Communicating with UAP's about the importance of basic nursing care.

[Woodenpug, BSN]

I feel we suffered a serious loss when hospitals no longer required certification for all direct patient care personnel.

I can give many examples, but in a nutshell: The attitude toward basic nursing care seems to be "I do this because they tell me and they can't be bothered." I can easily see how I give that impression. I'll ask a UAP to do something, and if they can handle it alone, leave then go stare at a chart or the computer :behindpc: for lab values. I have very little time to explain my priorities. I do think that turning a patient, keeping him clean, etc is essential. But I'm more concerned about a K+ level of 3.0 or a weird new rhythm or what seems like 10,000 other potentially life threatening things. Most of those turn out to be false alarms, but what if I did not look into it?

If I don't specifically ask that a task be preformed and make a point of checking that it's done, it won't happen. The UAP makes a point of being offended when I make a point of checking that the task is done. If I do something related to a routine UAP task, I have to make sure to remind the UAP that the routine task is still necessary and again make a point of checking that that task is preformed. This ranges from my recording the water I got for the patient and still requiring the UAP to complete the Oral I and O's to when I feel it necessary to take a manual b/p and still want the UAP to take routine vital signs. Truth be told, most of the time it is simply better time management to preform routine nursing care without bothering the UAP. These things don't always happen and are not true for all UAP's, just all too often. Particularly, when I am "swamped.":bugeyes:

I do follow the leadership guidelines and remember to thank people for a job well done, as much as possible. I make an effort to publicly give sincere praise. I offer suggestions for improvement gently and in private. I take a personal interest in others lives and try to regard them with as much respect and consideration as I do for my patients, MD's and supervisors. I also make mistakes in leadership, but I'm aware of the basics and strive to improve. My leadership skills are probably at their worst, when I'm "swamped," and the UAP is sleeping or reading a novel.:sofahider

I would like to believe that the difficulties I'm having are related to a knowledge deficit. The problems I described above do not seem to happen when the UAP is certified or taking courses for Nursing/pre-req's. Other RN's on my floor also believe that it's nothing more than a knowledge deficit. (Likely, bi-directional)

I feel I had to say all the above to make a request and receive an answer targeted to my concerns. May I have some help in preparing written material for UAP's on the importance of routine V/S, pt turning, daily weights, and I/O's?

Thank you for reading this post and in advance for your help.

[lpnflorida]

I am not quite sure how to address this. All of our Nursing Assistants are Certified. 90% do a great job, are willing to do what ever is requested in regards to a patient's need.

To the ones who just show up to work and do bare minimal. I only pray they are not assigned to my patients.

[Woodenpug, BSN]

I am not quite sure how to address this. All of our Nursing Assistants are Certified. 90% do a great job, are willing to do what ever is requested in regards to a patient's need.

To the ones who just show up to work and do bare minimal. I only pray they are not assigned to my patients.

In a way, I'm addressing those. I believe that they would find a better environment with equal pay if they don't care and "just show up." I feel it's a knowledge deficit. Materials from nursing texts are too long and what I write sounds condescending or too technical. The best I have so far is similar to the first post.

[lpnflorida]

There must be a book somewhere that gives the rational as to the why it is important a patient to be turned every 2 hours and other basics which the CNA learn. I will ask around, and try and web search to see if I can locate something which might be helpful.

Our hospital, maybe it is the state of Florida requires our CNA to take 12 units of continued learning , yearly. It is not the same as CEU;s but it does address things such as care of the suicidal patient, body mechanics, helping to prevent pressure ulcers etc.

[lpnflorida]

http://www.doh.state.fl.us/mqa/cna/cna_ceu.html

64B9-15.011 In-service Training Requirements for Certified Nursing Assistants.

(1) Each certified nursing assistant must complete a minimum of 12 hours of in-service training each calendar year. For candidates certified during the calendar year, the minimum in-service hours required shall be prorated at the rate of 1.0 hours per month from the month of initial certification to the end of the calendar year.

(2) Every 2 years, in-service training hours shall include, but are not limited to, the following areas:

(a) HIV/AIDS, Infection Control;

(b) Domestic Violence;

© Medical Record Documentation and Legal Aspects Appropriate to Nursing Assistants;

(d) Resident Rights;

(e) Communication with cognitively impaired clients;

(f) CPR skills; and

(g) Medical Error Prevention and Safety.

(3) After meeting the requirement in subsection (2), health care career/technical courses in a college, university, or approved nursing program may be used to meet the hours requirement in subsection (1).

(4) A certified nursing assistant is exempt from the inservice education requirement in subsection (1) if the certified nursing assistant was on active duty with the Armed Forces for 6 months or more during the calendar year, and was in good standing with the board at the time active duty began. However, this exemption will not arise on the basis of the performance of short periods of active duty (such as summer or weekend drills) by a member of the Armed Forces Reserves. Duty in the United States Public Health Service is not considered duty in the Armed Forces.

(5) A certified nursing assistant who is the spouse of a member of the Armed Forces and was caused to be absent from Florida due to the spouse’s duties with the Armed Forces shall be exempt from inservice hours requirements. The certified nursing assistant must show satisfactory proof of the absence and the spouse’s military status.

(6) Each certified nursing assistant must retain in-service compliance records for a period of 4 years and submit records to the board if required for auditing.

Resources for In-service Programs for Certified Nursing Assistants:

Florida Association of Nurse Assistants, Inc

1920 Verano Drive Suite 205

Haines City, Fl. 33844-8585

Elite Continuing Education

118 West Vinning Street

Winter Garden, FL 34787

CEU Network www.CEUNetwork.org

Helen Malin-Christiansen

FL. Nursing Provider # 50-923

12033 Arbor Lake Drive

Jacksonville, FL. 32225

the above information as copied from their web site including the contact information given on the site

[Woodenpug, BSN]

for clarification:

Yes I agree. CNA's are great, but my hospital does not require UAP's to be certified. I did not mean any criticism of my hospital policies or an over generalization of certification requirements. I've just had little success in finding material that is not overly technical and worse success in writing something myself. Ideally, it would be like those patient hand outs on "Why did my doctor prescribe Coumadin." Hmm.... a new search strategy.

Thank you again and sorry for my lack of clarity.

[SuesquatchRN, BSN, RN]

Heh. That's an issue. NYS requires cert and CEU's.

[mama_d, BSN, RN]

Ugh...good luck in what you're trying to do.

I agree, the ones who are in nursing school or have been doing it for years and years and have developed the knowledge to follow our rationales make the most cooperative, helpful techs.

Unless they're the ones who think that having med-surg clinicals under their belt makes them competent to place judgement on and snottily question my decisions that I make for our tele patients after working as a nurse on the same floor for over five years...but that's another thread entirely, I suspect.

I've found that being direct and matter of fact with our less proficient techs has helped..."Mrs. Jones is in CHF and renal failure, in order to accurately assess the effectiveness of the medications that I'm giving her, I HAVE to have accurate and timely I & O's on her." This way they know the reasoning behind me bugging the crap out of them to chart it right. Maybe having a booklet with headings like "the importance of I & O's on our patients" and then examples like that?

We've got a few techs who I'd love to clone so that they could work 24/7. And a few who I just wonder what the heck they're going to be like as a nurse and just shake my head.

[SuesquatchRN, BSN, RN]

Woodenpug, does your hospital have an education department? Maybe get them involved. Frankly, I foresee toe-stepping-on if you don't. And resentment from the UAPs.

[classicdame, MSN, EdD]

UAP's may need more attention from your Education staff. We only hire CNA's, but I do 2 full days of inservice every year to give them updates and discuss new products, issues, etc. We always cover "what to tell the nurse and when". I get vendors to come in and talk about their products (skin care, beds, linens, etc). The idea is to treat them like professionals. Many people will respond positively to this.

[Woodenpug, BSN]

Thank you. My education department is where this started. They suggested that I find materials related to the reasons basic nursing is important. I did find a nice one from the Mayo clinic on turning patients, but they charge $1.70 per copy for permission to copy.

If I were reading this, I think I would get the impression that the OP does not have much support. That is not true, I think other priorities, like the upcoming conversion to paperless charting, take precedence.

[SuesquatchRN, BSN, RN]

No, I just didn't know if you were going off on your own.

I'll see what I can snag from the nursing home tomorrow. They have tons of in-service and training stuff. I'll see if I can get you a copy of the curriculum. PM or email me your snail mail.