Med Surg Question

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Last semester our Med Surg clinicals were pretty rough. We had to do complete care of 2-3 patients plus RN duties, and most of the time it was pretty difficult to get assistance from a CNA when needed.

This semester we are doing Med Surg II and were informed what took place last semester was inappropriate and that it was not going to take place this semester. So, we are responsible for 100% of the RN duties and must follow our RN the entire 12 hours so we can see what they are doing etc.

Two of us Nursing Students took break together mid morning per our Clinical Professors instructions, we signed off to our RN and left the floor a 15 minute break. While we were gone one of the patients that my peer had rec'vd some order changes and wanted them done as soon as the doctor left the room. When we came back on the floor a Nurse really went off of my peer about being off the floor and having patient responsibilities etc. She was not aware that our clinical professor was behind her and some words were exchanged that the Nursing student has a right to a break and in effect the nurse is responsible for the patient etc.

Anyways, at post conference that night our clinical professor began to talk to us about the CNA's and the anger that they have with the Nursing students this semester as they have all been told that the Nursing students will not be providing personal morning care/bed making etc, that it is important that we know how to function as a Nurse this semester. Our professor told us that he works with a handful of CNA's that will refuse to make beds, do personal care etc and he has to try to fit it in between his responsibilities, and that he has a handful of CNA's that are so good to work for that he tells them to take a few minutes extra break, lets them take an extra break etc to reward them for their hard work.

Is this normal?

And please know, that I am NOT bashing the CNA's by no means, last semester there were two in particular that were wonderful to work with and helped me a great deal.

I know in a nursing home a CNA is responsible for certain things, and I assumed that in a hospital setting the same thing would apply.

I am worried that I will not be able to do my responsibilities as a Nurse plus 3 or 4 bed baths, etc while working on Med Surg.

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I've had similar experiences during clinical. We do total patient care on 2 -3 patient's, as well. Some of the CNAs continue to do their jobs and will sometimes perform morning care and 4 hour vitals. Others seem to consider nursing student days paid holidays. I'm very appreciative of any help I can get.

The CNAs are responsible for all morning care on all the floor patients when the students aren't there.

As far as breaks are concerned I see the nurses leave the floor and take their breaks in the break room and leave another nurse in charge while they are on break or lunch.

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Specializes in Home Health, Case Management, OR.

Wow I must have had a group of amazing CNA's this last rotation!! Not a one of them expected us to do their job, in fact they went on doing what they normally do until we told them that we would be taking over certain cares, then they were very appreciative of our help.

They should still be responsible for their pts, as they are the EMPLOYEE of the facility, however I have known and worked with CNAs (as a CNA) that I wouldnt put it past to pull this crap! I think it has a lot to do with jealousy, possibly the feeling of being upstaged by nursing students, though I wish they woulnt think that way. I have gained TONS of valuable information from the CNAs at clinicals. They are such a valuable asset on the floor, especially when they work together with the other staff as a team.

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Specializes in Psychiatry.
I think it has a lot to do with jealousy, possibly the feeling of being upstaged by nursing students, though I wish they woulnt think that way..

I doubt that. I've heard many PCAs/CNAs say since they see what RNs go through on a daily basis, they would NEVER want to be one. Oh, BTW I was a PCA too.

I'd be very very careful on this board about making a generalized statement like that. You could really offend someone. Many PCAs/CNAs are awesome and very proud of the work they do. For many, it is a lifelong career choice.

If you THINK they are feeling "upstaged" by you and other nursing students, you may want to examine your own behaviors and see if there are valid reasons for them feeling that way.

Just some helpful advice. I like to call it "survival tips" Just my :twocents:

All the best,

Diane :nurse:

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Specializes in Home Health, Case Management, OR.
I doubt that. I've heard many PCAs/CNAs say since they see what RNs go through on a daily basis, they would NEVER want to be one. Oh, BTW I was a PCA too.

I'd be very very careful on this board about making a generalized statement like that. You could really offend someone. Many PCAs/CNAs are awesome and very proud of the work they do. For many, it is a lifelong career choice.

If you THINK they are feeling "upstaged" by you and other nursing students, you may want to examine your own behaviors and see if there are valid reasons for them feeling that way.

Just some helpful advice. I like to call it "survival tips" Just my :twocents:

All the best,

Diane :nurse:

Not meaning to offend anyone thats for sure. I was just visualizing my own clinical experience and local hospital as i responded, and the majority of the CNA's are in nursing school, pre-nursing or would just love the opportunity to go. Haven't personally run into many career CNA's that have not made mention of having the desire to pursue nursing. So I should restate my post: My personal observation...haha! Really not trying to offend anyone so really sorry I am not meaning to!!
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Specializes in med/surg, telemetry, IV therapy, mgmt.

your clinical instructor stood up for you. the problem is with the staff. the staff was going to abuse the student and your instructor stood up to them, as he should have, and repeated the rules to the staff nurse. your clinical instructor is your boss while you are a student and not the staff nurse.

i worked in the hospitals at a time when cnas were not hired to do patient care; lpns were. we still had problems. some lpns got a lot of attitude and felt like they were doing everything and we were doing nothing. this is what happens when each is busy and can't see what the other is doing.

when i worked in nursing homes problems with cnas were a real pain in the butt and more behavior oriented. it was often like dealing with children. some cnas just have a lot of anger toward authority and display it as insubordination and all other kinds of behavior. some will sabotage their work thinking they are going to "stick it to you". because they are not college educated or licensed they are not aware of the consequences of their actions, so you need to be on your toes.

when you are supervising the work of subordinates which is what is going on when you are an rn and working with lpns and/or cnas you need to be aware of your responsibilities and the principles of delegation. as an rn you are responsible for the management of the patient's care under you. you never assume anything. you always follow up to make sure the cnas are doing their job. now, some cnas in particular don't like that. too bad. they can go back to school and become rns if they want, but until then, they work under my direction and supervision. this doesn't become too much of a problem with lpns because they have licenses to protect and know better than to pull childish shenanigans on an rn.

two books i used to help me when i first had trouble with cnas in nursing homes were

  • managing difficult people: a survival guide for handling any employee by marilyn pincus
  • working with difficult people by muriel solomon

games people play: the basic handbook of transactional analysis by eric berne, m.d. was required reading in my bsn program and helps identify how people manipulate others. it has been in publication for a very long time and should be in any library. it is difficult to read, but the description of the games is fascinating.

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I work on a 30 bed surgical unit that has one nursing assistant. Yes, you read that right, one.

Patient care is part of the RN or LPNs job in addition to their other duties. Our NA is there to help with two person care, shower the walking that need setting up, assist with feeding any elderly we might have, make beds and assist with general tasks such as limb holding.

It is expected that all nurses be able to manage am care on her patient load.

Back in the stone ages when I was a student, to graduate I had to be able to manage all the care, dressing, assessment, wounds on five surgical patients, and be able to admit and discharge as required. Our instructors made a point of telling us that we could not expect to have a NA help us and that we must learn to work as a team with our fellow nurses.

We've had problems lately with BScN students who have tried to delegate their patient care to regular staff as they are there to "learn to be RNs". Students have to remember that they are guests in the facility. Quite honestly, we don't see you as a source of free labour. Infact, there are times that we wish we didn't have students on the units, we have to assess your patients to protect our licenses. We have to check that the dressings are correct. We have two RN programmes, one PN programme and a couple of NA programmes that use my hospital, factor in the groups that come through with instructors and the students on their final placements. There hasn't been a week this year that we haven't had a student from school on our floors and it does get tiring for the staff. New faces, names to remember, trying to figure out where our charts are, explaining the routines over and over, cut us a break. The floor nurse isn't paid to have you there, your instructors and colleges are.

Well, am care lets you assess the skin, mobility and often the mental status of your patient. Somed patients only require linen and basic grooming items and can do it themselves. Total cares are few and far between on surgical wards.

And yes, I've met career NA's who are very good at their jobs and have no desire to become either LPNs or RNs.

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Specializes in 2 years as CNA.

We've had problems lately with BScN students who have tried to delegate their patient care to regular staff as they are there to "learn to be RNs". Students have to remember that they are guests in the facility. Quite honestly, we don't see you as a source of free labour. Infact, there are times that we wish we didn't have students on the units, we have to assess your patients to protect our licenses. We have to check that the dressings are correct. We have two RN programmes, one PN programme and a couple of NA programmes that use my hospital, factor in the groups that come through with instructors and the students on their final placements. There hasn't been a week this year that we haven't had a student from school on our floors and it does get tiring for the staff. New faces, names to remember, trying to figure out where our charts are, explaining the routines over and over, cut us a break. The floor nurse isn't paid to have you there, your instructors and colleges are.

Well, am care lets you assess the skin, mobility and often the mental status of your patient. Somed patients only require linen and basic grooming items and can do it themselves. Total cares are few and far between on surgical wards.

And yes, I've met career NA's who are very good at their jobs and have no desire to become either LPNs or RNs.

I understand what you are saying and I hear you. I am sure you do get tired of having students. But when you say that the floor nurse isn't paid to have you there, well I think yes you are. You are paid to work your shift and if the hospital is paying you to do your job and if the hospital decides that part of your job is to work with students then yes you are getting paid! I understand you don't get anything "extra" on the days a student is there but it is still your job. There are many jobs, not just nursing, where one has to do "extra" duties when their employer demands it and one doesn't get paid to do it.

You also said that you have to access the student's patients and you have to check that dressings are done correctly, but if the student was not doing it in the first place wouldn't you be doing it? So I would think that is not costing you any time loss.

That is just my thoughts and not meant to be rude to you at all. All nurses have my upmost respect, but they don't need to dump on students either.

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Specializes in 2 years as CNA.

Two books I used to help me when I first had trouble with CNAs in nursing homes were

  • Managing Difficult People: A survival Guide for Handling Any Employee by Marilyn Pincus
  • Working With Difficult People by Muriel Solomon

Games People Play: The Basic Handbook of Transactional Analysis by Eric Berne, M.D. was required reading in my BSN program and helps identify how people manipulate others. It has been in publication for a very long time and should be in any library. It is difficult to read, but the description of the games is fascinating.

Thank you for posting these books to read. I am definitely going to get these books. I want to be the kind of leader/manager that is fair and respectful but at the same time gets the job done. Again, thank you!!

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THank you for sharing the books, I just ordered them from Amazon.

This is where I get confused. I was a CNA for 13 years, geriatrics. I was finally able to go back to school for Nursing and after 3 years on the waiting list I decided to switch to the ADN program for Medical Assisting. I worked as a CMA for 2 years in Family Practice and decided after 2 years that I would put my name back on the waiting list for Nursing School.

That was 4 years ago, and I am finally in my 3rd semester of the ADN program.

1st semester we spent the entire semester doing CNA clinicals, and doing CNA responsibilities in a Nursing Home 16 hours a week for 7 weeks I believe. I cannot tell you what a RN does in the Nursing Home setting, because I was too busy doing care on my patients.

2nd semester on Med Surg we spent fifteen 12-hour shifts doing CNA responsibilities, with the exception of needing to be available to pass our meds, if the Nurse didn't do it first. I learned nothing related to being a RN on the hospital floor.

As of this semester counting my ADN in Medical Asssiting and four years of attending school full time I am over $30,000 in college loan debt. THat is no ones problem but my own, but, I decided to continue on for my RN, and I am learning the skills of a CNA because I need to help their workload and the RN doesn't want to be bothered with a student. Personally, I think this is a little backwards. And it is very, very frustrating to say the least.

I have only had one clinical situation where the Nurse was not happy to have a student. It was very evident, especially when she dispensed my medications to all three of my patients, because she didn't have the time to be held up. I learned absolutely nothing that day. All of my other Nurses that I have worked with have gone out of their way offering me tips and hints and most importantly teaching me, and being a mentor that I hope to be some day.

I am not at clinical to waste a working nurses time. I am at clinical to learn to be the best floor nurse and patient advocate that I can be and A LOT of that can not be learned from a textbook or a lecture, it is learned from an experienced Nurse.

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