So here's the deal. I'm a new grad RN, 22y.o. often mistaken for 17y.o. and even 12y.o. by one patient. The CNA is probably in her 60's and has worked on the unit for a very long time.
When I first met her, I too, thought she was a nurse, I don't know why, it's just the way she presents herself. Then when I started working with her, some patients thought she was their nurse and I was the CNA or nursing student. I would always correct the patient, and assumed their mistake was because I look so young, and she so old. But then one day I walked in while the CNA (who's name will be changed) was introducing herself to a patient and she said "Good morning. My name is Martha, I'm one of your nurses today." Mystery solved!
So some time passed, and I've been brushing it off my shoulder and just correcting people because I figured she was otherwise harmless... until this recent event:
I work on the surgical unit, and my patient had a hysterectomy. Martha comes up to me and says "so you're patients peripad was saturated so I changed it." I asked her if she saved it so I can see it. And she said "oh it was just a moderate amount of serosanguinous fluid." I thought to myself, I hate she did that because now I can't document it. But I didn't let it bother me, I figured I'd chart that the CNA disposed of it and so on. As I go to chart I see that she's already charted HER ASSESSMENT. Then there was a new order to ambulate the patient. It would be her first time up since post-op, I always prefer to be with the patient first time. But Martha comes up to me an hour later and says "I walked the patient, and she started feeling dizzy and nauseated so I returned her to bed" (Great, another assessment, I missed). Those offenses were almost excusable, but the next one absolutely is not. The same patient tells me that "the doctor told the nurse that he wants her to change my dressing." :angryfire As politely as I could, I told the patient "Martha is not your nurse, she is your nurse's aid. I am your nurse, and I will be doing your dressing change." That was my last straw with her. There is NO reason why she should be talking to the doctor about patient treatment. And I finally decided to confront her.
I told her I had a few things I was concerned about. #1 the peripad and documentation to which she said "the other nurses don't mind that I do that" and I told her, well for me, my preference is that I see it and I document it.
#2 ambulating the patient to which she had the nerve to say "I don't have time to wait around for the nurse to come around and ambulate the patient." I was speechless to that one. So I moved on to #3 and said "you spoke to the doctor..." to which she cut me off and said "no, the doctor spoke to me, and I told him to write it all down. I've been here so long, all the doctors think I'm a nurse here." I said fine, then what did the doctor say, and she ran down a list of orders. Which by the way I still find strange, that a Doctor would tell a nurse's aid a list of orders... unless she introduced herself as the nurse. It's also strange that she didn't tell me she spoke to the doctor, that I only found out through the patient. Anyway, I go to the chart, and the doctor forgot to write an order to change the dressing, and I spend the rest of the day trying to get a hold of the doctor so I can get a telephone order. In the meantime, the patient's all mad at me for the hold up. And all I can think is, if the doctor told me instead of Martha, I could have written a verbal order.
Am I crazy? would all of this get you angry? Are nurse's aids aloud to document? I thought ASSESSMENT is a nurse's job. Any similar events out there? Please give me your opinion, I'm too new on the field to know if I'm overreacting or if she's oversteping her boundaries.
Sorry, but I agree with the OP about the peripad. Yes, the CNA could change it but she should have set it aside. "Serosanguinous fluid" is a NURSING observation, not a CNA's observation.
So the aide has to call it "kinda reddish-yellow fluidy stuff"?
Of course a CNA can use the proper terminology.
I have no idea who does what charting in this facility. When I did LTC the CNA's charted a lot of stuff, including all I/O and ambulation.
Specializes in med/surg, telemetry, IV therapy, mgmt.
No, I don't think you're crazy. But you are inexperienced. First, of all you waited too long to confront this nursing assistant. Secondly, when you did confront her you unfairly unloaded a whole bunch of stuff on her at one time.
You will learn over time that you can't be in two places at once. That's not your fault. Nor is it the CNAs fault. I'm sure she's just trying to be helpful. I've never let the fact that a CNA refers to herself/himself as "one of your nurses" bother me. I always make an initial round of my patients and introduce myself to them by my name and tell them I am the RN who is in charge of their care and Flopsy and Mopsy are the two nursing assistants helping me out today who will be helping them today as well. You really ought to start doing that. Over time you might want to add to that by doing a little bedside teaching and letting patients know that if they need medication, have IV problems, or need something that involves calling the doctor it has to be done by you and all Flopsy and Mopsy can do is give you the message.
When the incident involving the throwing away of the peripad happened you should have then and there told Martha, is it?, not to throw any peripads away before showing them to you. In your post you said you didn't let it bother you that she threw it out, but, you see, it really did, didn't it? And what happened was that it created a build up of anger and frustration in you as other things started to happen. Her assessment, I say it was an observation, wouldn't have been so bothersome to you if you had seen the peripad and had something to chart yourself.
So the CNA talked to the doctor. She happened to be there when he came around. That's not her fault. Her fault, if any, is that she didn't tell the doctor that she couldn't take an order from him or remind him to write the dressing change as an order and that's what you might want to instruct her to do in the future. But, I've got to say here that the doctor knows better than to give a verbal order to a CNA and should bear all the blame here and not your CNA.
When you confront people it is best to do it over one thing at a time and not over a whole shopping list of problems. Your subordinates cannot possibly know what you expect of them if you do not make it clear to them (1) what they did wrong, and (2) the exact way you expect them to do it. It is often through trial and error situations like this that two people who work together learn what the limits of each are. This is how the "honeymoon" period of any type of relationship goes. So, just calmly and factually tell this CNA how you want her to do something when she hasn't done it the way you want. Do it immediately upon discovery and use words that make your desire very clear. Use pleasant tones no matter how ticked off you are.
You do not say anything about this CNA getting nasty or mouthy with you, so I rather doubt that she is going to oppose what you ask her to do. At 60 years old I'm sure she's pretty much seen and endured a lot over her lifetime and she can take whatever you dish out. But, do be respectful. Some new RNs have to deal with CNAs who have attitudes, nasty mouths and who find ways to sabotage the new grads and make them look bad so that their first nursing job turns into a living nightmare. It doesn't sound like this lady is one of those. But, by the same token, please don't mistreat a good CNA.
Well Flopsy and Mopsy have no business saying they are "one of your nurses." Aside from the fact that it IS illegal, it's also misleading to pts. because they might assume that either one and also that person who says they are the RN have the equal ability to do any nursing duties, and would not know to question an aide that is going beyond their scope.
Who's responsible for the patient? Who's license is it?
It just kinda bothers me for some things to continue because "they've been here a long time - it's always been that way" type attitude. Sometimes we all need to be reminded of what is right/wrong, legal/illegal. Certainly you would not be lying about hearing her say she was the patients nurse. An aide is different from an RN or LVN. Saying you are a nurse when you are not is, as has already been said - illegal.
That said, you should confront her on a level which will not "ruffle her feathers" but remain firm - hopefully. It's mainly in the delivery of what you say - how you say it. Just treat her like you would want to be treated. It sounds as if she might feel threatened in her job or even jealous. There will be days you will need her to get the pt out of bed for the first time - after you get to know and trust her abilities.
Talk with her and give it a little more time. If the situation doesn't get better, then have a meeting with your nurse manager and the CNA.
Remember - in whatever instance - you are the one responsible for the patient's care you are assigned to.
You do not say anything about this CNA getting nasty or mouthy with you, so I rather doubt that she is going to oppose what you ask her to do. At 60 years old I'm sure she's pretty much seen and endured a lot over her lifetime and she can take whatever you dish out. But, do be respectful. Some new RNs have to deal with CNAs who have attitudes, nasty mouths and who find ways to sabotage the new grads and make them look bad so that their first nursing job turns into a living nightmare. It doesn't sound like this lady is one of those. But, by the same token, please don't mistreat a good CNA.
Reread that first post, I think the OP DID say something about the CNA being nasty, mouthy, and dismissive of her input as the RN.
So the aide has to call it "kinda reddish-yellow fluidy stuff"?
Of course a CNA can use the proper terminology.
I have no idea who does what charting in this facility. When I did LTC the CNA's charted a lot of stuff, including all I/O and ambulation.
Sue, it may sound ridiculous but this is actually true. :uhoh21: I am just and RN student, but i worked as a CNA a few years ago in 2 different settings and this was the case, and i also recertified (did the classes and practicum and the whole bit) last summer and it was still the case. We can't chart "what" the type of fluid is that we see, just describe it in regards to color, amount, consistency etc...
Well Flopsy and Mopsy have no business saying they are "one of your nurses." Aside from the fact that it IS illegal, it's also misleading to pts. because they might assume that either one and also that person who says they are the RN have the equal ability to do any nursing duties, and would not know to question an aide that is going beyond their scope.
Everything else can be debated as there is grey. But not this point. That's the main thing that bothers me about this CNA, saying "I'm one of your nurses" obviously her ego is getting in the way of saying "I'm your nursing assistant for the day".
I was just trying to keep things a little light and since it's close to Easter. I get accused of being too mean sometimes.
You did make some valid points even if you are mean. :) It's not fair to store things up to blast someone all at once when a breaking point has been reached. It's much more effective to deal with things as they come up.
Marie_LPN, RN, LPN, RN
12,126 Posts
It would be a little hard for me to chart accurately on someone else's word or observation and know that my charting is accurate.