New CNA has questions for RNs re: trauma-surgical floor

[golson]

First off, I wasn't really sure where to post this, since the job I just landed is on a trauma-surgical step down floor. That didn't seem to match any of the specialty boards, so I'll post it here. If there is a better place for this topic, I'm sure a helpful admin will step in.

So, I'm a brand new CNA and landed a job working overnights on the trauma-surgical floor of a hospital with a level one trauma center. During the interview, I learned that I would have 9 patients on a typical night, with those patients split between 3 RNs. I don't have any relevant experience, just a 40 hour Army course called combat lifesaver that apparently helped me get an interview. That course focused mainly on first response to heat injuries and trauma from gunshots and explosions. They taught us how to put in NPAs, start IVs, correct tourniquet placement, and a few other things. I don't see how any of that is going to come in to play at a hospital.

Here go the questions:

I've got about a month before I start the job. I'm making sure I have the normal range for all vital signs drilled into my head. As an RN, what would you like to have your CNAs prepped on? What should I be reading up on with the time I have available? I'm not in nursing school yet, but I have taken A&P I and II, so I'm not starting from zero, just really close to zero.

Should a CNA look into getting malpractice insurance? If so, what is a good resource to get started in researching providers?

What are the most common problems you have with new CNAs?

What should I not read up on, or take with a grain of salt because it will vary from hospital to hospital or floor to floor?

[RNperdiem, RN]

Hello and congrats on your new job. One thing to learn is that many trauma and surgical patients have restrictions on positioning. Most trauma patients are put on full spinal precautions when they come to the hospital. That means the patients will have a cervical collar on, will have to lie flat, and only be logrolled without twisting their spine until the doctors give the order to clear spinal precautions. Hopefully by the time the person reaches step-down, they won't have these precautions, but you might see them.

A CNA in step-down will spend time helping patients get up. The catheter is out, the patient needs to get moving, and you will be there to help them. I used to be a CNA on orthopedics. I spent many hours of my shift assisting patients to the bathroom and back.

The most common CNA problem I have faced are the absentee CNAs. These CNAs spend a lot of time off the floor on smoke break, coffee break etc. If you are present and willing to work, we will get along just fine.

[Been there,done that, ASN, RN]

Start by getting report from the RN. Know how often vital signs need to be taken, quickly report any significant change or abnormal sign.

Answer call lights, know your patient's activity orders so you can assist them correctly.Be proactive in ambulating them and getting them up for meals.

My biggest problem with CNA's was the slackers and the ones that gave me trouble when I asked for the simplest of tasks to be done.

Just by you asking your question, I have a feeling you will do just fine!

Good luck, let us know how it's going.

[golson]

Thanks for the kind words. If simply being there and eager to learn are what it takes, I'm going to knock this out of the park.

[~PedsRN~, BSN, RN]

Good luck! The fact that you are already working on being the best, I think you'll do fine. :) Just listen, learn, and kick butt! Let us know how it's going.

[golson]

10 months on and things are going well. I'm bracing myself for the trauma patients to start coming in, since the weather has warmed up. They're a different stripe than my elderly falls and general surgery types I get in the winter. I'm just about a year away from graduation from my ADN program.

[Altra, BSN, RN]

10 months on and things are going well. I'm bracing myself for the trauma patients to start coming in, since the weather has warmed up. They're a different stripe than my elderly falls and general surgery types I get in the winter. I'm just about a year away from graduation from my ADN program.

Just out of curiousity ... what was most valuable to you in the early days of this position?

Thanks for the update, and good luck with your studies!

[golson]

Being lucky enough to have co-workers that saw a shift as a team event, rather than a clear division of tasks. Getting introduced to relatively "safe" people with altered mental status helped a bit, too. I'm not sure how well I would've done with a really off the wall 1:1 right off the bat.

[TheCommuter, BSN, RN]

Thank you for updating this thread. :)

[Lunah, MSN, RN]

I don't have any relevant experience, just a 40 hour Army course called combat lifesaver that apparently helped me get an interview. That course focused mainly on first response to heat injuries and trauma from gunshots and explosions. They taught us how to put in NPAs, start IVs, correct tourniquet placement, and a few other things. I don't see how any of that is going to come in to play at a hospital.

I am sure you have realized that while CLS might not have been specifically applicable, the qualities and skills instilled by the military — discipline, communication, respect — are relevant in any setting. :)

Good luck in the rest of your program!

[Here.I.Stand, BSN, RN]

10 months on and things are going well. I'm bracing myself for the trauma patients to start coming in, since the weather has warmed up. They're a different stripe than my elderly falls and general surgery types I get in the winter. I'm just about a year away from graduation from my ADN program.

Ah yes, the snow is gone and birds are singing...motorcycles have begun crashing, and the gang boys have begun shooting. Winter is over.