Incompetent nursing assistants

[ICU, RN, BSN, B.S.]

Hi nurses.

Anyone else feel like many of the PCAs/CNAs/LNAs- whatever, do not have approriate training and competency for their job?? I did while I was working on a medical/tele floor for almost 3 years. Fortunately, I'm in the ICU now, and we do all of our VS and such. While on the med/tele floor, I encountered EVERY PATIENT had a RR of 18 or 20. I repeatedly told my manager about this; she addressed it in staff meetings a few times and sent out an email or 2, but it was never resolved. The problem continued. It annoyed me soo much because the interns/residents/attendings go by the patients vital signs. They are so important. One of the attendings actually said, "when the RR is different from 18-20, then I worry". I counted many pts that were in the 30s-40s and informed the PCAs about this; or vice versa, one patient had RR 10.

Another issue was one of the CNAs forgot to record the diastolic for my pts BP. I told her she forgot to write down the diastolic and she replied "what is that?" I explained it was the bottom number ( I guess that is all they know, about bottom or top number on blood pressure). I always thought they had much more training and understanding of what they were doing!!

I'm venting---but when it comes to patient care, safety- I can't stand the fabrication and laziness. It was absolutely ridiculous!:mad:

[tyvin, BSN, RN]

It all boils down to the pay IMO with lack of initiative following close behind. The lack of initiative is related to the pay. The problem is everyone knows how much they're going to make before they do the training to get the position. Then they get hired and realize they are doing a very important duty and getting squat for it. Nothings going to change, the pay will always be low because people keep accepting it that way.

I empathize and realize that CNAs are vital to nurses. But I've seen this everywhere I've worked. You'll get 1 or 2 aids who really care and do the job and the rest sit and read the newspaper daring you to write them up. I do ... and I've gotten in major clashes with it all boiling down to "We aren't paid enough!" Yes, I know; but you knew that before you took the job.

You want to change things ... congregate, march on Washington, write your congressmen, write papers to newspapers ... make a change.

[newlpn80]

in the past i have worked with an aide who thought all diastolic numbers, no matter the patient was 88........

[chulada77, ADN, BSN, MSN, APRN]

I have heard of facilities that have proficient CNA/Nurse Techs but I haven't encountered them at my place of work. I love it when I am reviewing the file for the care plan and see that the patient gained 5-10lbs over 1-2 days and nobody reported it or thought it might be suspicious. Many times it is not a weight gain at all but the employee's inability to do proper mathematics!!

Frustrating. Many of the techs tell me that can't do certain tasks like file documents. What good are they if they can't do anything correctly or refuse to do the work?!

[finn55]

OMG! how can you work and not know who to read or write. isn't that illegal!???!

Who the heck passed this person in her NA program, first of all?? Secondly, how did she become CERTIFIED??? The last I knew, literacy is an important element in health care. How (or who) filled out her employment application? I had the (unfortunate) experience of having a CNA who copied VS from two months prior into the current month's record. She wasn't illiterate, but purely LAZY. She had worked in this LTC forever, and had an attitude a mile long. Needless to say, when I worked charge, her attitude changed. There is no room in health care for incompetency.

[danh3190]

I agree that improved pay and benefits are good positive motivators, but at the hopital where I work they have good pay and pretty much the same benefits as me but it doesn't matter to some people. What's also needed is motivation from the other end, i.e., being called to account for poor work.

[ddunnrn]

This message thread reminds me of when I was a nurses' aide in a nursing home about thirty years ago while I was in nursing school. There was another nurses' aide where I worked who always got 60 for the patients' pulse. We couldn't figure out how she did that until we realized she was just counting the seconds go by on her watch for 1 minute. She also used to parboil the patients in our whirlpool tub by running the hot water only, and not taking the temperature of the water before putting the patient in with the chair lift. The patients used to come out so nice and red and lobster-y, I wished I had a little melted butter and a fork to go with them. She still had her job long after I left.

Later, when I was a fresh RN at the state mental hospital, the psych aides only did vital signs once a week on Wednesdays. The VS were recorded in a composition book, and it was amazing how they were almost exactly the same from week to week, except that maybe one value was off by a slight amount, so for example, the systolic was 122 instead of 120. Of course I reported this to my supervisors, who couldn't have cared less.

And of course, over the years, how many NA's filled out suicide watches and other paperwork for the whole shift, even the times they were on break, or the patient wasn't there. Yet, all of these places always passed their instpections!

[knewme]

I agree that improved pay and benefits are good positive motivators, but at the hospital where I work they have good pay and pretty much the same benefits as me but it doesn't matter to some people. What's also needed is motivation from the other end, i.e., being called to account for poor work.

Yes, accountability is definitely part of it. And that is up to the hospitals, LTCs and agencies as well. Good management motivates good employees through adequate compensation, recognition, and promotion. Without these motivators most workers lose the will to do a good job. Most CNA's do not have performance reviews and when raises do come they are usually a blanket 2 or 3% for everyone no matter their performance amounting to a paltry 25 or 30 cents an hour. So how long is a good CNA going to keep busting butt for the same treatment as their "lazier" counterparts? If the powers that be were truly concerned about any of the issues raised on this thread things would change quickly.

[IdrilRN, BSN, RN]

I once caught one of the LNa's just writing the weekly vital signs in the charts at the LTC I worked in. I confronted him on it and instead of just going to do them he apent 20 min complaining to everyone, residents too, he didn't have time to do them, Oh and he didn't have to listen too me as i wasn't the regular nurse just the floater. One wonders why he didn't make it through nursing school.

[JSlovex2]

Had to weigh in on this one as I am a CNA with 8 years experience and I will begin nursing school in the Fall. I have seen this trend with my own eyes..the CNA's lately have changed considerably. There is a lack of "professionalism" overall. I feel the training is adequate, however...it usually ends there. After training ...there are no CEU's or additional training. I think the position should pay more also...our pay in Texas ranges from 7.25-10.00...which is low when you consider that we really are the "frontline". You can make that working at McDonalds...I mean come on. There still are a few of us ..that give it every thing we have..and understand the importance of our job...but they are few and far between. I personally ...find it a HUGE incentive when I am working with a nurse that shows my position some respect...and listens when I do report something of concern... instead of "being bossy and too busy to listen to me".

I SOO agree! I am a RN now and the best thing I ever did was start out as a CNA. It has given me so much insight. I found during my work as a CNA that even when I did report something of concern that often times the nurses seemed "too busy" and there were even times they wouldn't even look up at me. Picture this scenario: you're charting on a patient when a CNA comes up and says, "sarah, the pt in room 10 has a really low blood pressure." Sarah doesn't look up, but says, "uh huh." You say, "it's 76/48 and she says she's feeling funny." Sarah says, "okay, thanks, but doesn't move." Five minutes later the rapid response team is there, there's a big "to-do" and you stay out of the way and go about your business. Five minutes after everything has calmed down the nurse manager comes and tells the nurse (while you're standing right there) "oh, sarah, the rapid response team was bragging about you! they were so proud of you for noticing the patient was in distress before it was too late, etc, etc." and sarah continues to say, "aww, thanks! i try to stay on top of things you know. blah blah blah." and NEVER mentions the fact that the patient would've gone downhill if it weren't for YOU alerting them! not only that, but they never even say to you in private, "thanks for letting me know about that patient." not good enough? you think that is "the CNA's job"? what about when the CNA walks into a room to find a patient UNRESPONSIVE and calls a code while you're sitting at the nurse's station eating lunch and haven't checked on them for 2 hours? the team comes up, resuscitates the patient, sends them to ICU, and EVERYONE on the unit is asking about/talking about what happened and the nurse talks about what was going on when SHE walked into the room? everyone congratulates her for doing a "good job" and consoles her for feeling like she "could've done more" and once again, not a word is said about the fact that the CNA was the "first responder" so to speak. these are a couple of things that happened when i was a CNA. i'm not the type of person that needs praise in order to feel like i am doing a good job, but i couldn't help but notice how my role was always dismissed EXCEPT when there was a mistake. I think it has made me a better nurse though and my CNAs appreciate the recognition that I give to them. If a CNA approaches me about something they think isn't "right" i acknowledge it (whether it's important or not) and when it IS important i always thank them and give them credit when speaking to others. A little kindness goes a long way. Not all CNAs do a good job - we all know this. Not all nurses, bankers, teachers do a good job. People don't need praise every time they do their job well, but people DO like to be acknowledged and told "good job" every now and then. So, my advice to those of you who DO have good CNAs is to TELL THEM. If you pretend like Mrs. Smith whose RR is 34 is not a big deal by your body language of not looking up at them then the next patient you have with a RR of 34 is not going to seem like a big deal to them. When they report a low BP on a patient that ends up in ICU minutes later and you pretend as though you already knew there was a problem, they aren't going to find it so urgent as to "bother you" with that information. Even if they report something that isn't crucial, you should explain to them WHY it was "okay" and thank them for telling you. it might save a life in the future. okay, i'm off my soapbox.

[UpstateNyDollCna]

I do not think you should generalize, not all nursing assistants are like this, I know that at my former job I was anything but incompetent. I happened upon another thread that you made a comment on and saw that you disrespectfully called nursing assistants "task monkeys". Just remember that just because you might have more education than someone does not make you better or more intelligent than they are, a little humility and graciousness goes a long way.

Sincerely ,Task Monkey

[nursej22, MSN, RN]

I work with some awesome CNAs and try to thank them every day. They alert me to abnormal VS as well as subtle changes in appearances. And they always leave once they finish nursing school. Grrrrr. (j/k)

But there is one that floats to our unit that does take forever to do vitals and always complains that ours is the only floor that does them every 4 hours on every patient. Now I wonder if she can read...

And there was the one who wanted wrist and waist restraints applied to her 1:1 because the patient was interrupting her television show!

[Hygiene Queen]

Good CNAs often do get overlooked for their contributions.

I tell people I'm a CNA. I either get a look of concern, distaste or a "what's that?".

I tell people I'm nursing student. Oh, well, then the response is completely different... how awesome, right?

I noticed, especially in LTC, that when a resident died or moved elsewhere, that when we received Thank You cards, the family would always thank "the nurses" for the great care, Mom was always so clean and well tended and yadda yadda yadda.

No mention of the CNA.

I suspect that, perhaps, the family didn't understand/know the difference.

But, for sure for sure, the nurses were given all the credit for it and some shamelessly took it.

But none of that should matter.

We all should have awesome respect for the fact that we have vulnerable lives in our hands.