No Nursing Care?

WalkieTalkie, RN · Jan 9, 2009

Sometimes this is so true. For example, I once got a patient from the floor who coded and died about 20 minutes after I got him. I spent more time (at least an hour) doing paperwork, which is 3 times the amount of time I spent caring for the patient.

This seems especially true in the ICU, where it takes about as much time to do the documentation that goes with giving certain meds and blood/blood products, as it does to actually give them. Meanwhile, the poor patient may think you are ignoring them, when actually you are taking care of all the details to ensure that their care and treatment is being done in the "proper" manner, and that all the rules and safety regulations are being followed. *sigh*

RN1982 · Jan 9, 2009

I think it depends on the area where the nurse works. I provide total nursing care because I work in SICU. I don't always have a CNA available to assist me. The same goes for when I worked on a stepdown. When I go in to do my initial assessments on my patients that are sedated I make sure that they are not soiled, have been turned and are covered with a warm blanket. Now doing all that depends on the status of the patient. I obviously am not going to stimulate and move a patient who is unstable. If I have a patient that is a little more independant and can move on their own, I make sure to ask if they need an extra blanket, more water and make sure to remind them to shift their both around every hour or ask if they'd like a pillow to help get them off one side or the other. Some nurses don't have time for doing all that especially if they have 8-10 patients and have to rely heavily on CNAs for help.

CoffeeRTC, BSN, RN · Jan 9, 2009

Yes and no.

Some days I find I really wasn't able to do "hands on care" but others...it feels like that is all I am doing. It ebbs and flows. When I do get a chance, I make sure I spend a few minutes with my patients/ residents. It really only does take a few minutes to help someone into bed from a chair or take them to the bathroom or help them get changed.

Yeah, sometime those few minutes are few and far between.

Nursing is an awesome career, there are tons of opportunities for you...don't give up. It will be worth it. (I still eat ramen noodles and keep the thermo down to 65 tho, LOL)

casi, ASN, RN · Jan 9, 2009

I'm in the same boat as you much of the time. As a CNA I love that one on one time with patients. I can't help but think that maybe something I'll miss once I get the RN.

fuzzywuzzy, CNA · Jan 9, 2009

I know exactly what you mean. I love being a CNA in LTC. If I made more money I would do this forever and get my degree in art history (and then just never use it, haha).

allnurses Guide · Jan 9, 2009

I would stay a CNA if I could be paid more... no doubt about it. I always said, "Nurses get the money, but CNA's get the fun part!"

JB2007, ASN, RN · Jan 9, 2009

As an RN in LTC I miss the resident care the most. I liked being able to spend time with the residents. I also feel like I knew what was going on with my resident better when I was a CNA. I saw their skin everyday and the residents would have the time during care to talk to me about what was going on in their lives. That goes to show you how much the nurse has to relie on the CNAs to be our eyes and ears.

BlueBug · Jan 9, 2009

Keep at it, advancing your education and becoming an RN will be worth it. Nurses do provide care, even if it is at a different level than what you are used to as a CNA. I have my BSN and work in a med/tele unit and provide alot of the 1 on 1 patient care you describe. Sometimes I don't have a CNA to help and do total patient care; thus I provide ALL the care to the patient. When I do have a CNA to help out, I always make sure they know I will help with anything they need. Helping to bathe or toilet a patient is an excellent opportunity to asses the patients skin condition. How are they tolerating movement/activity? Is there a change in the mental status of the patient? I help to pull them up in bed, prop them with pillows, and bring ice water. I talk with the patients and get to know them when I can. I talk to them while assessing them, I can learn all sorts of things while I inspect a person's feet and legs, and not just the condition of those feet and legs. I learn about the patient's family, life, hopes, and fears. I know that many nurses do not do this, and it is a shame.

Not all the working environments are the same, and there is a lot of varience for the same type of nursing in different hospitals, or within the same hospital and different shifts. One med/surge floor at hospital A may be worlds different from hospital B. Day shift and night shift can be totally different in their attitudes. You might have to look around and try a few different areas/hospitals, but I think you will be able to find a position that lets you do all that you want.

Remember, everyone who works in the hospital provides care, we just all fill different little aspects of that care. Becoming a nurse is a big change and is moving you out of your comfort zone. I think that if you follow through with this you will be happy and see that you will have more ways to show you care in addition to the things you do a CNA. Nobody says you can't help arrange pillows or get a blanket, you just have to be the nurse that still sees that as being part of her job... I do. :)

~BlueBug

wanderlust99 · Jan 9, 2009

I wouldn't be a CNA again if you paid me the same salary I get now.

No way!

As the pt's nurse you provide complete pt care. You really are that pt's advocate and that is a good feeling. Once you figure out that you have to be excellent at time management, you will have time to give pt care. A lot of my time is spent on a computer charting, but it's important not to spend too much time out of your pt's room.

I work in an ICU, and at my current hospital we don't have CNAs. I give all of my baths, feed my pts, help them to the bathroom, etc... Another nurse will help me turn my pt.

As a nurse, you will give the majority of pt care, not the CNA. (the good nurses anyway)

You will learn to balance it. It took me awhile, but I'm figuring it out. Keep checking in on your patients. Let them know that you are watching them lol. I promise it makes them feel better. Talk to them, ask them about their lives while you do your first assessment.

I feel like I give 1,000 times more pt care now than I did back when I was a CNA! Not to mention you are giving their meds, educating them, making sure the doctors are doing everything right, etc... You are basically managing their care and making sure everything is done right...and that is a GREAT feeling.

Just wait until you save someone's life because of your knowledge as a nurse...

Daytonite, BSN, RN · Jan 9, 2009

CNA_Timmy. . .RNs are managers and supervisors of patient care. That has always been our job. As an RN you make decisions about what takes priority and delegate patient care. When an RN performs actual hands on care it has many reasons behind it and not just to make the patient comfortable. You will learn all about this when you go to RN school. If all you want to do is provide direct care, then stay a CNA. If there is more to you and you have the ability to think and solve patient problems in nursing care, then you want to further your education and become an RN. There is much more that you need to learn yet to help understand the larger picture.

I agree with you that nothing beats the feeling of bringing a warm blanket to a little old lady or propping up pillows under the kid who was in a bad car accident. However, playing successful phone tag that actually saves a patient from being stuck needlessly and painfully a second time for a blood specimen or to report a terrible pain in a patient's chest that turns out to be the start of an MI that gets treated immediately also comes with a huge feeling of satisfaction--and only an RN, unfortunately, can manage those problems. If your grandmother was lying in bed complaining of being cold and having terrible chest pain would you want me to take care of her chest pain or bring her a blanket first?

Stay in school. Keep on with your studies.

nursemike, ASN, RN · Jan 9, 2009

When I was in school, a CNA friend made the same observation, and I sagely advised her that the nurses you see charting all the time are the ones who want to chart all the time. Boy, was I ignorant! Turns out, there's a good deal of truth in what you say, but it isn't as bad as it looks. First year or so, it was a pretty big struggle to get all of the "busywork" done--well, passing meds and doing assessments aren't exactly "busywork," but they can seem very task-centered, and charting, while important, sucks. But I find that as I get better at the basic tasks and at managing my time, I do have more time for the "fun stuff." Part of what made med passes and assessments time consuming was that I always was inclined to be a bit chatty while doing them. I did, and still do, make sure the pt knows what they are taking, and why, but now that I'm better at getting the pills out of the packaging, I can also ask how they are feeling and do they need anything.

I work on a neuro unit, and neuro checks are a big part of my assessment. I do ask every patient who they are, where they are, what day it is, are they in pain, etc. But, with most, by my 0400 checks, I can "disguise" my neuro checks as more natural conversation, check pupils without a flashlight, estimate strength in extremities as I help them to the bathroom. And while a lot of charting does require actual thought, there's a fair amount that's just mechanical stuff you can whip through pretty quickly.

It also helps to have a good relationship with the aides. If they know I'll help with baths and toileting when they need me, they'll also let me know when they are doing them (even if they don't need me) so I can get my skin assessment done at the same time.

It sounds weird to say you can find shortcuts in nursing that allow you to spend more time caring for patients, but there's at least some truth to it.