Are You Kidding Me????

[Flo1216]

Last night I was at work and had to turn a patient who had a million dressings and I knew they needed to be changed. So I told the lpn who was supposed to be takin gcare of that patient and she got a big old attitude and I couldn't figure out why. I thought it was just because the guy had a million decubitus and his dressings take a long time and he didn't feel like doing it. One of the sores is so bad that you can see the entire hip bone. She goes, " I can't do it, " and I said "Why"? "She said because it makes me sick and I will throw up, " I said, " But you're a NURSE!" There's a lot of shit that grosses me out, but I still do it. Anyway, she refused to do it so me and the other CNA did it while she looked away in disgust and gagged. But even though I am a senior in nursing school, as a CNA, I am not allowed to do dressings. The other nurses can't stand her because she does stuff like this all the time. She won't do anything gross. I think maybe she just didn't know how to do it and she was afraid to say because once I worked with her and a trach patient really needed suctioning and I kept telling her but she never did it. Finally, she asked me if I could tell her how to do it. But I couldn't believe her excuse for not doing it was because it grossed her out. The other nurses were ready to KILL her because they had to do everything.

[Flo1216]

Was the CNA a student as well? Did she have any experience in wound care?I am not saying what I did was right because it wasn't. But I did know the supplies to use and I wouldn't have done it if I didn't know how. But I just COULDN'T leave him like that. I probably knew better how to do it then the LPN. But you are right, in that you have to be careful and it is not something I normally do. I only did something similar one other time. There was an elderly woman who had fallen down the stairs and and was supposed to have her dressings changed every day. Well, the last person who did the dressings was smart enough to date them and they hadn't been changed in FOUR days. It was 11-7 so I told the nurse and she said, "OK-I'll document it, " I said , "You're not going to DO it? " And she said, " No, because then I will have to do it every day,"(usually 7-3 does the dressings) What makes it even worse is that there were very detailed instructions about the dressings above the pts bed and the supplies were at the bedside. They were simple dressings,(those foam pads)- there were just a lot of them. So I did it. When I took them off, the smell was horrible and some of the wounds were necrotic.She ultimately had to have a debridement I did the dressings and the next day I went to the d.o.n. I told her that I changed them because no one else would and I WAS reprimanded, but she said she understood. All of the nurses for that pt. on each shift were written up and afterward the dressings were all at the bedside pre-dated so it would be known if they had been done. Incidentally, we have CNAS who feel that they have the right to suction trachs and ventilator patients and change dressings, etc simply because they have worked there a long time. And the nurses know about it. I would NEVER do that, especially with a vent pt. And she doens't get in trouble.

[Squeeta2]

No, the CNA was a longtimer but not a nsg student. I allow aides who are students to accompany me & even let them do a nsg skill after I have demonstrated it. BUT i still go with them. I also work on a vent unit. One night while working some OT I found out the hard way that they were allowing the aides to suction our pts due to short staffing, she failed to pull the cathater all the way out resulting in the vent alarm to sound. The pt was in obvious distress, but no one could figure out why until I entered the room.

Remember lesson #1 from school? Follow your tubing, know where it goes & what it does!!

[Flo1216]

Well...the nurse WAS with me, technically.

[Squeeta2]

In your case ,yes. But I was referring to mine where the Nurse simply wanted to avoid a difficult family.

[NICUNURSE]

Just a quick reply...I too was a CNA while in nursing school and was put in a similar circumstance. Just something to think about. I know it's really hard to just stand by and let a patient be mistreated, but like everyone else said, BE CAREFUL! Even while doing something as simple as a dressing change, imagine if the patient's family walked in while you were going this. I know that if it were my family, I would be upset to see someone other that the assigned nurse performing procedures on my family member. I would report this immediately to the supervisor (which would be before you would have a chance to tell him/her what had occured). From how you describe this nurse, it seems like she would be the type to cover her own **s, saying she never gave you the authority to perform this procedure. What I'm trying to say is that you could find yourself in the position of having no one there to verify that you were told to do this procedure, which is completely outside of the scope of practice of a CNA. So just be careful..

[lisamcrn]

Flo....technically you are not a nurse or a graduate nurse or a nursing student being supervised in this situation. Two wrongs don't make a right as the cliche goes. I understand your actions....but, legally you don't have a leg to stand on. You don't have a license and if this continues you might lose your chance of ever getting one. Don't throw away all of your hard work.....report this to your administrator and/or your state inspectors and get the hell out of there.

I applaud your pt. advocacy...go luck to you. You will make a fine nurse after you follow the requirements to get there.

[Flo1216]

Well, this patient had no family and no one else to advocate for him. But I know you are right.

[Flo1216]

Ummm....did I not say I KNOW I was wrong and I know the risks involved and it was not something I usually do? Anyway, I hope after that night that the charge nurse reported the lpn. Actually, the point of my post was not about what I did but what the nurse didn't do and that she gets away with it. It seems as though no one is ever really disciplined because of the nursing shortage. It's a shame.

[Squeeta2]

Flo, please don't get offended. In this case we are trying to help protect you, not eat you! I agree wholeheartedly that the LPN should be counselled at the very least but unfortunately your right, the shortage is preventing appropriate disciplinary actions. So we are stuck with them as coworkers & worse the pts are stuck with them as caregivers. This is just part of the frustration we feel because of the shortage.

[Flo1216]

I am not offended because I know I am not licensed yet, it's just that the focus of my post was not intended to be on ME. I know I took a risk. I am kind of mad that I was even put in that position. And because the nurses were so mad(and rightfully so) at the LPN because she was creating extra work for them, everyone seemed to forget about the patient. The other nurses wanted to teach the lpn a lesson by not doing the dressings and ultimately, the one who suffered was the patient.

[Dr. Kate, BSN, RN]

When everyone knows something is going on that adversely affects patient care and no one does anything, it's time to get risk management, process improvement, quality improvement, whatever they call it in your facility, involved.

I presume your hospital has some kind of mechanism for reporting events that could result in increased laibility for the facility in a manner that maintains the legal confidentiality of the report, e.g. an incident report or notification report. I do not usually advocate dealing with problems this way but the failure to change dressings when required either by state of the dressing, physician order, or policy and procedure is a reportable error. File an incident report. If your hospital has these go through the manager, and if you know the manager is aware of the problem and it is continuing, send the form directly to risk management. Do not make a copy of it. Do not tell everyone you are doing this. Keep your mouth shut. Do not carry the form around in your pocket for a week or two. Just fill it out and send it. If you feel some need to document something, make a dated note to yourself of what you said on the report but NOT that you sent a report to RM (anything more compromises the legal confidentiality of the report.)

Increasingly, pressure ulcers are becoming an area of litigation as evidence of substandard care. It is essential report and maintain the legal confidnetiality of the report.

Flo, you're going to run into times when everything in you says you have to do something outside of your scope of practice. Don't make these decisions on your own, yet (or maybe ever but time and experience do come into play.) There are supervisors available to you to help. Pose questions that speak to your lack of understanding of what to think or do in a situation, to your concern for what is going on. Pose the question so that the supervisor knows you know your scope of practice limitations but are feeling yourself being placed in an untenable position.

Be careful and remaining caring. You ARE the future of the profession.

[BadBird, BSN, RN]

I can understand your frustration at this nurse not taking care of her patient. In the future think before you act as you do not want to risk your job or the patients safety. Notify the supervisor immediately, write up an incident report and let the managers deal with her. The charge nurse should step in and take care of the patient and then deal with the nurse.