help training cna's

I don't know about coding, but one area in which I think CNA training is lacking is that many do not understand the the nurse is their immediate supervisor, and they are to do what she says.

I have worked with a large number of CNAs who are regularly insubordinate, and do not know what insubordination is.

Some CNAs seem to think I am just there to bother them. They are so shocked when they find out I am the person who writes their reviews and that I have input into what their raises will be.

Many CNAs need to understand that if they are not busy, and they see that other staff are busy, they need to put down that magazine, get off their cell-phone and HELP.

I regularly speak to CNAs about these things. They seem to think it's just me who wants these things from them. They do not feel it's their job to do what nurses ask, and to help their co-workers.

I think if these things were stressed more in CNA training, many nurses would not have such a hard time convincing CNAs of them.

I am speaking only of the problem CNAs, not the great ones out there.:wink2:

God Bless the CNAS who know their job, and do it with diligence and care.

Sorry that this post is really off topic, panurse101.

Maybe someone else can answer your question about coding.

hello fellow pa mds nurse!!! caretracker is truly a blessing. i don't really have any answers to the problem. it seems that once one cna (or nurse, for that matter) codes something one way, the others follow suit. i ended up having double amputees marked as 1/1 for ambulation!!! perhaps if your seven day assessment didn't have the cna's putting in the numbers, but rather changing it to asking questions like "how much assistance did the resident need to use the bathroom, do am care, eath their meal, etc. ?" then you change their answers into the correct code. the trick would be to ask the correct question to answer all of section g. it's tough. one thing i always emphasized was that they needed to code correctly so that administration would know just how much effort is needed to care for the pts. that way they might be able to justify extra staff, or at least not be told that they're overstaffed. when we started out we told the cna's that their documentation showed that they could do the job with less staff....they sure paid more attention then!! good luck, and feel free to ask any questions i might be able to assist you with. deb:mad:

I do a quarterly inservice with all CNA's on coding. Rather than reinvent the wheel each time, I use the same inservice over and over w/ 2-3 different sets of "test" questions. The CNA's that have proven themselves and can pass a pre-test don't have to attend every quarter.

I try (but don't always get it done) to work with the new CNA's that get hired in. We do have a caretracker system and I stand over them and we code some residents together for a few days. Seems to help and then they also feel more comfortable coming to me later with questions. It is very helpful that my office is within shouting distance of the caretracker computers.

hello, i hope this is a help to you.

independant: you do absolutely nothing for the resident. they can go to the med cart and get a towel, etc.

supervision: talk only, provide cues and reminders, no touching!!!!!

limited assist: touching only, guiding arms, etc into sleeves, no lifting!!!!!

extensive: bearing weight if only once during their shift. holding up legs to put on teds, lifting their legs up into the bed, lifting their head to adjust the pillow, bearing their weight during any part of care.

total: pretty much they can't or won't do anything. a person that is "coma-like", severly demented, you do absolutely the entire process.

activity did not occur: just plain , it did not happen, be it walking, locomotion, dressing (is in street clothes, not johnnies!!!!!!).

i do constant inservices, put guides up over the computer charting area and call them on their errors via e-mail........i inservice late loss adl's the most, and just repeat the 4 areas over and over and hit the others randomly.

good luck.

cj

In my facility, the nurses do the MDS charting. I find that interesting because while I do try to help when I can, I spend most of my time on med pass, charting, tx's, and other "nursey" stuff and can't possibly know how all 60 of my residents were assisted that night. I bug the crap out of the aides with "What about this person? Did you do this? How about that? Does he/she do this? Or that?". They are busy, too, and don't have time to sit there and answer 8600 questions. But, what helps me make sure I code them correctly is it was put to me this way: The more accurate the coding, the more we get paid, and the better chance of good raises/other benefits. It worked for me.

In my facility, the nurses do the MDS charting. I find that interesting because while I do try to help when I can, I spend most of my time on med pass, charting, tx's, and other "nursey" stuff and can't possibly know how all 60 of my residents were assisted that night. I bug the crap out of the aides with "What about this person? Did you do this? How about that? Does he/she do this? Or that?". They are busy, too, and don't have time to sit there and answer 8600 questions. But, what helps me make sure I code them correctly is it was put to me this way: The more accurate the coding, the more we get paid, and the better chance of good raises/other benefits. It worked for me.

I recently went to a seminar where the speaker told us the best way to get CNAs to code ADLS correctly was to use the actual G section of the MDS.

We have the Care Tracker system and it was a challenge for many of the CNAs who were used to copying what ever was on the flow sheet.

I found the best way was to do a demonstration with them. We blabbed on and on about weight bearing versus non weight bearing but most of them thought it only pertained to walking or transferring. I walked around the building for days with a big shirt in my hands. If I saw one of the CNAs standing at the Care Tracker I'd go over to them and we would discuss the difference between limited and extensive assist (they understood all the others.) Then I'd ask them to put the shirt on me....if they held they shirt and aimed my arm by gently pushing my arm in the direction of the sleeve...limited assist. If they had to hold up my arm to get it in the sleeve...extensive assist...if I just stood there and they had to wrangle my arm into the sleeve..dependent.

Not only did it clarify the definitions for them, it was a fun way to learn.

Overall, I love caretracker. We'll never perfect the system, but at least the facilities we work for are trying. Again, 3.0 is on the horizon!