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.
Giving prn medication is way above your scope as a CNA. CNA's cannot legally assess a pt, period. I'm not saying you as a person are not capable, I'm saying it is legally not within your scope of practice.
Well luckily tomorrow I have a job interview, so hopefully I get to turn in my two weeks on Wednesday and have these delegation days behind me! WOOTWOOT
I don't understand. We have nurses come in from time to time to do periodic assessments/evaluations on them but when they are admitted here their condition has already been assessed and known.
I'm confused. These nurses delegate us with no issue, yet I bring it up here and it is an issue.
Go back to your original post...the description of the other CNA who made a med error. That is why RNs/LPNs have an issue with this. You might say "blame it on the state." When something bad (really bad) happens and it is splashed on the news, where is the blame going to be dumped then? Not on the state. On nurses. Ours is a profession that has a foundation based on ethics and safe practice. When that foundation is disrupted the profession suffers. I just hope that does not happen here.
Also, I have a big time issue with nurses who delegate yet aren't even in the building. Again, in your first post, you stated the facility has no RN, MD, etc. Who is delegating? Even if an RN comes in now and then, that does not constitute delegating.
I'm sorry, this is not directed at you--the entire situation is a mess! In sincerely wish you good luck in finding another job. Even though the task was "delegated" to you, if you make a mistake (and even those who are really good make mistakes) it can follow you around for a really, really long time.
I agree with the above; a CNA cannot be "delegated;" tasks can be delegated TO a CNA.
They're pretty much making up a word here. Delegate is a verb, not an adjective.
A nurse cannot be delegating to a CNA if s/he is not even in the building. It doesn't make any sense. They should come up with another title for these CNAs (caretakers?), but appearance is everything, apparently they're set on deceiving patients, their families, and potential patients/families in the name of money.
I agree with the above; a CNA cannot be "delegated;" tasks can be delegated TO a CNA.
They're pretty much making up a word here. Delegate is a verb, not an adjective.
A nurse cannot be delegating to a CNA if s/he is not even in the building. It doesn't make any sense. They should come up with another title for these CNAs (caretakers?), but appearance is everything, apparently they're set on deceiving patients, their families, and potential patients/families in the name of money.
And see, this makes sense to me. But it also confuses me, because all these nurses and whatnot explain to me that the way we're doing it is how it works. I don't understand why nurses would delegate and then never be around. They treat it like it's totally normal and commonplace. I don't get it.
OP - just curious - who owns this "group home" that you are working in - like a private individual or a corporation?
I have read that this type of setting is an emerging trend in elder care.
Two private individuals, a married couple. They started it with good intentions but I think they're a bit out of their league, personally. They don't even have a background in healthcare/health management/etc.
So our set up is we can house a max of 6 residents, all of them but one having severe dementia. We have one manager, who is all but a CNA herself but she does all the office work/doctor, nurse, pharmacy calls/etc. Then including myself and the manager there are less than 10 staff.
Two private individuals, a married couple. They started it with good intentions but I think they're a bit out of their league, personally. They don't even have a background in healthcare/health management/etc.
So our set up is we can house a max of 6 residents, all of them but one having severe dementia. We have one manager, who is all but a CNA herself but she does all the office work/doctor, nurse, pharmacy calls/etc. Then including myself and the manager there are less than 10 staff.
And this setup is approved by Medicare? Any accreditation agency you know of? Can't imagine what you described here as being kosher...?
Is the facility licensed? Do you get state inspections?
I worked with a CNA who was also from WA state. She told me there she was a med aide (not sure where) right out of high school. Apparently WA state had some pretty lax laws when it comes to nursing scope of practice?
Is the facility licensed? Do you get state inspections?
I worked with a CNA who was also from WA state. She told me there she was a med aide (not sure where) right out of high school. Apparently WA state had some pretty lax laws when it comes to nursing scope of practice?
Yes, they are licensed (certs hang right on the wall as you walk in) and also recieve state inspections.
Idk why but yes, I'm learning that WA is VERY lax.
Update: this topic is exactly what we talked about in class today, with emphasis on "you cannot under any circumstances delegate someone for anything that requires assessment. As a nurse, that is YOUR responsibility."
So I took the liberty in just talking with her after class privately about my concerns. She said she cannot give me a 100% answer as she is most familiar with the hospital setting/policies/laws, but she was going to speak to a colleague of hers that is familiar with these kinds of places. However, she said she didn't like how it sounded and (as another PP stated) that they sound like they're stretching the law outside of its intended boundaries, especially when administering PRNs and doing wound care. She said she feels that a nurse should always be present for that.
So my confusion is, how is state doing inspections and not seeing that this occurs and is allowing them to operate the way they are? Unless maybe when state comes in they make it a point not to do PRNs/wound care in front of them...? I have never been present at an inspection yet.
WOOTWOOT
chevyv, BSN, RN
1,679 Posts
Giving prn medication is way above your scope as a CNA. CNA's cannot legally assess a pt, period. I'm not saying you as a person are not capable, I'm saying it is legally not within your scope of practice.