Couldn't believe he did this...

Nurses General Nursing

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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.

:/

OP you are correct, you are being used by your company. At the expense of a licensed nurse foolish enough to "delegate" these things to any unlicensed persons.

What you are doing is acting in the capacity of a nurse when clearly you are not licensed to do so. It amazes me that any home that has federal/state funding and reimbursement can think that ok.

A "bit out of your scope" is out of your scope. Period. Then that means it is NOT a state sanctioned activity.

Perhaps they should let CNA's bridge to LPN's so that at least as you all are assessing, treating and medicating you have a broader education/clinical base than at present.

What state are you in?

OP you are correct, you are being used by your company. At the expense of a licensed nurse foolish enough to "delegate" these things to any unlicensed persons.

What you are doing is acting in the capacity of a nurse when clearly you are not licensed to do so. It amazes me that any home that has federal/state funding and reimbursement can think that ok.

A "bit out of your scope" is out of your scope. Period. Then that means it is NOT a state sanctioned activity.

Perhaps they should let CNA's bridge to LPN's so that at least as you all are assessing, treating and medicating you have a broader education/clinical base than at present.

But the point is I'm certified to do these things. All of these things I have described are legal nurse delegated tasks for CNAs. You may not think it's okay for me to pass meds and the like, but clearly the state thinks it is fine. I even told my nursing instructor and she wasn't alarmed at all because it has started becoming the norm here. There are some CNA jobs you can't get here unless you have these delegation certs. The state does not feel this is out of our scope, otherwise we would not be able to be delegated for these tasks and verified and signed off by RNs to do it...

If it makes you angry, ultimately the anger needs to be directed at the state for allowing it to happen. Us nurse delegated CNA's are just doing what we are legally certified to do, and that is passing meds, blood sugar testing, insulin injections and some wound care. This is being taught now in state certified and approved CNA courses. This is not our fault.

I guess if my company were to find me on here, my description of my situation would be enough. The state is WA.

http://apps.leg.wa.gov/RCW/default.aspx?cite=18.79.260

I think you have misunderstood what you can do as CNA.

For example you are administering psych drugs in patients who are not stable

"Delegation of nursing care tasks in community-based care settings and in-home care settings is only allowed for individuals who have a stable and predictable condition. "Stable and predictable condition" means a situation in which the individual's clinical and behavioral status is known and does not require the frequent presence and evaluation of a registered nurse."

The clinical scenarios you cite, a nurse should be evaluating this patient. That is the trouble with this law the CNA does not have the training to assess patients.

Also administering PRN meds? Is a nurse assessing the patient before your administering the med?

http://apps.leg.wa.gov/RCW/default.aspx?cite=18.79.260

I think you have misunderstood what you can do as CNA.

For example you are administering psych drugs in patients who are not stable

"Delegation of nursing care tasks in community-based care settings and in-home care settings is only allowed for individuals who have a stable and predictable condition. "Stable and predictable condition" means a situation in which the individual's clinical and behavioral status is known and does not require the frequent presence and evaluation of a registered nurse."

The clinical scenarios you cite, a nurse should be evaluating this patient. That is the trouble with this law the CNA does not have the training to assess patients.

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. So...not sure what to think here. I'm just a CNA doing my job, and people with licenses above mine and my supervisors are instructing me that it is appropriate.

But either way, I'm trying to find another job.

Also administering PRN meds? Is a nurse assessing the patient before your administering the med?

If you're meaning is a nurse there to assess them at each and every instance they need a PRN? No, because the med is prescribed to them by their doctor with the intent of the nature of that instance. If someone is having an agitated outburst and cannot be consoled and they have a PRN granted by their physician and delegated by the nurse to us that they can take for agitation, then we give them the PRN for agitation and chart that we gave it as well as the outcome half an hour later.

If you're meaning is a nurse there to assess them at each and every instance they need a PRN? No because the med is prescribed to them by their doctor with the intent of the nature of that instance. If someone is having an agitated outburst and cannot be consoled and they have a PRN granted by their physician and delegated by the nurse to us that they can take for agitation, then we give them the PRN for agitation and chart that we gave it as well as the outcome half an hour later.[/quote']

What if they are agitated because they are in pain, but are too confused to tell you? What if they have an infection, like a UTI, which is causing the agitation. Do you know how to assess this? Or do you give the PRN for agitation, because they are agitated? I'm not saying you are not doing what you've been told. What I am saying is there is a big assessment piece to this that could easily be missing.

What if they are agitated because they are in pain, but are too confused to tell you? What if they have an infection, like a UTI, which is causing the agitation. Do you know how to assess this? Or do you give the PRN for agitation, because they are agitated? I'm not saying you are not doing what you've been told. What I am saying is there is a big assessment piece to this that could easily be missing.

If for the last day or two there is a repeated pattern of high agitation then we would take a urine sample (and inform the nurse). If there is no UTI but the agitation is still peaked and PRNs do not suffice, we then make a call to their doctor and go from there. But usually it is either a UTI or occasional outburst purely related to their dementia.

I know you said this is allowed by your State, but I find this very scary.

I know you said this is allowed by your State but I find this very scary.[/quote']

And I don't disagree. :(

At first I thought it was awesome that I could pass meds as a CNA and give insulin injections, until I witnessed how not all CNAs I work with are as careful or really aware. Now I'm just uncomfortable, even though I know I'm doing it right. I feel like I have to hover over my coworker that day or ask questions because I'm scared they didn't do it right. I shouldn't feel the need to police anyone, which lets me know that I just need to get out of there.

I wonder why the state allows it in the first place?

You may have already seen this, but I think it would be good to look through if you haven't:

RCW 18.79.260: Registered nurse â€" Activities allowed â€" Delegation of tasks.

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