Nurse and CNA argument at the end of my shift

[zippeh]

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....

[Orange Tree]

I have a real problem with CNAs telling me what I need to do NOW. As a nurse, my priorities may be different than theirs, and some of them don't seem to understand that. I don't know anyone who likes sitting at a desk and shuffling paperwork, but some of it IS very important and needs to be taken care of- even if there's a colostomy bag that needs to be put back on.

For example, I had an admission recently who was SOB, hypertensive and having seizures. He was from a nursing home and had orders to continue his nursing home meds, but his med rec had not been created yet and pharmacy was closing in about 20-30 minutes. I quickly reviewed and wrote out the urgent medications I needed that night, faxed them to pharmacy, and called to confirm that they received my fax. Height, weight and allergies had to be charted for pharmacy to process my request. I also faxed and paged RT, then waited a few minutes for their call before going to set up suction in the new admit's room. The CNA for another patient approached me about three times during all of this. She was annoyed that I hadn't replaced a dressing that had come loose on another patient. Her perspective was that I was just "sitting in the nurses station" while a patient was waiting to be taken care of. I even heard her complaining to another CNA that she "kept telling the nurse" and nothing was being done. She had no idea what I was busy with, and frankly, I get tired of feeling like I have to justify my actions to her. Most of the time, I no longer bother, because if she doesn't get it by now she's never going to.

I also prefer to give report before tying up last minute loose ends. It's hard to get things done when you have a full load of patients still under your care. Delaying report also puts the next shift behind. And so what if I giggle because someone says something funny while I'm working ...am I supposed to spend all day crying to show how seriously I take patient care?

OK, I'm done now.

[Prairienurse1989]

I was a CNA and now I am a nurse. If you were off shift girl, you were off shift. As far as I'm concerned you reported what needed to be done, and the nurse dropped the ball. Takes 2 minutes to change an ostomy bag, report could have waited.

[zippeh]

I have a real problem with CNAs telling me what I need to do NOW. As a nurse, my priorities may be different than theirs, and some of them don't seem to understand that. I don't know anyone who likes sitting at a desk and shuffling paperwork, but some of it IS very important and needs to be taken care of- even if there's a colostomy bag that needs to be put back on.

For example, I had an admission recently who was SOB, hypertensive and having seizures. He was from a nursing home and had orders to continue his nursing home meds, but his med rec had not been created yet and pharmacy was closing in about 20-30 minutes. I quickly reviewed and wrote out the urgent medications I needed that night, faxed them to pharmacy, and called to confirm that they received my fax. Height, weight and allergies had to be charted for pharmacy to process my request. I also faxed and paged RT, then waited a few minutes for their call before going to set up suction in the new admit's room. The CNA for another patient approached me about three times during all of this. She was annoyed that I hadn't replaced a dressing that had come loose on another patient. Her perspective was that I was just "sitting in the nurses station" while a patient was waiting to be taken care of. I even heard her complaining to another CNA that she "kept telling the nurse" and nothing was being done. She had no idea what I was busy with, and frankly, I get tired of feeling like I have to justify my actions to her. Most of the time, I no longer bother, because if she doesn't get it by now she's never going to.

I also prefer to give report before tying up last minute loose ends. It's hard to get things done when you have a full load of patients still under your care. Delaying report also puts the next shift behind. And so what if I giggle because someone says something funny while I'm working ...am I supposed to spend all day crying to show how seriously I take patient care?

OK, I'm done now.

Okay Orange Tree,

I understand your frustration with that. It can be very annoying. I knew she was busy with a patient's orders/status of a new admission coming in. Although, I came up to her and told her and she told me, "okay, I'll be there in five minutes", and I approached her two more times after that in five to ten minute intervals. It was not until 11:15-20 she finally told me to go home and night shift would take care of it (she thought the pt. was in bed, while I told her numerous of times that the patient was sitting there waiting). The point is, I understand nurse's get busy... very busy, and as a CNA I can't fully understand at that time how busy they really are. Although, as a nurse, do not tell your CNA's that it will be five minutes. If you are going to be longer than that, OR you don't know, tell me that. That way I can prepare the patient and get him cozy instead of waiting with him for you to come. I went up to her yesterday and I apologized if I came across rude. I reinforced that I still stood by what I said, but if my attitude was negative towards her or the other nurse, I apologize. She said it was okay, and tried to reinforce to me that I should have put the patient to bed. I understand that part, and next time I will get the patient in bed, because as a CNA, I do need to cover myself. If anything happens after I provide care to the patient, I can say, "I did what I was supposed to do, and I alerted the nurse X amount of times about the issue." MY BIGGEST COMPLAINT, is what I stated before. DO NOT tell me you are going to be somewhere in a certain amount of minutes, when you in fact know something is more important (like getting meds from the pharmacy before they close). Tell me what to do (prep the patient, and lay a towel over patient). As a CNA, I don't know and am not trained in the proper procedure of putting a colostomy bag on. Every nurse I have ever worked with has put the bag on the patient while he was sitting up (probably to save time). Furthermore I did not tell the nurse to do anything. I told her multiple times what was going on and the patient needed her. I would have left her a lone if she told me what to do and that she couldn't have made it for a while to the room. LASTLY, your example was a perfect example of prioritizing, while she had pressing matters that were also important, I alerted her before her report started(while she was attending her urgent matters). You can ask the ethical aspect as to, is my report more important or is my patient that has the possibility of having feces all over him and having a possibility of him eating it more important. She could have also delegated her task to the night nurse, as much as people don't like to do other's people's work, it needs to be done at other times. The report was already late, and being another 5 minutes late really would not make a difference. Yes, it would have been a hassel and a nag on the other nurse, but as we both know... Everyone has their nights. In the healthcare field, you rarely ever finish on the right time. (just because I stayed after my initial hours, does not mean I clocked out. Things happen all the time where you have to stay after. IF you are clocked in, you automatically are covered because you are still "working". IT is when worker's clock out and then return to their work, the facility technically isn't responsible for your actions/injuries that occur after you do that.)

Thanks EVERYONE for their feedback. I really appreciate it. Like I said above, I approached the nurse and apologized if I came across rude, but I stood by my actions and what I did say.

[Orange Tree]

Sometimes you really plan to be somewhere in five minutes, but it just doesn't happen. Things change constantly. Priorities change constantly. A lot of tasks only take five minutes to complete, but it can often be difficult to fit all of those five minute tasks into one twelve hour shift. I don't see an ethical dilemma here (with the colostomy care delay), but I can understand why you were frustrated about waiting and ultimately getting nowhere. The nurse should have at least apologized that she wasn't able to get there as soon as she thought she would. You seem like a fairly reasonable person...not at all like the type of CNA I was ranting about!

[starlyn14]

I'd like to comment on this from a patient's daughter perspective. My mom is 88 yrs old and has a colostomy bag. I would outraged if I ever found out she was treated as callously as the nurses described in the above thread did. I agree with the aide that the nurses were wrong and should not and should never make an elderly patient, with dementia wait to be cleaned up. I find it hard to believe their "paperwork" is more important than the patient. Perhaps the nurses need to remember that the elderly should be treated with compassion, patience and with dignity. How degrading to this patient that he was forced to wait until the nurse felt like it was convenient for him/her to "get to it". Shame on both of those nurses. Is this how you would want your parents treated?

[klone, MSN, RN]

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.

"Talking back"? Are we not all adults here? CNAs should not be treated like children.

[misty97]

I have been a CNA for one year and currently I am a fourth semester nursing student so I cam speak in regards of both sides...

Yes nurses have a lot on their minds, situations that are life or death take priority over any feeding or cleaning

so yes she might have been really busy, but the way she talked to you was inappropiate

there must be mutual respect between everybody doctors to nurses and nurses to cna

we are all there to do patient care so I disagree with sone of the comments you've gotten saying "I wouldn't have dared talked to the nurse like that, I wouldn't have disrespected her like that!" I want to say the nurse is NOT your mother and you owe her no more respect than the one she is giving you HOWEVER that also goes both ways..

probably she was stressed out or you simply got a crappy nurse

there are CRAPPY nurses and CRAPPY nurse assistants I have seen it all by now