A few observations about the nurses I work with from a new CNA...

EarthChild1130 · Mar 27, 2009

It was sort of like that on the med/surg unit I worked on too...the techs reported to each other, and the RNs to each other, with very little communication between the groups, until something happened to a patient that was a direct result of poor communication. The manager's solution was to have one tech sit in on our reports and then provide report to the others.

I didn't like that because I felt the information passed hands too many times. Why not let everybody that was oncoming just sit in? I don't work there anymore (thank the gods LOL) so I dunno what they're doing now.

You'll want to think carefully about doing things that you KNOW are outside your scope of practice. Should something happen to the patient, everyone including you will be held accountable for it. If the nurse is supposed to be doing the dressings, then if I were you I wouldn't hesitate to let her know. Anyhow, how can she chart how it looks if she doesn't physically assess it??

You sound like a wonderfully caring person and you're gonna make a great nurse! Best of luck in your career!!

GaMBA · Mar 27, 2009

Thanks! :-)

stellina615 · Mar 27, 2009

A good post that touches on a lot of issues. I am currently working as an LPN and going to RN school at the same time, so I have seen both sides of the nurse/aide delegating issue. I'm going to paste a post that I read on another thread that I thought was really great and thought it might be relevant to this post too. I do like what you said about aides and nurses giving report to one another. I've worked on floors where this does happen, and I've worked on floors where it doesn't happen. It probably goes without saying, but there seems to be better continuity of care and better team cohesiveness when all team members talk to one another. On another note, you also mentioned a nurse who asks you to do things outside of your scope of practice. BE CAREFUL! I love learning and trying new things as much as the next nurse (maybe more!), but if you go through with something that is not within your scope of practice (check out the Nurse Practice Act in your state), you WILL be held accountable if something goes wrong......you never know what may be going on underneath that gauze!!! Anyway, here's that post I was talking about...

Originally Posted by PlaneFlyerRN

Mr. So and So rings the light. He's lying in about 15 minutes worth of poop-detail cleanup, but he's physiologically stable.

Meanwhile.........

I've got a patient in the other room with a b/p of 78/42. I've paged the doc, and I am busy trying to get an IV in this same patient so that I can give fluids. Meanwhile, I have someone else who is working with me who can't start the IV, and can't take orders from the doc, but CAN help by doing peri-care on my other patient in the other room.

Meanwhile...........

I've got a patient whose abdominal wound is seeping bloody drainage around the dressing. The patient's lying in a big pile of ooze. Gosh, I sure hope the wound hasn't dehissed. I need to change the dressing and see what's going on underneath all of that gauze, but I'm still waiting for that call back from the doc for my patient with the low blood pressure. I should probably take another blood pressure, go ahead and start IV fluids without a dr's order, and.......

Darn....My patient whose got the poopy but is on the light again. "I need some help!"

I poke my head in the door. "Sorry Mr. So and So, I'll be back in to take care of you in just a moment."

In the distance, I hear an IV pump start alarming. "Shoot - my blood infusion is already finished in room 424........I need some help."

I'm on my way to the IV alarm and the doc calls back. I'm sitting at the desk talking on the phone with the doc when my coworker/CNA comes to me to see what I needed. I'm writing down a lengthy order that needs to be faxed to the pharmacy, then I have to get the med, give the med............

"Can you please go help Mr. So and So - he's all dirty". (I get a dirty look from the CNA as she walks away.)

By the way.......I do care. I care about the kidneys that are about to go south on the patient with the low blood pressure if I can't get the blood pressure back up. Meanwhile, I'm taking matters into my own hands in order to address that issue - I finally get an order from the doc to cover me for what I just did.

I also care about the patient whose leaking out about two cups worth of serous/sanguinous fluid from their abdominal wound that I need to assess.

I also care about what the CNA thinks of me, but I can't even begin to explain all the reasons why I need the peri care done by the CNA instead of doing it myself.

As I get off the phone, I hear a loud crash from down the hallway. A patient tried to get up by themselves and has just fell on the way to the BR.

So much for waltzing out the door on time tonight.

Sarcolemma · Mar 27, 2009

in med surg nurses defense (coming from an ICU nurses perspective)

med surg nurses are worked like dogs. and treated like them.

walk a mile in their shoes and all that.

of course, there are plenty of bad apples wherever you go, but i think thats the exception.

d!gger · Mar 27, 2009

It's fantastic that you're a CNA before going into Nursing. I wish I had. That's gonna cut the learning curve like you wouldn't believe. It'll also make you a more effective nurse who actually knows what the CNA can/can't do.

Where I work, the CNAs sit in on report, and that works wonders as the whole team can prioritize before we hit the floor. THey know what I'm keeping my eyes on. I know what mountain of a job they're gonna need help with in the next half hour, etc...

It also helps when things get insanely busy. We have some idea of why we all of a sudden get snappy with each other. That creates understanding, which helps us through the way understaffed shifts... that and instant lotto scratchers after the really brutal shifts - "Hope our luck changes!"

I second, third, forth, whatever ... the caveat - don't do anything outside your scope of practice. It could jeopardize everything you're working towards. Sure you'll get asked to do it by people who should (and need to) know better. But if something goes wrong or doesn't get assessed in time or worse, **** flows downhill.

Good Luck,

dig

catshowlady · Mar 27, 2009

Re: #1, I have so much charting to do, and so much I have to do (meds, tx, check & sign off orders), I wish I had more time to spend w/ my pts. I don't sit except to chart. And I'm an ICU nurse, with 2-3 pts. Med-surg RN's often have six to eight pts to do all this stuff for. Maybe fewer meds/IV drips than my pts, but everybody still has to be assessed, etc. I do often feel like I don't get much time with my pts, especially the stable ones when you've got someone who's not (and therefore getting most of your time).

Re: #2, you are right, there is a big opportunity for a breakdown in communication between the nurse & the tech. I think we all start our day so focused on what we need to get done, we forget to talk to each other. This was true for me when I was a tech, and still true now that I am the nurse. Don't be shy about asking your nurses what they need from you on pts. When I was a tech, it worked well for me to talk to the RN when I saw her in the hall. I'd just say, "I have pts X & Y of yours, this is what I was told about them. Do you need anything else on them today?" I'm trying to learn to do this with my techs, too.

Re: #3, I'm not sure what to say, I try to do as much as I can for my pts, as do my co-workers.

Re: #4, be careful. Do not perform duties out of your scope of practice, you can get in some real trouble. Just say, "I'm sorry, but that is outside my scope, and I'm not comfortable performing that task, but I'd be glad to assist you if I can."

You sound like you work hard and care about your pts, good luck w/ your pre-reqs.

blondy2061h, MSN, RN · Mar 27, 2009

Regarding Aids- it shouldn't really matter than you know he has aids as you should be assuming EVERYONE is contaminated, basically. Hence standard precautions. Some nurses feel sharing medical information on anything but a strict need-to-know basis is a HIPAA violation.

Nurses are required to do tons of documentation. I have about 4 different forms I'm required to document on on each of my patients every 2 hours. And that's just for the status quo. If something actually happens, there's more. And that's not counting my MARs and reviewing orders and lab results and such. I spend a lot of time in front of the computer, but a lot of it is honest-to-goodness work I need to get done. It does detract from the amount of time I can spend with patients.

It's good aids who are willing to help when needed, have a good attitude, and care about patients that make my shifts go so much smoother.

Valerie Salva, BSN, RN · Mar 27, 2009

I was a CNA for several years, then an LPN, and I've been an RN for nine years now.

It is true that CNAs often have more time to spend w/ the pts. Nurses are very overworked- worked like dogs as one poster said. I didn't realize this until I actually became a nurse. Nurses want to spend more time w/ their pts, but they are given soooo much paperwork and other crap to do, it just is not possible.

I much prefer facilities where the CNAs are in on report, and I always give report to my CNAs/techs- some of them aren't interested, though.

psalm, RN · Mar 27, 2009

As an RN, I wish ALL the aides on our floor would check the patient's Kardex to gather information on pt. needs. Such as how often are vital signs/diet/fluid restriction/activities/urine or stool samples. It is all there printed for us. If new orders come up it is my job to inform the patient's aide of the change...and I always remind my aides to call me if they need help with care or repositioning.

Having said that, I am frustrated when aides don't take note of patient needs. I don't like to be called to ask what pts. have VS q 4 hours. It takes me away from pt. care or interrupts pt. care.

Virgo_RN, BSN, RN · Mar 27, 2009

1) Define "patient care". As an RN, I must know my patient's diagnosis and medical treatment plan, medical history, labs and imaging results, medication allergies, what medications they have received as well as what medications I am to give, track their vitals, perform a head to toe assessment, assess their IV site and make sure they have IV access, assess their pain, give medications (be familiar with those medications so I know what to assess prior to administration in order to know if they are safe to administer), be alert to any changes in patient condition that require a call to the doctor, call the doctor, take orders, check the chart to make sure all orders have been entered correctly into the computer system, document all of my nursing interventions as well as the patients' responses to them, and many, MANY other things. I do dressing changes, pull femoral artery sheaths, administer and monitor vasoactive drips, administer blood transfusions, prepare patients for open heart surgery, and more. While the CNA may be assisting the patient with ADLs, I am monitoring the patient's overall status and implementing nursing interventions to keep the patient safe. I've found that most CNAs really are clueless as to how much the nurse actually juggles.

2) Go to your nurse for report. Make sure the nurse has already taken report on their patients, and be sure to check in with your nurse periodically throughout the shift. Believe me, the nurse does not have time to track you down to make sure you know what to do with the patient. The nurse is counting on you to know what your job entails and to do it.

3) Believe me, the nurse is not leaving "every single thing" for the CNA to do. Just because a nurse doesn't have time to help you with a boost or a linen change does not in any way, shape, or form, mean that she is sticking you with all of the work. What is really happening is that she is delegating tasks to you that you do not need a nursing license to do, because she cannot delegate the tasks that you do need a nursing license to do. You can do a linen change, but you cannot pass meds. You can change a diaper, but you cannot call the doctor and take telephone orders. You can get the patient some ice water, but you cannot assess their pain and administer pain meds. You can get the patient a warm blanket, but you cannot do chart checks. If the nurse cannot help you with a turn, a transfer, a linen change, and so on, get another aide to help you. There is far more to patient care than basic ADLs.

4) Do not practice outside your scope. Just don't do it.

Ayvah, RN · Mar 28, 2009

1 - I didn't realize how little time nurses actually spend with their pts.
2 - I don't understand the lack of communication b/w the nurses and techs when it comes to pt info.
3 - I am amazed by the aversion to pt care and the lack of pt care skills that some nurses have.
4 - I don't mind helping nurses with things that are out of my scope and part of THEIR job, but please don't expect me to do it simply b/c you ask and can't get around to doing it yourself. It's still YOUR job!

1- This is an incredibly frustrating part of nursing today. There is so much paperwork that I am not at the bedside nearly as much as I want to be. I also spend a large chunk of my day coordinating care, speaking with specialty departments - PT/OT/ST/Resp etc, calling doctors, ensuring orders are in correctly, fixing problems with the med sheet (this patient can't take meds whole, but there are 3 meds listed here that can't be crushed; why does the med sheet list 100mg metoprolol when the chart says 50mg, and how did this already get past a secretary, nurse, and pharmacist?), placating families, keeping track of labs/test results, preparing patients for tests (this patient is now NPO, have to start this new IV, have to prepare antibiotics that will be given in surgery, etc). I would love to be able to sit down with a patient and really be there for them, talk with them, help with baths so I could do a thorough skin check on everyone, daily, and be on top of their care instead of feeling like I'm barely keeping my head above water day after day.

2- Do you verbally tell your nurse in the morning (or at night) what the blood sugar results/vitals are? If so, then just ask if there is anything you need to know about the patients such as specimens to collect. We meet with our CNAs in the morning and they give us vitals, and we give them report. I prepare a special section of my note sheet for info for them, such as foley/blood sugars/specimens/ambulatory status/special things to note such as DNR or being discharged today or watch out she will try to hit you but management won't let me put her in restraints/special diet such as thick liquids or npo or no straws/seizure or fall precautions/requests such as please help her eat. I also call them during the day if the doc orders something such as a specimen, or a test which will require npo. Communication between nurse and cna is very important. I'd recommend catching the nurses by 8-9 to see if they will give you any more info. They may soon come to understand its importance.

3-It is good to be a CNA first because you become familiar with the healthcare environment to make the transition to nurse easier, but also because you pick up tricks and tips of the best way to do transfers, baths, etc. The nurses should know the basics of how to do these things but likely you will be the expert at the best way how to do these things, since you've been doing it day in and day out. For example, I don't know how to use the bedscale but the CNAs do since they use it daily. I'll help get the patient rolled onto it but they are the ones that operate it and make it lift/take the weight. Or as another example, for a stool for OB, I know how to do it but I don't know where the supplies are located so it will take me longer.

4- don't do something outside of your scope, it will come back to bite you, seriously. Offer to assist in holding the i.e. leg but don't actually do it yourself. Don't hesitate to stand up for yourself (and the patient) on this. Sometimes the wound must be cleansed with a particular cleaner, for example, that the doc just ordered. If its outside of your scope, then its outside of your scope. Its something you could be fired for if it got to management's ears. Don't put yourself on the chopping block like that.

That all being said, I work with amazing CNAs, who are an absolutely vital part of the team. They work hard and have often brought valuable information to my attention. I rely on them greatly!