would you be mad at your CNA?

So yesterday, my nurse was in a care plan meeting. I'm merrily doing my last rounds and I go to turn a lady who wasn't doing so hot. She was obviously having trouble breathing, so I checked her O2 sat. Which was 80. I can't just decide to put her on oxygen, so I trotted over to the next unit and asked the nurse to come check her out. She gets mad at me and says that I never should have checked the O2 without the nurse's permission. She looks at the lady and says "Well, if she's on comfort care you can't check O2," which isn't true, and "If she's a DNR you shouldn't check it" She puts the lady on 2.5 liters.

So was I totally wrong to check it in the first place? My nurse came back and said I did the right thing, that some nurse's have the attitude that if you don't know about it you don't have to treat it. But the other nurse was quite bent out of shape. Would you be mad at me if I was your CNA?[/quote

No, you did the right thing. Don't worry about it. Just keep up the good work.

I would not be mad at the CNA but I think checking the O2 sat yourself would set you up for liability if you did not report the situation. I know in this case that did not happen. I would prefer you interuppted my care plan meeting, let me evaluate my own residents respiratory distress and act from there. It sounds like you are a very conscientious CNA and one I would love to work with.:)

You did a right thing when you used your judgement and asessment skills when you saw your patient being in respiratory distress. I just don't understand if the RN for that pt. left the floor for the meeting, why didn't she get another nurse to cover her patients?! This is extremely unprofessional and dangerous practice. Emergency can happen any minute and you shouldn't have to go to another unit for help! Also it would be appropriate to page this RN to return to the floor. I'm sure her meeting was not as emergent as a respiratory distres her pt was having. I hope this helps.

NO you were not!!!!!!! And just FYI too...DNR doesn't mean don't check either!!!

You don't need a nurses permission to get a pulse ox in most places..so check with your nurse! I would be very upset if I get called STAT to a blue woman and my CNA didn't even have the time or inclination to do some assessments in order to help the patient! In fact, I would be downright furious beyond belief! If your residents show signs and symptoms of distress..you help them, call the nurse, and get to assessing as much as you can to help speed the process! Seconds count..and there is a point where rules be da*ned if they are against doing simple assessment of your patient, your JOB and DUTY is to the patient!

By the way...wonder what she thinks ABC is all about...check that airway..then check breathing...checking for breathing can also be of benifit with use of pulse ox as well as watching for chest movement, color, consciousness..the rest! The O2...need an order and follow that order...because technically that is a med!

"Well, if she's on comfort care you can't check O2," which isn't true, and "If she's a DNR you shouldn't check it" WRONGO!!!!!!!!!

Okay on to my DNR lecture! Oh this one ticks me off all the time...if a person is DNR they do not wish to be resusitated..okay that means no bringing them back from the DEAD! No pulse and no respirations is the ONLY ONLY time you honor the DNR!!!! If they are breathing you do what you can for comfort till emergency services arrive and then it is up to them to choose what they will and will not do per patient request. They all have specific parameters and are trained in this...let them do the job..you do yours...stablize as best as you can and get the info!

If they are on hospice, you may see an order to call hospice first...then that must be done before calling 9-11. I had a patient who fell and hit her head pretty bad...I wanted to leave her there and not move her...get 9-11 on the way with c-spine equipment...and I called hospice and they said "oh heck sure!!". A fall didn't require resusitation..just some help to make sure she didn't suffer a break or spinal injury that would make her comfort during end of life horrible!

Please please please Never sit around saying "well they are DNR" and so you don't act, that isn't the point...they just don't want heroic efforts after death to revive them, and even if they don't understand that part..and really do want to die..well that isn't our call guys...that is between the Doctor and Patient..our job is to stablize and get 9-11 and let the chips fly where they may with the paramedics under advisement of the DOC!!! And thank goodness for that...it is serious CYA in our field!!!!!

Some doctors also give standing orders for not doing certain things for patients that wish for NO life saving measures what so ever..this is COMPLETELY different from a DNR. I have specific orders written (I also write them in the MAR's for easy access) that 9-11 is not to be called under any circumstance, or NO O2 under any circumstance, No IV, etc. These have to have a doctor's order and updated yearly (we do ours every 90 days). Without those specific orders...you have to treat under first aid and stablize as non-invasively as possible (a nurse can go more invasive if they feel they wish to, or can by standard protocol).

I consider watching a patient dying and not doing anything neglect and malpractice (unless you have SPECIFIC MD orders), and so do many courts of law. If they are breathing, and have a pulse..you must assess and stablize (not necessarily full CPR...we are talking positioning, O2 if ordered, making sure airway is secure and open, checking breathing, taking a pulse or bp, and things like that...). It is up to a PHYSICIAN to make the calls after that (only they can D/C treatments kids! That includes O2, feeding, IV, meds, CPR, intubation, respiratory efforts......).

Remember...it is this simple...DNR is do not resusitate (that is it..IE the Do Not Resusitate title!)...do not bring them back once dead. Advanced directives, POLSTS (pink paper in some states specific to "Physicians Orders for Life Sustaining (notice sustaining!) Treatment"), or specific orders from hospice and Physicians are a totally different thing!!!! One deals with death, one deals with the journey there!

Oh yes..and if you have a question about a particular patient's orders (not DNR..but life sustaining orders before death occurs) ask your nurse or do some reseach on your state laws! I find talking to paramedics also helps in this endevor..they know the rules better then we do...and they are the ones that get sued all the time if they screw them up...so they are an awesome source if you can pick their brain for a moment!

Just some additional info on DNR's...the definition for you 

What do CPR and DNR orders mean?

CPR - cardiopulmonary resuscitation refers to the medical procedures used to restart a patient's heart and breathing when the patient suffers heart failure. CPR may involve simple efforts such as mouth-to-mouth resuscitation and external chest compression. Advanced CPR (or ALS - Advanced Life Support) may involve electric shock, insertion of a tube to open the patient's airway, injection of medication into the heart and in extreme cases, open chest heart massage.

A do-not-resuscitate (DNR) order tells medical professionals not to perform CPR. This means that doctors, nurses and emergency medical personnel will not attempt emergency CPR if the patient's breathing or heartbeat stops.

DNR orders may be written for patients in a hospital or nursing home, or for patients at home. Hospital DNR orders tell the medical staff not to revive the patient if cardiac arrest occurs. If the patient is in a nursing home or at home, a DNR order tells the staff and emergency medical personnel not to perform emergency resuscitation and not to transfer the patient to a hospital for CPR.

Is my right to request or receive other treatment affected by a DNR order?

No. A DNR order is only a decision about CPR and does not relate to any other treatment. (THIS would include assessments...since assessments are not a 'treatment' they are not covered by CPR, therefore done! Assessing for need of CPR is vital for you to even establish that the DNR needs to be carried out...because without assessing the pulslessness and apnea you don't know if you should or shouldn't honor a DNR in the first place.)

You mean you saw a problem and reported it to the appropriate staff member??? OMG ...how DARE YOU!!!! hehehe....j/k

You can work with me anytime :)

So yesterday, my nurse was in a care plan meeting. I'm merrily doing my last rounds and I go to turn a lady who wasn't doing so hot. She was obviously having trouble breathing, so I checked her O2 sat. Which was 80. I can't just decide to put her on oxygen, so I trotted over to the next unit and asked the nurse to come check her out. She gets mad at me and says that I never should have checked the O2 without the nurse's permission. She looks at the lady and says "Well, if she's on comfort care you can't check O2," which isn't true, and "If she's a DNR you shouldn't check it" She puts the lady on 2.5 liters.

So was I totally wrong to check it in the first place? My nurse came back and said I did the right thing, that some nurse's have the attitude that if you don't know about it you don't have to treat it. But the other nurse was quite bent out of shape. Would you be mad at me if I was your CNA?

DNR does not mean you don't check vitals (O2 being a part of that).

However, some doctors will specifically write orders for people on comfort measures to not do their vitals.

In other words, you did the right thing, and the first nurse you went to didn't like it. :)

You mean you saw a problem and reported it to the appropriate staff member??? OMG ...how DARE YOU!!!!

LOL!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Too Funny.

I would not be mad at the CNA but I think checking the O2 sat yourself would set you up for liability if you did not report the situation. I know in this case that did not happen. I would prefer you interuppted my care plan meeting, let me evaluate my own residents respiratory distress and act from there. It sounds like you are a very conscientious CNA and one I would love to work with.:)

I agree.

You did a great job! I would love to have you work with me!

If you were my cna you would get my praises and thanks. I get mad when my cnas think something is wrong and don't check vitals. What you did shows you are observant and a caring person. Have you considered going into nursing school?

Even though I don't work with you I want to say thanks for being part of the team...............

renerian