What CNAs need to tell the nurse

[UM Review RN]

in a postop, i want to hear about:

pain level (could indicate compartment syndrome or that dose needs adjusting)

c/o nausea/vomiting (could indicate an ileus)

bp over 140/80 or under 90/50 (lots of reasons, but needs treatment)

temp over 100.4 (some temp is expected in a postop patient, but after a certain point, the doc will want stat blood cultures)

but in the stroke patient, a temp over 99 needs to be reported (stroke patients need treatment for any temp over 99f)

a previously alert, oriented patient becoming confused. (could be an infection, a stroke, low o2, or a low blood sugar, but needs immediate investigation)

please save or show me any bleeding, any diarrhea, any discharge, any vomitus, and any urine that is not clear yellow or stool that is not soft, formed and brown.

if you notice any change in temperature or color of the skin of an extremity, please tell me. (a cold, white extremity could mean a clot and is an emergency)

if you find any pills in the bed, save them and tell me.

(some patients carry their own stash and can od themselves by accident)

please let me know if anyone has any trouble breathing or if their o2 sats are 92% or less or if their respirations are over 23. (the patient may need o2)

please let me know if the patient's heart rate is not regular or if it's over 100 bpm. (patients with an irregular heart rate might have a more accurate blood pressure when taken manually.)

[texas_lvn]

has anyone mentioned the change in appreance of stool? In anyway.

[chadash]

Thanks guys!

And bethin, remember that the nurses really need your observation. You are in the room more, and can alert them: they cant be everywhere. But also, sounds like you might want to go to nursing school so you can do more.

Right now I am trying to work smarter at this level. this has been so helpful.

[anonymurse]

Any patient who c/o chest pain needs to have the nurse alerted and a stat full set of vitals, and prepare to do a stat EKG.

Yeah. So you collect the big bucks for assessment, care planning, and delegation--and you expect the CNA to do it for you.

Get a grip.

You know why you don't get abnormal data ASAP in the middle of the CNA taking vitals?

Because it takes 15 minutes to find you which she can't afford even when she's only vitaling half the floor, let alone the whole floor by herself, and you're not helping by not carrying your pager.

Because every other RN on the floor is hollering for (1) their vitals and (2) come here NOW and help me/do this/do that.

Because she's WAY overloaded before anyone starts hollering: if you took total care of your pts, you'd find yourself spending half your night on changing, cleaning, and bathing, yet with 5 RNs for 1 aide, you expect all that done "and where are my vitals and I's and O's?"

Because she knows what normal is, and not only that but what floor policy is, but so many times she's gone hunting for an RN with data that's out of limits and been told, oh I don't worry until it's X or Y or Z, or, did you really have to wake up the pt for a BP and anyway that's normal for him -or- leave him alone, he's dying.

But mostly she doesn't do your assessments, plan your care, do critical thinking, and do your delegations because she doesn't have RN training.

[Marie_LPN, RN, LPN, RN]

Yeah. So you collect the big bucks for assessment, care planning, and delegation--and you expect the CNA to do it for you.

Get a grip.

You know why you don't get abnormal data ASAP in the middle of the CNA taking vitals?

Because it takes 15 minutes to find you which she can't afford even when she's only vitaling half the floor, let alone the whole floor by herself, and you're not helping by not carrying your pager.

Because every other RN on the floor is hollering for (1) their vitals and (2) come here NOW and help me/do this/do that.

Because she's WAY overloaded before anyone starts hollering: if you took total care of your pts, you'd find yourself spending half your night on changing, cleaning, and bathing, yet with 5 RNs for 1 aide, you expect all that done "and where are my vitals and I's and O's?"

But mostly she doesn't do your assessments, plan your care, and do your delegations because she doesn't have RN training.

Wow, that was very rude, assumptive, and very uncalled for.

[chadash]

Yeah. So you collect the big bucks for assessment, care planning, and delegation--and you expect the CNA to do it for you.

Get a grip.

You know why you don't get abnormal data ASAP in the middle of the CNA taking vitals?

Because it takes 15 minutes to find you which she can't afford even when she's only vitaling half the floor, let alone the whole floor by herself, and you're not helping by not carrying your pager.

Because every other RN on the floor is hollering for (1) their vitals and (2) come here NOW and help me/do this/do that.

Because she's WAY overloaded before anyone starts hollering: if you took total care of your pts, you'd find yourself spending half your night on changing, cleaning, and bathing, yet with 5 RNs for 1 aide, you expect all that done "and where are my vitals and I's and O's?"

Because she knows what normal is, and not only that but what floor policy is, but so many times she's gone hunting for an RN with data that's out of limits and been told, oh I don't worry until it's X or Y or Z, or, did you really have to wake up the pt for a BP and anyway that's normal for him -or- leave him alone, he's dying.

But mostly she doesn't do your assessments, plan your care, do critical thinking, and do your delegations because she doesn't have RN training.

I dont think angie Oplasty meant for us to do her job, but to alert her so she could do her job....and that would be the information I was looking for: when to alert the nurse.

It is true that sometimes I alert the nurse to vitals that are iffy, and they may say, ah, not really bad in this situation. But they dont (usually) seem irritated that I informed them needlessly. It is important for the nurses to understand that I cannot assess the significance of specific indicators for individual patients. That is why communication is so important.

also angi's reply was helpful in informing what actions we could initiate: get the vitals going, prepare the pt for EKG. I am not sure what got your ire up with this. Sounds like you have had a tough day with some less than understanding nurses.

And Angie Oplasty, thanks for the information!

[smk1, LPN]

Yeah. So you collect the big bucks for assessment, care planning, and delegation--and you expect the CNA to do it for you.

Get a grip.

You know why you don't get abnormal data ASAP in the middle of the CNA taking vitals?

Because it takes 15 minutes to find you which she can't afford even when she's only vitaling half the floor, let alone the whole floor by herself, and you're not helping by not carrying your pager.

Because every other RN on the floor is hollering for (1) their vitals and (2) come here NOW and help me/do this/do that.

Because she's WAY overloaded before anyone starts hollering: if you took total care of your pts, you'd find yourself spending half your night on changing, cleaning, and bathing, yet with 5 RNs for 1 aide, you expect all that done "and where are my vitals and I's and O's?"

Because she knows what normal is, and not only that but what floor policy is, but so many times she's gone hunting for an RN with data that's out of limits and been told, oh I don't worry until it's X or Y or Z, or, did you really have to wake up the pt for a BP and anyway that's normal for him -or- leave him alone, he's dying.

But mostly she doesn't do your assessments, plan your care, do critical thinking, and do your delegations because she doesn't have RN training.

This post scares me as a student nurse and a CNA...

[anonymurse]

This post scares me as a student nurse and a CNA...

It should. It should. You have your CNAs who will slack on you no matter what, true. But you also have intelligent ones with a strong sense of responsibility with or without some nursing abilities (students were mentioned) who get beat up and yes, it's very human to get gun shy. Now all these get lumped together by more than a few RNs, and what happens?

What happens when time pressures are inhumanly high and you have an aide who is susceptible to that pressure? They go fast, way too fast. They miss things. And these are the conscientious ones who are most vulnerable. The ones who don't care, don't care.

Plus some units have a strong "I got mine" culture, and usually--well I have never seen it otherwise--this is transmitted downward from the RNs. Hey I'm sure we all learned about Stanley Milgram's prison and shock experiments in our psychology prereqs. Or did we really learn it?

[MidnightTang]

I'm soon to be a nurse and am currently working as an aide. The truth is that iffy vs, loose stools and open areas on the coccyx do not often seem to be spend ten minutes tracking down the nurse emergencies, but I would hope that a diaphoretic patient with SOB or a sudden change in mental status, etc. would get reported ASAP. There are abnormals and then there are ABNORMALS!! All these changes should be reported in a timely manner, but some are more important than others. This is not a matter of doing the nurses job, it's a matter of CARING for the patient. If all aides and nurses would look at their jobs in terms of the best care for all the patients instead of whose job is what and which patient is mine, things would run a lot smoother.

[chadash]

I'm soon to be a nurse and am currently working as an aide. The truth is that iffy vs, loose stools and open areas on the coccyx do not often seem to be spend ten minutes tracking down the nurse emergencies, but I would hope that a diaphoretic patient with SOB or a sudden change in mental status, etc. would get reported ASAP. There are abnormals and then there are ABNORMALS!! All these changes should be reported in a timely manner, but some are more important than others. This is not a matter of doing the nurses job, it's a matter of CARING for the patient. If all aides and nurses would look at their jobs in terms of the best care for all the patients instead of whose job is what and which patient is mine, things would run a lot smoother.

another great post: what are the abnormals that should send us into the hall screaming and flailing our arms...(not literally, you know) and which are the things that need reported with less urgency? Assume I know nothing....:smilecoffeecup:

[bethin]

Thanks guys!

And bethin, remember that the nurses really need your observation. You are in the room more, and can alert them: they cant be everywhere. But also, sounds like you might want to go to nursing school so you can do more.

Right now I am trying to work smarter at this level. this has been so helpful.

Funny you mention nursing school, I'm applying for fall 2007.

[anonymurse]

If all aides and nurses would look at their jobs in terms of the best care for all the patients instead of whose job is what and which patient is mine, things would run a lot smoother.

It seems that every unit and even different shifts on the same unit can have extremely different cultures. I really believe it starts with the NM and charge. If they are laissez-faire, or contribute to the "I got mine" mentality, then things are going to be awful. If they take control, establish accountability, communication and accessibility, and set the example for quality care, then things are going to be great.

There are other factors. Stability is very important. I have a friend who got involuntarily moved to another unit. When he got there, the NM asked him what he wanted, he said only weekend nights, and she said he'd have it, and as long as he stayed there he wouldn't have to bother even looking at the schedule. He's been there a few years and she's been true to her word. You couldn't budge him out of there with a crowbar.

Culture is everything. What we're really talking about here is the kind of commitment that can cause people to ask how they can better serve and others to teach them. Initiative is a delicate flower and easily killed. The best leaders can create cultures in which initiative thrives.

[TiffyRN, BSN, PhD]

I work with mostly motivated and perceptive techs. Our manager hires mostly pre-nursing and currently nursing school students. I think that helps but we also have techs that are good that have no school ambitions.

I like the list Angie gave. Especially the vital sign list. Pretty much everywhere I've worked the techs/na's have had a list like that. It hasn't always been followed and that is a frustration for me.

But if you can't find me for a complaint of chest pain. . .

wow, ok