How many CNAs do you have on your floor?

melizerd, ASN, RN · Dec 18, 2014

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 · Dec 18, 2014

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 · Dec 18, 2014

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 · Dec 18, 2014

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, BSN, RN · Dec 18, 2014

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 · Dec 18, 2014

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.

imintrouble, BSN, RN · Dec 18, 2014

The trend where I work is fewer CNAs, expecting the RNs to shoulder the extra work load. I've never opposed "helping" CNAs. But when I'm expected to do do two jobs, one of those jobs is going to suffer. It's becoming more and more obvious, that both jobs are being performed inadequately. It's part of why I'm so burned out. I can't be the nurse I want to be, when I'm expected to be theCNA. I can't be a good CNA, when I have to be the nurse. They are two separate job positions.

The only winner here is the hospital who gets away with fewer salaries to pay. Patients have to wait longer. CNAs are being run out of the business. Nurses are graduating under false pretenses. They're entering an inflated job market that can and will demand they do more with less.

I'm not too good to wipe butts. I just don't have time.

Make my ratio 3/4-1, instead of 6/7 -1 and I wouldn't have a complaint.

crx971 · Dec 20, 2014

It's funny people say you learn it in a BSN program. So what? By this logic, say, Donald Trump should do his own accounting. Just flat out sit in the accounting office and crunch his numbers. Or plane pilot should go refuel his own plane. Just go out there, grab the hose and stick it into the gas tank of his plane.

Just because you know how to do something doesn't mean you have to function at the most basic level.

Also, the whole myth of "learning about your patient"... you don't learn squat! Just like in the examples above D.Trump can learn something about his company crunching numbers... or pilot can learn that his plane has grey numbers on its wing below... is that a useful information that he needs to fly? No. Same with pts... If you do learn something by wiping someone's butt, or spreading bedsheets, you probably didn't pay attention during a change of shift report or didn't read the chart on the patient. I have never found out anything new or useful while wiping pt butt... If a pt is in pain from rolling side to side when wiping, I don't need 30 minutes to find out about that... I can just ask aide who did it, and the answer will take about 2 seconds.

I'm pro-efficiency. I don't like stupid assignments. Making nurses do CNA work is stupid. You don't see doctors doing nurses work, do you? They could too... I'm sure it was in their program too, how to start meds etc... As I said, I'd rather have extra pt and have CNAs do stupid vitals and poops. The amount of time I'd save would give me plenty of time for doing something only _I_ can do, and while we're at it, professional development and maybe my hospital could have 20% less nurses. I don't know what you're developing spreading sheets on a bed or hooking up blood pressure cuff to one's arm.

It's a shame that most nurses kind of went with it and now we're all stuck in this poopy situation and most nurses are made to naively believe they're actually benefiting from this setup. Greatest hospital scam ever.

Here.I.Stand, BSN, RN · Dec 20, 2014

What ever happened to AN member NOADLS?

Well anyway, it looks like your mind is made up. But just a piece of advice--if you find basic nursing so far beneath you, don't plan on moving to the ICU (or stepdown for that matter.) The work DOES involve poop, bed baths, linen changes. Maybe case management or something would be better suited to you...you use your brain but don't have to wipe butts.

Red Kryptonite · Dec 21, 2014

What ever happened to AN member NOADLS?

Maybe if you say his name three times, he'll pop up and start wreaking havoc again.

SubSippi · Dec 21, 2014

What ever happened to AN member NOADLS?

Probably had to change the username, seeing as how no bedside nurse can avoid all ADLs forever!

NurseGirl525, ASN, RN · Dec 21, 2014

I honestly understand what the OP is saying, I just think she should have written it differently. I think what she is saying is that she spent a lot of money to obtain her BSN to become a nurse and she is not getting to do that job because she doesn't have enough help. For everyone who is being judgmental, you need to think about it, we are getting a degree. If everyone single one of you wanted to be a CNA, then you all would have spent much less money to become a CNA.

Yes, cleaning up bodily fluids is part of a nurses job. It doesn't bother me at all, but this nurse is frustrated because that is all she is doing and she can't take care of her more critical patients the way she needs to. I understand what she is saying and I think she may need to look somewhere else to work.

I think the OP was just very frustrated when she wrote this and her words came out wrong. I don't think she thinks she is above this work, just wants to be able to be an effective nurse that she was trained to be.