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.
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.
I've stated that while nurses are not there 24/7, they come in periodically for delegation purposes and then delegate you (if they havn't already done so). I have been personally delegated for everything I do now. However, the nurse was comfortable delegating me over the phone and not in person for wound care (which I already explained I wasn't comfortable with as it didn't seem quite right to me, so though she quote "delegated" me no, I don't consider myself delegated for wound care and do not take on any wound-related responsibilities).
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.
And no disrespect to you, but just because I find a physical task to be easy for me to do and understand does not mean that I do not find the task itself serious or take it lightly. I find this comment to be demeaning and insulting.
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.
First of all, I did not post acting as if my delegation learning was above any kind of regulation. Second, WA ALLOWS for these tasks to be done by CNAs as I've already stated numerous times, so where is the "trumping of state and federal regulations" happening? WA has state-certified classes designed specifically for CNAs to be certified to do these things, be nurse delegated for them and then do them without a nurse present. That is not against state, that's doing what the state seems to want us to do. Look at WA cirriculum for nurse assistant delegation. It's all there. Like I said before, why WA allows all this is beyond me. I have no idea.
Yeah, I get the thing about LPNs, and that is unfortunate. But again, that is not my fault. That is an issue of the state, for they think it's okay to have CNAs do similar tasks. Which is why I already said to a PP...if you're angry about it, your focus of anger is at the wrong party. Do not condemn us nurse delegated CNAs for doing our job in which our state allows and certifies us to do. I do not see the point in that.
I was trying to find my first CNA job and this job contacted me. I needed to be delegated in order to take it, so I did what I had to do and took the job. I did not know what I know now of really ALL the responsibilities I would be expected to have and how taxing that would be on me for just being a CNA, otherwise I wouldn't have taken it. I just wanted to get some sort of experience somewhere, and being fresh on the healthcare scene, only had a superficial understanding of all of this. I didn't even know I could be delegated for these things until I found out about it through this job (the CNA cirriculum to allow delegation changed after I took the class - now it is the norm).
I feel like you're either missing or skimming over the parts where I am saying that I agree that nurse delegation of this magnitude should not happen as there is far too much risk in our hands. I also said numerous times that I'm trying to find another job that has nothing to do with the work I'm doing now - to get out while I still can.
How do you know if their behavior is not related to their psych illness, but a symptom of something else instead?
I already answered this question from someone else and am not going to repeat myself.
All of your responses in regards to me doing my job sounds accusatory, or as if you as the RN are trying to put me, a non-RN, "in my place." I refuse to be put to some sort of chopping block, especially since I have well acknowledged the responses already made here. This is at least how I interpreted your comments, and it offends me.
is it possible the CNA was a nursing student from a different school? The nurses I worked with would let me insert foleys because I was a student
No. She was just a regular old CNA that was not in school. In her 60's or late 50's. Was not American. I assume she was a nurse in her country. I see a lot of that here. A lot of older CNA's that were nurses in their country won't become nurses here. I doubt she was a student.
She said to me. "I'M the one who put in his foley ya know." It was so very random. This was as I was washing up my patient. It was so very random. Kind of in a bragging way.
Uh... we can insert foleys as CNA's in Iowa.... i don't get it. That being said, a lot of the floors have taken that away, for infection risk purposes, but there are some floors that do allow it.
Uh... we can insert foleys as CNA's in Iowa.... i don't get it. That being said, a lot of the floors have taken that away, for infection risk purposes, but there are some floors that do allow it.
Yeah, foleys maybe I can see, but insulin boggled my mind.
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.
So a CNA can't decide if a blood sugar is "good" or "bad"? How do they know what readings to report to the nurse right away?
This is a group home not a hospital these people have other needs that are met in the group home setting if they were at home with their families their families would be giving insulin
That's so bizarre, In Australia only RNs insert catheters, and in certain states and certain hospitals, only doctors are allowed to, especially in men. ENs (I think they are the equivalent of an LPN) may be allowed to, but I'm not certain about that.
Nursing assistants here can pretty much only take obs and do personal care. I think in a nursing home setting, they can administer meds only from a blister pack, and usually the blister packs are checked by the RN on arrival from the pharmacy. They certainly would not be allowed to administer injections.
We are trained that if their blood sugar appears low, give them some juice or something, wait 15 minutes and test again. If it doesn't improve, call the manager immediately. Of course as you know this is all relative to the time of day, too. I would expect it to be low upon waking in the morning, that would not surprise me.
If it appears too high, we give them a glass of water, have them walk around/ambulate, and take it again in a few minutes. Same procedure if no change.
In the chart notes when we put in blood glucose results in the eMAR, a warning pop-up always comes up that says, "Notify the manager immediately if the blood sugar is above/below x amount." Those values are taken from their doctor's established parameters for them.
There is only one resident that receives insulin and her insulin is given off a sliding scale, which is posted in the med cabinet. Which I why I say giving insulin is an easy task for me to do for this particular client, IMO. I test her glucose level with the glucometer. It gives me the value. I look to the chart and it tells me within the value range how many units to give. I give/do not give the # of units depending on the blood sugar value.
This is a group home not a hospital these people have other needs that are met in the group home setting if they were at home with their families their families would be giving insulin
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.
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.
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.
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; pt needs to be regularly assessed with a licensed nurses eyes and ears, in addition to the eyes and ears of the CNAs.
Elizabeth Renee
143 Posts
I've stated that while nurses are not there 24/7, they come in periodically for delegation purposes and then delegate you (if they havn't already done so). I have been personally delegated for everything I do now. However, the nurse was comfortable delegating me over the phone and not in person for wound care (which I already explained I wasn't comfortable with as it didn't seem quite right to me, so though she quote "delegated" me no, I don't consider myself delegated for wound care and do not take on any wound-related responsibilities).
And no disrespect to you, but just because I find a physical task to be easy for me to do and understand does not mean that I do not find the task itself serious or take it lightly. I find this comment to be demeaning and insulting.
First of all, I did not post acting as if my delegation learning was above any kind of regulation. Second, WA ALLOWS for these tasks to be done by CNAs as I've already stated numerous times, so where is the "trumping of state and federal regulations" happening? WA has state-certified classes designed specifically for CNAs to be certified to do these things, be nurse delegated for them and then do them without a nurse present. That is not against state, that's doing what the state seems to want us to do. Look at WA cirriculum for nurse assistant delegation. It's all there. Like I said before, why WA allows all this is beyond me. I have no idea.
Yeah, I get the thing about LPNs, and that is unfortunate. But again, that is not my fault. That is an issue of the state, for they think it's okay to have CNAs do similar tasks. Which is why I already said to a PP...if you're angry about it, your focus of anger is at the wrong party. Do not condemn us nurse delegated CNAs for doing our job in which our state allows and certifies us to do. I do not see the point in that.
I was trying to find my first CNA job and this job contacted me. I needed to be delegated in order to take it, so I did what I had to do and took the job. I did not know what I know now of really ALL the responsibilities I would be expected to have and how taxing that would be on me for just being a CNA, otherwise I wouldn't have taken it. I just wanted to get some sort of experience somewhere, and being fresh on the healthcare scene, only had a superficial understanding of all of this. I didn't even know I could be delegated for these things until I found out about it through this job (the CNA cirriculum to allow delegation changed after I took the class - now it is the norm).
I feel like you're either missing or skimming over the parts where I am saying that I agree that nurse delegation of this magnitude should not happen as there is far too much risk in our hands. I also said numerous times that I'm trying to find another job that has nothing to do with the work I'm doing now - to get out while I still can.
I already answered this question from someone else and am not going to repeat myself.
All of your responses in regards to me doing my job sounds accusatory, or as if you as the RN are trying to put me, a non-RN, "in my place." I refuse to be put to some sort of chopping block, especially since I have well acknowledged the responses already made here. This is at least how I interpreted your comments, and it offends me.