Do I sound like a terrible nursing assistant??

[blondy85]

I am a nursing assistant from the float department. I got floated today to work on the floor for one of the units because their NA called out sick. Everything was going well until I sat down to put in the outputs for the lunches and voids for each patient I was assigned to. Behind me using a computer were 2 nurses- 1 was new so the other nurse was training her. Then I hear them saying "who put the pain level in, it's not her job, override it, it's part of the physical assessment, why is she putting this in etc..it's only her job to put in the inputs, etc" Then the nurses turn to me saying how I'm not supposed to put in the pain level because it's part of their physical assessment. They gave me such an attitude about it, and I told them, we are supposed to ask the pain when we are doing vitals, we put them in and tell the nurses if anyone is having pain. They give me the meanest stare saying it's part of their assessment. They overrided my input. Then the new trainee gives me the dirtiest look a few minutes later. I put the pain level, number, and if it's okay or not. Is this such a bad thing that they had to give me an attitude in front of other colleagues???

[HouTx, BSN, MSN, EdD]

We can't help you by answering the question as to whether it's OK for you to enter the pain level. You need to refer to your employer's Policy & procedures on documentation. It should provide information about who is supposed to document what pieces of information.

I do agree, it is never OK to disrespect our co-workers, either openly by criticizing or just giving them a "stink eye". Try to take the high road - you can reply by just telling them "I normally enter the pain level when I work on unit XYZ - no one told me that it is different in this department. Thank you for letting me know". And then just walk away.

[PediLove2147, BSN, RN]

At my facility the NAs put in pain level when they do vitals so I can see what you did being correct. Regardless, the nurse had no right to be rude.

[nurseprnRN, BSN, RN]

It is true that it is the RN's duty to make that sort of assessment as part of preparing and executing/delegating a nursing plan of care. However, assessment data can come from many sources. It is perfectly OK for an RN to hear a CNA assessment of pain level, and either go recheck herself or, if there is a good understanding between them of assessment data, to accept the CNA's report, especially on a familiar patient. It also perfectly acceptable for a CNA to chart a pain assessment along with the rest of her charting, and it appears that on another unit in your hospital this is acceptable.

If there is no written hospital policy on who may chart pain levels, it might be a good idea to ask the float coordinator who assigns CNAs around the house to clarify this with nursing so everyone is on the same page, as it were.

[netglow, ASN, RN]

I agree OP, you should go inform your supervisor that "some nurses" were very sure that I should not be entering pain info, and ask if you still are to do so.

I think they are upset because if someone enters pain, the RN must act on this and in a timely manner. If an NA does not report in a hurry, then it appears the RN was slow to deal with the problem, eg. you enter pain, and it takes a while for you to get to the RN to tell her, time flies by and since the EMR is time stamped, it will appear there was a delay that nobody intended, you see? Sometimes too many cooks in the kitchen make things very difficult. But, I think that if you are experienced NA, and you see something, it is your duty to report to the RN, you are supposed to simply do that, not diagnose or treat, but report changes you see in a patient to the nurse eg patient grimacing or telling you they are in pain, trouble breathing, you can't arouse patient, more bleeding, etc. you know what I am talking about.

[BSNbeauty, BSN, RN]

I'm sorry you have to put up with some of these attitudes. The attitudes in nursing are almost unavoidable. There is always someone, somewhere who are going to give you attitude for one reason or another.

Next time you over hear something, walk up to them and ask for clarification or what you can do to help. It'll throw them off, and maybe then they'll come off their high horse.

[OCNRN63, RN]

I'm sorry you were treated so rudely; there was no call for that. I agree with the PP about asking a co-worker who is sniping behind your back for clarification.

As a side note, I preferred to get my own pain levels, since a patient having pain will require additional assessment and most likely meds.

[blondy85]

I am a nursing assistant from the float department and I work the day shift. I had 13 patients on my side of the unit. I usually come in early to the floor before I clock in to get oriented first since I am from the float pool and every floor is different as to how they want vitals, etc.

The other nursing assistant came late so I just chose a side since I didn't know which side she is usually on. Then when she comes, she says she usually has one side so I just let her have it since it was her floor. But I find out the side she chose was the side with mostly "walkie-talkies" and my side, mostly partial assist or complete care. Anyways, I let it go and introduced myself to the nurses and got a brief report after they got their reports.

I had to do 9 blood sugars out of the 13 patients before their breakfast came. I tried to do a few washes, not the whole head to toe, at least their face and help brush their teeth. Then it was time for morning vitals so the nurses can give their meds. Did I take the 15 minutes morning break like the other nursing assistants? No way. Within those 15 minutes, I'd rather do another wash. As I'm doing vitals, some needed to go to the bathroom so I'm assisting them, and that takes time away. Bed alarms are going off so I'm running out of the room trying to make sure the patient is okay. I try to put in the vitals as soon as possible. ( I always panic about this..I don't know why..)

As soon as vitals are done, I try to take the trays away after they are finished so I can know how much they ate so I can put them into the computer. While I'm doing this, I empty any foleys, urinals, help with bedpans, etc and put them in as well. Some patients take longer in the bathroom and need more help which takes more time. Then it's the lunch sugars, again 9 blood sugars. Lunch trays setups, record what they ate. Afternoon vitals come along. Did I get to change their beds? NO. I think I changed 1 bed. I did a head to toe wash for 1 patient because they family was being rude and cranky saying how no one washes him etc. Bed alarm going off again for 1 patient because he's bed rest and he keeps trying to get out of bed. I'm trying to put in the vitals and all the intakes and output. Did I take a lunch break? NO way.

What I felt horrible at the end was one patient who was a complete care and I couldn't even wash him. All I did for him was check his vitals, empty his foley, help him eat his lunch. For that patient, a new orientee nurse was assigned to him and the nurse had only 2 patients. I asked her if she needed any help and she said no, she will ask the nurse that's training her if she needed any help so I let it go.

I don't know what's wrong with me...do I sound slow? I feel like I should be able to do more and when I come home, I feel like I might've neglected some. I don't have to wash all the patients right? I try to but it's hard to get to all the patients with the washes...

[PediLove2147, BSN, RN]

Don't beat yourself up, some days are harder than others to get everything done. Prioritize (which it sounds like you did) and go from there. Those patients will be washed tomorrow. If you are really worried next time ask the night shift if they have time to do a bath. Sometimes it's quieter and they are able to get it done.

[Nurse ABC]

You did the best you could and that's all you can do. No one ever died from not getting a full bath! I think you worked your butt off and prioritized well! Besides, 13 patients of that caliber is a bit much! Next time take the other side if you're there first (first come first serve)!

[iluvivt, BSN, RN]

I would be kissing your feet if you were my assistant. You are only one person and can only do so much. So do your best and let the rest go for there will be another day.

[Mommy&RN, BSN, RN]

It sounds like you did wonderfully with what you had to work with. 9 FSBS while trying to get vitals and I&O and having to feed is outrageous!

On our unit bed alarms are everyone's responsibility. So you shouldn't be expected to leave another pt to tend to the alarm.

We do total care and confused pts on night shift If possible.

Seems that the "bad" assignment was handed to you and you did everything possible with what you had to work with.

You can come work with me!