If there were no CNAs...would that be a bad thing?

[Kunzieo]

Hi. I almost hate to start another CNA thread, as so many degenerate into a nurse-vs.-cna thing....but that is not my purpose here.

We were talking in class today about how the trend in the hospitals (here in the Twin Cities, anyhow) seems to be working toward eliminating the CNA (PCA, aide, whatever.)

I work as a PCA on a cardiac step-down unit that recently re-worked their staffing grid. They lowered the patient ratios for the RN's (3-4pts) and greatly increased the patient ratios for the PCAs (~10pts on days/eves, and ~18 pts on nights.)

Many of the PCAs I work with (and some PCAs in my class) are angry about this. (Having to work harder...not feeling as valued.)

I actually think it makes a lot of sense. I think if you could get acceptable patient ratios, nurses might be better off doing all the cares for the patient themself. And I mean ratios that NURSES find acceptable, not management.

Then nurses would have the opportunity to examine/assess the patient during bath/changing/etc. Never again would the nurse have to worry if the vitals are accurate, or if the CNA measured urine correctly, or if the blood sugars will be done in time for insulin before breakfast. This appeals to me because I always prefer to do my own work....I always worry that it wasn't done "right" or well enough when I have to work with partners.

So...my question is...

Does this appeal to you at all? Why or why not? What kind of unit do you work on and what would your patient ratio (or accuity level) have to be in order for this to work for you?

Thanks!:redpinkhe

[Semperdave]

For the record: I am a CNA.

I think in hospitals, if the pt:nurse ratio were low enough, that would probably be better from a nursing and patient standpoint.

That said, I don't think there is an LTC in the world where that would work. With pt loads around 25 or more, and all the crap nurses have to do besides pass meds... Might work with 50 nurses in our facility. Instead of 4 or 5. The cost would be soooooo extravagant... and I would be out of a job.... Bad idea... sorry to ramble...

David

[bethin]

It would be for me. I've had this job for almost 7 years. The hours are great, the pay isn't but it's better than retail (at least I hope so).

I work primarily med/surg and ICU. I get vitals, blood sugars, report any abnormal findings to the nurse. I ambulate, I answer phones and relay messages. Even if a nurse had 3 patients and no aide, she would be responsible for baths, turns, toileting, admissions, vitals, blood sugars, returning phone calls, answering questions for family members that an aide can give out such as the pt's last bp. Even with with 3 pt's that's alot of work for a nurse. Plus, assessments, new doctor's orders, IV's, etc.

I can't help but thing a nurse would cringe if she was up to her eyeballs in new orders and a pt asked for a coke or snack. Sometimes as an aide when I'm super busy with important stuff (pt circling drain, nurse needs help stat) and a pt needs a coke NOW.

Granted, I can't do half of what a nurse can but I can help out with the little things. I ALWAYS ask nurses if there is anything I can do to help, within my scope of course.

[bethin]

And it's the aides responsibility to restock rooms, dressing carts, etc. Just another thing to add to an already demanding nurses day.

[Dolce, RN]

This might sound bad, but I would much rather work a little short on RNs/LPNs and have plenty of CNA support staff. There is something so nice about having a "team" effort where I can ask my CNA to do things for me and we can go from room to room with our patients, doing cares together, repositioning patients, etc, etc, etc. I love my CNAs and I hate a shift where I have to work without one. I had a shift recently where I only had 4 patients but no CNA and it was terrible. They do so, so much for us.

Don't take away our CNAs!!!!!!!!!!!!!

[rnmi2004]

I work as a PCA on a cardiac step-down unit that recently re-worked their staffing grid. They lowered the patient ratios for the RN's (3-4pts) and greatly increased the patient ratios for the PCAs (~10pts on days/eves, and ~18 pts on nights.)

Many of the PCAs I work with (and some PCAs in my class) are angry about this. (Having to work harder...not feeling as valued.)

My hospital is actually looking into reworking the staffing grid similar to what you mentioned.

My night can be helped or hurt based on the type of aide I have. I can come to work & see that I'm with Aide A and know that she will be on top of her VS and reporting to me abnormals, accuchecks, if the urine output is too low--basically, she makes my night easier.

Then there is Aide B. Aide B is like having an extra patient. Even though I get with her at the beginning of the shift with requests re: letting me know about abnormals, I'm chasing her down for the rest of the shift trying to find out how my patients are doing because instead of charting VS & I/O, she is surfing the internet. If the VS are charted, the abnormals (which show up in red) have a note saying that the nurse was notified, which I wasn't. :angryfire I get the rolling of the eyes when I track them down and ask if they got that accucheck, can they please recheck a temp, are my patients making enough urine (although most of the time I'm emptying urinals & hats because they're ignored).

The "aide Bs" in my facilities always leave exactly on time, while I'm stuck charting for another hour or so. The "Aide As" are getting fewer and farther in between. Basically, reworking the staffing grid would be met with revolt if we had more of the "Aide As", but the nurses are already picking up the slack on so many of the aide tasks anyway why not rework it?

[time4meRN]

i work in ohio. one of the new hospitals in our system has no techs in the ed. i can't imagine working without them. if i'm with a critical pt , i don't want to have to worry about a pt that need a bed pan or transported to where ever. i really need that extra set of hands to do the little things that take time away from where i need to be. the nurse pt ratio in that er is 1:5 in the new hospital. i think i would just have to shoot my self if i had 5 pt's with no tech. i think it is a reflection of what the powers' to be think of the nurse, and what we really do on daily basis. i think it shows how disconnected they are from the trenches of the hospital.. seems admin always forgets what type of buisness we are in. they get caught up in numbers, making the place look like a hotel, making people "happy", but forget that mean while we are caring for the dying, criticaly ill, getting cursed at, asked to work overtime, working with no breaks , insurance cut, etc...you know the story. but the place sure looks nice.

[MoopleRN]

I find all these responses interesting. I've been a CNA, an LPN and now an RN. I have a LTC hx and can relate to much that's been posted from both sides.

We NEED CNAs. Good ones. Just as we need good nurses/physicians/PT/OT... We really are a TEAM EFFORT to provide quality pt care. Having said that, it's the CNAs that form the basis of that care. We need to make sure they understand how valuable they are not only to us but to the patients. We need to supervise them, yes, but we also need to accept their feedback as valid and give them input on what else to look for/teach them so they can further aid us in our assessments. It truly is a team effort.

We also need to be assertive if they're NOT doing their job. Some nurses/CNAs slack off, some don't. Be the one who doesn't slack off and try to inspire the one who does. If that doesn't work, CYA!

[loriangel14, RN]

We have no CNAs or any kind of aides or techs up here in hospitals, only in LTC. We just have nurses that do primary care for our patients. I enjoy being the one that provides all the care, i find it makes it easier to assess and really see what is going on with my patients.

[nyapa, RN]

We have no CNAs or any kind of aides or techs up here in hospitals, only in LTC. We just have nurses that do primary care for our patients. I enjoy being the one that provides all the care, i find it makes it easier to assess and really see what is going on with my patients.

This is my situation. Yes, I do enjoy providing care. But I am oh so grateful if another nurse, or our one seriously overworked solitary PCA can help a patient when I am flat out. If you have CNAs then as a team you can all provide care. And all team members should be respected equally.

Just out of interest,

1. what is the

• CNA : patient ratio on a morning shift, an afternoon shift and a night shift respectively
  
• nurse : patient ratio on a morning shift, an afternoon shift, and a night shift
  

in a ward staffed with CNA's

2. what is the pt:nurse ratio without CNAs?

And in hospitals which don't have CNAs, what is the nurse : patient ratio

[catlynLPN]

What you're describing is a problem with a particular person (or persons), not with NAs in general or their value to the healthcare team. What should be done in a case such as yours is they need to be counseled to either do their job or they'll be terminated.

I've known of some damned lazy nurses who sit on their tails and don't do their work, but I wouldn't suggest getting rid of all RNs.

I did not say this was a problem in "general" with ALL CNA's, if you completely read my post you would see that I SAID, "I know that all CNA's are not like this. "

Enough said. Thank you for your remarks.

However, EVERYone, has an opinion, even myself, and my opinion is that a team of licensed nurses could do a better job together.

THAT IS MY OPINION and I'm entitled to it. HOWever, I have enough common sense to know that it will never happen, so I deal with reality. In reality LPN's are more likely to be eliminated than CNA's, so I'm just biding my time to get my work career over and get into retirement.

[burnoutward, BSN, RN]

I will be honest there are great CNAs and then there are CNAs that the hospital would do better letting them go.

I work with a couple CNAs that make my job so much less stressful. If they need help they ask and if I need help they ask. We work hard and our patients are treated like gold.

On the otherhand, there are some I hated working with. One in particular made work hell for me. I would end up doing parts of her workload while trying to handle all 6 of my patients. Only to find her gossiping or talking on the phone to her family. Then the kicker to say the nurses don't do anything or help her.

I can do everything a CNA can do, maybe not as fast as most like, but if I have a good CNA on my shift I know I won't have to worry if my patient received the highest quality of care that we could give during my shift. Afterall that is the goal at work.

[UM Review RN, ASN, RN]

I've worked with techs and without. Count me in with the all-nurse team.

A good tech is very valuable. In general, I've identified three types of CNAs -- the rare career CNA who's experienced and awesome to work with, the CNA who's passing through on the way through nursing school, and the CNA for whom it's just a job.

The career CNA anticipates and is proactive for the patient. The nursing school CNA is too busy reading the charts and second-guessing the nurse's decision to do much actual care for the patients, and the CNA for whom it's just a job has lost momentum and motivation and spends the shift in absentia or complaining about the nurses, the patients, the family members, and the amount of work that she has to do -- all by herself, of course.

Frankly, I'd get done faster without help in most cases. I don't need the added stress of trying to play hide-and-seek when someone needs to be changed or when vitals are due.

A good tech is absolutely priceless, but because there are so many that are not that great, I'd really rather not use them at all. Yes, I'll be sorer at the end of the shift, but I'll know that my patients got the best care possible.