Do the right thing. Every time. No matter what.

[Mully]

*All names have been changed for confidentiality.

Beginning of shift:

Ding dong... Ding dong. This is the sound that a regular call light makes. DINGDONG,DINGDONG,DINGDONG. This is the sound that a call light pulled from the bathroom of a residents room makes, while simultaneously flashing red on the ceiling of the hall. As I walk onto the unit today I see, not one DINGDONG,DINGDONG, but two going off at once. This in and of itself is no problem. However, upon reaching the nursing station, I find not one, not two, but four of the five CNA's currently on duty sitting.Kicked back. Throw some sand on the ground and put a Corona in their hands and you'd have thought they were on the coast of Bermuda catching some rays.

My hair is already on end. Ok I understand that first shift is the busiest shift and you guys are tired and blah blah blah (don't I sound so understanding?) but this isn't just a regular call light. How about you try sitting on a cold toilet for 12 minutes while you wait for your diva CNA to get done texting her baby's daddy and come help you up. It's bull crap.

So of course, I say something. Something so small a mouse couldn't have gotten offended... unless the mouse had a reason to be defensive... hmmm. "Marie is done on the bathroom," I state calmly as I walk to set my stuff down. From over my shoulder I hear something to the tune of, "Well get her off then."

I will. Gladly. Only she's a 'no male CNA' so I can't. But how about the fact that that is beside the point. So I decide to sling some crap at them like 'you lazy sons of sloths..' and they sling some crap back at me like 'keep your pinocchio nose out of our business..' and now I'm beginning to wonder how many CNA's it will take to wipe all this crap up before we can just get Marie off the dang toilet. In the end, I feel I did the right thing by speaking up, yet it didn't really seem to accomplished much.

FAST FORWARD

End of shift:

Ding dong.. Ding do"Hey Reta what can I do for you?"

"Get my nurse, tell him I need a breathing treatment."

...

"Hey Ed, Reta is asking for a breathing treatment."

"That's too bad Reta's going to have to wait. She just got one 45 minutes ago she can't have another one for at least 15 minutes squeek squeek mumble garble..."

(This is how Ed ALWAYS reacts no matter the request from no matter the resident. The font size represents how much I'm paying attention to what he's saying. He's not as bad as he sounds, usually when I tell him so and so needs a pain pill or whatever, he rants and raves about how they have to wait and he's busy and all this jazz but he's basically all talk.)

Ok I think to myself. He's the nurse. Roughly 10 minutes go by and Reta's light is on again. Same thing. Wants a breathing treatment. Only this time, her respirations seem more labored than usual to me. Now Reta is end-stage COPD, so she's not exactly the picturesque example of healthy respiratory function, but man is she breathing hard! That's it. I'm gonna have to make this happen.

"Ed, Rita's requested a breathing treatment again. She needs one too she's breathing way too heavy."

Ed gives me the 'she's going to have to wait' shpeel again.

"Ed, she can't breath! Curtainly there is something you can do!"

"Well I'll get to her in a minute and check her sats but she can't have another treatment for such and such minutes so she's just going to have to blah blah blah"

"Ok Ed, where's the O2 sat monitor? I'm doing it myself."

*Giant sigh* "Fine! #%$@!! I'll *$&@ do it now!!"

I get busy with another room. As I come out roughly 10 minutes later, Ed is scrambling around multiple carts looking stressed out as ever. My sweet Rita's vitals? I'm glad you asked! HR:150 O2:45%. Sweet Rita was in respiratory distress and did I ever feel like a future RN and an awesome patient advocate!

Do the right thing. No matter what. Even if it means you get trampled on by a pack of 1st shift CNA sloths. Or getting your head chewed off by your superior. If you live with a clean conscience, you'll be the one sleeping well at night. Goodnight!

[vagirl76]

You definitely did the right thing, and you will make an awesome Rn!

[eslvn]

That sucks, it shouldnt be taken lightly when someone is haivng difficulty breathing. Even if someone cant have a PRN I always go tell them myself so I can at least assess them...mostly in cases like this. As for the CNA's my facility enforces a policy that NO ONE can walk past a call light (unless you are pushing a resident, have dirty linen, meds, etc.) And I hate it too when people sit there while lights are going off, drives me nuts.

[carolmaccas66, BSN, RN]

If it's that bad, complain to the NUM/CEO of the facility.

And I hate to say, but with end stage COPD, there's nothing you can do to get them breathing better, when all is said and done. You can put O2 on them, but their alveoli have deteriorated so far their exchange of O2 and CO2 is limited (to say the least) - she was probably a CO2 retainer. Their airways are so constricted & damaged, that most med's won't dilate them much anyway and the O2 doesn't do much; it's more of a comfort measure. And, as RNs/EENs we can't just keep piling respiratory medications one on top of the other too soon, cos they all have serious side effects, like arrythmias. So it's the old push and pull situation - you want to help, but you can't give too many meds cos you will basically send them spiralling downwards towards death more quickly. That is why the nurse was trying to explain to you that he had to wait 15 minutes or more to give the medication, and why he was probably frustrated.

Could you have sat her up and put her on oxygen yourself? Did you initiate non- medication measures to help her? Even sitting with someone and holding their hand & talking to them can help calm them.

I cared for an end stage COPD, CO2 retainer in the ED not long ago, and the family was desperate for her to have more medications, but I had to refuse and it is not nice. This lady was cachectic as anything, breathing hard and using accessory muscles. Unfortunately her time to die was approaching, but the family panicked and brought her into the ED (against her wishes I might add). We could only initiate comfort measures and get the palliative care team involved. The family could not understand why we weren't giving her more medications and 'why the doctors aren't doing more!' Sometimes you just have to accept that a person's time has come and nothing we do will delay that.

[Black Jade, BSN, RN]

I wonder if the hospital will get sued, if something happened to the neglected patients because some stupid lazy CNA or "nurse" didn't care.

[CVmursenary]

well if you want to be respected and listened to as an RN i wouldn't tell co workers that they are "lazy sons of sloths." People respond to respect better than they do to such statements.

[jpeters84]

1) I take it you were never a CNA.

2) You definitely have a point, no matter CNA, RT, RN get up off it and attend to your patients. I wonder though if maybe they got thrown under the buses by the nurses all day with too much work too little help by nurses who decided to have them do all the work all day and they had just had it. B/C when I was a CNA that was a common occurence.

3) Too busy calling the baby-Daddy=judgemental, belittling, and ridiculous comment.

I'm an RN now but until you've walked in a CNA's shoes don't go there with me. Being a CNA was 8,000 times more back-breaking and difficult than being an RN is and will ever be. If it bothers you than you go take care of it. They shouldn't have given you attitude back but seriously its as much of your job to answer that call light than it is theirs. So step to it...

[NrsNikster]

Kudos to you and your actions, but I'm curious to know what happened to Rita....

[skipaway]

1 If it bothers you than you go take care of it. They shouldn't have given you attitude back but seriously its as much of your job to answer that call light than it is theirs. So step to it...

I believe he would have, and he did state the patient was a "no male CNA" patient.

[kakamegamama]

OP--yes, we are to do the right thing, no matter what. Sadly, not everyone thinks that and excuses the lack of concern/action on the part of the CNA's you describe. I've been a CNA. I know how hard they work. I've worked as an RN with some awsome ones, and with some who enjoyed the desk and gave attitude when asked to do something. Seems like she didn't last too much longer...Anyway---best wishes to you in your future. I hope the patients under your care benefit in a positive way from your care.

[Mully]

What a mix of opinions I've received! Cool :).

For those who liked my post, thank you! I'm glad!

Let me clarify some things for those who didn't seem to. First off I am a CNA, not a nurse (yet). I have been for 3 years. As my profile states I'll be graduating with my RN come May. One thing about the way I write is sometimes I tell the verbatim truth and sometimes I intentionally fabricate for writing's sake. For instance, I never actually called anyone a "lazy son of a sloth" lol. I think I'd be laughed out of the room.

Thanks for the write up on end-stage COPD! She was in fact sitting up with O2 on when she was in distress. I'm severly ignorant on this topic but I find it hard to believe that there is nothing more that could have been done? Usually if anything serious is happening we ship the person right out to the hospital. Are you saying if we would have done that, there's nothing more the hospital would have been able to do?

The "baby's daddy" comment? Sorry if that offended you. ... I don't know, I still kinda find it funny.

As far as what happened to Rita? Good question. This was last night and since I only work every other weekend, I won't find out for two weeks. Sorry.

Thanks to everyone for reading :)

[Mully]

And after reading one more time I want to clarify that it wasn't that I wanted her to have a breathing treatment so bad necessarily. It's just that I wanted Ed to assess her and see if there was anything we could do. I don't know if I conveyed that well.