Dealing with CNA's

[miss_c]

I am a new Grad on a Tele floor, last night I overheard a Nursing Assistant telling my patient not to eat the broccoli in his salad since he is on Coumadin. She went on and on about how she "thought" it would interact with his Coumadin, but she wasn't sure and he should "look it up when he got home". I was a little angry about her conversation with this patient, since I felt she was way out of her scope of practice, but I did not say anything to her. I worked at this facility as a Nursing Assistant while in school and even a preceptor to this particular Assistant when she started. Since this is only my second week on the shift I will be working, I did not say anything, but now I feel that I should have spoken to her. I did speak to my Preceptor about the incident; she asked "How do you want to handle it". My feelings last night were to not to rock the boat in my first weeks, but I think now that I was wrong and should have spoken to the Assistant. I am hoping for any and all advice on how to handle this type of situation the next time? Thanks for your advise! :redbeathe

p.s. This patient was just put on Coumadin and later that evening I did do patient education with regards to food and drug interactions with Coumadin.

[CNL2B]

I think this type of situation is common. I've encountered it myself, actually. I've had NAs helping me with patient care and they will say something like "that's not the way that is supposed to look, is it?" right in front of the patient. Whether the answer is yes or no -- it's not their job to be assessing patients and providing a running commentary right in front of them, although I would certainly appreciate a heads-up on something new or unexpected.

Patient teaching would be the same -- not the NA's role, no matter how much they know, and as a former NA (when I was a student RN) you DO pick up a lot of knowledge just being in the hospital environment, even as non-licensed staff. However, complete and totally accurate patient education is paramount for patient safety and that is certainly not something that an NA has acquired no matter how experienced they are -- they just aren't educated to that degree.

I think it is always a good idea if people are outstepping their bounds to remind them of their role limitations -- but likely this is an issue for your manager to handle. If I were you, I would simply report off my observations to the manager and let her take it from there.

[Safetymouse, LPN, LVN]

I try hard not to speak to patients of things I do not know for certain as a tech because I do not want to tell them the wrong thing (but I may be spoiled for being on a small floor and most of the nurses being easily approachable). If I did say something in error and a nurse heard it, I would expect and not be mad at her for correctly me politely and then educating both patient and I. If during your educating on the subject, another tech walks into the room to learn too don't be surprised. Most all the techs on the three floors I've been on at my hospital are nursing or pre-nursing students with varying degrees of curiosity.

[Safetymouse, LPN, LVN]

For some reason, it does not want me to edite the post to add some clarification...I'm a bit slow after 4 hours of sleep...

I'm still on orientation so I'm mainly helping out other techs and we get asked about all sorts of things from discharges to types of soda available for me to fetch patients. I'd never educate on their condition but we can say something like "please don't get up yet, I need to pin your drains to your gown. this is because they would become terribly uncomfortable if they were hanging unsupported when we go to transfer you to the chair, etc". I would never say anything outside my scope of practice (especially regarding medication).

[dthomasa]

My advice is to talk to a supervisor or mentor for guidance. I am

very direct and professional when talking to CNA's regarding patients, giving medical advice, education

etc. You will have this type of issue over and over throughout your nursing career,,,

so do your homework, talk with other experienced nurses and get their advice on how they handle

these types of problems. CNA's are very valuable, and they are very knowledgeable, but if they are

out of their scope, it should be addressed asap. Unfortunately patients sometimes think they are talking

to a nurse, when its actually a CNA, when they repeat what they are told, they will say the nurse told me,,,

so NURSE UP! GOOD LUCK:nurse:

[canoehead, BSN, RN]

I would ask the CNA to inform the nurse if s/he felt the patient had teaching needs that need to be addressed. I would also ask her to never initiate teaching if it was a topic that she was unsure of, since patients are so easily confused. Just say "I'll find out," and do so, or hand it off the the RN assigned to the patient.

[miss_c]

Thanks everyone for your advise! dthomasa I will try to "NURSE UP" (I may even quote you on that).

[JDZ344]

The CNA should have asked him to holding off eating for a few minutes whilst she went and got the RN to come check it was OK. Sounds like they were just confusing the patient.

[foreverLaur]

On my floor, we had a girl that had graduated nursing school and passed the NCLEX-RN, but hadn't found a job yet and she kept working a a PCA on the floor. She found it really really difficult to not do any nursing since she was hired only as an unlicensed individual despite being a RN.

I find it hard even at my job. I have taken the pharmacology required in nursing school (although not at the one I'll actually attend) and it is so hard working at a mail-order pharmacy. I'll have a patient call in and ask "the hctz... that is my water pill, right?" and I'm not allowed to answer - have to defer to a pharmacist even though I know hctz is a water pill! Even if the patient has two rxs on file - hctz and lipitor and they say "i only want to order my water pill" I need to hear them say the name because I can't decipher that hctz is a water pill and the lipitor is not prescribed for that reason. Gets hard to remember, especially when we're really busy.

Some of the pharmacists even get touchy. We fill rxs for the Ryan White program and we're supposed to know that they can get their HIV meds and sometimes depression/anxiety meds, but other meds aren't covered. I didn't know that at the time and sent an e-mail to a rph asking if the patient was able to get allegra-d or any other type of allergy medication and the pharmacist ripped me a new one saying i should not know that allegra-d is an allergy medicine. I'm in nursing school - am I just supposed to forget what I learned in pharmacology when I come to work? I realize I can't state that knowledge to patients as counseling can only be done be a rph, but this was interoffice communication! Eeshh...

Sorry - done ranting :)

[NP Sam]

I am currently a CNA and definitely do not try and act as if I have been to nursing school and outstep my boundaries. However, it is important that CNAs are not thought of as incompetent because I have taken pharmacology and have a health science degree. Where I work there is even a CNA with a Masters degree! And there are many CNAs who have been to nursing school or are in nursing school.

But I completely understand what you are saying, some CNAs try to dispense medical advice when they really do NOT know what they are talking about:). I bet that can be very annoying....

[Batman25]

Talk to the CNA about this issue. Be polite and kind but firm. Let her know while you are happy she is looking out for the patients best interest in circumstances such as these she should come to the nurse to ask before giving info. Short and simple.

[happy456]

Maybe the tech was out of line, but speaking for techs I know many who are well educated and no what to do in certain situations before the nurse does, especially when a pt. is coding!experience! Thank You