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

ERNUTBALL · Jan 18, 2004

Well, Larry I am one of the techs I spoke of. Salary renges in the MD are anywhere from $8-15/hour depending on the hospital/level of experience, etc. Some days I would say that is plenty, but others I would say its a far cry from fair. With the ever expanding patient load, especially in the ED's CNA's/Tech's are taking on more and more roles and hopefully someday the salary structure will increase as well.

featherzRN, MSN · Jan 18, 2004

When I worked at the VA, the NA's could do catheters, tube feedings, sterile dressings, apply medicated ointments, respiratory treatments - pretty much everything except IV's, blood sugar checks and medications. They went through training at the VA to do all this before starting on the floor.

Gennaver, MSN · Jan 18, 2004

Hi,

This is in response to the salary question. When my current employer first hired me they offered me something around $8.00 an hour. This is in a large hosptial with an urban/suburban patient population. In my opinion this was too low of a salary for this area and for my 15 plus years of experience so I refused it and they upped it by several dollars an hour. However two and a half years later I've only received one raise. Of course like every other compassionate and competent healthcare worker, I work my rear off too.

Jen

LPN-n-2005 · Jan 18, 2004

the one thing that sucks about having CNA/tech's doing all the thing described above in the posts is that it saves hospitals from having to hire more nurses (=more money saved). if i already had my nursing license then i would not want that responsibility hanging on my license that i worked so hard to get. what do ya'll think?

SmilingBluEyes · Jan 18, 2004

Originally posted by LPN-n-2005
the one thing that sucks about having CNA/tech's doing all the thing described above in the posts is that it saves hospitals from having to hire more nurses (=more money saved). if i already had my nursing license then i would not want that responsibility hanging on my license that i worked so hard to get. what do ya'll think?

agree. but this is a growing trend and you already said why.

SharonH, RN · Jan 18, 2004

At the last hospital job I worked, the CNAs or PCT's did not do foley insertion but it is only a matter of time before they get there as they are already trained to do simple dressing changes, tube feedings and accuchecks. This freed the nurse up to help the aide by performing duties like changing patient diapers and feeding patients. It was not unusual to be told by the CNA/PCT, "I can't do _______right now because I have to do these accuchecks, etc. and you'll have to do it yourself." And you do have to do it yourself because after all the buck stops with the nurse and if it isn't done, they don't call the CNA/PCT on the carpet. It was then the nurse's responsibility to "help" the techs by doing what was formerly the tech's job. If you complained or acted like you were too busy to do it yourself if you were say for instance, passing meds, calling doctors, or performing some other skilled treatment, then you were reported and reprimanded for not being a "team player".

Also, it was the nurses' responsibility to follow up with the techs to make sure that these tasks were actually done and done correctly, so often it was't a timesaver at all just another aggravation as they often did these tasks at their leisure. What was funny was whenever management announced that they were going to "help" the nurses by passing more of these types of duties to the techs, some of the nurses would oooh and aaaahhh and act like it was the greatest thing to happen ever. It just meant more work and responsibility for the nurse.

Tweety, BSN, RN · Jan 18, 2004

Originally posted by LPN-n-2005
the one thing that sucks about having CNA/tech's doing all the thing described above in the posts is that it saves hospitals from having to hire more nurses (=more money saved). if i already had my nursing license then i would not want that responsibility hanging on my license that i worked so hard to get. what do ya'll think?

I agree that "nurse-extenders" like techs and CNA's are a way for the hospital to save money, or to give the nurses more patients in the midst of a shortage, rather than find solutions to the shortage in the first place.

Our licenses are on the line with every delegation. As was said above the main thing is are the competent, are there documented competencies.

I learned to cath patients in nursing school the very first quarter, right after learning how to give a bath. I've been lucky. In my experiences techs doing caths haven't caused any problems. I haven't heard of any nurses in our facility with their license in jeopardy due to techs cathing patients. We're lucky I guess.

sandy06 · Jan 18, 2004

I am a CNA in North Carolina and I am not allowed to insert catheters - just clean them. Many RN's would like us to do more, but we are not permitted to do that.

Agnus · Jan 18, 2004

This depends entirely on what the nurse practice act defines as the scope of practice of a CNA. Every state has its own practice act.

Generally anything that is allowed by law and saves money in the short run hospitals and other facilities take advantage of.

The long run would be the outcomes: infection rate, injury, etc.

LPN-n-2005 · Jan 18, 2004

you know what would be really nice? on my floor for instance we have 26 beds. it would be nice to have the nurses, then maybe two techs who primary responsibilities would be the finger sticks,catheters,etc. then have 2 patient care aides who does the busy work like bring juice,towels,toileting,diaper changing,etc. but that is only in a perfect world!!!!

NYCRN16 · Jan 18, 2004

Maybe this is some strange pet peeve that I have, but I like to do my own accuchecks. I dont care whether its a tech, CNA, or another nurse doing it, but when I do that I know that it was done right (yes there are ways to do it that will make it come out inaccurate) and on the correct patient. If I am the one that has to cover the patient with insulin, I want to make sure it is accurate, and I am not giving Mr. Smith 10 units because the machine says 400, which is actually Mr. Jones's accucheck because the person taking it didnt identify the patient.

Shotzie · Jan 18, 2004

Larry, All I can say on this topic is YIKES!!!

Back when Columbia hospital system ruled the South and was expanding repidly, they decided that non-professionals could do most of the tasks that nurses do and at a lot less money. So they put in place a corporate wide program of de-professionizing as many positions as they could and suddenly nurses were supervising all kinds of people doing things like insertion of indwelling catheters...unfortunately, it seemed like such a good idea on paper many other hospitals soon climbed on board.

During a lot of that time I was working as an educator in a major hospital in Houston Texas, a major trauma center with great influence in the community. This hospital too, against the advice of the nurse-educators, began a practice of teaching CNA'a (also called "techs" for this new position) how to do catheters and a few other minor invasive procedures.

The end result is that the nurses continually screamed at having to supervise and have their license on the line for something they were not doing themselves. After about a year to 18 months the infection control and risk management departments were also screaming at having to deal with the results of this debacle. Nosicomial infections were up noticibly and we'd had a couple of lawsuits filed against us based around the techaving put in a foley.

For example:

#1. A foley was improperly placed, balloon inflated in the urethra, with a pressure injury resuting that became gangrenous, clearly accelerating the death of this brain injured patient. The family sued and won big damages.

#2. Patients w/ infections were staying in the hospital longer and requiring more meds, many times staying past the allowable mediare/medicaid days causing the hospital to lose money.

In the end, the hospital recended that policy due to the fact that they were spending a whole lot more money trying to fix the monster it created than they ever would have spent on hiring a few more nurses.

So Larry, No, I will not advise that you use nonprofessional people to do this task.