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.
There have been a couple of incidents at the hospital that I work for where CNA have introduced themselves to the patient's as "one of their nurses". Something that one of my preceptors enjoyed me to do from the start is to introduce myself when I first go in the room as the nurse and to then tell the patient who their CNA is going to be for that day. There are times when I am able to go into each room with the CNA and we introduce ourselves at the same time. I will say though that right now, the CNAs that I work with are awesome and we have a real team effort.
Oh my. I am not an RN yet but I have been a CNA. I worked in a facility where some of the older CNA's thought that they were the nurse. They would take out IV's, administer meds, mess with GI tubes. The CNA's would always tell me, its ok, the nurses dont mind and if we know how to do, then why cant we. I told them no thank you. I rather have the nurse do it instead of possibly doing something wrong or hurting someone, then its my job that will be on the line.
RN's get the proper schooling, even if the CNA has been at that job for 25 years, it does not give them the right to take over the nurses responsibilites.
You're main concern is that she is passing herself off as a nurse. But also remember she's experience and confident in her skills and knows the routine around her very well, however passing herself off as a nurse is wrong and as stated above not appropriate.
Changing peripads and ambulating patients are indeed nurses's aides jobs and you should not discourage her from doing that in my opinion. You should ask her in the future to save the pads so you can document what you see, but you could have written something like "peripad discarded by CNA who states...blah blah blah." If you insist on getting patients up for the first time yourself, the CNA should know this at the begining of the shift "Please allow me to ambulate the patient for the first time". But there is nothing wrong with charting "during ambulation with CNA patient stated she was dizzy......".
The patient confirms what the CNA states that the doctor talked to her because she happened to be in the room. This doc may have known this CNA for years and is comfortable talking to her. MD's are notorious for not hunting the nurses down to speak to them.
CNA's are your eyes and ears and should be utilized as such. I don't see where she stepped out of bounds in her actions, except for passing herself off as a nurse. I can't count the number of times a CNA has come to me with information about a patient's condition, or simply "something isn't right with this patient" and my first response is not "humph, how dare this CNA think they can do an assessment". I'm grateful for their competent eyes and ears.
This CNA definately has some issues, but it also sounds like she's a capable and experienced CNA and you shouldn't try to stifle that. You confrontation should include "you do a great job being proactive in your care of the patient, such as......blah blah blah......but I feel............."
CNA's chart where you are? Here they chart vitals signs, baths, diet toleration, etc. but not peripads. That surprises me. Like I said, there are some issues.
One tactic you might try is to say to your patient "I'm Jalvino your RN for the today and so and so will be the CNA you may have met her already". Or something like that, make the roles clear.
I'm with "THE TWEETSTER" and "TIMOTHY" on this one....
I think all the issues in the OP have been addressed. When you go around and see your patients, just reiterate that YOU are the nurse. At the hospital where I work, we have boards next to all the patients beds. They are updated Q shift with the RN and Nurse's Aid name. Maybe you can suggest that at your next floor meeting.
i look young for my age too. i still get carded for winning "pull tab" tickets. i get carded for everything. and your situation happens to me too. i don't let it affect me though. the job has to be done. if it means the rpn is calling me "her little helper" then i'll go with it. all in the name of peace and tranquility. when all hell breaks loose, then i'll step up to the plate and take charge. no problem.
i don't mind getting carded. and i don't mind when the long term care residents call me "the kid." i don't mind when people walk past me looking for the "charge nurse". but when it comes down to it, i know i can take on whatever is thrown my way. i know that both my jobs trust me to do the work and do it well. so what if someone likes to pretend they are something they are not? don't worry, when the time comes you will shine too. yer 22 years old. experience comes with time. and then you'll start to run away from it all. all those people looking for you to "talk". all the visitors looking for the "charge nurse" when you'd rather catch up on the paper work.... all the residents looking for "the nurse" to pull up their blankets.... all the docs looking for the "charge nurse" so they can read off their orders!!! all the new grads looking for you wondering if they are making the right decision....
umm... sorry about the tanjent. you know what? maybe this cna has something to teach. i don't know what kind of experience you have or education but i'd listen to her. even though you are in charge, maybe she does have something to say. maybe she really cares about the patients/residents and wants to pass on valuable information. take it. in my area, a lot of the rns, rpn's, psw's in getting ready to retire. when i have time, i ask them questions about their experiences. they always want to talk. even the psw i work with in the nursing home, i ask her questions after questions. try it. just ask her about her experiences? she has to have some. what have you got to loose? sorry this is so long.
This needs to be reported to your supervisor because there are risk management problems asso with someone who mis-represents themselves in any capacity (you can't say you are an MD or even a resp therapist if that is a licensed position and you do not have that license.)
This person is DANGEROUS. She may be giving out advice on home care or disease processes.etc. Get it stopped.
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.
I am a cna and i wouldn't EVER say something like that. I have however seen some non-nurses doing nursing duties, and never have felt comfortable doing them myself (I would always refuse). maybe you should talk to your supervisor and then go up the chain of command if that doesn't produce any results.
This needs to be reported to your supervisor because there are risk management problems asso with someone who mis-represents themselves in any capacity (you can't say you are an MD or even a resp therapist if that is a licensed position and you do not have that license.)
This person is DANGEROUS. She may be giving out advice on home care or disease processes.etc. Get it stopped.
You are so right! In fact, some of the more confident NAs I have worked with have been terribly misinformed. Me included, though I am not so confident, more overly nosey;)
Isn't it amazing what a wide range of opinions there are about this situation?
OK, a couple of you thought it was a bad idea to bring up the subject of this NA becoming a nurse. This is how I imagine the conversation:
"It seems like you have a lot of knowledge about nursing. It probably wouldn't be a difficult step for you to get licensed as a practical nurse. Have you ever thought about it?" Wouldn't the NA take this as a compliment?
I am also a new nurse, but I work in the ER. We have some NAs who are amazing, and some who stink. At my hospital, the RNs (and LPNs) all wear navy pants with white shirts that are embroidered with the hospitals name, logo, and RN or LPN over the left breast (you have to be sure to cover your chest when checking orientation to place though!!) We also have boards that we write the RN and tech's names.
My thoughts.....this tech sounds like she is overstepping her bounds because you are young and inexperienced in her eyes. I have run into the same issue a few times....each time, I have waited until we were out of the patient's room, and simply said "I understand that you have been here longer, but I am the RN for this patient, and it makes me uncomfortable that you just xxxxx. In the future, please don't." Or something similar. We have a very casual and laid back dept, and many of us are friendly - plus, a lot of our techs are nursing students or EMTs who miss being allowed to use their skills. So sometimes a joking "Hey buddy, that's out of your scope of practice" remark works perfectly fine. The important part to me is to get my point across while not alienating the person.
When you are a new nurse coming onto a unit that has a dynamic established already, you must fit in without compromising yourself. Meaning that you shouldn't drop your standards of assessment. If you feel strongly that YOU need to see a peripad/ambulation/etc, then you should see it. I assume you had a preceptor on the unit.....try talking with her or another trusted senior staff member about your concerns. My guess would be that many of the nurses greatly trust this woman and appreciate her help, and have let her take on some of their duties. But again, if you aren't comfortable with it, don't let her do it.
This is definitely a sticky issue. Update us on how it goes!
I am a cna and i wouldn't EVER say something like that. I have however seen some non-nurses doing nursing duties, and never have felt comfortable doing them myself (I would always refuse). maybe you should talk to your supervisor and then go up the chain of command if that doesn't produce any results.
onarie
35 Posts
There have been a couple of incidents at the hospital that I work for where CNA have introduced themselves to the patient's as "one of their nurses". Something that one of my preceptors enjoyed me to do from the start is to introduce myself when I first go in the room as the nurse and to then tell the patient who their CNA is going to be for that day. There are times when I am able to go into each room with the CNA and we introduce ourselves at the same time. I will say though that right now, the CNAs that I work with are awesome and we have a real team effort.