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.
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.
I agree, but that's something that comes with experience. Few people are 'natural born leaders'. For most of us, it's a learned skill, a skill btw, not taught sufficiently in nursing school
From what I can see: The CNA was outta line. But the trouble might well be that the other nurses on the floor let her do this - kinda sends out mixed signals.
She needs to stop introducing herself as the nurse and she needs to let Docs know that she isn't supposed to be taking orders from 'em (if she can't find a nurse, the least she needs to do is let the Doc know that she is a CNA, not RN/LPN).
The rest of it is stuff that needs to be hammered out between the twose of you - every nurse has their own preferences, so do CNAs. It helps if we all get onto the same page early on - so that we avaoid situations like this in the future.
Still, better late than never, aye?
a skill btw, not taught sufficiently in nursing school
So I'm going to go off on a tangent here.....but at the hospital I used to work at, the nurses and the nursing assistants had to wear different colored uniforms to work. The nurses (RNs/LPNs) were required to wear solid royal blue and the nursing assistants were required to wear solid teal uniforms. There were also signs and pictures put up in every patient room describing who wore what color uniform and it gave a description of each person's role in the patient's care.....this info was also printed in the patient handbook. Helped to decrease confusion among the patients and the families as to who was who and who did what......okay, back to the original topic now!!
before i start my shift, i always have a quick meeting with the na's i'll be working with; to give a brief report along with requests, expectations. i haven't encountered any problems for the many yrs i've been doing this. if there has been a problem, it wasn't for lack of communication.
You and I both know that Z, but obviously the CNA in question doesnt ehhh?
It is semantics where the CNA is concerned, she sees herself as a
"nurse" whether it be a CNA or not. She is told by her facility she is part of nursing staff/nursing service. Whatever they call it where she works. I dont think there is a actual intent to "illegally impersonate" a nurse. I doubt she was versed in the "legal definition" 20 or 30 or more years ago when she started her career. And she probly still isnt.
I think when dealing with CNA's that have been around the barn for a while its best to approach a situation like that a bit more gingerly.
Don't think for one second that woman isn't able to differentiate between CNA and RN. If she can't, then she's too stupid to be working in the hospital. She should be constantly reminded of her position by a number of factors including an inability to legally perform assessments, take orders, sign orders, give IV meds (I know some states allow CNAs to take a class and pass meds), start IVs, etc., etc., ALONG WITH HER HOURLY PAY THAT REFLECTS HER POSITION!!! Hmmm. As others have pointed out, this sort of behavior is illegal and should be reported. What is she gives completely false/unsafe/wrong info to a patient/family member and they have the perception that it came from a "nurse". No way. I wouldn't put up with that for a millisecond. Some times you are better off with no help.
I agree, but that's something that comes with experience. Few people are 'natural born leaders'. For most of us, it's a learned skill, a skill btw, not taught sufficiently in nursing school
~faith,
Timothy.
Which is why us experienced old folks need to mentor the new grad, not judge. Nothing wrong with gently pointing the way. I hope that's how we're, yourself included, are coming across.
So I'm going to go off on a tangent here.....but at the hospital I used to work at, the nurses and the nursing assistants had to wear different colored uniforms to work. The nurses (RNs/LPNs) were required to wear solid royal blue and the nursing assistants were required to wear solid teal uniforms. There were also signs and pictures put up in every patient room describing who wore what color uniform and it gave a description of each person's role in the patient's care.....this info was also printed in the patient handbook. Helped to decrease confusion among the patients and the families as to who was who and who did what......okay, back to the original topic now!!
Due to patient complaints and confusion about who their nurses were we started about a month ago wearing "RN" and "LPN" in big letters underneath our name tags.
It is indeed confusing when even the secretaries, dietary and housekeeprs wear scrubs.
At the hospital where I work, nursing assistants wear wine colored uniforms hospital wide and nurses wear white and/or unit specific colors. On my unit, we have "orientation boards" in the pt's room where we write the day/date and RN: ________ and PCA: ________. I have worked on both sides of the fence (PCA and RN - same unit). As a PCA, I have used medical terminology in my charting before, but always reported to the RN what I was charting. Now that I am an RN, I co-sign what the techs do (our computer charting system allows that), e.g. co-signing vitals, pt activity, % meals eaten, baths/linen changes, etc. The computer system only allows PCA's to "participate" in minimal charting, such as the items I listed above. I have never had a PCA misrepresent her/himself as an RN nor have I had an MD mistake a PCA for an RN (like I said, wine uniforms sort of give it away!) Like a previous poster said, everyone has their preferences (aides and nurses). Communication with your techs is a KEY thing!!
I had a problem because of my age that I continually was mistaken for a nurse, so I had to be doubly sure to identify myself as an assistant. It is great that your assistant cares about the patients, ambulates them and keeps them clean. But I never ambulate a pt who has just had surgery without checking with their nurse first. I have learned to not assume that on the face of things, that this or that patient should be ambulated after surgery just like the last person I dealt with. My education does not include determining all the variables. Its silly, but maybe the person wasn't able to walk before surgery:)
Any hoo....she was not very prudent to not check with you (though most nurses think I am a pain in the XXX, cause I check incessantly) and she should not chart in your place.
I have loads of experience, and sometimes, just from seeing so much, can make some pretty good judgements. But if it is outside of my scope of practice not going to do it! What do they say, a little knowledge is dangerous? That be me kingosobbi!
Oh, and saying I am "one of your nurses"....if she has been doing this for as long as she has, she KNOWS that is wrong!
She may need some talkin to.
Assistants who do this make the rest of us look bad...
( If I didnt make it clear, I am a nursing assistant)
Sorry, I still think that "seroanguinous" is a nursing observation. Yes, she should have charted "reddish-yellow fluid".
I know serosanguinous when I see it too, but I woud not have charted that, because, again, I am a nursing assistant. I am not a nurse. If the nurse wanted my description, I would have described it. If she wanted to see the pad, I would have shown it to her. That's why they call me a nurses "assistant".
I know it is difficult for a old timey NA, who has seen it all, to hold back. And I do voice concerns to the nurse, have even suggested what I was seeing might have certain implications. I express things to the nurse, but I am not so arrogant as to assume her role.
Sorry, this boils my pudding!
CNAs that presume experience equals education and license, something that requires a systematic and thorough approach to acquiring skill and judgement, make other CNAs who share observations with the nursing staff fall under suspicion. If I am going to be able to express my concerns to my nurse, she must be able to trust me not to jump the bounderies of my certification.
not going to do it! What do they say, a little knowledge is dangerous? That be me kingosobbi!
ZASHAGALKA, RN
3,322 Posts
I agree, but that's something that comes with experience. Few people are 'natural born leaders'. For most of us, it's a learned skill, a skill btw, not taught sufficiently in nursing school
~faith,
Timothy.