More CNA woes.

[Virgo_RN]

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?

[nursel56]

we have had some problems with our CNA's , our hospital will be going to all RN's and the CNA's will have to find employment elswhere.... it seems the cNA's have no accountabliity.. i don't mean to flame anyone... they are here to assist us , and when they can hang blood and push iv meds i will gladly pick up a tray for them ..

starting in jan, 2010 there will be no more CNA's at my hospital and our staffing will be 4 RN's to 1 patient rather than the 6 to 1 now.... there are some wonderful CNA's out there working with the patients , but there are some that just don't care. RN's have a high standard of practice, and our standard includes being responsiable for everything , and they know if they don't do it we will have to... so they don't do it ..and if we complain they get their nose all of of joint.... well at my hospital the RN's complained and the manager said " i can easliy hire more RN's and get rid of the CNA's and thats what happened...... .....

There was a big vogue for that back in the eons of time. Primary nursing vs. Team Nursing. I much prefer the Primary Nurse concept, I had 3 patients, total care. I guess it must not have been feasible economically, 'cause it seems like now it's much more common to see the Team Leading concept. The rationale was that nursing job satisfaction was higher with this, and the nurses didn't get the feeling they were on an assembly line.

[Virgo_RN, BSN, RN]

I actually did make that suggestion to my NM in one of my emails. Of course, she didn't respond. I've said many times that I'd be happy to do total care if I had fewer patients. Hiring a few more RNs would be more cost effective than keeping on several CNAs, and I'd be willing to bet job satisfaction among the nurses would skyrocket. But from what I have seen, RN retention is not a priority on this unit.

[RuRnurse?]

That sounds like a bad crew there...I've been very lucky where I work, most of the CNA's are just wonderful! As a nurse, I certainly don't mind feeding, toileting, etc, if I can, but sometimes you just don't have the time. But the CNA's where I work will do a lot of stuff they aren't technically responsible for, and I know they are often short on time, too.

But there has to be teamwork, for sure.

[treysdaddy08]

I too happen to work in Illinois and it isn't as you describe, at least not at my hospital. I answer to the management. The RN is the leader, but she is NOT responsible for what I do/don't do.

If this happened on my unit there would be hell.

I don't give a damn about their education - they get paid for it, and what does respect got to do with it? I do my job because it's my job. And yes, I sometimes ask the RNs for help, there are times I can barely manage and I see nothing strange in asking for help if I really need it. Since I'm a good CNA and always help others, I almost never get a flat refuse. Besides, I like the nurses I work with and they probably like me too

We all know this. The problem here is the management. I cannot even imagine what would happen if this was my unit...

Actually, in all states the CNA works under the en license. People seem to forget that CNA is NURSEs ASSISTANT!!! They're not thier own job, I'm sorry to say. In nursing school you are taught that, legally, ALL patient care is your responsibility, and you can delegate certain particulars about said care to a CNA. But if that care isn't done, ie if VS aren't done or are made up, it's not the CNA that the BON will go after if something bad were to happen, it's the RN. A CNA has a difficult job, but honestly if they lose thier license they can find another. If an RN were to lose thier license bc of neglect by an aid, they just lost out on an entire career and those 4 years of schooling. There is a huge difference btw cna and rn, the the aides work directly affect the rn's job security.

[kcochrane]

I agree with others that this is a management problem. IF they aren't going to deal with it, it won't change. I've worked for some great CNAs from 65 to 18 and they are worth their weight in gold. But the ones that don't want to work really pull the whole unit down. Nights seem to be the worst IMHO because my NM isn't around to see what goes on.

[KarynicaRN]

Flatbelly:

you have no respect for the nurses? what a great thing to say on a nursing forum, and to add, in LTC I AM responsible for the CNA's work whether you believe that or not. I work as the Charge nurse and I am TOLD by management that it's part of my job description to make sure the CNA's do their work

I am rather offended that you have no respect for anyone. That's really sad. I feel for your patients, coworkers and any other person working with you.

You can flame me all you want, but after your post about having no respect, I won't be answering any more of your posts. I must have really touched a nerve. Coming from a military background I guess I just have learned what the chain of command is all about and if you have never learned what it means, it must not come to easily.

[pagandeva2000, LPN]

I understand your issue. Most nurses that have been CNAs before know how hard it is to be one; especially having experienced the backbreaking labor the job entails as well as the blatent disregard they experience. It benefits us ALL, patients, CNAs and nurses when we treat each other with appreciation and respect.

On the other hand, they do have a job description and they did go to training for these positions, so, they KNOW being a CNA includes bathing, specimen collection, obtaining routine vital signs and ADL. If people assume that the nurse is to do it all each and every time, what justification does the facility have to keep them? I often feel really bad for the aides that make a special effort to do the right thing by their patients and to be great team members to the nursing staff because many times, they are stuck making up for those that don't.

Since the management does not seem to support disciplining the wayward ones, I guess that a meeting with the other nurses to discuss how to work your way to ensure that patient care is done properly may be the next agenda? I know that leaving is the best option, but it may not be an available choice right now in this economy. I think that I would do that first, while simultaneously looking for other job opportunities.

[Flatbelly]

Flatbelly:

you have no respect for the nurses? what a great thing to say on a nursing forum, and to add, in LTC I AM responsible for the CNA's work whether you believe that or not. I work as the Charge nurse and I am TOLD by management that it's part of my job description to make sure the CNA's do their work

Obviously, understanding what you read is not your strongest point. I never wrote that I have no respect for nurses. Quite the opposite, I respect almost every nurse I work with. Not because of their education - mine is superior BTW, I am in the midst of changing careers and work as a CNA while getting through nursing school. I don't respect people because of their education. It may impress me, but that's another story. I respect people for what they do. Furthermore, I find it absurd you suggest a CNA should do her job out of respect for the RNs. As I wrote before, I do my job because I was hired to do it and have strong work ethics.

I am rather offended that you have no respect for anyone. That's really sad. I feel for your patients, coworkers and any other person working with you.

You don't know me, don't know my coworkers and our relations, yet you feel sad Not to mention not knowing my pts. I am a good CNA and am liked my the vast majority of my pts.

You can flame me all you want

I have no intention.

but after your post about having no respect, I won't be answering any more of your posts.

Be my guest.

I must have really touched a nerve.

Not a bit.

Coming from a military background I guess I just have learned what the chain of command is all about and if you have never learned what it means, it must not come to easily.

Sigh

Let's not do this anymore, OK?

[treysdaddy08]

Obviously, understanding what you read is not your strongest point. I never wrote that I have no respect for nurses. Quite the opposite, I respect almost every nurse I work with. Not because of their education - mine is superior BTW, I am in the midst of changing careers and work as a CNA while getting through nursing school. I don't respect people because of their education. It may impress me, but that's another story. I respect people for what they do. Furthermore, I find it absurd you suggest a CNA should do her job out of respect for the RNs. As I wrote before, I do my job because I was hired to do it and have strong work ethics.

You don't know me, don't know my coworkers and our relations, yet you feel sad Not to mention not knowing my pts. I am a good CNA and am liked my the vast majority of my pts.

have no intention.

Be my guest.Not a bit.

Sigh

Let's not do this anymore, OK?

your education is superior to that of a nurses? How? Nurses are educated to make extremely quick decisions in high pressure situations that can save a life-or end it, if they make the wrong decision. A nurse is the last line of defense after a doc and a pharmacist when it comes to the meds a pt receives. We had better be right, and better be sure we are right, or patients may die. Please tell me what education is supirior to that?

[tattooednursie, LVN]

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.

i was a cna for 6 years in both ltc and acute settings. my duties were: vital signs, passing and collecting meal trays, transfering patients, turning patients, bathing patients, and all other adl duties. while i did enjoy some aspects of being a cna, other aspects of being a cna is what made me wish to become a nurse. yes . . . i said vital signs. routine and as needed. while it is part of the assesment, it is still okay for the cna to obtain them. i am willing to work as a team with my cna's, and i do expect that they will work as a team with me in return.

i am very fortunant to have good aides. 80 % of them i do not worry whether or not they are doing their job, because i truely believe that they would do the same quality of work even if there were no one supervising. however, there are always a few that do not do what they are asked, and would rather go sit someplace with their nose in a magazine. i do not put up with that. there is no excuse. that is their job. i will not ask them to do anything i wouldn't be willing to do myself, but i am not going to do their work for them.

there is a chain of command, and cna's do not delegate tasks to nurses. mine know better than that. i can't believe that cna texted you and asked you to help pick up trays. that is absolutly not okay!!! nurses do have their own duties.

when i was a cna, i always thought that the nurses had it easy, but i have learned quickly that they do not. that, "all nurses do is pass meds, do treatments, and chartm how hard can that be?" mentality left my head the first day of clinical.

always remember that a good cna is worth their weight in gold. those who do not do their job need to be let go to make room for those more willing to do their job.

[Virgo_RN, BSN, RN]

Again, I really do not want this to degenerate into an RN vs. CNA debate. As I've said, I was a CNA and I know first hand how tough the job can be, and I do have so much respect for the few CNAs that I work with who do their work and do it well.

I also understand that RNs are not above reproach simply due to their status. There are RNs who do not like to get their hands dirty, and will avoid as much of the grunt work as they can. I am not one of those.

What I am is a nurse who is expected to perform and document a full head to toe assessment on each of my patients within the first two hours of my shift, perform and document a pain assessment and reassessment, IV assessment, falls risk assessment, assure that appropriate careplans have been implemented, check charts for new orders and assure that they have been entered into the computer system correctly and if not, fix the mistake, administer medications in a timely fashion, respond appropriately to changes in the patient's condition, perform patient teaching regarding medications and procedures, answer phone calls from worried family members, communicate with pharmacists, physical therapists, respiratory therapists, phlebotomists, radiology, nuc med, the cath lab, take report on admits, admit new patients (perform an admission assessment, head to toe assessment, do the medication reconcilation, nurse review all the orders, fix the mistakes in the orders), start new IVs, discharge patients (fill out the discharge instruction sheet cause the docs never do, review the med list and make sure it's correct, perform patient teaching regarding their diagnosis and follow up), look at the telemetry monitors and interpret the rhythms, post the strips in the charts, and oh yes, help the CNAs pass and pick up dinner trays and take turns with them doing the ADLs, and get my own vitals, all with constant, nonstop interruption!

Oh yes, and I'm supposed to tell the patient "Is there anything else I can do for you? I have the time."

Am I leaving anything out?

[nursel56]

No, Virgo, I don't think you're leaving anything out. In fact, maybe it should be a sticky post for when people start threads asking, "What does a nurse actually do?" :wink2:

I can feel how frustrating that must be. It sounds like your unit (warning- not bashing CNAs!!) is more like a mob-rule cabal reminiscent of old black and white racket movies. It is very perplexing as to why this unit retains this culture and the others do not. I don't believe for one second that the problem is that you don't understand how hard aides work is, or lack of therapeutic communication, or the wrong management strategy, or. . .

anything other than what it obviously is.

If there is any way you can get out of this job, I would, before it sucks the last bit of life out you and your health to suffer. hope you find something better, you really deserve it.