More CNA woes.

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Some of you are probably already familiar with the culture on my unit, where CNAs are permitted to perform abysmally with no consequences (this has been the culture for years). Float pool nurses and nurses from other floors have refused to float to our unit because of it. Good RNs have left the unit because of it.

Not very long ago, the aides made it clear that they expect RNs to *take turns* with the "toilet Q2s" and the "turn Q2s".

Well, now they're complaining that some RNs delegate all routine vitals to them, and we're going to reevaluate our VS protocol as a unit, and they're requesting that RNs help with passing and picking up meal trays.

It's one thing to help out with this stuff when I have time, and I totally don't mind, but this is getting ridiculous. It's not like I sit on my behind picking my nose while the aides scurry around. I have missed many a dinner break and have had to stay late to finish charting on many an occasion, yet the aides *always* get their breaks and get out on time.

They take a half an hour to give CNA to CNA report, while call lights go unanswered that entire time. What if the person is having chest pain? What if they are bleeding from their groin site?

I even recently overheard one CNA saying to another "We don't do VS. That's part of the RN's assessment."

Then, last night, while I was busy in a room with patient care, my wireless started ringing in the middle of what I was doing, so I looked at it before silencing it (instead of throwing it out the window, which is what I really wanted to do), and it was a text that read "Please help pass trays".

Is this normal? Am I crazy to think this is absurd?

nerdtonurse?, BSN, RN

3 Articles; 2,043 Posts

Specializes in ICU, Telemetry.

Time for a new job, sounds like. Because if a pt had a bad outcome because you were passing trays or changing a patient, it's not the CNA that's going to lose a license.

If they don't want to toilet,turn, feed or do VS on the patients....just what is it that they think they are supposed to be doing? Assessments? Pass Meds?

Sounds like the inmates are running the asylum. Time to go....

Chapis

400 Posts

Specializes in interested in NICU!!.

what all do cna are entitle to do? i thought taking vs and doing food trays was part of their job, so if they don't do that, what do they do? don't flame me, i'm just asking as i don't know.

Virgo_RN, BSN, RN

3,543 Posts

Specializes in Cardiac Telemetry, ED.

I don't know what they think they're supposed to be doing. They have 9-10pts apiece, do not have to do baths, and only have one meal on our shift. I had one incident where I was all dressed up in a contact room and needed help to clean a bedbound patient who had soiled herself, so I put the call light on. I busied myself with other things (and there was plenty; she had TPN and lipids, a PCA, IV abx, PO meds, etc.) while I waited for help to arrive. After ten minutes, nobody came. Then, I saw the aide walk/right/past the room. I called after her and asked her to come in and help me, and she said "In a minute, I have to pick up meal trays". A different aide, who was on her dinner break and just happened to be walking by, came and helped.

Another time, it was time for one of my patients to walk after having his PCI, and I had been so busy I needed the aide to do it (plus it's their job) so I could catch up on my work. I had to track her down because she was not answering her phone, and when I asked her to get the patient up and walk him, she said "I can't right now, I'm doing my garbages."

Another time, I was watching another nurse's patients while she was at dinner, and one of her patients wanted to shower, since she had had a smelly accident earlier and didn't feel so fresh. I asked the CNA to shower her, and the CNA replied "They showered her on days. I'm going to dinner." and then promptly walked away. I showered the patient myself.

I swear/to/God I am not making this stuff up.

abbaking

441 Posts

Specializes in Telemetry, Med-Surg, ED, Psych.

Sorry for your situation....I understand it is stressful. I was a CNA for a long time so I understand there point of view. When the CNA makes a statement about vital signs being an RN assessment - at least on my floor - that is correct. The RN should be responsible for doing vital signs for procedures like blood/plantlet transfusions, chemotherapy, and blood pressure medication administration.

However, CNA's need to work cohesively with the RN's to make sure all essential patient care is preformed in a timely manner....Making sure that routine vital signs are done on time and appropriately documented.

I think it is also important to note that CNA-to-CNA report usually does take 30 minutes (my experiences) because the CNA usually has a large load of patients to care for. When I was working as a CNA, I wanted to know all information I could so i could plan my care and provide all that I could offer. As RN's we sometimes forget that while we have 4 or 5 patients, the CNA sometimes has 20 patients by themselves!

In essense Its all about proper communication. Sometimes what I thought would help the RN do his/her job better made it worse - How was I to know that you did not want me to empty the JP's in 302? I went by my usual routine of emptying the drains, and catheters. Open communication is key - Thankfully nobody got hurt or injured with this type of communication breakdown.

Virgo_RN, BSN, RN

3,543 Posts

Specializes in Cardiac Telemetry, ED.

Abbaking, I am talking about routine VS. Our aides have 9-10pts. And, I was an aide *on this unit* prior to becoming a nurse, so I understand their POV as well. I often had 12-16 post OHS pts when I was an aide, and still did not expect the RNs to do my work. When I worked in LTC, I had upwards of 20, and the nurses did not help.

Not saying it's right to have that many, but for an aide to whine about having 9 patients, most of whom are walkie talkies, does not induce any sympathy from me, because I know what a heavy patient load as a CNA is like, and this ain't it.

abbaking

441 Posts

Specializes in Telemetry, Med-Surg, ED, Psych.
Abbaking, I am talking about routine VS. Our aides have 9-10pts. And, I was an aide *on this unit* prior to becoming a nurse, so I understand their POV as well. I often had 12-16 post OHS pts when I was an aide, and still did not expect the RNs to do my work.

Struck a nerve there......

RN's and CNA's should be working together cohesively - No CNA should expect the RN to do his/her job and vise versa. Its all about teamwork and proper communication.

Ity sounds like you should confront those individual in question and bring the managers involved

Virgo_RN, BSN, RN

3,543 Posts

Specializes in Cardiac Telemetry, ED.

Other nurses have confronted individual aides, which has resulted in shouting matches in the hallway, and management is totally aware. Some aides will *not lift a finger* for your patients if you get on their bad side by confronting them. Aides have been told by management that refusing a delegated task is not an option, so instead they don't outright refuse, they just quietly go about *not doing it*. Seriously, things are *****. Either that, or I'm nuts and this is all completely normal.

I should add that there are a couple of good ones that I feel really fortunate to work with when we are assigned together, and I have made sure to let my NM know about them (and thank them profusely for their excellent work). However, they are the exceptions to the rule, it would seem.

Anyway, this is all background info. The latest thing is the meal tray thing, and it just feels like the last straw. I never had a problem helping to pass and pick up trays *when I had time*, but to have it be a requirement in addition to everything else I do.....well, it's just mind boggling to me that management is not backing the nurses, and not drawing a line *somewhere*.

libbyjeanne

110 Posts

Specializes in med-surg.

Wow. After reading all of these posts, I really feel blessed with the CNAs I have. I have no idea what I would do if I were in your situation, but I do believe in killing them with kindness. It amazes me that management wont do anything about this...especially since it sounds like its effecting the patient care on your floor. Not good...

Virgo_RN, BSN, RN

3,543 Posts

Specializes in Cardiac Telemetry, ED.

Anyway, I really don't intend for this to be a CNA vs. RN debate, as we've already had plenty of those on this board, and this is an issue specific to my unit. I truly do respect those hard working CNAs who are reliable and put the best interests of the patients first. I was a CNA myself, and so I have walked in their shoes. I know how hard and thankless the work can be.

My real question is whether the environment on my floor is par for the course, or whether it is an exception. According to the nurses and aides I have chatted with, my floor is the only one in the entire hospital where the CNAs "get away with murder". Whenever a CNA floats from another unit, my routine VS get done, my patients get walked, meal trays are delivered and picked up, patients get HS care; everything is done without my having to "delegate" it or do it myself. Somehow, these aides find the time to do all of this, and I don't have to ask. They just know what to do and they do it, no whining, no huffing, no problem.

leslie :-D

11,191 Posts

if you're with a patient and receive a text to 'help pass trays', ignore it, and continue on w/what you're doing.

you need to act like you're the one in charge, and not the aides.

keep your cool: do not become flustered.

just do not acknowledge the texts.

why is mgmt supporting this?

leslie

RN1982

3,362 Posts

Specializes in ICU/Critical Care.

Amen to that, Leslie. My aides do not pull this type of crap with me. They know that they are expected to empty urine hourly, check glucoses and stock as well as assist the RN with turns and baths. They are also expected to answer call lights. They have it easy as far as I'm concerned.

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