would you be mad at your CNA?

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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?

Specializes in MS Home Health.

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

renerian

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Specializes in Home Health Care,LTC.

I would be very happy that you saw a need and took action. I would have liked for you to have interuppted me in my meeting so I could have asssesed the pt. myself also. (unless I had let you know there was another nurse in charge while I was gone ) Keep up the good work

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I would have been proud that my CNA had used her common sense and cared so much for her patient. Keep up the good work!

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I think it is great that you recognized the acute change in your patient. Usually a cna is the first person to notice a change in a LTC resident. However, taking the time to go get a pulse oximeter machine and "assess" the patient yourself BEFORE sending for a nurse is really out of your scope of practice. I would have wanted my cna to stay with the patient and turn on the call light to seek help.

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Specializes in Mostly LTC, some acute and some ER,.

Shame on you for doing the right thing!!!!!!!!!!!!! J/K. That nurse had no right to yell at you. I am a CNA myself, and was put in simmalar situations. The thing that I observed from your post is that the nurse you got was from another unit, and she was probably just being whiney for having to take care of an important task on another unit. Maybe she's one of those who is against helping fellow nurses.

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Specializes in LTC, home health, critical care, pulmonary nursing.

Okay. The nurse I went to is the nurse who was left in charge. I knew all the lady's orders, and PRN O2 was ordered, but per agency policy, a CNA cannot make the judgement that a patient needs it. Therefore I found a nurse. My DON and ADON said I was 100% in the right. They both said it was NOT out of my scope of practice, that was the first thing I asked. Thanks for the replies, and to TriageRN for some good info!

BHolliRNMS-I happened to have the pulse ox in my pocket.

And to butterflynurse, I'm doing prereq's right now. Finals tonight!:)

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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!

Good info.......:)

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Specializes in Utilization Management.

Good job! You'll make a terrific nurse!

Our CNAs are required to take O2 sats, so I don't know where that other nurse was coming from.

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