Nurse and CNA argument at the end of my shift

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I have been a CNA for about two years. I have never really gotten into it with any nurse before tonight. I got into it with the night nurse and the evening nurse. It was about 10:40 PM. I was doing my last rounds and I was going to put my late-night patient to bed.

So I walk into his room and start taking off his clothes, and his colostomy bag leaked out everywhere. (He always picks at it, he has heavy dementia and always forgets what it is). So this is a very common occurrence (it already happened once during the day before I gave him a shower). Now, I go to the nurse and I tell her. She is filling out her documentation and she said she would be there in about five minutes. So I went and cleaned him up really good and got him all dressed and had him hold some wipes over the stoma. She still wasn't there, so I went with another CNA and finished my rounds on my patients. Then 10:50 came around and she still was sitting at the desk doing paperwork and talking to the night nurse.

I went up to her and asked her again, she said she forgot and would be there soon. So I went and did some re-checking on some of my patients. I changed someone and came back and SHE WAS STILL AT THE DESK GIVING A REPORT NOW.

I walked up to her and she said she was busy doing the report at the moment and would do it when she is done. This was about 11:00... The end of my shift... SO at this time I figured I would completely get him ready for bed by changing the leg catheter bag with the foley bag. I did that and had to re-clean him and change his gown because he "forgot" to hold the wipes on the stoma and feces got all over the gown. Now, I was angry. I walked out there and told them he is sitting there and I'm going home, the night CNA could put the patient to bed, he's all ready, he just needed the colostomy bag replaced. They said that was fine.

I even told the night CNA and she said it was okay. So now, I was doing my documentation and it was 11:20 and the night nurse was sitting at the desk and said that he needs him in bed so that the skin can stretch properly and he can place it in. I said, "well, you can have you night CNA do that because I waited for you guys for 30 mins and you kept telling me to hold on" and he said, "you were waiting for (evening nurse's name) not me". I said, " sorry, but if you would have told me at 10:50 when you heard me talking about it I would have done it." So it got quiet and I finished my paperwork.

I was leaving and I said bye as I walked away, both the nurses said to me, "Did you put the patient to bed?" I obviously said no. They then went on that it was my job to put the patient to bed, and I could have just put a towel over the patient's stoma and covered him up and if he made a mess in the bed they would have cleaned it. I told them firstly, "you should have told me from the beginning when I told you he was sitting and waiting for the new bag to put him into bed and I would have. Secondly, it is un-ethical and un-moral that you guys had him wait for 45 mins almost an hour (it was 11:35 at this time) to have a bag put on, while you did paperwork and reporting that could have been halted for five minutes." They then went on to explain that it was still my job to put my patient into bed, no matter what.

I then brought up that I was not going to put my patient to bed and have him soil the entire bed and roll around in it because I knew he wouldn't hold the towel there for very long. Why would I risk soiling an entire bed?

In my mind, I see that as a huge contamination risk and a HUGE waste of material/supplies... Nurse's are suppose to advocate for the patient and use supplies and materials in moderation. These two nurse's did neither I feel and I was made to believe that I was completely doing something against what I should have been.

I feel I advocated for my patient and refused to do something that no human would want. Yes, he was still going to have a soiled gown (even after I changed it, because he forgets why he is holding the wipes on the stoma and it gets the gown dirty), but that must be better than having your stoma squirt out feces while your laying down and the possibility of you rolling around in it... (because with his condition, even if I placed a towel over it, he would most likely move it). Plus exposing the patient to even more contaminated than sitting up in a chair... This just happened 2 hours ago.

What are your thoughts and what should my course of action be? Should I follow up with the DON or confront the nurse/nurses about the topic.

Thanks guys, and sorry for the long novel. I am extremely flustered I walked out saying, " okay you guys are right, goodnight" and walked out the door, I did not want to argue against two people that obviously are teaming up against me for no reason... If the nurse would have said, come with me and put him in bed so I can put it on I would have done it, but he was just sitting at the desk, with no rush to get it on. So I have no idea at what time he would have actually done it....

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Well-I think your mistake was telling the night nurse to have the night CNA do it because you had been waiting 30 minutes...If a nurse asks me to go do something-whether it's an am, pm, or noc-I go and do it. I would *never* dream of talking back like that... Sure the nurses should have helped the resident and not made him wait, but it doesn't help anyone for you to get an attitude about it. I am pretty sure if my PM nurse heard me talking like that she would have my hide.

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It's hard to know what to do in the moment, especially when you feel like you're not feeling like you're being heard. I've worked LTC a lot too. Maybe check this guy a little bit earlier in the shift? If that's not possible, carry around some extra tape, and reinforce the colostomy bag. I've had to do that before for people who seem to have that happen a lot. Are you letting the air out of the bag periodically throughout the shift? That helps too. It isn't in your best interest to complain to management in this situation from what you've said. It might make things worse, actually. Maybe go to the nurse and ask them when is the best time to check on him for her/him. Sorry you had to go through a rough night at work.

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I understand your frustration, you want to provide the best care possible and it felt as if the nurse was brushing aside your concerns. In the future I would definitely recommend cleaning the stoma with wipes then reinforcing with tape. Put the patient to bed if that is your current task then tell the nurse you cleaned him, reinforced dressing to prevent leaking, and put him to bed. You don't need to tell the nurse more than once.

No one will ever fault you for doing your job to the best of your abilities.

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Hi there. Sorry you had a bad night! It happens.

They tell us all the time in nursing school that although we may perceive OUR patient's needs to be the most urgent (you are right; no one would want to be rolling around in their feces), there may be other pressing matters like changes in another patient's condition.

When nurses take report, they have a LOT more to hear/say than we CNA do. All CNAs say during report is, "So & so needs to be toileted at X time, so & so got up and fell this morning, I showered so & so this afternoon, watch So & so because they always get up several times at night." Nursing report can be very long because there is just so more to it than med passes. Perhaps on a regular night when nothing major occurred, the colostomy bag would have been addressed sooner.

I would just let it go. You were trying to do a good thing for your resident; however, you know the night CNA was there. It would have been possible to just clean up the resident, put him to bed, and ask the night CNA to keep an eye on him.

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I am a nurse, never an aide. I think if the nurse had no intention of getting up and doing the care, he/she should have said so, and, perhaps added that they would assist with that care after report. A nurse should NEVER put off a good, competent caring aide, ever. Can't get to it right now? tell it straight.

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It probably would have been best to put him to bed and cover the site well with a towel, and place some additional chux under the patient. A colostomy change is not life or death. And it was late and the patient was probably very tired and should have been put in bed.

Nurses are under enormous pressure to transition both in and out of their shift and get report done so that the incoming shift can take over. Sometimes a colostomy change takes a few minutes, sometimes a complication can come up and the nurse will be stuck there for a lot longer.

As a result the incoming nurse will not be able to assume the floor and will not be able to handle any other urgent issues that come up during that time.

Nurses rely on CNAs to be able to take the initiative in situations like that.

So it sounds like you wanted to do right by your patient, but were not aware of what the nurses were thinking or coping with. Sometimes what looks like a nurse charting is something a lot more urgent that requires immediate follow up. Hopefully next time you will know better.

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Thanks for the support guys. I really appreciate it. Maybe I just wasn't thinking clearly since I just started the nursing program and have been stressed/limited on sleep. I just feel that I wasn't responsible to put the patient to bed since they initially told me it was okay that he was sitting there, and then when I was getting ready to leave, at 11:20/11:30 they told me to do it, when I was suppose to be out of there at 11.

The bag completely feel off, and there was too much feces all on the adhesive to really tape it back on. And it wasn't even half full, or air filled. The patient just likes to pick at things at night. I think the best thing I got from you guys was to check on him earlier than I did. Even if he likes to go to bed late, I could have checked him at 10 or even 9. Got him ready, and then went back at 10:30-45 to get him into bed. I wasn't really talking back to the nurse, because the night CNA said she would do it to me and not to worry about it. The night nurse was very rude I feel and said, as stated above, "you were waiting for the "pm nurse's name" not me" which I felt was rude because he was there when I came to the pm nurse so he could have told me at 10:50, not at 11:30.

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I still feel upset because I know that what they were doing was completely unethical. Yes she was documenting, yet she (pm nurse) was also talking and laughing with the other nurse. And I talked to her BEFORE she started the report. So, the patient had no right to have to sit there for as long as he did (close to a hour), even if he was laying down. He would have moved whatever I put over him. That's the biggest reason I was upset because they didn't seem to advocate for this patient. Thus, this is why I think their actions were completely unethical and unmoral. (haha, they probably think, "nursing student - thinks he knows it all") :p

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Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.

I empathize with your frustration. I've been a CNA for about a year and am a nursing student. I think that it is important not to interrupt nurses during report, BUT, from what I read, you told her of the problem prior to shift change an report time. I don't think you back-talked the nurse. I also DON'T THINK it's solely *your* job to put a patient to bed. :no:

Nurses are busy and have responsibilities in addition to direct patient care, but that does not, in my opinion, mean that it's solely your job, as a CNA to put the patient to bed! It makes me mad that the nurse said that, after s/he refused to do her job in a timely manner.

Possible solutions:

Option 1: I know that some CNA's change colostomy bags and do other things that nurses typically do when staffing is limited. Not sure if this is legal, but I know some CNA's who claim to have been trainined on how to do this.

Option 2: Don't "talk back" to the nurse, just make your own documentation notes (for personal use, not for charting) that at XX time, you notified nurse, that at XX time you told her again, at XX time, you were off, and at XX time, the nurse told you you had to stay after work to put the aptient to bed AFTER you waited an hour for them to change colostomy bad

Option 3: Cover your own orifice by putting patient to bed, as nurse said, and leaving the "mess" for someone else to clean up. This also will require personal documentation because you might get in trouble the next day for leaving the patient in a mess.

However, I see nothing wrong with the approach you used because it's okay to speak up regarding patient care issues and I admire your forthrightness!

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I use to defend CNAs bc I was one myself. The ones I work with now are crap. Sounds like you had a crappy nurse who was only thinking of herself and not what's best for her/ur pt.

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I would speak with the DON of the facility. I have been working as a CNA for 10 years, and as a student nurse for 3 years. I understand both roles, as I have been working in the nursing system and also have observed the nurses role throughout my 10 years as a CNA. I understand the duties, and have practiced the duties in the capacity as a nurse. Sure it gets busy, sure things get hectic, but at the end of the day we do our best. It sounds as if both sides- yours and the nurse, could have done things a little differently. However, almost one hour to address that situation is inappropriate. I have also worked with many dementia patients, and also patients with stomas. He could have tried to eat his feces, or gotten it into his eyes. It does appear that her course of action was inappropriate, and perhaps the situation can be prevented from happening in the future if it is brought to the attention of hopefully a skilled-leader- the DON. She should have a good perspective on both sides of the situation. If your shift ended at 11:00, you are off shift. It sounds as if you were already assisting the patient off the clock, and staying even later to catch up on your paperwork, that this preventable incident clearly took you away from. As a future reference, perhaps if it occurs again, I would think about putting him to bed before it is time for you to punch out. It is annoying for the other nurses to clean him up, but it is safer for the patient as cleaning up a dirty bed is not as critical to the patient as a decubutis ulcer would be from staying in the chair. Just food for thought. On another note, as for the new night shifts ganging up on you, you spoke to the night CNA, it actually was the night CNA's duty to put him to bed, and the RN/LVN's should have asked the night CNA- the CNA who is on the clock. You were not on the clock, and if an injury occurs, the hospital may not be liable for your injuries. As RN's Im a little surprised that they were not on top of it- it is part of our job as nurse leaders... I am wondering if they did not know the situation at first, and then became defensive after you told them what happened (you were angry by that point, and anger causes the person hearing it to become defensive). If you think that this is what may have happened, perhaps in the future you can keep that in mind when you respond to a person outside of the incident, and keep that perspective that they are completely fresh. You seemed to be understandably upset, but just try to practice not taking your frustration out on the new nurses as a result of the previous nurse- if thats what happened. It is REALLY frustrating, but if you practice that it will actually help to keep you from getting too angry for your own health. All in all, I would definitely speak with the DON. The DON should be aware of the situation, and clarify the appropriate response on both sides. This situation could happen again, and I do not think what the nurse did was appropriate. She definitely will think twice in the future before brushing you off. But that is not the only reason why too. It affects your patient, and if she would do that so "easily", she most likely will do it again. If I was a busy nurse who really had no time to change a stoma bag, I would NOT be laughing with another nurse. It sounds like she wasn't focused or very concerned about the patient... Talk to the DON. As a side note, and as a CNA who does the heavy physical and mental work- therapeutic communication is exhausting for a good CNA- I think that it is important we all respect one another- Nurses and CNAs- for the duties which we do, and work together for the good of our patient. Both roles are CRITICAL to our patients, and we cannot have one without the other to properly care for our patients! What if it was us who was the patient?!

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