mcneillmama3 3,540 Views
Joined: Feb 5, '08;
Posts: 77 (22% Liked)
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I'm in NC and the entire process is just ludicrous. It does nothing to help ease the nursing shortage either! I had to complete EMT hands on skills testing at a state testing site back in the late 1990s and it was nothing compared to this new CNA testing. I think it's a big money racket. So many NAs are failing the hands on skills challenge on the first attempt and they have to pay every time they repeat the test. Who came up with this idea anyway? What bugs me is the books are so inconsistent across the board. They are going to learn these skills one way to pass a CNA test, and then if they go to nursing school, they are going to be taught the way we were and have to relearn everything they were taught.
I was taught in nursing school (and I've never contaminated myself or a patient) that you untie the waist strings with gloves on. Then remove gloves. Then untie the neck strings without touching your neck. Then you wash your hands before touching around your face. Then take off the mask. Then wash hands one more time before leaving the isolation room. Is that the way you learned sterile scrubbing?
That's what I told my students. They are the ones that will be standing in front of the examiner. The CNA text is inconsistent as well. Three skills state gloves "if indicated", then when it comes to washing somebody's hands and face, it tells them gloves are required. It makes no sense at all. I caught the removal process not being correct as well.
Let me ask you something-when you were taught sterile gowning and gloving, were you not taught that everything below the waist is considered contaminated? I was. So that means when you get ready to remove the gown, you should untie the waist strings with your gloves still on so as not to contaminate your hands. Then remove the gloves. Their books are telling them to remove their gloves, then untie the waist strings. It just boggles my mind. If the gloves are contaminated and the waist strings are contaminated, then the gloves should touch the waist strings, not the bare hands. Isn't that right? I got my Taylor nursing book out from nursing school and that's what Taylor states with the raitonale for why.
I love this forum. It is the best place to find practical, no nonsense answers.
I agree with GDiFiore. Gloves don't prevent the spread of infections, handwashing does. I told my CNAs, if you walk into a patient's room and it is wreaking with feces or urine, that's an indication that you should glove up as soon as you walk in the room and probably gown up too. I've actually seen BM smeared on the side rails of beds when we were only turning and repositioning, but I think we still should be using professional judgement. I don't don gloves to take a BP or pulse or listen to an apical pulse, but I DO wash my hands and clean my stethoscope with alcohol before leaving the room. For example, the making an occupied bed skill states, "use gloves if indicated." We have to be educated enough to know when gloves are indicated and when we are over using. I've worked as a flu clinic nurse for many years and the CDC pink book guidelines state that gloves are not indicated for SC or IM injections. However our employer tells us in orientation each and every year that we are to use gloves only because the public thinks that gloves prevent the spread of infection and the public expects to see us wearing them. That is not correct rationale and it does not prevent the spread of infection since vinyl gloves are not sterile gloves. Plus it is causing skin break down on my own 52 year old skin from repeatedly removing vinyl gloves that stick to my skin and take the skin off with them. It is our responsibility as nurses to educate the public the correct way and stick to the evidence based/ science based practices that work.
I found the answer to my question and I was right after 15 years of nursing. This is from the WHO website, the watchdog for infectious outbreaks, so I trust this information. If you'll look at page 3, there is a very useful pyramid that delineates when gloves are needed and when they are not needed. I'm sharing this with everyone. I figure if I'm confused by it, then others are too. I think the only raitonale for teaching bathing using gloves the entire time for CNAs is that they may lack the professional judgement that a LPN or RN would have from experience.
I worked in long term care insurance case management and care planning. I have applied at several big name insurers like United Health, Aetna, and Blue Cross Blue Shield and AARP, for geriatric case management and disease management, but to no avail. I'm from NC.
I took the ANCC Case management exam back in Dec 2011 and passed it on the first try. The ANCC study guide was very helpful. However, even with certification and 8 years experience in Geriatric Case management, I still have not been able to find a permanent, full time job in the field. I've filled out over 35 applications with several different major players and never hear back or if I do hear back, it's a computer generated Dear Jane letter stating that they have looked over my resume and feel that other applicants were more qualified. I know it's computer generated because I've received the same letter worded the same way for several different jobs within the same company. Career Builder and Monster have been totally useless, a waste of time to apply there. I finally had to give up my contract position I've held for over 8 years because the company does not pay the nurses gas mileage incentive and high gas prices were causing me to lose money, not earn money. Now I'm back to teaching CNA1 classes and working flu clinics again this fall.
I've been a nurse for 15 years in all kinds of settings-long term care, acute care, home health, geriatric case management. I recently went back to teaching CNA-1 classes and I'm confused about how the books are teaching certain skills such as bathing, foot care, hand care, and massage.
Standard precautions state to use gloves if in contact with body fluids except for sweat, and non-intact skin, when shaving a pt, when providing oral care, when providing perineal care, or if your own hands have open lesions, cuts, or injuries, etc. So why do the CNA textbooks show to wash a persons' hands and arms, wearing non-sterile gloves if that person's skin is intact and the person is not on wound/skin/contact precautions. The same book states for hand and foot care to wear gloves if there is a likelihood of coming in to contact with non-intact skin. The book states the same for a back rub. If we can touch a person's arms to take a BP or perform ROM exercises without applying gloves, then why are gloves being required to wash the same hand and arm?
My Mosby nurse skill videos I had from nursing school show the nurse bathing the arms, hands, abdomen and back only using a bath mit. Then the nurse applies gloves to wash the lower half of the body. This is the way I've always bathed my patients on the ICU. The only rationale I can come up with is that new CNAs lack the judgment to know when they should or shouldn't use gloves.
Does anyone know what the CDC's guidelines are for this? I found a chart on the CDC website which pretty much reiterates use gloves if coming in to contact with non-intact skin and mucuous membranes or for person's on contact precautions.
I'm confused too. I've got a CNA-1 manual out and it states to wear gloves if measuring an oral temp with a glass thermometer, but to use gloves if likely to come in to contact with secretion when using the digital thermometer. Why would you need to be gloved with a glass one, but not the digital one? Secretions are secretions, right? Also if you are washing your hands after contact with your client, isn't that the gold standard, the best method for preventing the spread of illness. I've never used gloves when measuring vital signs, unless it's for a rectal temp and I use contact precautions if a patient has a rash on their skin and I have to touch them to take a pulse or take a blood pressure.
When I went to ADN school we had a very big to do- separate nursing graduation ceremony and pinning= very moving. When I entered an RN to BSN program at the University, the pinning ceremony was elective. Probably most people didn't go because with a University, students attend from all over. I would have been a tiny fish in a very big ocean. I did attend the December university graduation ceremony. The university I went to divided that ceremony into and afternoon and morning ceremony by majors, so we each got to walk across the stage and have our name read aloud with our degree and our honors. The school didn't even have a guest speaker to blab and take up time either. The Chancellor said he felt like it it was more important to walk across the stage than to listen to him talk! To me that was the big deal because I graduated summa cum laude. At my son's graduation, it was so huge, no one walked across the stage, just an entire major stood up together and sat back down.
Yes the only dumb question is the question not asked that kills a patient. There is a right way and wrong way to speak to a coworker or nursing students and that nurse's behavior was uncalled for and unprofessional. My motto is praise in public and criticize in private. If a coworker ever did that to me, I would be having a pow wow with them, mark my words.
You can also expand on the SOAP format by making it a SOAPIER note. subjective, objective, assessment, plan, intervention, evaluation, reeval if needed.
And DAR-data, action, response keeps you organized.
I've always preferred soapier notes.
We used to make puzzles or anagrams (?) out of the words. For Example Lomotil: Loose stools, observe bowel function, monitor electrolytes, oral drug, toilet, intestinal distress, little analgesic activity
Ativan: anxiety, terminate gradually, IV/IM, very drowsy, anxiolytic, no alcoholic beverages
You get the picture.
Check out this website. I too was wanting to refresh on nursing documentation since I have been using pre printed forms for the past 8 years. This looks really good:
a nursing documentation template. »
I would recommend you get a good care planning book, such as Doenges or Mosby's and a book I used a lot was Saunders Pocket Reference for Nurses ( 0-7216-4459-7). I also use quite frequently on my job Mosbys PDQ for RN (978-0-323-05189-7) and a great little book we used in the CCU to help calculate cardiac drip rates is Quik Check for Critical Care Nurses by Ann P. Santa. There isn't a ISBN number for the book. You order it direct by contacting REsources for Nurses, 5280 Baypointe Drive, Powell, OH 43065. This book has lamniated charts for every drip you'll ever hang in an ICU or CCU or ER and you can carry it in your pocket. I have a very huge library of reference books now that I've worked for 15 years. I guess I need to get rid of some of it.
I recently got accepted into The University of Southern Mississippi (USM) Nursing School and I will be beginning in the Fall, 2012. I was wondering if you could offer me some advice on what to expect in nursing school, some books that will help me adjust to nursing school, and just some basic tips on just how to survive it. I am very anxious about nursing and just would like to do my best.
Thanks in advance,
We nurses get paid more because we paid more, e.g. took out more students loans and gave up 4 years of our lives to get that BSN. It wasn't a cheap education. Who would graduate a BSN program, $20000+ in debt and expect to be paid what we were being paid to work as CNAs, a training program that only lasts 147 hours here in NC. I'm not knocking CNAs. I used to be one. I used to teach CNA1 classes. Working as a CNA was a stepping stone to becoming a nurse. Psych nurses have to put up with a lot of junk on their job-getting physically abused by violent patients, being spat at, bit, kicked, cursed. By the way that's what I deal with in long term care. They deserve every penny they make and then they are still not paid what they are worth. I heard something on the radio once about if lawyers were paid what they were worth and nurses were paid what they were worth, we would be drawing the lawyers' salary!
Back to nursing school, nursing students have to tolerate being treated like POWs in a prison camp the 4 years they are in that nursing program too! Our instructors had us scared to death the entire duration of the program that we were going to be kicked out for one reason or the other. That's not to forget that every semester, we all got automatically accused of plagiarism whether we were or not. It was like being on the Survivor show. You had to outwit, outlast, outplay. The sole survivor got the money.
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