Cna Gone Wild

[dorselm]

Last week I had to give my first SS enema to a male patient. My instructor gave a couple of the students patients with lots of issues and lots of meds so she didn't have time to show me how to administer this enema. This is a CNA responsibility at the hospital that were at. So my instructor told me to ask the CNA to help because the CNA has been at this hospital for 20+ yrs and my instructors said she wouldn't mind helping me. So I go to the CNA and ask her if she could show me how to do it. She said "Don't you students help each other?" I said none of us know how to do this. She said "Oh well you gone have to wait because I'm goin on my break and I gots to have my break." I said that's no problem, I can do it when you come back. She said " Where's your instructor, why isn't she helping you?" I said she can't because she's helping other students and by the time she gets to me it would take too long. She said "Well that's not my problem because I don't get paid to instruct nobody that's what she gets paid to do." I said isn't this your job? She said "Yes but it's all of our job on this floor". (The patient that I was giving the enema to was her patient so technically if I didn't have to do this she would have). I said I don't need you to touch the patient, I just need you to show me what to do. She said "well you're gonna have to wait." So I went to my instructor and told her what happened. She said she's usually a nice CNA so we'll just chalk this one up to her having a bad day.

The next day we come in the Nursing Coordinator pulls my instructor into the office and proceeds to let her have it about the fact that she has the CNA instructing students and that's not their job. The CNA went to the coordinator and complained about us!!!!! I couldn't believe it! Come to find out the old nurse and the old CNA are in cahoots with each other because before my instructor came along, the students answered all the lights on the floor and did all of the aide work but my instructor said we are not there to learn to be aides or to do their job. Our priority is assessing and treating the patients. So now the students are target practice basically. I can't wait to leave this hospital.:angryfire

[eldragon]

I also agree with the CNA. She has been doing that work for 20 years, how many nursing students do you think she has seen over that period of time?

And I have no idea what the instructor is thinking if she says nursing students aren't there to do CNA work or answer call lights. That's the basics of nursing care, too! Alot of what goes on in the hospital is un-specialized, but it makes the patient feel more comfortable, and that in itself is a skill.

I am finishing up an LPN program, and I have 4 more days to go until graduation. Yesterday was my first preceptorship day (12 hours) and for the first time, there was a difference between what I was doing, and what the CNA's were doing. I helped them when I had free time, but it wasn't required that I do the dirty work, so to speak. I did do my share of cleaning up after a bowel-incontinent patient, because she had a dressing change on her coccyx. Never in a million years would I have asked a CNA to do that, I did it.

So whether you are a CNA, LPN, ADN or BSN, or more....the focus is still on patient care, and we all need to do our part, all the time.

[Conrad283, BSN, RN]

The instructor was wrong for not doing her job, and the aide was wrong for saying what she said, and stuck in the middle is a nursing student who is getting shafted by everyone.

People need to grow up. Just like when everyone was kids and you were told to clean someone else's mess. Why not just do it and get it over with instead of standing there bitching about it.

The other night when I was working, a pt coded. No nursing assistant's responded. The nurse went to go find them. One was in a room and the other was "on her break." The nurse chewed her out for believing that someone's life is less important than one's "break."

There's a housekeeper that will not strip a bed once a patient is discharged, annoys the hell out of me. Instead she'll walk all the way to the desk to tell me that the bed's not stripped. She won't do it because it's not in her job descript. Well it sure as hell isn't in mine (I'm a clerk), but I go do it anyway just to get it done.

[roni221]

Love the dramatic title So just thought I'd put my 2 cents in. I can see how the CNA's job is not to teach you and yes she should be able to take her break, however....I'm a CNA that is new (I've been a cna at a nursing home previously) at a hospital and we (the CNAs) do the enemas. I haven't been able to do one yet but when I do a CNA will be showing me how. So, I guess I don't see why it was such a huge deal for the CNA to show her? Such a big deal that she had to get the supervisor involved. If the instructor didn't have time to show the student to do the enema it would fall to back to the CNA anyway.

....Also I'm not sure if everyone agrees it's ok for CNA's to do enemas, I was a little surprised but that's how it is at my hospital and apparently at this one too. Just my thoughts...

[Alternator81]

CNAs have it tough enough. Why should they have to disrupt their work flow to "instruct" nursing students? Although this particular CNA could have been nicer in her response, I agree with her. Having a student follow you is a pain in the butt. I'm sorry, it just is. They don't get paid enough for that. It is not their responsibility.

Disrupt their work-flow? It would have been the CNA's work-flow if the students weren't there. It's so ridicules for the CNA not help her out! Yes, the instructor should have been available, but sometimes in clinical the instructor is busy with more pressing problems that other students have. Is the CNA really going to make a patient wait for the instructor to be free to get the enema, because she doesn't feel she gets paid enough to let students watch?

It isn't that she "could have been nicer in her response," it that she has a terrible attitude! I can not believe that people can defend someone with an attitude like that. Would you like to work with someone who pick and chooses what they get "paid enough" to do?? It is very unfortunate that CNA's don't get paid well enough, but if you don't like your job, move on!

[WDWpixieRN, RN]

1) I agree it was not her place nor her job or responsibility to supervise or teach you this on a pt...that liability/responsibility lies squarely with your instructor.

2) In which case, since your instructor was busy and she can't "teach" you, if it had been me, I would've clearly let he know that when she was done with her break, then it would be necessary for HER to administer this enema since your CI was busy. This, to me, is no different than when I have a pt who needs a med in a pretty timeframe and my CI is busy with other students and has informed me she doesn't have time to get my pt in a timely manner. In that case, I notify the RN who then administers the meds.

Pretty cut and dried IMO. Your instructor was wrong to send you to her for "teaching"....observing, perhaps....

[Alternator81]

Alterator81 -

There is a huge difference between asking a CNA to help you change a resident or fix a bed and asking a CNA to show you how to administer an enema (a medication).

Thats a big nono. The instructor needed to be the one to show the OP how to administer a medication.

As far as the school paying money for you to be there? Thats true, but they are not paying for the nurses and CNA's salaries. They are paying your instructors salary, and the instructor is there to do just that - instruct. She cant expect others to teach you when its the job she was hired to do.

I have to say that I was surprised that a CNA even gives an enema, only because it is a medication ordered by a doctor. Never the less, I see were you are coming from and I agree with that. It is a medication and the instructor should be showing her. The real problem I have is with attitudes some people have. If the CNA was concerned that it was a medicaton, I can appreciate that. But, to say that something is not your job and that you don't get paid enough is just ridicules.

And what I meant about paying is that I was always under the impression that our school pays fees for our slots in clinical sites. I may be 100% wrong about that.

[sleepyndopey]

Disrupt their work-flow? It would have been the CNA's work-flow if the students weren't there. It's so ridicules for the CNA not help her out! Yes, the instructor should have been available, but sometimes in clinical the instructor is busy with more pressing problems that other students have. Is the CNA really going to make a patient wait for the instructor to be free to get the enema, because she doesn't feel she gets paid enough to let students watch?

It isn't that she "could have been nicer in her response," it that she has a terrible attitude! I can not believe that people can defend someone with an attitude like that. Would you like to work with someone who pick and chooses what they get "paid enough" to do?? It is very unfortunate that CNA's don't get paid well enough, but if you don't like your job, move on!

I believe the student did not just want to watch, she wanted to do the procedure under the instruction and supervision of the CNA. As we all know, taking time to instruct and supervise someone takes longer than just going in and doing it. I agree the CNA was rude. She probably shoud have just said she wasn't comfortable with it.

As far as the getting paid enough, yeah-they are not paid enough to instruct nursing students. They are not paid enough to care about nursing students. Not everyone is going to care about the nursing students experience, they are not the center of the universe. The instuctor should be doing her job, not the CNA.

Also, since it is not the CNAs job to instruct nursing students, she will not have to move on as you suggest.

[Lisa CCU RN, RN]

Whatever.

An enema is not medication unless it's a medicated enema and it's administration is within a CNA's allowed duties. I really think that all skills should be checked off in skills lab before being performed in clinical. If not for that, I think the CNA had a nasty attitude and if she had spent all the time she had trying to get out of showing her something, she could have shown her the dang skill. I HATE people who have this attitude. It's got to be jealousy or something.

I agree with the poster about the houskeepers complaining about beds. Good grief, it takes two seconds to rip sheets off. Get over it.

Lord, when did people get so ridiculous?

[Lovely_RN, MSN]

Nope, it's not the CNAs job to teach students how to do anything. Instead of going back and forth with the CNA you should have been agreeable and said that since your CI wouldn't be able to show you how to do it that you wouldn't be administering that enema.

C'est la vie...it would have just been another task for her to do after her break.

I had a CNA give me grief because I asked her to demonstrate the glucometer for me so that I could get the blood sugars for a couple of patients.

I know how to take a blood sugar, I've done it in other places but not in this hospital. I just wanted to be shown how that particular machine worked. She went on and on about how she didn't have time for this and what do they teach us in nursing school and on and on.

After a few seconds I asked myself if I needed this kind of grief? Why was I trying to be so helpful anyway? If no one was going to show me how to use the equipment then why should I do something that might get me in trouble?

I told her no problem, I will let you get the blood sugars since you work here and you know how to work the machine. So instead of taking 2 minutes to show me how to work the machine she got to spend the next ten taking blood sugars....C'est la vie.

If your CI doesn't have time to supervise you or demonstrate a procedure or how to use a piece of equipment and there is no licensed person available don't use the equipment or do the procedure. You may be opening up a can or worms and end up getting into a lot of trouble.

I know it sounds wacky but Heaven forbid something went wrong with that enema...who do you think would be blamed?

[bethin]

I do not agree with the CNA. What a bad attitude!! The "not my job" attitude just irritates the heck out of me!

The school pays alot of money for us to be there. There is one instructor and usually at least 10 students. At least at my clinical sites, the RNs and CNA's are expected to help educated us. When the hospital has a lift I am unfamiliar with, or I am having a problems getting a brief on, or I can't get the bed to work (argg..), the first person I grab in a CNA, not my instructor!

I've worked with students and I've helped change beds, bathe, etc. If it's a procedure the student has never done then the instructor needs to be there to make sure that she follows proper procedure and protocols. How I do it may not be the right way. There's the real world way and JCAHO, instructor, etc way. By right I mean not throwing linens on the floor even though in the real world that's where they end up. If I showed a student that and she/he did it, odds are the instructor would be very upset.

If a student doesn't know how to give a IM, am I expected to teach her that too?

I have no problems helping out. I love having students on the floor. They're so eager. Breath of fresh air.

The CNA was wrong to behave that way. A polite explanation would suffice. I would also go to the instructor and express my concerns.

[Valerie Salva, BSN, RN]

I think that both the CNA and the nursing instructor were in the wrong in this situation.

But, I think that a facility allowing CNAs to give enemas is the most wrong thing about the whole situation.

[Virgo_RN, BSN, RN]

Giving enemas is within the CNA scope of practice in my state. They teach it in CNA class. If a task is within the CNA scope of practice like changing an occupied bed, for example, then why shouldn't a CNA be allowed to show a nursing student how it's done?