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 i said over and over, the nurses do not always have the time to tell me anything before pt. A, B, and C need something that only he/she can do.
My total shift is 8 1/2 hours, the first 30 are spent leafing through the new pt. chart. A lot of the people we have had, have been there for weeks, so i know them pretty well. Typically i only need 10 minutes to get through 35 charts to get what i need, all the while the nurses are giving report to each other.
The kardex is the way it is, because there had been an incident where someone picked up another pt.'s Kardex "just for something to read". This person was a visitor. So now our Kardex is only used for I and O, and vitals.
I could see the problem if i were reading the pt.s chart and yelling down the hall "ya know Bob Smith hasn't pooped in 5 days!". Doesn't matter what your job title is on this, there are several people that do that sort of thing all the time, however i am not one of them, i know how to keep privacy private.
We ALL signed the HIPAA agreement when we were hired at our facility, doesn't matter what field you worked in. I take it seriously. I don't discuss the pt.'s info with anyone but the nurse, and usually when i do it's something like "i think Mr. X would benefit from a wider BSC, since he's getting stuck between the armrests when he's getting up." And it's not said around the other nurses.
Summing up my thoughts on this : had i NOT been able to look at pt.'s charts, i would have given regular liquids to someone that needed a thickner, i would have given fruit punch to someone that was due a blood sugar an hour later, after telling me she wasn't diabetic. I would have gotten a 250 lb. man up out of bed even though he was ordered bedrest since he was on fall precautions.
Specializes in LTC,Hospice/palliative care,acute care.
Originally posted by hogan4736
"I think they even go through charts when no one is around."
Oh my God...Call the president...
Relax on this particular one...
Why can't a CNA look through the chart?
I'm the nursing supervisor at a LTC facility. Before I started to work there, the CNAs weren't even allowed to use the phone in the nurses' station...Give me a break. Now some CNAs sit in on nursing report AND (are you sitting down?) look in the charts WHEN I'm around...
CNAs can have valuable input, and should be thanked for giving it (when appropriate)...
I have 150 patients in the facility...I can't assess each one every day...The LPNs and CNAs are my eyes and ears...
It's called teamwork!
Sean
THat is a violation of HIPAA regs-that's why.In our LTC facility we have made many changes to be compliant because there are consequnces.As the charge nurse it IS my duty to make sure the nurses station is secure-...As a supervisor you should be familiar with these issues.The cna's should be encouraged to go to the careplans which are kept together in a separate book.THey have access to a phone-but not at the nurse's station.I worked as an aide for alot of years and I never once used the phone or even sat behind the nurses desk.The nurses don't need the distraction.I can not concentrate with half of the aides behind the desk talking about that they are ordering in for lunch.And the time they spend placing that order on the business phone is usually when I am waiting for a return call from a doc and you know they will often NOT HOLD.......We have payphones on each unit for the staff and patients-many of the aides get calls all day-and some of the nurses,too-when they should be attending to the needs of the residents.We all get report together..The charge nurses ARE your eyes and ears-and they do depend on the cna's....But the charge nurses have to be leaders-there are captains on every team,right?
Specializes in LTC,Hospice/palliative care,acute care.
Originally posted by perkines212
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.
OTE] Wrong! The FIRST thing you should be doing when YOU find a patient unresponsive is calling that patient's RN or LPN-and if you are not getting the info you need in report at the start of your shift you need to bring it to the attention of your nurse manager.What you have described is beyond your scope as a cna....as it would be for me in acute care in Pa...As an LPN I can not give an IV push med-I would need to call the RN covering for me right away also..You HAVE to recognize your limitations..
Specializes in LTC,Hospice/palliative care,acute care.
Originally posted by LPN2Be2004
Summing up my thoughts on this : had i NOT been able to look at pt.'s charts, i would have given regular liquids to someone that needed a thickner, i would have given fruit punch to someone that was due a blood sugar an hour later, after telling me she wasn't diabetic. I would have gotten a 250 lb. man up out of bed even though he was ordered bedrest since he was on fall precautions.
Again-if you are not getting basic info regarding patients in report then you need to go to your nurse manager.All of the above are things that should be clearly communicated to all nursing staff and this is done everywhere I have ever worked.Diabetics wear a certain color of ID bracelet-patients with swallowing protocols have signage somewhere close to them-NPO signs on the wall,etc...As an aide if you do not know that a patient is on a regular diet then you better be asking the patient's nurse before you give them anything.It seems as though you are taking responsibilty for things way outside of your scope of practice.Nothing wrong with taking direction or asking for direction from the nurse in charge of the patient.And if they are "bothered" by your questions then you better stick to bedbaths and transport before someone gets hurt.
Specializes in LTC,Hospice/palliative care,acute care.
Originally posted by LPN2Be2004
"stick to bedbaths and transport"
Gee, thanks.
THat is certainly NOT meant to be a "put down" Those things are JUST AS VITAL to the patients well-being as anything the nurse can do and you well know it...I tell the aides at work that the patents are often more concerned about the things they do for them-they often could care less if they get their routine meds on time but they want to be clean and fed and comfortable....It's hard to draw the line especially when you are working as an aide while going to school.....but there is a difference in our job descriptions and legal and moral responsibilites.great harm can come from someone acting outside their scope of knowledge..We all need to take responsibilty for doing our jobs to the best of our ability-mopping the floor or giving an IV push...We all matter...Please read the post again and get the info out of it that I intended......No put down intended.....
Seems to me that a few of the RNs on this forum are on some kind of a power trip! Again, we just need to respect each others positions. I don't think that is too much to ask.
Seems to me that a few of the RNs on this forum are on some kind of a power trip! Again, we just need to respect each others positions. I don't think that is too much to ask.
While it may seem that way to you and some others, there is the issue of licensure to consider. CNAs and other UNLICENSED assistive personnel are working under OUR LICENSES and that may very well be where the concern lies.
You know something we all go around and around with this C.N.A issue and it never seems to be solved. Having been a C.N.A. myself I have a little more sympathy for their job and see things from both side.
The rift between the nursing assistant and the licensed nurse if born of both parties not understanding the other's job.
Neither one can care for residents in Long Term Care with out the other. Nursing assistants are not indentured servants who are there to serve at the pleasure of licensed nurses; they are there to care for the residents who live at the facility. Nursing assistants have the closest contact with the residents on a given unit and are expected to report changes in the resident's condition to licensed nurses. Good nursing assistants take ownership of their unit and their job and to a certain extent the residents they care for. There are many things a nursing assistant can tell a licensed nurse about a resident because they are there to see it. We often fail to listen to them and discount their opinions because they do not have the same level of education that licensed nurses do. This has always struck me as strange since the same observations coming from the resident's family would elicit a much different response.
Licensed nurses are all too often guilty of elitism when it comes to their relationship with nursing assistants. True the nursing assistant is the least educated and lowest paid of the staff caring for our elders but that is a function of how the health care industry is set up. Ask your self this question. Would you, with the amount of training that you have invested in your self, work for what nursing assistants are paid? I didn't think so. While each of us can do the job of a nursing assistant would we want to in addition to everything else we do to care for our residents? I didn't think so. So it is in the best interest of licensed nurses to work with nursing assistants instead of looking down our collective noses at them because they have less training and all to often come from a different socio-economic group that most licensed nurses come from.
On the other side, nursing assistants have to understand that licensed are responsible for the action of the nursing assistant and for the overall planning and implementation of care for every resident living on the units licensed cover. Much of what we do is governed by our nurse practice acts, standards of practice and State and Federal regulation. They cannot do our jobs and most know that but nursing assistants also know that we licensed nurses look down our noses at their job while preaching how important they are to the quality of life for each person we care for. Nursing assistants are not stupid and can see the disconnect.
I see nothing wrong with nursing assistants sitting on report. What is wrong with this opportunity for dialogue and coordination of the shift's work? As far as the resident's record is concerned HIPPA is clear about this and in servicing of the law and facility policy should have stressed what the nursing assistants responsibility is.
I have very little problems with the nursing assistants I work with; they know who I am and what my responsibilities on the unit are. When they are asked to do something I take the time to explain why. Most adults expect this. When they have something to report to me I take it seriously enough to listen to them and assess the situation. I then give them feed back of my assessment. Most adults expect that also. This is the same as I would do if a resident's family came to me with a problem. You know something the nursing assistants appreciate this.
.And if they are "bothered" by your questions then you better stick to bedbaths and transport before someone gets hurt.
I don't even have to respond, other than this statement helps me make my point...
Some nurses are arrogant, and in particular...
If a nurse is bothered by a CNA asking about a diet, then this reinforces the points being made in this thread...
Let them look at the charts
Not all places have Kardexes
What are some of you afraid of???
I polled the 6 LPNs and 15 aides in my facility today...No nurse ever heard of disallowing aides to look in charts, and EVERY aide wants to be involved in report and enjoys learning about the patient through the charts...
Look at it this way...Why should 3 nurses on a 50 bed unit hold all the pertinent info for all 50 patients...It's so secretive...YES, the patients' info is a secret and confidential, but NOT to those providing care...
And you as the med/charge nurse really want to be bothered w/ every little happening w/ every patient, at the moment it happens?
Sound like some nurses have serious control issues here...
Marie_LPN, RN, LPN, RN
12,126 Posts
Like i said over and over, the nurses do not always have the time to tell me anything before pt. A, B, and C need something that only he/she can do.
My total shift is 8 1/2 hours, the first 30 are spent leafing through the new pt. chart. A lot of the people we have had, have been there for weeks, so i know them pretty well. Typically i only need 10 minutes to get through 35 charts to get what i need, all the while the nurses are giving report to each other.
The kardex is the way it is, because there had been an incident where someone picked up another pt.'s Kardex "just for something to read". This person was a visitor. So now our Kardex is only used for I and O, and vitals.