt.'s vitals while they're awake. And i REALLY appreciate that!
Now that is what I call team work. For those nurses who do not want nursing assistants looking at the patient chart give them report. They have just as much right to know what they are walking into as you do and want to be informed of any exposure risk just as you would want to. Why does nursing always have to pull against each other.
You're kidding me. I cannot believe that people who take care of patients are not allowed to look at the darn chart, and people on this very site are advocating "putting their foot down." You show me where it says HIPAA, and I'll shove it right back because that is some nurses intepretation of the laws to make sure they ahve control of the information, not the actual reading of the law.
Maybe the CNAs are overprotective and bossy because they have dealt with too many incompetant nurses. Everything described isn't incompetance, it sounds like they have the patients best interest in mind, while the OP seems to be worried more about her authority.
And the crack about CNAs taking smoke breaks is rude and demeaning.
my theory exactly...yes there are lazy CNAs, but aren't there lazy docs, rns, lpns, and just lazy people in general???
or maybe many CNAs are overprotective, because too many NURSES have been too demeaning, bossy, and downright mean...I HAVE SEEN IT W/ MY OWN EYES...
I was at my LTC facility on an off day doing some paperwork, and an aide came up to two nurses in report...she said "excuse me, but the patient in room 313's hand is swollen, I think her IV infiltrated"
By some nurses' logic, the CNA should be publicly hanged for 1) actually knowing a medical term (she must have seen it in a chart, she couldn't know that term on her own, right, you know, she's "not smart enough" , and 2) interrupting report w/ pertinent info...anyway, the nurse screamed at her in front of everyone...no "thank you for the info", no "I'll be right in to check it" just harshness and rude, loud words...
NURSING REPORT ISN'T THE GENEVA CONVENTION!!!!!!!!!!!!
IT CAN BE INTERRUPTED!!!!!!
Get off your high horse and listen to your aides...
You know I think it is MORE of a liability for the Aides NOT to look in the chart to know what is going on...
My situation was.. Get to work.. Get my list of 10pts start my vital signs.. Go into a room with a pt who is not very cooperative, tells me if I don't leave him alone I will regret it... So I leave, just thinking this guy is an a$$, go find the CHART.... And guess what he has HIV....
Things like that I think should be told to the new staff coming on, by the other Aides AND the nurses.
I agree that the measure of authority given to CNA's here was a bit excessive, and that everyone needs to respect each other. I also find it interesting that the CNA's, in your description, are too "empowered". It is odd that nurses want empowerment but that we sometimes get annoyed when other groups have it.
CNA's do more physical, hands on work with pt's in a SNF, just as RN's do much more physical, hands on work (compared to doctors) in a hospital setting. Both are very valuable.
I have encountered the question of NACs looking in patient charts several times. As recently as 2000 the State of Washington said it was a breech of confidentiality and fined several facilities for allowing it. With the implimenting of the even more stringent Federal rules I can not imagine it has relaxed any.
Patient charts contain financial, legal and insurance information. That information has NO bearing on an NACs ability to do their job.
Thank you Kid-R-Fun for supporting what I was trying to point out as well..and you said it better.
We have had many inservices on HIPAA at my facility and we really can't be too careful with information these days.
I call you paranoid, and afraid of CNAs usurping your "power"
Back off please. I work LTC,I'm the weekend supervisor, and I see CNA abuse... And not letting a CNA see a chart or enter the nurses' station, because you are afraid of the (nonexistant) HIPAA police, just widens the gap that already exists. And another example of nurses exerting far too much control over every single minutia that transpires on a ward.
Sean
This post makes many assumptions. Paranoid? Don't think so...just cautious and within the law as I believe I mentioned.
"NONEXISTANT" HIPAA policy?? Ignorance of the law is no excuse....I've heard that one before somewhere.
One might might consider Kardexes as a safer alternative (also quicker) than referring non licensed staff to charts and the confidential info there.
If you have no new policies since HIPAA it would be wise to ask for a policy by the DON....making sure she has LOOKED at HIPAA.
Nurses are prudent to protect ourselves and our licenses, IMO. 'Nuff said.
Our "kardex" doesn't say anything but what the pt.'s vital were for the day and the intake and output.
The Kardex doesn't tell me that the pt. is on fall precautions.
The kardex does not tell me that the pt. is NPO after 3 am.
The Kardex does not tell me that someone needs ambulated QID.
Kardex does not say that someone's dressing needs changed at 5 am, therefore, to get supplies ready for the nurse ahead of time.
Kardex doesn't tell me if they are OK to have grape juice.
Kardex doesn't tell me what side a confused pt. have a partial mastectomy on.
Information i need to do MY job to the best of my ability.
'Nuff said.
So wouldn't the obvious solution be to introduce a new Kardex system? Or for the CNAs to get report from the nurse and then share that w/ the next shift?
When I was a PCT I learned quickly the type of info I needed to perform my job. I made a list, a report sheetp per se, and then got that info from the nurse for those patients or from the off-going shift. Besides, I was usually so busy as a PCT that I rarely had time to go through a patient's chart!
I have to disagree with the CNAs not looking at patients charts-In my current training as a CNA, our instructor says that she expects us to be familiar with the PT charts. She says it is important for us to know what is going on with the PT. We will also be expected to document everything on the same chart the nurses use. Maybe the laws differ from state to state, and agency to agency. After all, as CNAs, why should we not know what is on the charts? CNAs are giving most of direct PT care anyway, it would only make sense that we are familiar with the situation as well. Now, that is not to say that I would unecessarily look at a chart, or nose in to family conversations, etc. I know as a CNA what my boundaries will be. And yes, the nurse does have the final say regarding PT care(aside from the doctor, of course), I would never try to act as though I have just as much authority as the nurse. Whatever is happening at that one facility with CNAs running the show, needs to be stopped. CNAs do not have the training nurses do, and legally have no right to assume any authority at all. There is such a risk to the patients as well. I am on my way to becoming an RN, and as hard as we have to work for our degrees, and the knowledge that comes with it, no RN should be bullied by a CNA. Totally unethical behavior. I do hope, however, that during my employment as a CNA, I will be respected by the RNs, I have heard horror stories about RNs treating CNAs really bad as well. We all need to respect each others positions, or there will be no such thing as teamwork.
Marie_LPN, RN, LPN, RN
12,126 Posts
This is the attitude of the 10 nurses i work with on my shift, and this is why i can't sing their praises enough on how great of a job they do.
They treat me with respect, and i in turn do the same. Whatever little thing i can do for them, i do it. I see that a pt's IV bag is low, i get another one of the same bag, after checking the orders to make sure that the solution is not to change to another formula. That way the bag has already been put in the charge book, and sitting at the nurse's desk ready to go. A big time saver, and for something that small i always get a 'thank you' for.
Same thing that if a pt. on QS vitals rings for pain medicine, the nurse usually takes the Datascope with her(him) and gets that pt.'s vitals while they're awake. And i REALLY appreciate that!