I worked over on Med/Surg yesterday. There is one CNA there who, although a hard, willing worker, takes it upon herself to blab way too much to the patients. I would be walking by the door to the patient's room and hear her giving out way too much information that wasn't really her business to be giving out. Then, when there was a crisis that came up where PT had left a fresh hip pt in his chair after ambulating(first time up), and was going to come back in 2 hours (according to pt), severe pain, pt extremely orthstatic, diaphoretic, thready pulses, light headed. When I checked the BP systolic was 70, so I turned his LR back on for a 250 fluid bolus and got two other people to lift him back in bed, then called the doc (BP went up to 100/50). Pt responded to a another 1000cc fluid bolus that the doctor ordered and was fine, he was still behind on his fluids from the surgery apparently.
I planned to talk to PT and let him know that next time a pt is lightheaded, esp his first time up, second day after sx, to not push so hard and to get him back in the room for a BP check when he has these symptoms. Well, of course this CNA had to say all this in front of the patient (to the physical therapist) before I had a chance, telling him that he was in big trouble, ha ha ha. He was very embarrassed. I managed to help him save face, and the patient and his wife were really nice (He was a very young PT guy, good learning experience for him). But, it forced me to have this conversation in the room, in front of the patient, a big no no in my mind.
I didn't want to make a stink, but I sometimes don't like working with CNAs because some are indiscrete like this. I've noticed this throughout my nursing career. Has anyone else had this problem?
i know nurses are constantly amazed with nursing assistants. they are amazed that we think we know so much, and then again, are surprised we know so little.
sounds like double speak, but this is how it works.
obviously the cna has no place sharing this info with pt or the patient. she knows too little, she may misspeak, and this is out of her scope etc.
but then there is the expectation that the cna should be pretty darn smart, knowing the nuances of what not to, and what to say.
maybe the pt asked how the patient was doing, was it safe to move him? i have had pt ask me that, knowing i have spoken with the nurse and have possibly moved him earlier. i have gone as far as to say "i'll ask the nurse for you" but often, they will say
"what have you seen?" it is not inappropriate for cnas to share observations. we just can't draw conclusions.
the med stuff and what not; educate. it is your job to let the cna know where to draw the line. much is said out of ignorance, and even sympathy for the patient.
nursing assistant are not rocket scientist, lets face it. you need to supervise and educate. i have so so appreciated the nurses who have done that for me. even the ones that have been a bit tough on me.
you could create a bond with this cna and have a real great assistant.
oh, and of course, she should have never said the patient was in big trouble!
Just want to clarify, the CNA told the physical therapist that he was in big trouble. She said this in front of the patient. She meant that the physical therapist is in big trouble with me. So, when I walked in the room, the physical therapist, who was a young physical therapist, was already embarrassed because the CNA had already told him that he was in big trouble (with me) since he had left the patient there after ambulating the patient without paying attentions to the symptoms and complaints of the patient, which were that he was very lightheaded.
My point is that the CNA should have let me discuss this with the physical therapist, which I wouldn't have done in front of the patient.
We had nurses in our ED that were constantly telling the pt's that this doc was incompetant or this one makes lots of mistakes. They'd even tell them, "I'd hold off on doing what the ED doc told you to do and just wait and talk to your personal doc on Monday". To me, it always seemed out of their scope and that's what the ED docs complained about, but they insisted they were looking out for their patients best interests.
How do you reconcile that with your scope of practice? You disagree with the doctor and think you know what should really be done. Is it protecting your patient and looking out for their best interests to tell them the doctor is wrong and they should ignore his plan and try something else? Even if you're telling them to get an appt w/their reg doc, that might take a few days.
Is this the nurse's place or stepping way out of bounds?
I will say that the ED docs aren't our regular staff. Sometimes we've only met them at the beginning of the shift and may never see them again.
Hi, I am a C.N.A and throughout my experience this past year I have learned that not only C.N.A's gossip or speak on things they have no buisness but nurses do as well. I am only 19 and I take my job very seriously. I think it depends on the person and how disciplined they are.Not everyone thinks alike.
My only bad experience with a CNA was when I was working in a doctors office for a group affliated with a large hospital in the city I live in.
She was a really good CNA, so good in fact that the doc's thought it was just fine to grab her and bring her into minor surgical procedures (done in our clinc) to assist. This was done when the RN's were all in rooms with patients.
Sounds like an ok idea right? Well, the problem is that she is an employee of said large hospital and the procedure and policies for assisting in these minor invasive procedures clearly state that a RN or LPN must assist, not a CNA, MA or PSA.
She was also asked to draw up certain meds, which is WAY out of scope for an aide.
We have JACHO at our facility right now and even though the nurse mgr has informed both the docs and the aides of this policy, they continue to do this.
The poster above made a good point about RN's realizing that CNA's might not know that they "can't" do something.
CNA's and aides must know their scope of care and their limits as per facility protocol. My issue with this is that CNA's fall under the direct supervision of the RN's when providing patient care on a floor or in a clinic setting.
The CNA was told more then once and the docs told more then once that this was against policy. They continued the behavior.
The CNA was reported and now is on suspension. This CNA would do anything for the doctors, but couldn't see clear enough to protect herself.
i know nurses are constantly amazed with nursing assistants. they are amazed that we think we know so much, and then again, are surprised we know so little.
sounds like double speak, but this is how it works.
oh, and of course, she should have never said the patient was in big trouble!
chadash makes a good point....and that is why communication is so important. if any staff of any level do not know what the expectation is, then how can they be expected what and what not to say?
[color=#483d8b]education and communiation....they go hand and hand.
I agree with Rachet....just tonight, I got asked to d/c a foley, do a dressing change, something else right now..........and I'm going "sorry, THAT'S OUTTA MY SCOPE!" I am protecting my little heiney until 18 weeks from now when I have that shiny license.....All i need is somebody saying "that guy was a little rough taking out my foley...and BOOM!
I agree, fellow CNAs....protect yourselves! It's not worth the crap to do things that just isn't in your scope.
FireStarterRN, BSN, RN
3,824 Posts
The nursing assistant should not have been the one to confront the physical therapist, let alone in front of the patient.