Nickle and dimed!!!!!!

[Virgo_RN, BSN, RN]

[rant] For time, that is.

I get so frustrated when I have a really busy patient, with multiple drips into a central line, piggybacks, IVPs, PO meds, incisions, and on and on, and I take my time to look through the chart, check the labs, check the meds, just so I'll have it somewhat together when I go in the room to do my initial assessment and hang a bag and give a couple of pills, ONLY to find half a dozen family members wringing their hands because grandma doesn't have any water, she's hacking up a lung and has no tissues, she doesn't have enough pillows and needs a warm blanket, etc. etc.

Now, in theory I don't mind at all doing these things for my patients. It's a part of nursing. I do these things all the time. BUT, come on!!!! The shift started an hour ago, the names on the board have not even been changed, the I&Os from the last shift are still up, vitals have not been done, where the H E double hockey sticks is the CNA????? I have a busy group of patients, I'm going to be lucky if I get out of here on time, I need to be able to get in and out and move on to the next patient. I cannot do that without help!

This wouldn't bother me if it happened every once in a while. As a former CNA, I know how busy it can be, and how you really have to hit the floor running 99% of the time. But this happens so frequently, I'm doing total care anyway. This is why I am running my tail off for the first six hours of my shift, have to choose between taking a dinner break and staying late, and can't get my assessments charted until the last hour of my shift.

I'm not blaming the CNAs. I blame inadequate staffing. But it's still frustrating, and I absolutely HATE having to "track down" a CNA to get help with a two person assist to the BSC or to pull someone up in bed. I wish that the aides could just round on each patient at the beginning of the shift so we could get everyone fluffed and puffed together, or better yet, team up with the other aides to fluff and puff the patients that take two, so the nurses can get their assessments and pass their meds safely. Heck, I'd be happy to do my own vitals if I knew that the water, pillows, blankets, pottying, positioning, fluffing and puffing, would be done.

[/rant].

[rizzle]

I hear you, sister!

[Okami_CCRN, BSN, RN]

I understand how you feel but you must also understand that in recent years the job description of a CNA has changed drastically. I know that as soon as I come on the floor I need to do vitals and put them into the computer. then start on my two page list of blood sugars. By the time that is all done its already 8 to 8 30. At the start of shift I really do not have any time to clean someone up or get them a blanket.

I know family does not make it easier but I always explain to them that even though I cannot get them what they want right now it will come in about half an hour.

Just take deep breaths and continue on with your day because as I tell myself. Every Shift Has An End.

[Virgo_RN, BSN, RN]

Just want to add that I work with some really great aides who understand the importance of their role and take pride in their work. They truly are a pleasure to work with. Unfortunately, I also work with some who do the bare minimum. The good ones have saved my bacon and made my shift so much more manageable despite the fact that they're spread so thin and can only help me so much. I appreciate that, and take care to thank them for their help.

[Virgo_RN, BSN, RN]

I understand how you feel but you must also understand that in recent years the job description of a CNA has changed drastically. I know that as soon as I come on the floor I need to do vitals and put them into the computer. then start on my two page list of blood sugars. By the time that is all done its already 8 to 8 30. At the start of shift I really do not have any time to clean someone up or get them a blanket.

I know family does not make it easier but I always explain to them that even though I cannot get them what they want right now it will come in about half an hour.

Just take deep breaths and continue on with your day because as I tell myself. Every Shift Has An End.

Our aides write the vitals on the white board and put them into the computer later. I don't really care if the vitals get into the computer promptly, as long as they are on the white board. They don't do the CBGs, the lab does. We're supposed to be doing hourly rounding, alternating hours with the CNAs, but I often don't see my CNA for several hours, sometimes the only time I see them is in the break room at dinner (if I get a dinner break; they always do). If I have to give a patient pills, they need water now, not in a half an hour. As a nurse, if the patient is complaining of pain, and positioning might be a contributing factor, I am obligated to address it promptly, not in a half an hour "when I get a chance". The level of responsibility is different between an aide and a nurse, and that's where those really great aides who understand this can make such a big difference.

The buck stops with the nurse, and that is why having reliable help, knowing that warm blankets and pillows and water and jello and fluffing and puffing will be done, is so incredibly important. I do not have time to do all of those things for my patients. If that is my focus, then they will not get their blood pressure medications, antibiotics, antiarrhythmics, on time. I will not be able to monitor that drip I'm titrating next door, or respond promptly to a patient with chest pain. I'll be elbow deep in poop when the MD returns my call about that patient who's not looking so good. I might make a med error because I am so rushed. The aides are so, so SO important!

[Okami_CCRN, BSN, RN]

I think you are twisting my words around a bit, patients can wait for water and a blanket. If they need to be positioned and there is someone willing to help be I will do it but certain things patients can wait. As a Nurse your job is a bit more mental than mine and I have to figure out who needs my help the most and the patient who is cold is ranked lower than the one who is in a ROS.

So Nancy please do not talk to me as a lazy NA. I know my job and I do it to the fullest we just have different working enviroments.

[Virgo_RN, BSN, RN]

I fail to see how my post could be interpreted as a personal slam against you. In fact, if you read my posts, I have praised hard working CNAs repeatedly.

It does sound like we work in different environments. I work in acute care, on a cardiac telemetry floor. Our patients are acutely ill and have a lot going on. Their condition can change rapidly. Their treatments are complex and their families demanding.

[Okami_CCRN, BSN, RN]

I work on a stepdown med/surg unit and I am well aware that things will change once I finish nursing school and I have always told myself I will not do med surg nursing.

I much rather work in an enviroment such as ICU where I know I can do most everything for my patient.

If the NA's at your facility only perform care and vitals there is no reason as to why it should not be done. In my facility we as NA's do specimen collection (including blood and glucose), vitals, patient care, EKG, and in my case translating all over the hospital. I am really swamped with work so a blanket is really in the back of mind when I have to run to ICU and get the EKG machine for the patient with chest pain.

I do apologize for being snippy but an NA at my facility has a lot of responsibilities that sometimes makes us focus on different aspects of the nursing care.

[Virgo_RN, BSN, RN]

If the NA's at your facility only perform care and vitals there is no reason as to why it should not be done.

That is the case. Lab does CBGs, EKG techs do the EKGs, etc. The CNAs do basic patient care. The reason it doesn't get done is a combination of factors, namely not enough CNAs and not enough good CNAs. Basically, a nurse can judge what kind of shift they're going to have by how many CNAs are on the floor and which CNA has been assigned to their patients.

Good luck in your schooling. How much longer do you have?

[Okami_CCRN, BSN, RN]

well... I gave up getting my ASN for many reasons being that I was in a school that set you up for failure. Now I am enrolled in a BSN program and I LOVE IT!!!! It feels great knowing that I go to a prestigious school with a good rep. lol but I have 3 years left.

I orginally wanted to be an MD but after working in a hospital I knew nursing was for me.

[clee1]

That's why I now work in the ICU.

I did not come into this business to run from room to room harpooning people or shoving a few pills down their throat before rushing to the next pt.; Assessing on the fly and charting hours later; ALWAYS staying late to finish something!

Having two pts, with plenty of help, means I can give excellent care without "running" everywhere. I also work nights, meaning it is rare for the "day shift headaches" to interfere.

Floor work is what gives this profession a bad name: one of these days administration will figure out that their pee-poor "customer satisfaction" scores are 99.9% due to short staffing.

[RNperdiem, RN]

What stood out in the OP's post for me is that she walks in for her first assessment and the family is all there.

Where I work, there is no family visitation from 7-8:30 day and night. That way a nurse can perform the crucially important first assessment completely away from families. This makes a nurse's job so much easier.

No visitors till 0830 gives a nurse a chance to get the shift off to a good start. Once assessments and vitals are charted, and the earliest meds are given, then a nurse can work on those other needs.