Not sure about this setup at all

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Specializes in med surge, PCU, Tele.

I am a new nurse (Dec 2012) and am 5 weeks into my first job. Let me say, I am under no false illusions nor am I delusional. I knew exactly what to expect as far as nursing stuff that everyone (well most people) just have to live with because that is nursing. I am on a busy 28 bed med surge floor. It is set up with a max of 7 pts and a team leader 7-3 that does accuchecks, admits and discharges. Which is great if that actually happened all the time. But, we are short staffed (isn't everyone?) and many times the TL ends up being a floor nurse. Ok. It happens. I understand craziness and chaos-that's gonna happen too. Here's my issue. Im sure most are familiar with hourly rounding. They have RN's doing even and CNAs doing odd. Thats fine. But I got a rude awakening when my pager went off my first day at 0803 and it says "pt *** needs to be put on the bsc". I'm thinking "why are they paging me instead of the cna?" Well, it's because on those 'even' hours, RN's are expected to do the CNA duties for their patients. All 7. So, for 6 hours of my 12, I am expected to do my job and the CNA's. Why? That was their budget cut. To get rid of the 3rd CNA and have up to 16 pts for 1 CNA and let the RN's do the CNA duties every other hour for their patients. Our floor is the only one in the hospital that does it. Is this common every where else? Am I just getting my drawers in a wad over something that happens all the time? I don't know, I was ready to deal with all the other things that I've seen and heard about, both in my life and on here, but this one is just bugging the heck out of me. Opinions please?

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Specializes in Emergency, Telemetry, Transplant.

So what is the CNA doing during the even hours?

I do remember at my first RN job we had pagers. It always seemed to go off when I was gowned up in a C diff room. Because some messages were urgent, I would de-gown, come out of the room, etc. to check the message. It was often "room 24 [yes, they would refers to pts. as a room number] would like his water pitcher refilled." After refilling the pitcher, I would go back to the desk, as the secretary, couldn't a tech do that? The answer was (almost always) "well, they are all in rooms...ya know, making beds and stuff....they are busy." And I was just standing in the c diff room watching the ball game with the patient. :sarcastic:

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Specializes in med surge, PCU, Tele.

Well, each CNA has 14 patients a piece, so they are doing vitals, ambulation assists to bathroom, etc and answering the other 100 pages. It's not that they aren't busy, it's that we need a third CNA. I don't know. I don't have any problem doing CNA duties, but I do have a problem being expected to do my job AND the job of a CNA for 6 hours of my day. I know that time management is a skill that has to be learned, but there is only 1 of me and I just don't know how I'm going to learn to be more than that. The other girls get there stuff done, but there also is crazy turnover on my unit. There's only 1 person that has been there longer than 2 years and I can see why. I really like the unit and everything else about it except this.

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Specializes in Critical Care, Education.

OK (grumpy old nurse here) There aren't any such things as "CNA duties" - if it's patient care, anyone can do it if it is within the scope of their license/certification. Sorry, that just gets my Depends in a wad.

I don't have any magical answers for you, just an observation. This is another typically bone-headed Administrative decision - cutting the (least paid) staff that actually perform the most visible / needed patient care activities. The end result is always predictable. It will end up with decreased patient satisfaction, decreased physician satisfaction with nursing care, and increased turnover. The ultimate hits, both in terms of finance and quality, to the organization will far exceed any gains achieved by the penny pinching decreases in the labor budget, particularly now that reimbursement is tied to quality outcomes and patient satisfaction.

So - why in the world does this keep happening? It's simple -- (drum roll please) the idiots that made these decisions will be long gone (clutching executive bonuses in their grubby hands) by the time it hits the financial bottom line. These budget geniuses will have moved on to another organization - where they will once again implement their cost cutting wizardry.

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Specializes in med surge, PCU, Tele.

HouTx,

I want to clarify my post. When I said CNA duties, I meant those duties that the CNA does, as a CNA. I fully understand that MY job title includes those duties as part of patient care (and I have no problem wiping butts, getting ice or any other patient care activity). BUT. I am only 5 weeks in and already understand that they want miracles from me. I am expected to do assessments, all meds, handle all issues with patients problems, family problems, physician problems, orders, pharmacy, IV's, and all of the absolutely ridiculous amount of charting that is required-with 7 patients. AND be paged 6 hours of my shift for toileting, ice, and all other things that the CNA does. It's not beneath me-it's just how the hell am I supposed to do all this-and not go into overtime? Because they want to save money by spreading out the job of a third CNA on the shift between the nurses? And I totally agree-it's about the freakin money. Are they gonna really save when the falls that they keep screamin at us to avoid keep happening because, and I'm sorry, but I can't be in 10 places all at the same time. Can't do it. They want me to stay with the patient the entire time they are on the toilet. Really? And in those 15 minutes, I can be paged to 3 other patients for whatever. And when they get up and do it themselves because I don't show up fast enough-it's my fault? Seriously? I don't know. I have read sooooo many of these stories on here. I guess maybe you can understand, but until you have to work it yourself, there really is no way to UNDERSTAND.

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OK...let me start by saying I haven't been in your shoes. I am sure it's frustrating as all get out having to deal with that! I'm sure I'd be spitting stones if I were in your place...that being said: during your even hours, try telling your patients "I will be back in 15 min to see if there is anything else you would like" (yes, dont vomit while saying it either...ick) this may cut down on the pages...but make sure you go back. Do you have a computer on wheels? If so, tote that around, chart while in rooms and give the pt time to see if there is anything they want. Make a deal with the devil---tell the CNA you'll trade X for Y to get things done faster. Example- When I have to interrupt the CNA because my spanish only patient needs something and I am in a rush (and she is too) I'll ask her to talk to the pt and see what she needs and I'll take over the chart making (or whatever she's doing) while she talks to the patient. This way, the charts get made, and I can figure out what the patient is saying. I've also found when we are busy that writing things down on the board keeps the call lights at a minimum- ex: CM dilated, No pushing, No getting up to go to the bathroom, Food/Drinks stop at 5cm...etc....if the pt is at 7 cm and she's thirsty, well, she can see that the board says no (if this is the case I will instruct a family member that they can moisten a wash cloth and have her wet her lips with that...and make sure to leave several clean dry washcloths available). It does stink. It really really does. I am very sorry! You may also have a group of nurses band together and create a system to fix the problem---two birds, one stone...problem fixed and add to the resume that as a new grad you spearheaded a problem that resulted in budget savings!

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We don't have CNAs on my 41-bed med-surg floor. Just nurses -- RNs and LPNs -- providing full primary on each of our 4-5 patients (8-9 per RN/LPN) team. I would love to have a CNA to even help with any amount of that.

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