Major venting about some CNA's

[michelle95]

First, let me say that I am not venting against all CNA's or even most...I've been one myself. I know how hard they work. I applaude the good ones.

My problem is the majority of the ones at where I work. They talk back, they leave people in messes...it's really making me mad. Just this morning, I told a CNA that was going to get my blood sugars at 5:30, to wait until at least 6:00 because I didn't feel comfortable giving insulin at 7:00 on a 5:30 accucheck. I had originally told her 6:30, but, after she explained to me that she couldn't at that time, I told her I would compromise and make it 6:00. (Sometimes our patients don't get their breakfast trays until almost 8:00 and 11-7 is responsible for the insulin at 7:00) She flat out refused. She told me that the boss said it was ok. I told her, she's not here right now, is she? You're working on MY license, not her's.

She told me no and went and got them at quarter of 6 in defiance.

I told the 'boss' when she came in, but, this is the same boss that let another CNA get away with telling me to 'shut the hell up', as well as, telling a patient to shut up. (Which is why the CNA told me to shut up...I was getting on to her for doing that)

I am so SICK of not being backed up when I tell a CNA to do something. I know I am just a little 'ole LPN at this time, but, I still expect the CNA's to do what I tell them.

I try to be fair. Like I said, I was a CNA, I know how hard the work can be....but, I didn't talk to my nurses any old way I feel, much less, tell them no when they told me to do something.

If the big bosses won't do anything, what am I to do? Go over their heads?

This is my last night tonight. I've done decided that the next place I work, I am not going to be so nice. I've got an interview tomorrow and I am going to explain to the administrator that I DEMAND back up. If I tell someone to do it, and, they snap off, I EXPECT there to be repercussions.

I hate to be so down and dirty, but, I had an spiritual experience a couple of weeks ago that made me see that every patient I come in contact with, is someone's loved one. I don't expect to see them laying in pee or dried food for hours. That is soooo undignified. If I don't take up for them, who will?

Any advice? Should I go to the ombudsman if the bosses won't do anything about these CNA's with an attitude?

I hope any CNA's that read this don't take offense. If you do your job honorable, I am not talking about you.

[Flo1216]

Nurs2B....I am a student. I graduate in June.

[Ortho_RN]

Well we are allowed to do certain things to the IVs, heck when we do I&Os we clear them out at night.. So... I guess every place is different... I just think if I can make my evening and the nurses easier then I do... But I guess that is just me..

[ktwlpn, LPN]

Originally posted by nurs2b

Well then does it make a difference to you whether the CNA/PCA is also a nursing student rather than just working as a CNA? I am just curious, not trying to start an arguement or anything...

If the student is working as a cna I would expect them to perform within that scope of practice.If the facilty has student "externs" or whatever-I would expect their scope to be a bit broader but that they would continue to perform within that scope.....As I said previously-my experience is with nurses doing the fingersticks and administering the insulin.Often a particular task is within the cna's scope of practice and the nurse in charge of the pt will carry it out herself....as I would.(No argumentative tone detected by me-it's ok to have a difference of opinion....) I think a valid point that I would like to make here is that if I administering insulin based on a fingerstick and sliding scale coverage then I am obtaining the fingerstick...Even if another nurse offers to help me out I would rather do it myself-unless that nurse is going to admin the coverage,too....In my mind it is no different then not administering a med you have not drawn up...It is not so much a cna vs.nurse thing to me.....

[rebelwaclause, ASN, RN]

nurs2b...PLEASE come work with me!!!!!! (WE NEED YOU!!!)

Hahahahaha.

And 40 units should have put that LVN before the licensing committee. That high of a dose would've turned on a lightbulb for ANY nurse to check the actual MD order. THEN, it probably would've been realized it wasn't for the patient thought of.

Duh.

[mario_ragucci]

When I here that "lighthouse pinging" noise from the IV pump, I go in and make it stop. If its displays "OCCL" then I figure the obvious. If it has low numbers on it, then i can tell the PT it is finished and the nurse'll be in to take it out.

IV pumps blow me away because I know zilch about them.

As a CNA, the areas I have purposely avoided inquires to the RN's about are IV pumps and chart. Out of respect to the RN's I would never ask a frivilous question. Think I'll have to figure out IV pumps very formally.

[chicory]

40 units could be w/in the norm if it was Lantus.

And also the intended patient was large..even 70/30 doses can be that high in a large and/or insulin resistant person.

(just my 2 cents)

[rebelwaclause, ASN, RN]

Yes Lantus is a high dose Insulin. I'm thinking of the sliding scales at my facility (different at every facility - I presume?). Our docs cut off at about 12 units (regular) and specify to notify them, usually leading to an amp of something (D5).

We do not use Lantus. Is anyone using Lantus in the hospital setting? Expensive, new and a little temperamental for an insulin.

At any rate, 40 units of any insulin deserves a quick "CYA" peek at the patients chart. Again, this poor 145 pound woman wouldn't have been subjected to a dropped BS if done so.

[charissa]

I work on a floor that is a little different than regular med surg, our staffing isnt the same, so the nurses are always used to not having a STNA, and as such doing things themselves. So when we do have one we tend to forget and end up doing a lot of the work they are supposed to. However on busy days it seems to become an expectation that we will continue to do the work we help out with more on slow days, I was also a STNA for quite a while and i know how hard they work, i always ask for tasks to be completed and say thank you even if it is their regular job duties whether it is housekeeping, a STNA or the lab, it doesnt matter everyone deserves respect.

I have found out, however this tends to give many the impression they can take advantaqe of me. Our facility has been giving RN's more and more lately as we attempt to fix a few JACHO things, this in turn has restructured some job duties, like our STNA's doing sugars for the first time. Becvause of this i have gotten a lot of flack. When i am incharge of the entire floor, and i dont have a scretary, and i am covering IV's and have a pt of my own i dont have time to do the CNA"s work that day, it is her job. Everyone on my floor answers lights and so forth, but if we are busy the STNA's tends to think most of the time that she is the only one working if she answers most of the lights. Not taking into account the Dr's I am on the phone with, the meds i have that are late, or the questions i am answering for other staff members. Everyone has a job description, and occassionally if I am having these types of problems with a STNA i will point them out. I dont do it in a rude way, but it usually takes care of the problem, and if not I just get assertive, the key is, this is our livelyhood as well,

[charissa]

I work on a floor that is a little different than regular med surg, our staffing isnt the same, so the nurses are always used to not having a STNA, and as such doing things themselves. So when we do have one we tend to forget and end up doing a lot of the work they are supposed to. However on busy days it seems to become an expectation that we will continue to do the work we help out with more on slow days, I was also a STNA for quite a while and i know how hard they work, i always ask for tasks to be completed and say thank you even if it is their regular job duties whether it is housekeeping, a STNA or the lab, it doesnt matter everyone deserves respect.

I have found out, however this tends to give many the impression they can take advantaqe of me. Our facility has been giving RN's more and more lately as we attempt to fix a few JACHO things, this in turn has restructured some job duties, like our STNA's doing sugars for the first time. Becvause of this i have gotten a lot of flack. When i am incharge of the entire floor, and i dont have a scretary, and i am covering IV's and have a pt of my own i dont have time to do the CNA"s work that day, it is her job. Everyone on my floor answers lights and so forth, but if we are busy the STNA's tends to think most of the time that she is the only one working if she answers most of the lights. Not taking into account the Dr's I am on the phone with, the meds i have that are late, or the questions i am answering for other staff members. Everyone has a job description, and occassionally if I am having these types of problems with a STNA i will point them out. I dont do it in a rude way, but it usually takes care of the problem, and if not I just get assertive, the key is, this is our livelyhood as well, OUR LIVELYHOODS ARE OUR LICENSES. WHEN I AM RESPONSIBLE FOR SOMEONE ELSES WORK AND MY LICENSE IS ON THE LINE ULTIMATELY I CALL THE SHOTS. If someone has a problem with it then in the end perhaps we are a bad working relationship and shouldnt be placed together

[charissa]

We use Lantus in my acute care facility. it is a 24 hr long acting insulin that provides a steady bs coverage over that period of time. It is regularly given in does that high, and almost always in the evening. it should not be mixed with other insulins

[jude11142]

Originally posted by Susy K

I think alot of you are assuming alot here; assuming she had an attitude?! Ok, nothing excuses an attitude, but if the nurse asked for a blood sugar at a certain time, even WITH the attitude, then act upon the attitude, DON'T risk the patient's safety by blatantly doing something against what you were told to do. I think you all lost the big picture here. The big picture is that FOR THE SAFETY OF THE PATIENT, her blood sugar should have been checked at 0600, not 0545 or any other time determined by an unlicensed personnel. Take up the issue of attitude (IF there was any) with the individual or the manager; certainly DON'T take out your anger on the patients by refusing to do cares when deemed appropriate by a licensed nurse.

So...if a physician told you in a bossy manner to give the patient a pain med NOW, would you refuse to give it NOW because he didn't ask you nice, and leave the patient in pain and give the pain med when YOU felt like it? Come on. Grow up. Give the pain med and address the physician attitude separately.

Take the blood sugar at the requested time, and LATER discussed how it was asked of you. For pete's sake. It all ain't about you, people. It's about the patient, remember?

That CNA was wrong.

Hi Suzy,

I couldn't agree more:) ....Afterall, our patients are our #1 priority, so that should be the factor here. Not, if or if not there was "an attitude".......If there is a communication problem then absolutely it needs to be addressed at the "right time".........I worked many yrs as a cna, then as an or tech, now as a lpn who is finally going for rn and I know that I don't have to tell you that there are coworkers in ALL areas that just have rotten attitudes. It doesn't have to do with "their titles".........just like any other profession, there are good and bad. Sometimes, I have "bad days", yet, I never let that get in the way of patient care and I am never disrespectful to anyone. So, as Suzy has said, "it all ain't about you, it's about the patient, remember?"......That's it in a nutshell.

JUDE

[mattsmom81]

We will all work with people with bad attitudes someday..as has been said over and over here.

Lazy mouthy nurses, docs, CNA's, lab techs, RT's...one bad apple in every group. We will have to deal with them...and the original poster was venting about this. When an entire group behaves this way, it's nearly impossible to work with them, IME.

Let's not jump all over each other, pick apart each other's posts, or find fault with one word out of 200. It serves no useful purpose.

I would bet those of us here who take the time to correspond with other health care professionals and problem solve are NOT part of the problem. If we can discuss ways to deal with these situations productively won't we all be better off?

Have a blessed holiday season, ya'll!