Major venting about some CNA's

l.rae · Dec 6, 2002

Originally posted by Susy K
I think alot of you are assuming alot here; assuming she had an attitude?! Ok, nothing excuses an attitude, but if the nurse asked for a blood sugar at a certain time, even WITH the attitude, then act upon the attitude, DON'T risk the patient's safety by blatantly doing something against what you were told to do. I think you all lost the big picture here. The big picture is that FOR THE SAFETY OF THE PATIENT, her blood sugar should have been checked at 0600, not 0545 or any other time determined by an unlicensed personnel. Take up the issue of attitude (IF there was any) with the individual or the manager; certainly DON'T take out your anger on the patients by refusing to do cares when deemed appropriate by a licensed nurse.

So...if a physician told you in a bossy manner to give the patient a pain med NOW, would you refuse to give it NOW because he didn't ask you nice, and leave the patient in pain and give the pain med when YOU felt like it? Come on. Grow up. Give the pain med and address the physician attitude separately.

Take the blood sugar at the requested time, and LATER discussed how it was asked of you. For pete's sake. It all ain't about you, people. It's about the patient, remember?

That CNA was wrong.

Couldn't have said it better!.....I left a job like this once, best move l ever made....and i DID NOT treat the na's with disrespect, no matter what you said or how you said it, they did no more and no less than they wanted to.....The next job l had was different, several of my off the job friends were a couple of the na's l worked with...So Michelle, be careful about getting an attitude to prepare for the next job, it may not be the same. Now l work in ER, l do my best to treat pple the way l want to be treated...Leadersip is less about what we know about our craft and moreabout what we know about ppl and what makes them tick...I find that the book "be a people person" by John C Maxwell has a lot of wonderful advice for getting along with all kinds of ppl .....good luck......LR

l.rae · Dec 6, 2002

Originally posted by nurs2b
But on the other hand like at my hospital when went through training we were told the times to do CBG's for each shift... And if I was told 5:30 by the hospital then that is what I would do, no matter when the nurse wanted it done... That is something he/she needs to take up with higher authority.....

nurs2b...l agree with you when it is an issue of pt safety, however the original post wasn't about the nurses convenience...and l believe that such straight forward thinking as you state above is not congruent with critical thinking skills and will not serve you well in your career as an RN/LPN.....you can't always go "by the book"...hence the critical thinking, you can't just say, "the rules say this and l am only going to do this"... and right now, it is your nurse who makes these decisions.....granted you will always find some who are not capable. If a pt condition warrents that a certain plan of action is more effective/safe for a pt than what is routine and convenient for the facility, the pt's outcome ALWAYS out weighs facillity routine. If l asked a tech to get a CBG because l felt the pt's condition warrented it now and had to wait on a supervisor to vallidate my nursing judgement, l would be highly pissed..and with good reason.......LR

Mkue · Dec 6, 2002

Originally posted by Susy K
Take the blood sugar at the requested time, and LATER discussed how it was asked of you. For pete's sake. It all ain't about you, people. It's about the patient, remember?

That CNA was wrong.

I agree Susy, very well put

:)

mario_ragucci · Dec 6, 2002

I'm sorry if this is a little off track, but since we are on CBG's I need to chime in and ask, "Has anyone ever popped a PT for a CBG and other stuff besides blood oozes out of the tiny hole?" What should you do? Is it worth mentioning, because the nurse is busy enough. It's hard to document. What "CNA reports lymph mixed with blood on CBG at 0645, 06 Dec?" I've seen it a second time now, and don't know what to make of it when i pop a PT's finger. Im sorry :-(

itsme · Dec 6, 2002

what training does a CNA have for accu checks? Is she aware that she needs to tell the nurse STAT if it isnt in normal range? Just curious, because where I am at a CNA doesnt even do vital signs (except temps) let alone an accu check.

Ortho_RN · Dec 6, 2002

lrae.. I agree that if the nurse feels it should be done for a "reason" that is fine... But just for her conveinence I wouldn't do it. And yes the above mentioned post did not state that it was for conveinence, so forgive me for sidetracking a lil bit..

And my critical thinking skills are fine... Heck for the most part it is CNA/PCA's that catch problems with patients because we are the ones who see the patients more... I think however that it all depends on the CNA themself.. If they are just working as a CNA with no plans on furthering education then there mind frame is a lil different who is working while attending nursing school.

chicory · Dec 6, 2002

Mario..that's tissue fluid coming out. Try sticking another place on the finger, or a different finger. If you still get tissue fluid, let the nurse know and you can get a venous glucose to send down..the reading would not be accurate from just tissue fluid.

Q. · Dec 6, 2002

Originally posted by nurs2b
But on the other hand like at my hospital when went through training we were told the times to do CBG's for each shift... And if I was told 5:30 by the hospital then that is what I would do, no matter when the nurse wanted it done... That is something he/she needs to take up with higher authority...

This I can understand, but then this reflects an even greater problem within nursing. As a licensed professional, I can make determinations about when to do something as simple as a CBG's or whatever. This is what helps me assess and plan care for my patient; this is what I have been educated to do and this is what (I thought) I was paid and hired to do. A facility needs to support nurses in this type of autonomous practice and delegation.

And then, as a CNA, the CNA needs to understand that those rules are general guidelines, but that this is (or should be) subject to change on the nurse's discretion. And sure, I could do the tests myself, but then what's the point to a good CNA if I end up doing everything myself because the CNA claims "policy" won't let her do anything that was delegated outside "the box?"

l.rae · Dec 6, 2002

Originally posted by nurs2b
lrae.. I agree that if the nurse feels it should be done for a "reason" that is fine... But just for her conveinence I wouldn't do it. And yes the above mentioned post did not state that it was for conveinence, so forgive me for sidetracking a lil bit..

And my critical thinking skills are fine... .

After 22 yrs of nursing, l am STILL honing my critical thinking skills, so l would take issue with the statement that your critical thinking skills are "fine" as a 2nd semester RN student....You are very correct in asserting that CNA's and Techs catch a lot of things early due to significantly higher exposure to the pt....But, l might wonder too, what critical thinking skills are you employing when you determine if a request is being made for convenience or pt benefit?...it would seem to me that you are placing the pt and yourself at risk by assuming this...and this is why l still maintain, the proceedure should be done on request and questioned later....THAT is critical thinking...........LR;)

ktwlpn, LPN · Dec 6, 2002

Originally posted by michelle95
First, let me say that I am not venting against all CNA's or even most...I've been one myself. I know how hard they work. I applaude the good ones.

My problem is the majority of the ones at where I work. They talk back, they leave people in messes...it's really making me mad. Just this morning, I told a CNA that was going to get my blood sugars at 5:30, to wait until at least 6:00 because I didn't feel comfortable giving insulin at 7:00 on a 5:30 accucheck. I had originally told her 6:30, but, after she explained to me that she couldn't at that time, I told her I would compromise and make it 6:00. (Sometimes our patients don't get their breakfast trays until almost 8:00 and 11-7 is responsible for the insulin at 7:00) She flat out refused. She told me that the boss said it was ok. I told her, she's not here right now, is she? You're working on MY license, not her's.

She told me no and went and got them at quarter of 6 in defiance.

I told the 'boss' when she came in, but, this is the same boss that let another CNA get away with telling me to 'shut the hell up', as well as, telling a patient to shut up. (Which is why the CNA told me to shut up...I was getting on to her for doing that)

I am so SICK of not being backed up when I tell a CNA to do something. I know I am just a little 'ole LPN at this time, but, I still expect the CNA's to do what I tell them.

I try to be fair. Like I said, I was a CNA, I know how hard the work can be....but, I didn't talk to my nurses any old way I feel, much less, tell them no when they told me to do something.

If the big bosses won't do anything, what am I to do? Go over their heads?

This is my last night tonight. I've done decided that the next place I work, I am not going to be so nice. I've got an interview tomorrow and I am going to explain to the administrator that I DEMAND back up. If I tell someone to do it, and, they snap off, I EXPECT there to be repercussions.

I hate to be so down and dirty, but, I had an spiritual experience a couple of weeks ago that made me see that every patient I come in contact with, is someone's loved one. I don't expect to see them laying in pee or dried food for hours. That is soooo undignified. If I don't take up for them, who will?

Any advice? Should I go to the ombudsman if the bosses won't do anything about these CNA's with an attitude?

I hope any CNA's that read this don't take offense. If you do your job honorable, I am not talking about you.

I am in LTC and the cna's there do not do any meds or treatments or even vital signs....The LPN's and RN's do that.....I work days on a 44 bed secure unit-the cna's have plenty to do with the adl's...Maybe your facility is over-utilizing them to save money? I would do the fingersticks my self..Nights does fingersticks and gives insulin at 6:30 on my unit-trays start coming up at 7:10...If the trays are consistently coming so late maybe days should do the fingersticks and insulin...Or the meal times and routine needs to be examined-there are a few ideas to start with......If your staff are not doing regular rounds through the night you need to write them up-if your admin does not back you up then you need to WALK.....

Furball · Dec 6, 2002

Pts truly are individuals. There have been pts that I've done BG's q 15-30 minutes rather than q 1-2 hours per protocol while on an insulin gtt because their systems were much more sensitive than the avg bear. Then again, there have been pts on the opposite end of the scope and I've doubled their dose (selective fuzzy vision) to hurry up and get their glucose under control. Acidosis is a very bad thing. Cardizem gtt protocol states 0.25mg/kg given over 5 minutes. If the bp drops too low too quickly I just put the bolus on a pump and deliver it VERY gingerly. You do what's best for the pt. If you only follow guidelines you will be mediocre at best maybe even dangerous at times. Use your freaking brain. Or at least LISTEN to the person who has the education under his/her cap to make these decisions.

Sometimes (most times?) RN's just don't have the time to explain every little thing.

I like ICU because there are monitors for instant VS/hemodynamic checks and I do my own BG's...no waiting around or being interrogated by someone who may be clueless.

RRMLPN · Dec 6, 2002

First off, i'm really sorry you found yourself in this situation. I always found it worked for me to address my cna's before we hit the floor if possible (on any shift) and ley them know what i expected of them and in turn what they thought they may need back up on if they got very busy . I found explaining why i wanted things done at a certain time helped a great deal. I always let them know they are appreciated and that i could not do my job well if they did not do thiers well, they are my eyes and ears in alot of situations. I think anywhere you work, you will always have at least one person be it CNA,LPN, RN, MD, who either will not do thier job or doesn't do it well and it is never a easy situation, and if you have spoken to this person about thier performance and have follwed the chain of command all the way up then you have done your very best. I wish you the best on your new job.