Couldn't believe he did this...

Nurses General Nursing

Published

I work as a nurse delegated CNA in a very small adult family home that is state certified and actually takes place in a big house, not a facility. It's actually a pretty neat set up as it truly feels like you're in a comfortable home and not in an institution. That said, because we are super small and independently operated, there are only two CNA's on staff and that's it. No RN's, no doctors, no anything. However, we do not administer anything beyond oral medications and insulin injections. We don't take anyone in need of acute care, so it's not a place designed where nurses must be present at all times anyway.

So, my schedule recently changed since I'm in school and I now work with someone who has a lot of experience in LTC (20+ years) and has been working for this company from its beginnings (which is still fairly new, less than 5 years in operation). He is a nurse delegated CNA like me. I am a new CNA, but personally? I don't like to work with him. He does things "his" way rather than what is normally expected and it drives me nuts as I am the type of person that likes to follow rules and regulations to the letter, especially when it comes to other people's health. He does a lot of little things that bother me, such as having the diabetic patients already eating before he takes a supposed fasting glucose test, is very vague in chart notes (says someone ate and drank "adequately" instead of giving measurements/ratios), things like that.

To make a long story short, he made a major med error by giving a resident someone elses meds. My heart dropped. I understand people make med errors, but that to me is a HUGE error. I always follow the 5 rights because I am paranoid of this exact scenario potentially happening, so I do everything in my power to not let it happen when I am the one administering. But more disturbing than this is that he didn't make a big deal about it at all. In fact, it was as if nothing happened. I said that I was calling the manager to tell them right away of the incident. He says, "Oh, don't worry about calling her. It's not a big deal. I'll just chart about it later. And anyway, it's not like the medications that this person is taking will effect the other person adversely anyway."

I felt my heart pulsating violently in my chest in anger. Does RN, MD, or PhD follow your name in any way, shape, or form? Are you a pharmacist or pharmacy tech? If the answer is no, you don't know JACK about how that medication well effect that resident! This is the kind of error that could potentially kill someone! And to have no sense of urgency is just...I couldn't believe it. Oh, and he didn't even chart it. This whole thing was just so, so wrong. He should have known better. It shouldn't have even been a hesitation. The fact that he didn't even want me to call and to just keep it quiet...OMG. No. I advocate for my patients, thank you very much, and to hell if I was going to just sit back while a resident has someone elses meds pumping through their system with no one speaking up for them!

I only had a few minutes left on my shift when this all went down, and decided that I was going to call the manager immediately after getting off to tell them what happened and I did. They were shocked and appalled and both the manager and the owner drove to the home that night to address him. They called me while I was home, put me on speaker phone so he could hear me, and I explained the entire thing from beginning to end. The owner asked him if my account was accurate, and to my surprise the CNA said yes, everything I said was true and accurate.

I am not sure what disciplinary action happened, but it's going to be extremely awkward when I have to work with him next shift. Ugh.

:/

Specializes in Hem/Onc/BMT.

Wow this thread really heated up! A quick comment before I head out for work...

My turn to be condescending with all due respect. Not for nothing, but this is evidence based rationale. Exercise decreases serum glucose and adequate hydration helps optimize pancreatic function and performance of endogenous insulin. The fact that you apparently didn't understand this speaks to my earlier comment that most nurses know almost nothing about the pharmacokinetics and dynamics inherent to diabetes care. smh

Different interventions for different situations.

I'm sure exercise and hydration will help in moderate hyperglycemia. And it's good intervention for long term. However, if there is no endogenous insulin, or insulin resistance is severe, how would it help? All that glucose in bloodstream just cannot enter cells without insulin shot. Water probably will help preventing dehydration, which is a risk with hyperglycemia, and also help excrete some glucose through urine. Exercise, however, will not help in severe hyperglycemia. Besides, it can stimulate liver to release even more glucose but since there is still no insulin for cells to take it up from the bloodstream, it will only make hyperglycemia worse.

My turn to be condescending with all due respect. Not for nothing, but this is evidence based rationale. Exercise decreases serum glucose and adequate hydration helps optimize pancreatic function and performance of endogenous insulin. The fact that you apparently didn't understand this speaks to my earlier comment that most nurses know almost nothing about the pharmacokinetics and dynamics inherent to diabetes care. smh

exercise can help lower blood glucose when done on a regular basis over a long period of time. It is not an immediate treatment for hyperglycemia, In fact exercising when blood glucose is very elevated can cause it to go even higher.

edit: I see bluedevil was schooled by a few nurses before I posted this. Good then.

Omg, wow - I almost missed this! Thank you BlueDevil,DNP, for pointing this out.

Jadelpn, even just a quick Google search would attest that I am not incorrect. Not to mention that this is what the RNs have instructed me to do.

Silly how, because I'm not a licensed nurse, I don't have the capacity to understand even the most superficial aspects of health concepts...

hyperglycemia is a most superficial aspect of health concepts?

At the end of the day, though I have gotten defensive here on some things (more related to my personal feelings than the actual situation), I do agree that where I work has bitten off more than they can chew and I don't really want to participate in that anymore, because then all the responsibility falls onto me and my coworkers. Then I go home with a lousy paycheck.

I agree 100% that my few coworkers do not take it as seriously because they don't understand the gravity of the situation. After all, it's not their license in jeopardy here. I actually talked to one of my coworkers. I said that I heard that nurse delegation was a touchy subject among nurses, and that maybe we're doing more than we should be with nurses being practically 100% out of our picture. She said that that "is sad that people get angry about that. When you do become a nurse, you will have already learned so much and be comfortable doing this kind of thing. I think we're very lucky because we will have all this experience under our belts." Yeah, completely different perspectives!

And I'm just so sick and tired of playing police. "Did you check their FBS before they started eating? Did you give that med in the right time window? Did you check her recent BM patterns to see whether she really needs that Diocto you're about to give her?" I HAVE to prompt/ask because if I don't they will part of the time either forget or do something incorrectly.

This place doesn't deserve me. The unfortunate thing is that the residents do.

I noticed that a few of you were mentioning the family reactions. I will say that we have family members of all of the residents visiting the house regularly. They know the things we do and have been coming here for months/years being nothing but delighted with what we do. They know that no nurses are present. The families are comfortable with the situation and the fact that we're delegated to do all these things, even the insulin and wound care. I feel like they think this place is "heaven" compared to a LTC facility. We don't force them to wake up at certain times if they would rather sleep in a little that morning, we always ask what they would like to do, accomodate the foods they love, etc. I think that is what is impressing on the families the most, so they aren't even on the same wavelength as us in terms of medical perspective. Idk, I could be wrong.

hyperglycemia is a most superficial aspect of health concepts?

Ah, I guess I did word that strangely. Also, perhaps "superficial" was not the best word to use.

I didn't mean it in that sense. I meant that I may not know advanced skills or methods, but that I do know basic concepts of some health topics. For example, I know basic things you can do to initially try and lower/raise blood sugar. But if those basic things don't work and more is involved, then no I don't know what else to do other than to call the manager, who then calls the nurse/doctor and so on. Which is why it would be nice to have an RN or LPN around.

So yes, I do know some basics. I know the basics enough to know that - and keep in mind that I'm loosely paraphrasing here - "ambulating someone and having them drink water will do absolutely nothing to lower blood sugar" is not a true statement. Does it always work in all situations? Obviously not. But is it recommended to try if possible? Well, yes, because it can help (I've seen it happen).

Ah, I guess I did word that strangely. Also, perhaps "superficial" was not the best word to use.

I didn't mean it in that sense. I meant that I may not know advanced skills or methods, but that I do know basic concepts of some health topics. For example, I know basic things you can do to initially try and lower/raise blood sugar. But if those basic things don't work and more is involved, then no I don't know what else to do other than to call the manager, who then calls the nurse/doctor and so on. Which is why it would be nice to have an RN or LPN around.

So yes, I do know some basics. I know the basics enough to know that - and keep in mind that I'm loosely paraphrasing here - "ambulating someone and having them drink water will do absolutely nothing to lower blood sugar" is not a true statement. Does it always work in all situations? Obviously not. But is it recommended to try if possible? Well, yes, because it can help (I've seen it happen).

ok just checkin ;)

ok just checkin ;)

It's okay, no problem. :) I should have articulated that better!

Specializes in CDI Supervisor; Formerly NICU.
I don't like to work with him. He does things "his" way rather than what is normally expected and it drives me nuts as I am the type of person that likes to follow rules and regulations to the letter, especially when it comes to other people's health.
I fear you're in for a rude awakening when you graduate and get a nursing job. Nursing school will teach you the "right" way to do many things, and when you get that first job, you're going to find that not many of your peers do things as they are taught in nursing school. People take shortcuts, etc, in an effort to keep up with their 6-7 pts, and the care you gave as a student in clinical, with 2 pts, will be nonce but a memory.
I fear you're in for a rude awakening when you graduate and get a nursing job. Nursing school will teach you the "right" way to do many things, and when you get that first job, you're going to find that not many of your peers do things as they are taught in nursing school. People take shortcuts, etc, in an effort to keep up with their 6-7 pts, and the care you gave as a student in clinical, with 2 pts, will be nonce but a memory.

Yes, I hear often that "there's the nursing school way, and then there's the hospital way." I definitely believe that is true. I should have clarified more though that that comment wasn't really made in terms of different styles of work among coworkers. Rather, he would just do things totally wrong. You just shouldn't take a FBS when the resident is over halfway done with eating. You shouldn't give meds outside their time window.

Now, when it comes to people working differently than me and making up methods that save time and whatnot, I'm all for it as long as the patient is cared for properly to the best of their own ability by the end of the shift.

Specializes in Oncology; medical specialty website.
THIS... We have to make sure when we are discussing issues, what setting the context is in. Also the US is a state-regulated as well as federally regulated country...the "balance of power" theory; states are allowed to fit the needs of the people, as long as it is within the federal limits of the law.

As far as the thread itself, I have been reading and following the updates of the thread.... this is an unfortunate situation, mostly born out of money, on BOTH sides-the group home needs money and a body, so they are willing to take ANYONE, even people who obviously need skilled nursing; however, the family as well as the patient doesn't have the funds to be eligible for the area nursing homes; a lot of patients are not being taken in as "charity" cases anymore, it has become "nursing skilled" driven; a plus for us in the business-if done the right way; which, is NOT happening, but that's a WHOLE 'nother thread.

The group home setting was designed for people that were not "skilled" enough for LTC, not anticipating further complications down the line; unfortunately, the bottom line doesn't see if there is a need to increase or modify care; there's no way until a serious decline happens; that's where is "skilled nursing" comes in, and I don't mean tasks; it involves assessment, evaluating EVERYTHING; labs, history of symptoms and illnesses, intake patterns, medication history and possible side effects of prolonged administration of taking the meds, or the advancement of many disorders...it involves seeing the forest AND the trees. :yes:

I worked at a group home for pediatric children; there were at least three licensed nurses in the building (we had about 40 kids) per shift and five CNAs or less, depending on the shift; it was a home setting, but the children needed extensive care. I think that should be an option for ALL group homes IMHO, at least ONE licensed nurse should be on site; especially if there are at least 3 patients.

It seems like this place is really bending the definition of what a group home is and what skilled and non-skilled nursing means.

The title "Nurse Delegated CNA" seems deceptive to me on two points. One, putting the title "Nurse" before the rest may be confusing to some, particularly older patients. They hear "Nurse" and don't hear the rest, so they think they're getting their care from a nurse. Second, it could give the impression that the care the patient is getting is being overseen by a nurse on-site. It's a lot like PAs who say they're supervised by a physician, but then when you talk to them further, you find out the doctor just reviews a few charts once a month.

​We have all these new grads in need of jobs. It's a shame that homes choose to give care on the cheap.

Specializes in Oncology; medical specialty website.
Thanks, Mods for merging the threads.

I am intrigued by the responses.

I believe the best use of this topic is not to divide us, but to keep dialogue open. All of us in the medical field (RN, LPN, Provider, CNA, MA, ancillary, specialists, ad infinitum...) should strive to be as ahead of the game as is possible on the trendings. (I think we can all agree trendings are fiscally based.)

A knowledgeable body of medical caregivers is an empowered body. Otherwise "stuff happens" and decisions/laws are made while the rest of us--in the words of a poet--"sit 'round and pluck blackberries."

Anyone entertaining the notion of entering (or advancing in) the medical field needs to keep abreast.

As a side note, I see many more MA jobs posted at hospitals than ever...with a (vague-ish) job description that entails much of the same that is required of RN's (including IV/meds/cooordinative care on the floor...)

Not saying it's "right or wrong," but, I'm asserting that the face of the nursing profession is changing rapidly, and right under our noses.

When patient care in hospitals is coordinated and delivered by MAs, then it's not nursing. I don't know what to call it, but it assuredly isn't nursing.

Many days I'm sorry I had to give up being a nurse, but when I read stuff like this, it makes me a little less sad.

Specializes in Pediatrics, Emergency, Trauma.
It seems like this place is really bending the definition of what a group home is and what skilled and non-skilled nursing means.

The title "Nurse Delegated CNA" seems deceptive to me on two points. One, putting the title "Nurse" before the rest may be confusing to some, particularly older patients. They hear "Nurse" and don't hear the rest, so they think they're getting their care from a nurse.

Second, it could give the impression that the care the patient is getting is being overseen by a nurse on-site. It's a lot like PAs who say they're supervised by a physician, but then when you talk to them further, you find out the doctor just reviews a few charts once a month. ​

****We have all these new grads in need of jobs. It's a shame that homes choose to give care on the cheap*****.

Couldn't agree with you more, especially with this last statement. :yes:

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