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.
Yes I completely understand the concern and frustration. Although frankly, I was thinking about it, and I actually don't feel sorry for at least one of the nurses assigned to us. She is comfortable delegating over the phone. Yes, over the phone, without showing you/watching you. I'm pretty positive that isn't legal for ANY type of skill whatsoever. Ugh. I want to flee and never come back. I don't even want to put in a two weeks notice but I feel like I have to.[/quote']
I don't feel sorry for the nurses either, as they have agreed to do this. I hope you can find a better place to work!
CNA's in Texas cannot be delegated to do anything that requires a nursing license, like give meds or make nursing judgments (such as ws the blood sugar reading "good" or "bad"). Medication aides have some privileges, but they are limited, and do not include narcotics. Overall, the nurse practice act for the state should dictate what can and cannot be delegated. In the above scenario I believe the male CNA is acting inappropriately, should be reported to the BON and is the reason we have laws to protect the public.
Consider it part of the Dumbing Down of Nursing. A chip at a time, shaving away at the education and profession, making it (appear) as though anyone with four active brain cells can and should do the nurse's job.
And yet, those in power don't want to see diploma grad RNs, no, you have to have an ADN. But wait, an ADN isn't sufficient for RNs, you really should have a BSN. And you want to do MORE than mop floors? Well, then, it's an MSN for you if you want to stay in nursing beyond the bedside.
But don't worry, your patients will all get their insulin, and meds, and wound care treatments one way or the other---from the housekeeper if necessary. After all, she saw a video....
Specializes in Oncology; medical specialty website.
Thank you, I appreciate that.
And yes, CNAs can be certified to be nurse delegated to administer various medications (including narcotics) and also nurse delegated specifically for diabetes in my state (which allows us to take blood sugar levels with a glucometer and to administer insulin injections).
I know that many RNs do not have the best outlook on nurse delegation and I understand those feelings (this example being a primary reason why). However, I don't mean to toot my own horn at all, but I am very good at what I do and I'm extremely aware and careful. I do not take it lightly and I report everything. When I give insulin injections and measure dosages, I know what I'm doing and the nurse who delegated me thoroughly trusts me, which I am very grateful for. I have yet to make a med error.
How can you be "nurse delegated" when there is no nurse delegating these tasks to you? And I am with Guttercat. I want the person giving me my meds knowing more than just the 5 rights.
It's commendable that you haven't made a med error...yet. If you're giving that many meds, eventually you will make a med error. The best nurses have made medication errors. Knowing how to handle the error, beyond just calling someone to report it, is what distinguishes you.
Specializes in Oncology; medical specialty website.
The state has it set up as an online course. Nurse delegation is 9 hrs and diabetes nurse delegation is separate at 3 hours. You complete modules, watch videos and take a test on it. When you pass you get certificates printed for them. Then, a nurse physically shows you how to do it, then watches you do it three times before you're okay to do it on your own without an RN being present.
I was scared at first about giving insulin, but then when I actually did it I realized how easy it was.
That's it?!? And no disrespect, but insulin administration and management of the diabetic patient is not "easy." It's serious business. Screw up and you can kill or irreparably harm the patient.
Specializes in Oncology; medical specialty website.
So if the nurse delegates it, and you do it, and you mess up (much like your co-worker) the RN has to take full responsibility for your actions or inactions?
I am an LPN and my pharmacology was a 6 WEEK course of study in itself, then onto clinical practice of same. And if you didn't pass the pharmacology exam, you didn't get to move on.
I understand that UAP's in "homes" usually observe the residents taking their own meds, usually from a pre-poured box that an RN pre-pours. When you start administering medications, this is where I am not sure I would take that sort of responsibility.
And as you noted, you also do wound care? That in itself is NOT something I would take responsibility for either. That goes into another territory of why the resident is getting bedsores, assessing the skin, and tracking to be sure it does not get worse, there's mapping and assessing with dressing changes. That is something that RN's and LPN's get specially certified for. And something that most state/federal insurances do not re-imburse for. If you have bed bound residents, then they are not necessarily appropriate for an assisted living situation and would perhaps need an alternate level of care.
Perhaps your co-worker seemed so apathetic about the entire situation because at the end of the day, the onlt thing that can happen to him is that he could lose his job. The RN who has done the delegating can lose her license.
There's been all sorts of news about "assisted living" and residents who are/are not appropriate for same. It doesn't matter how "good" you are or are not, careful or not, unless a resident can take their own meds, take their own FBS and know how to dose their own insulin, and are mobile and not prone to bed sores--I would think long and hard about what you are practicing and if you want to continue to be involved in this. Now that this error has happend, the state will perhaps come and look at the processes in place at the home. I think you may find that you all are practicing well outside your scope.
Agree. There is no way I would accept responsibility for this. How does a non-nurse health care worker assess wounds/know how to tell if the present treatment isn't working and needs to be changed.
Consider it part of the Dumbing Down of Nursing. A chip at a time, shaving away at the education and profession, making it (appear) as though anyone with four active brain cells can and should do the nurse's job.
And yet, those in power don't want to see diploma grad RNs, no, you have to have an ADN. But wait, an ADN isn't sufficient for RNs, you really should have a BSN. And you want to do MORE than mop floors? Well, then, it's an MSN for you if you want to stay in nursing beyond the bedside.
But don't worry, your patients will all get their insulin, and meds, and wound care treatments one way or the other---from the housekeeper if necessary. After all, she saw a video....
I hate to use use the term "dumbing down" because administration knows full well that RN's (ADN/BSN) need extensive education.
But we now have a brewing situation where you need an ADN to mop floors, and a CNA w/additional certifications to dose insulin.
Specializes in Oncology; medical specialty website.
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.
Sorry, but your certifications do not trump state and federal regulations. If they (surveyors) ever come in to evaluate this place and discover you're in a nursing student, you could find yourself in a lot of trouble if they determine you were doing things you were not supposed to be doing, like assessing patients, for one. Your could find your dream of being a nurse going up in flames.
There are LPNs in certain areas who don't make much more than you do, and they are nurses with licenses.
Specializes in Oncology; medical specialty website.
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.
How do you know if their behavior is not related to their psych illness, but a symptom of something else instead?
SaoirseRN
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