Is It A Widespread Hospital Practice For CNAs To Catheter Patients?

Marie_LPN, RN, LPN, RN · Jan 18, 2004

I do blood draws also, except from central lines.

Katnip, RN · Jan 18, 2004

Where I work our aides are called techs and can instert caths, draw blood, start IVs, do EKGs, and change simple dressing. On our unit they don't though, mainly because they are so darned understaffed and busy that they can barely get vitals, ADLs, fingersticks, and errand running done.

Tweety, BSN, RN · Jan 18, 2004

The techs here can insert foleys as well as discontinue them. They have to attend an inservice and demonstrate competency by doing it three times in the prescence of an RN. After that they are on their own.

However, it's not a skill many of them choose to learn. I don't work with any at the moment that are able to do it, except the one's who are in nursing school.

So the answer to your question is yes. My experience with it has been positive.

efy2178 · Jan 18, 2004

Even if your state allows this there are some things to be aware of:

1. The RN delegating to the CNA retains accountability for the catheterization being done correctly.

2. The employee who is placing the catheter should be competent to perform this procedure.

3. If the person who is performing this procedure is not competent, or there is no competency for this procedure, or there is no policy which says a CNA can perform this procedure or the RN responsible for delegating this task does not believe the person can perform this procedure correctly then DON"T DO IT! You will still be held accountable for it. Furthermore as a patient advocate you should protect the patient and be sure the one you are delegating to is competent.

An RN friend of mine was in a similar situation at a University Hospital where techs were allowed to do trach suctioning. One tech traumatized the trach everytime he suctioned it. The RN refused to allow him to do it again (much to the chagrin of the other techs who were insulted she no longer trusted him). It hangs on the RN's license in the sense that if she knows he is incompetent and still allows him to do it she is failing to protect the patient and advocate for him/her.

Check out the ANA's delegation grid on how to delegate nursing tasks.

Eileen

barefootlady, ADN, RN · Jan 18, 2004

Only CNA's with special training may insert foley's here. Used to have "orderlies" on floors who cathed males. It was considered too private a procedure for the female RN to do. That was before my time, but was common place when my Mom worked.

P_RN, ADN, RN · Jan 18, 2004

In SC there are no Certified Nursing Assistants. One is either a Nurse Technician (SNT if a student who has finished fundamentals, or a NT who has had special training) Either way everyone newly employed is required to pass Competency Based Orientation with yearly refresher and demonstration of skills. This applies to all from the NT all the way up to the Clinical specialist.

There are also PCA -patient care associates who also are trained to do ekgs, lab draws and several specialty area skills.

SmilingBluEyes · Jan 18, 2004

NO! not anywhere I have worked. NO way.

blondielaine7rn · Jan 18, 2004

No, not the CNAs. When I was in school (just graduated in Dec), I was a nurse tech on a Surgery floor. Techs were nursing students who were in or past their foundation level of clinicals. We were responsible for indwellings, in & outs, iv's, tubing changes, dressing changes, blood sugars, admit profiles, vitals, etc. The CNAs were responsible for patient care: baths, bathroom assistance, vitals, bedmaking, etc. Then we had PCAs (patient care assistant) who did little extra things like pass ice, wheel discharged patients down, bring patients things (juice, towels, etc). But no, CNAs couldn't do anything invasive.

MtnMan · Jan 18, 2004

Procedure responsibilities vary greatly depending on state nurse practice acts. In PA it is up to the institution and the competency training at the facility. Us ED Tech's at our place do catheters. Our skills vary greatly even in our department. OUr day babes do very little as far as procedures. There are more RN's on during the day. At night I do caths, EKG, phleb, IV removal, set up fluids, drips, and anything else the nurse/doc need. I had extensive training and experience as a navy corpsman and also have had to prove my skills at my current position. The staff I work with has faith in my knowledge, skills, and ability.

I guess that is why they are paying for me to go to school and plan to place me right back in the ER or in our ICU.

PMHNP10 · Jan 18, 2004

Once again, this applies to specifically TX. The following comes from the TX Nurse Practice Act.

(2) the following are nursing tasks that are not usually within the scope of sound professional nursing judgment to delegate and may be delegated only in accordance with, 224.6 of this title and paragraph (1) of this subsection. These types of tasks include:

224.6. General Criteria for Delegation.

The following standards must be met before the RN delegates nursing tasks to unlicensed persons. These criteria apply to all instances of RN delegation. Additional criteria, if appropriate to the particular task being delegated, may also be found in224.8(b)(1) of this title (relating to Discretionary Delegation Tasks).

(1) The RN must make an assessment of the client's nursing care needs. The RN should, when the client's status allows, consult with the client, and when appropriate the client's family and/or significant other(s), to identify the client's nursing needs prior to delegating nursing tasks.

(2) The nursing task must be one that a reasonable and prudent RN would find is within the scope of sound nursing judgment to delegate. The RN should consider the five rights of delegation: the right task, the right person to whom the delegation is made, the right circumstances, the right direction and communication by the RN, and the right supervision as determined by the RN.

(3) The nursing task must be one that, in the opinion of the delegating RN, can be properly and safely performed by the unlicensed person involved without jeopardizing the client's welfare.

(4) The nursing task must not require the unlicensed person to exercise professional nursing judgment; however, the unlicensed person may take any action that a reasonable, prudent non-health care professional would take in an emergency situation.

(5) The unlicensed person to whom the nursing task is delegated must be adequately identified. The identification may be by individual or, if appropriate, by training, education, and/or certification/permit of the unlicensed person.

(6) The RN shall have either instructed the unlicensed person in the delegated task, or verified the unlicensed person's competency to perform the nursing task. The verification of competence may be done by the RN making the decision to delegate or, if appropriate, by training, education, experience and/or certification/permit of the unlicensed person.

(7) The RN shall adequately supervise the performance of the delegated nursing task in accordance with the requirements of 224.7 of this title (relating to Supervision).

(8) If the delegation continues over time, the RN shall periodically evaluate the delegation of tasks. For example, the evaluation would be appropriate when the client's Nursing Care Plan is reviewed and revised. The RN's evaluation of a delegated task(s) will be incorporated into the client's Nursing Care Plan.

As I read this, it tells me if you are going to delegate this, you definitely want to be present if you value your license.

ERNUTBALL · Jan 18, 2004

In our ED Techs do almost everything except give meds. IV's, EKG's, blood draws, point-of-care urine tests, accu-checks, breath ETOH, and yes cath's (although limited to same sex). They have recently added nasal washings to the never ending list of tech skills. And yes, like most states, MD requires training and competency evaluation of all "delegated" procedures.

Havin' A Party!, ASN, RN · Jan 18, 2004

Great responses, people! Thanks again.

May I follow-up with the those indicating that their CNAs, techs, or other personnel do caths:

What's the approximate wage (or hourly range) of these folks?

Appreciate your info.