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How many CNAs do you have on your floor?

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crx971 crx971 (New) New

I worked 4 years in a nursing home. It was a common sense that the more CNAs you had, the happier the pts were. They got fed on time, they got dressed, they got changed more often etc etc. Simple, common sense. Nurses didn't have to do anything with poop. Or pee. Or dirty dishes. Or moping the floor. Or fetching soda pop. Or other things that don't really require BSN in anything. We could actually focus and spend all our time doing actual nursing whatever it was. Meds, tx, orders, labs, admissions etc. The stuff nurses go to school for, you know.

Imagine my surprise when I started my new job at the hospital and found out there's like one aide for the whole floor of about 40-50 people at night, and she's kind of doing her own thing and I'm supposed to do all the work. Now, I'm responsible for wiping poop 10 times a night instead of watching a titratable heart med administration. Or I'm sorry, another of my pt is having a stroke? Too bad, find somebody else, I'm currently to my waist in diarrhea and pee and vomit in a isolation room with my pt in a very awkward position, can't leave him like that, and it will take me a few minutes to clean up and exit the room properly. Can't run to another room like that! Anything else? Critical lab, you say? Doesn't matter, can't do it, tell them to wait or call the charge nurse... See, I got my BSN so I can wipe butts, not do critical thinking or take care of acute medical problems that requires several years of education. Sorry, once I take a set of wipes and briefs, I will be unavailable for at least 20-30 minutes. If anything happens... there better be other nurses around who can figure out what's going on with my pt right away, like his detailed hx, meds, etc etc. No. It's all equally important for a nurse in a hospital to do both poop wiping and high-level nursing. Because hospital can't afford a $14/hr aide or two. 10 nurses per 40 pts ok, but 2 aides instead of one - that's insanity! Gonna go bankrupt overnight. Hospitals aren't as rich as medicaid nursing homes that can afford 3 aides per 20 pts.

Do you get where I'm going? I hate it. I love hospital nursing, but I absolutely hate doing CNA job. I can help out, always did, but I hate being pretty much solely responsible for all that crap, pardon me french. It's like when you eat a delicious cake and stumble upon a piece of poop in it, literally, a piece of poop in the cake. And then you try another cake, and there's poop too. And almost all cakes have it. Some don't, but most do. That's how I feel about my shifts in the hospital. 2-3 complete bed changes a night completely **** me off and make me hate being there... and also makes me wonder - what the hell do hospitals think? How come nurses allow it? It makes zero sense. It's plain stupid. Why don't we strike and demand more aides?

So how many aides do YOU have? How do you deal with poop? Do you just accept/tolerate it? Love it? Does it make you hate your job sometimes? How do you feel?

malenurse69, MSN, NP

Specializes in ICU / Urgent Care. Has 4 years experience.

Poop and other bodily fluids have always been at the center of nursing care, surprised you didn't learn that from your rotations. Better brush up on your poop-kwon-do :eek:

Edited by malenurse69
spelling

I don't know how to say this nicely, but most facilities don't care about what makes the patients (or nurses for that matter) happy...it's all about making some profit. Functioning with the least number of staff means more money in their pockets.

Also, Nursing 101...you were taught to wipe butts, bathe patients, etc because that is part of caring for the patient. It WAS part of your BSN education, you know? If bedside nursing is too much for you, then maybe choose another position with the degree you hold. Case management? Admin?

caseyuptonurse

Specializes in Rehab, pediatrics. Has 2 years experience.

As stated previously, you do learn to "wipe butts with your BSN" in nursing 101. And as another has stated if you are so upset about this maybe you should switch to something off the floor such as case management. You sound really upset about doing things for your patients that are also in your scope of practice NOT just in a nurses aide scope. You seriously get mad if you have to go grab a soda for a patient? Are you that overwhelmed that you can't critically think and perform the rest of the care for a patient? My floor is staffed similar but we have less nurses and one aide, sometimes two. I've never had a problem getting stuff done while helping patients with their basic needs along with the "BSN stuff." There is always someone on the floor willing to help me out if there is a situation such as a patient having a seizure in the room while I'm caught up in another room. And if they don't know the patient they will trade with me and take care of the patient covered in number two while I go help the patient of mine that is in distress. I love the aides and I'm so thankful for them but I've always been one to help with their duties along with doing mine. I've never really thought about pushing my hospital to get more aides on the floor. I think maybe looking into other kinds of nursing may be beneficial to you or see what your supervisor's advice is on the current situation.

Red Kryptonite

Specializes in hospice. Has 3 years experience.

My workplace is cutting costs by reducing the use of CNAs. The theory? Nurses can do anything aides can do, but the reverse is not true. This is the direction many organizations are going. I think you better get used to wiping butts. Besides, as a colleague who is a LPN working toward RN told me, doing cares yourself is an excellent way to assess your patients.

TheCommuter, BSN, RN

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 14 years experience.

I'm fortunate to work in a specialty (physical rehabilitation) where CNAs are abundantly staffed. Our patients are extremely heavy due to major CVA, morbid obesity, etc, so we need as many helping hands as we can get. For a census of about 40 patients, we'll receive four CNAs.

Although I'll wipe poop to keep the patient clean and dignified, I dislike the stench of incontinent care.

melizerd, ASN, RN

Specializes in Med/surg, Onc.

My floor has 19 beds, med/surg/oncology

Days have 5 RNs, 3 aides

PMs 4 RNs and 2-3 aides

Nocs 3 RNs and 1-2 aides

We all pitch in for daily cares and some days I spend a lot of time "wiping poop" and some days I don't. It's not my favorite thing lol, but it's something I do with a smile to make my patients feel better, keep their skin clean and dry and their dignity intact.

havehope

Specializes in None.

My floor has 19 beds, med/surg/oncology

Days have 5 RNs, 3 aides

PMs 4 RNs and 2-3 aides

Nocs 3 RNs and 1-2 aides

We all pitch in for daily cares and some days I spend a lot of time "wiping poop" and some days I don't. It's not my favorite thing lol, but it's something I do with a smile to make my patients feel better, keep their skin clean and dry and their dignity intact.

Our staffing on a med/surg/telemetry floor is close to this.

Red Kryptonite

Specializes in hospice. Has 3 years experience.

My floor has 19 beds, med/surg/oncology

Days have 5 RNs, 3 aides

PMs 4 RNs and 2-3 aides

Nocs 3 RNs and 1-2 aides

Dude....um, that's pretty good staffing. I'd like to work there.

RunBabyRN

Specializes in L&D, infusion, urology. Has 2 years experience.

Many specialties don't even HAVE CNAs. I'm in women's health/L&D/postpartum, and I have yet to see a unit with CNAs. There's plenty of poop and moving a heavy patient with an epidural into an unflattering position and getting ice chips and helping someone to the bathroom and all of those "menial" tasks. When I was in med/surg for clinicals (I'm a new grad), there was ONE CNA for the whole floor, so the nurses handled pretty much everything.

I would rather have my 4 couplets (which is still above recommendation) than the 36 patients I had at my SNF job.

SNFs have a zillion CNAs and only use nurses for stuff only nurses can do for the sake of money. Think of bathing your patients as an opportunity to fully assess them. Think of grabbing them a snack or a fresh water as an opportunity to get to know your patient and what makes them happy. Hospitals have nurse/patient ratios that probably make it too expensive to hire additional CNAs, because they cannot in turn assign more patients to RNs.

Honestly, your post makes you sound like a princess, and not the kind of nurse most people (including CNAs, who HATE nurses who refuse to wipe a butt) want to work with.

RNperdiem, RN

Has 14 years experience.

It sounds like you have worked with some good CNAs-the kinds who actually do their jobs and help the patient. I would rather have a smaller patient ratio and do a lot of the cleaning up myself than have a larger patient assignment and a CNA who is always hiding out somewhere( breakfast break, smoke break, snack, another smoke break etc.)

For a 18 bed ICU, we have 2-3 ancillary staff. The CNAs are crosstrained to do secretarial work. The hospital is phasing out unit secretaries. CNAs stay busy as nurses, so sometimes the phone just rings and rings.

melizerd, ASN, RN

Specializes in Med/surg, Onc.

Dude....um, that's pretty good staffing. I'd like to work there.

Come to WI ;)

We also have a HUC from 0630-2300

Caffeine_IV

Specializes in LTC, med/surg, hospice. Has 7 years experience.

We have either 0 or 1 CNA on a 24 bed unit at night.

Poop is poop. If I encounter a dirty patient, I clean them up. I don't love it of course but it's par for the course in most acute care areas.

firstinfamily, RN

Has 33 years experience.

When I started nursing in 1981 in an ICU we did not use CNA's we did all the pt care ourselves. Today I work on a tele/med floor 26 beds, depending on our census we have from 2-3 CNAs. We help each other, if the nurses have the time they will give baths etc. Usually the CNA's do most of the direct hands on care, but I try to make myself available. It is true that nurses can do CNA work but CNAs cannot do nursing work. You have to set your priorities, let the CNAs know you are available, but also that they need to do their work so that you can concentrate on what other tasks only nurses can do. I have never had problems when I have had to let a CNA know I am not available to help. But I always try to let them know when I am available and that I am willing to help them when I can. It is a hard choice, of course I do not let a pt lie in urine or stool, and sometimes I am the one who takes the CNA by the hand and says, "lets go turn patients". You have to work as a team, the patients benefit when this is possible, and they can tell when staff work well together. It does make a difference. I would rather work with a BSN nurse who knows how to wipe poop than one that does not, or does not know how to put a pt on a bedpan. That is ridiculous!!! We all have varied roles, it is making those roles work that makes a difference. If you have to stay late to document or to finish a procedure then so be it. Direct pt care takes priority over whatever you have to plug into the computer. And, if management has a problem with you staying late, bring to their attention how many other job roles you are doing. Be the change agent for your unit!!! It is not the way it is, it is the way you make it!!

SubSippi

Has 2 years experience.

It doesn't sound to me like the OP has as much of a problem with cleaning a patient as the fact that having to spend so much time wiping butts takes away from time dealing with more critical matters.

Yes, basic patient care is covered in BSN programs. But I understand how it can be frustrating to spend so much time learning complicated pharmacology and pathophysiology, to end up spending the majority of your time doing full bed changes and walking people to the bathroom. Especially when those things could be done by someone else, so you can focus on other things that a CNA can't do.

sistrmoon

Specializes in Oncology. Has 13 years experience.

We have 28 beds. We have 3-4 CNAs on days, 2-3 on evenings, and 2 usually on nights(if we have 3 scheduled on nights, they will often float one or one will be pulled for a 1:1 sit.)

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience.

20 bed ICU, 0-3 CNAs depending on census and other factors (e.g. getting pulled to do a 1:1). Most of our pts are trauma (level 1) and neuro...read: max-to-total assist, hardware, lines, tubefeeds and their resulting loose/liquid stools... Even if we have 3 CNAs, the RN *will* deal with poop. Urine too, since we're trying to get away from so many Foleys ("the Foley is not a substitute for nursing care." That was a side note, but yes, you read that--NURSING care.) And daily bed baths. In most cases, it takes 2-4 staff to do incontinence care/linen changes. In many cases it's not a matter of education, it's a matter of math; with 0-3 CNAs on the floor, there *will* need to be RNs involved. Of course in many other cases, it is a matter of education, as we take into account ICP and respiratory issues w/ laying flat and turning, strict spine precautions, etc. that the CNA *cannot* be responsible for. And somehow we manage to deal w/ emergencies too.

From reading posts here on AN, many places are going to the total-RN-care model. No CNAs.

As PPs have said, and I touched on earlier in my post, incontinence care *is* nursing care. You should have learned it as Basic Nursing, Nursing 101, Intro to Nursing Skills...whatever your school termed it.

The issue that I see in your post (and what I'm gathering the other PPs see) is that you take the attitude not of "it's really difficult to get the pts' needs met in a timely manner with these staffing ratios," but "I didn't get my BSN to wipe butts."

And I agree completely that those ratios you describe are ridiculous. And what in the WORLD are they doing, keeping a pt with a vasoactive drip on the floor?? They should be on the stepdown unit at least.