Incompetent nursing assistants

Nurses General Nursing

Published

Hi nurses.

Anyone else feel like many of the PCAs/CNAs/LNAs- whatever, do not have approriate training and competency for their job?? I did while I was working on a medical/tele floor for almost 3 years. Fortunately, I'm in the ICU now, and we do all of our VS and such. While on the med/tele floor, I encountered EVERY PATIENT had a RR of 18 or 20. I repeatedly told my manager about this; she addressed it in staff meetings a few times and sent out an email or 2, but it was never resolved. The problem continued. It annoyed me soo much because the interns/residents/attendings go by the patients vital signs. They are so important. One of the attendings actually said, "when the RR is different from 18-20, then I worry". I counted many pts that were in the 30s-40s and informed the PCAs about this; or vice versa, one patient had RR 10.

Another issue was one of the CNAs forgot to record the diastolic for my pts BP. I told her she forgot to write down the diastolic and she replied "what is that?" I explained it was the bottom number ( I guess that is all they know, about bottom or top number on blood pressure). I always thought they had much more training and understanding of what they were doing!!

I'm venting---but when it comes to patient care, safety- I can't stand the fabrication and laziness. It was absolutely ridiculous!:mad::mad:

I SOO agree! I am a RN now and the best thing I ever did was start out as a CNA. It has given me so much insight. I found during my work as a CNA that even when I did report something of concern that often times the nurses seemed "too busy" and there were even times they wouldn't even look up at me. Picture this scenario: you're charting on a patient when a CNA comes up and says, "sarah, the pt in room 10 has a really low blood pressure." Sarah doesn't look up, but says, "uh huh." You say, "it's 76/48 and she says she's feeling funny." Sarah says, "okay, thanks, but doesn't move." Five minutes later the rapid response team is there, there's a big "to-do" and you stay out of the way and go about your business. Five minutes after everything has calmed down the nurse manager comes and tells the nurse (while you're standing right there) "oh, sarah, the rapid response team was bragging about you! they were so proud of you for noticing the patient was in distress before it was too late, etc, etc." and sarah continues to say, "aww, thanks! i try to stay on top of things you know. blah blah blah." and NEVER mentions the fact that the patient would've gone downhill if it weren't for YOU alerting them! not only that, but they never even say to you in private, "thanks for letting me know about that patient." not good enough? you think that is "the CNA's job"? what about when the CNA walks into a room to find a patient UNRESPONSIVE and calls a code while you're sitting at the nurse's station eating lunch and haven't checked on them for 2 hours? the team comes up, resuscitates the patient, sends them to ICU, and EVERYONE on the unit is asking about/talking about what happened and the nurse talks about what was going on when SHE walked into the room? everyone congratulates her for doing a "good job" and consoles her for feeling like she "could've done more" and once again, not a word is said about the fact that the CNA was the "first responder" so to speak. these are a couple of things that happened when i was a CNA. i'm not the type of person that needs praise in order to feel like i am doing a good job, but i couldn't help but notice how my role was always dismissed EXCEPT when there was a mistake. .

Don't you experiment this as a nurse ? The drs get " the credit" when sometimes the intern had no idea about an issue until you notified them? etc. (not as common where i work) . As the nurse you interpret the vitals and what action has to be taken. I dunno I dont do this to get congratulated for calling a rapid response. ( no one gets kudos for anythig where i work lol)

Good CNAs often do get overlooked for their contributions.

I tell people I'm a CNA. I either get a look of concern, distaste or a "what's that?".

I tell people I'm nursing student. Oh, well, then the response is completely different... how awesome, right?

I noticed, especially in LTC, that when a resident died or moved elsewhere, that when we received Thank You cards, the family would always thank "the nurses" for the great care, Mom was always so clean and well tended and yadda yadda yadda.

No mention of the CNA.

I suspect that, perhaps, the family didn't understand/know the difference.

But, for sure for sure, the nurses were given all the credit for it and some shamelessly took it.

But none of that should matter.

We all should have awesome respect for the fact that we have vulnerable lives in our hands.

you made some good points. when i was a CNA, the patients who knew the difference between CNA and RN would often ask, "are you in school?" and when i would tell them "my story" of how i had a degree/career in another field and was in fact in school for nursing their demeanor would change as if to say, "wow, so you have an education and you're doing THIS?!" i would instantly gain more respect even though i wasn't a RN, but just because i was "educated." education is valued in our society -that's just the way it is. that's why RNs receive more respect in general than CNAs. that being said, the majority of patients didn't know the difference between CNA and RN (and still don't). i ALWAYS entered patient's rooms, told them who their nurse was, introduced myself as "the assistant" and even wrote our names down for them. it didn't matter. they would roam the halls looking for "their nurse" and then announce that they'd "found her" if they spotted me. they'd be talking to someone on the phone when the nurse and i would enter the room and tell the person on the other end, "the nurses are in here." there's a lot of misconceptions by nurses that CNAs portray themselves as RNs (and i'm sure this does happen sometimes) but i know from experience that it's not usually the case. so, those "thank you" notes you mention that praise "the nurses" are more than likely talking about you as well. there are a few people who know and appreciate the difference, but most people consider the ones who took care of them to be "the nurses" and they don't differentiate between CNA, LPN, RN, etc. just my opinion, of course.

Don't you experiment this as a nurse ? The drs get " the credit" when sometimes the intern had no idea about an issue until you notified them? etc. (not as common where i work) . As the nurse you interpret the vitals and what action has to be taken. I dunno I dont do this to get congratulated for calling a rapid response. ( no one gets kudos for anythig where i work lol)

this does happen, and as a nurse do you not have those doctors who listen to you, take your advice into consideration, and show you respect? and then those doctors that you'd rather swallow a piece of glass than have to page? it happens in every field as crap slides downhill, but we're speaking specifically of CNAs in this thread which is why i pointed those scenarios out.

I have held my breath and still had 18 - 20 RR charted! :uhoh3:

I SOO agree! I am a RN now and the best thing I ever did was start out as a CNA. It has given me so much insight. I found during my work as a CNA that even when I did report something of concern that often times the nurses seemed "too busy" and there were even times they wouldn't even look up at me. Picture this scenario: you're charting on a patient when a CNA comes up and says, "sarah, the pt in room 10 has a really low blood pressure." Sarah doesn't look up, but says, "uh huh." You say, "it's 76/48 and she says she's feeling funny." Sarah says, "okay, thanks, but doesn't move." Five minutes later the rapid response team is there, there's a big "to-do" and you stay out of the way and go about your business. Five minutes after everything has calmed down the nurse manager comes and tells the nurse (while you're standing right there) "oh, sarah, the rapid response team was bragging about you! they were so proud of you for noticing the patient was in distress before it was too late, etc, etc." and sarah continues to say, "aww, thanks! i try to stay on top of things you know. blah blah blah." and NEVER mentions the fact that the patient would've gone downhill if it weren't for YOU alerting them! not only that, but they never even say to you in private, "thanks for letting me know about that patient." not good enough? you think that is "the CNA's job"? what about when the CNA walks into a room to find a patient UNRESPONSIVE and calls a code while you're sitting at the nurse's station eating lunch and haven't checked on them for 2 hours? the team comes up, resuscitates the patient, sends them to ICU, and EVERYONE on the unit is asking about/talking about what happened and the nurse talks about what was going on when SHE walked into the room? everyone congratulates her for doing a "good job" and consoles her for feeling like she "could've done more" and once again, not a word is said about the fact that the CNA was the "first responder" so to speak. these are a couple of things that happened when i was a CNA. i'm not the type of person that needs praise in order to feel like i am doing a good job, but i couldn't help but notice how my role was always dismissed EXCEPT when there was a mistake. I think it has made me a better nurse though and my CNAs appreciate the recognition that I give to them. If a CNA approaches me about something they think isn't "right" i acknowledge it (whether it's important or not) and when it IS important i always thank them and give them credit when speaking to others. A little kindness goes a long way. Not all CNAs do a good job - we all know this. Not all nurses, bankers, teachers do a good job. People don't need praise every time they do their job well, but people DO like to be acknowledged and told "good job" every now and then. So, my advice to those of you who DO have good CNAs is to TELL THEM. If you pretend like Mrs. Smith whose RR is 34 is not a big deal by your body language of not looking up at them then the next patient you have with a RR of 34 is not going to seem like a big deal to them. When they report a low BP on a patient that ends up in ICU minutes later and you pretend as though you already knew there was a problem, they aren't going to find it so urgent as to "bother you" with that information. Even if they report something that isn't crucial, you should explain to them WHY it was "okay" and thank them for telling you. it might save a life in the future. okay, i'm off my soapbox.

I think one of the best things that my school every did for me, is that during the first six months of training we had to do the jobs of CNA's and report to the nurses. We were so disrespected and ignored most of the time. This taught all of us in the program the need to listen and respect the CNA's that we work with. Their work is important, too.

those "thank you" notes you mention that praise "the nurses" are more than likely talking about you as well. there are a few people who know and appreciate the difference, but most people consider the ones who took care of them to be "the nurses" and they don't differentiate between CNA, LPN, RN, etc. just my opinion, of course.

Yes, I agree. The families had no clue the differences between the aide and the nurse. They just know someone gave Mom the bedpan promptly and assumed it was the nurse.

I understand that.

But it was frustrating to see assume credit for something they did not or would not do.

That was the part that really bothered me.

Anyway, it's being overlooked that can really wear thin for some aides.

Specializes in Dialysis.

I'm a nursing student and a newly oriented CNA. Before that, I worked as a special ed aide for 8 years. The main thing I want to say here is that a good team is invaluable. I really do care about the clients. Managers (nurses, case managers, whatever) often get in the habit of taking the help for granted. While I do my job the best I can, regardless, it really makes a huge difference when the managers PAY ATTENTION. Notice if I have a task that I can't break from (supervision, brief change, toileting), if I do, then prioritize and assign tasks accordingly. All the CNAs I've met at my facility are competent and motivated because they care. It really helps to stay that way with feedback (privately if negative) and proper prioritization of duties. It can be tough with 10 high acuity pts for one CNA.

...and yes I do understand there are bums, but not all of us are. :)

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