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

cargalrn · Sep 12, 2011

Nurse, CNA, unit clerk. Cant abide by the stupid or the lazy. Usually play stupid to avoid work. The woman who could n't breath could use some reassurance or just plain repositioning, opiates or what ever. Get off your butt and do your job. All of you.

Always do the right thing.

Esme12, ASN, BSN, RN · Sep 12, 2011

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.

I liked the babies Daddy comment...Your post was insightful and funny yet able to getthe point across that you cared and that you don't get it why others don't...well done.... :yeah:

roma4204, BSN, RN · Sep 12, 2011

Good Job

But perhaps stating that the patient was requesting a breathing treatment was a bit light.

Isabelle49 · Sep 12, 2011

I have had to tell at least on RN to get off her a.. and help a patient! And I got written up about it. No more hospitals for me!

enchantmentdis, BSN, RN · Sep 12, 2011

*All names have been changed for confidentiality.
while you wait for your diva CNA to get done texting her baby's daddy and come help you up.
Right on. Lol. And it's "baby daddy".

sistasoul · Sep 12, 2011

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...

I think being an RN is much harder than being a CNA. Nurses have all of the stress and responsibility plus it is a very physical job. We have to deal with irate families, irate MDs plus all of the other departments in the hospital. Won't even go there about being able to eat. I draw the line at being able to take a bathroom break- even though I sometimes get paged overhead or on my 2 way radio while in the bathroom for all of the 2-3 minutes I am in there. Also, as a nurse we rarely get out on time due to the rediculous charting. I have worked as a CNA and as a nurse so I know both sides. Being a cna is hard and I love my CNAs dearly as I could not do my job without them. If I got up to answer call lights I would never be able to get all of the nursing duties done that the CNAs can't do. I help when I can. Bed alarms are a different story. I will drop everything to answer a bed alarm.

I never would say that the CNA's I work with are on the phone or on the computer. But they have more downtime than I do as a nurse. If I am fortunate enough to sit during a shift it is to chart, call the MD, assess labs in the computer, etc. It is never just to sit. Even dinner- I sit and chart through it.

leslie :-D · Sep 12, 2011

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.

these resp meds often do nothing but make the pt more anxious and jittery.

however, these pts need a notable supply of ativan...

it works for many copd'ers, but not others.

a fan in their face is also helpful. (and of course, NEVER lying flat)

I think being an RN is much harder than being a CNA.

i beg you, please let's not make this a cna/nurse competition.:grn:

leslie

ayla2004, ASN, RN · Sep 12, 2011

Yeah end stage copy are hard to manage. They get so distressed

They ask does news around the clock, saline news work at times and avoids tachycardia assisted with salbutamol. Fan, morphine someone there.

JDZ344 · Sep 12, 2011

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.

I don't think there was any excuse for the RN in the OP not to go and at least assess Rita or tell her that her breathing treatment was not yet due. Her problems were likely made worse by anxiety, which in turn is getting worse as she feels ignored.

mazy · Sep 12, 2011

Well, I've worked on both ends of that scenario and my first thought is that an end-stage COPD patient who is getting breathing tx every hour is someone who at baseline you are going to expect to have some degreee of difficulty breathing.

Of course he should have come in to assess her, because it sounds like she was experiencing difficulty that was way and above what was normal for her, and if it had been me I probably would have asked you to get a pulse ox. But it's possible that he was worried about another patient in crisis and really wasn't hearing what you were saying or thinking too clearly himself.

That happens, as you will find when you become a nurse, sometimes we just can't be on top of everything, and we do get so much stuff coming at us that the brain circuits just stop firing. Now, if you had gone in right off the bat, gotten a pulse ox, and come back and said that her sats were 45%, that probably would have lit a fire under him.

Because as others have pointed out, a breathing tx was not necessarily the best course of action here, but what that nurse was hearing was simply that the patient needed a breathing tx, and the fact is, the patient was able to have one every hour so that request in itself was not necessarily cause for alarm.

And I agree with Leslie that this should not be a nurse/cna competition. I think it is a really good learning experience for both nurses and CNAs. We as nurses need to know our CNAs well enough to be able to guage from what they're telling us that there is a real concern (I've had CNAs go into full alarm mode over a temp of 99.3 on a patient wearing two sweaters and a blanket), and we need to be able to delegate some simple assessment tasks (like getting a pulse ox) to them in order to clarify and prioritize our care. And we need to be respectful of the information they give us.

And CNAs need to be mindful that nurses are dealing with patient issues that they are not aware of and are making judgement calls about multitudinous crisis situations. If you the CNA feels that there is real cause for alarm, please come to us with some objective data about what is going on, not just that Mrs. X is having trouble breathing and wants a breathing tx.

abbaking · Sep 12, 2011

You did the right thing - and you got to the point.

I have only the highest praise for you and your work ethic.

There will always be a thorn in the bush trying to distroy your integrity. The classic RN vs. CNA battle. But I side with the CNA ALMOST always. I have been there and I have done that. CNA work is by far the hardest work Period. For those Slacker CNA's - I am glad you took a stand. I have worked with some CNA's that are the laziest people on earth.

I find your story very interesting.....Since it seems that Ed didnt have the knowledge or prioritization skills to immediately assess Rita during an episode of respiratory distress and the consequences of not doing anything in a timely manner, His actions (or lack thereoff) seem like patient neglect.

Take a stand and speak up - Nursing sure as hell needs more realistic individuals.

Like I always say - If they can dish it out, they better be sure they can take it