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.
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?
Not really because, as it's been said, it's unsolicited advice, i.e. suggesting what someone else should do with their life, when that person never asked for it.
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.
I worked in a LTC for awhile as a second job. One of the things the aides there loved to do was mess with the feeding pumps. They would unplug the feeding and bring the patient in their geri chair out to the lobby.
I would often find them out there with the feeding not even close by. They wouldn't tell me, so I discovered it, I would have to go get it and plug it in. Some would turn the pumps off and leave them off, not telling me, some would turn it off and turn it back on, at their convenience to whatever they were doing.
Sometimes I would come on duty and find the feeding pump had been turned off for along time. And I could tell by the dates written on the bag, that the patient had not received what they were supposed to get that day. And no telling how long the pump had been off and the feeding left just hanging there getting old.
So I would have to replace it and start fresh.
Just a mess. One of the many many reasons I finally quit there.
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?
Not a 60 year-old nearing retirement age CNA. It would sound patronizing. IMO
I would be less fussy if she were a overly eager student, or an EMT, but if she is a seasoned NA, she knows she is overstepping.
The problem probably is the culture this new RN is finding herself in. This CNA probably has been doing this for eons with the silent approval of her peers.
I agree she knows she's overstepping, but has done it so long it's a habit she probably doesn't think of on a daily basis. She probably didn't think "I know I'm overstepping my bounds but I'll ambulate this patient and dispose of this peripad and write the word "serosanguanous" and not let on that I'm a CNA". She probably went about her business that she's been doing for years.
I'm not letting her off the hook, but I doubt this is a new behavior. It's one that has been if not condoned, at least enabled and reinforced by allowing it to continue to the point where she actually might not think she's doing anything wrong in her mind.
Now I did not read this entire thread as I have 2 reports due and a blood drive to work at tomorrow, but I wanted to say a couple things:
1. YES IT IS ILLEGAL for her to say she is the NURSE. This statement puts the entire hospital at a great legal risk!! Human resources should be notified and possibly their ethics team as well. It is very dangerous for her to be saying she is the nurse and you never know how far she is carrying it. She may even be trying to give meds or something! Your license and pts are also at risk here. What if she dropped a pt or got a docs orders wrong. She needs to be correcting the doc, or at the very least saying to wait while I get the nurse, I am just an aide and I can't take orders. I would name the doctor as well as proof she is doing this.
2. Given her experience yes, she can be a great resource and you don't want to dampen her spirits. I think that once she realizes the risk she is putting pts and the hosp in, she will understand better and be more likely to comply, but this reprimand needs to come from above you- way above!
3. You should document everything you have said and report it from a once removed situation. Take the emotion out of it from your perspective so that it does not look like you are just being young and inexperienced and jealous. You need to report the facts period. Fact is she is putting the hospital at risk as well as your license!!
4. I do think there is a bit of a power struggle going on here but nothing that can't be solved with time.
5. By not reporting it you are being complacent and allowing this to happen. Allowing the law to be broken and all the risks above to take place. If something should go wrong now, it WILL fall on your shoulders and the axe will fall on you. You wont be able to go back and say, "well, I knew she was doing it but thought I could handle the situation." It is way too big for that.
.....I like the suggested conversation but, as another poster said, be prepared for the CNA to then do NOTHING for your pts..... Or, to try and avoid this happening, when you have the original conversation you suggest that she and you sit for a few minutes at the start of the shift and talk about how you will work TOGETHER: "Would you please do this, and I'll do this, and please make sure I'm there when this happens."
As for the doc who gave her the verbal order for the dressing change, you might want to pull him aside and say something like, "I don't know if you're aware of this, but CNA's are not allowed to take orders from doctors regarding pt care. There was a delay in the dressing change because I had to verify the order before I could carry it out." True, doctors will give orders to the first person they see, without finding out if the person CAN take orders, but Martha should have told him, "I can't take orders, but let me go find the RN who has this pt."
The hard part will be not being confrontational, because I'm sure you're angry enough to rip her eyeballs out. Good luck in this!
I would hope that Martha would be more mature than to do NOTHING as a way to retaliate for the "talking-to"--after all she IS in her 60s! She DOES sound like a great asset and I'd emphasize that in my conversation with her--overall, be respectful of her but firm in expressing YOUR expectations.
I will be graduating from nursing school next may and I have been working as a nurse's aide for a couple of years while I am in school. I do see this happen at my job also. At my job we use dry erase boards to write down the nurse's name and the aide's name, that way there is no confusion. I think you should just let your manager know and maybe she can talk to this person about the seriousness of what she is doing. Maybe if she understands that this is a legal situation and that the nurse's liscense is on the line then she will stick to her own job description. Maybe even have your manager print out a guideline for her job description that way she can't say I didn't know. Good Luck!
I agree she knows she's overstepping, but has done it so long it's a habit she probably doesn't think of on a daily basis. She probably didn't think "I know I'm overstepping my bounds but I'll ambulate this patient and dispose of this peripad and write the word "serosanguanous" and not let on that I'm a CNA". She probably went about her business that she's been doing for years.
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Good point, I can see how that can happen: sort of the frog in the pot syndrome...
Wow, You've all given such great input. I know there's a mixture of agreements and disagreements, but you've all made a great point.
I wanted to clarify on a few things and update the situation as well.
First: I absolutely agree CNA's are great resources which is exactly why i've postponed the situation for so long. She is a GREAT CNA, extremely thorough, and extremely caring. In fact, I was greatful to work with her... at first. But that mindset is why I've let a few things slide, and how i got myself in this mess to begin with.
Second: I confronted her first instead of my charge nurse or nurse manager because I respect her, and didn't want to make a fuss if she listened to me... which she didn't, so I decided to go to my charge nurse in a round-about way. Without mentioning names I asked my charge nurse if it was ok for CNA's to ambulate patients 1st time post op, change peripads and chart their assesment. To my surprise, she said all of that was fine. With that said, I've let go of the ambulation part. I am lucky to have a CNA so willing to ambulate patients. However, that still does not excuse her extremely rude response of "I don't have time to blah blah blah". As for the peripad and the "serosanginous" I still do not agree, and still prefer to see it for myself for the following reason: What if the next day the patient hemorrhaged, got into severe trouble, and sued. When I get called into court, and they ask me "so what did the drainage look like the day before she hemorrhaged, what was your assessment of her status?" My response would be "I never saw it." Whether the CNA is aloud to do it or not, that is my liscense and my responsibility. Fine, she's aloud to chart, BUT every assessment that she makes is an assessment that I don't. And when it comes down to it, it will be my license on the line. Please give me your opinion. Wouldn't you be scared of that situation? or do you believe you'd be o.k. in court? Or am I still overreacting.
Third: I wasn't upset she spoke to the Dr. or the Dr. spoke to her. I was upset she didn't correct him. Instead of saying "oh I'm not the nurse" she said "can you write that down for me ." It's not just me or the Dr. I overheard the physical therapist refer to Martha as the nurse TO the pt. When a patient who's not mine asks me a question and I ask her who her nurse is they say Martha. So yes, she's an incredible CNA, the unit is lucky to have her, I'll be the first to admit that. But it gets me nervous that patients, Doctors, staff mistake her as the nurse, and she does NOT correct them.
Maybe the fact that she does not correct them has to do with EGO or self esteem. (please no offense to the wonderful cna's ma's and tech's that are "older") But the fact that she has been a CNA for so many years and not "progressed" (ahem...no better term is coming to mind) might be a sore spot to her.
I do know that LEGALLY she is misrepresenting herself. My thought is...if she is putting pt's at risk the issue needs to be addressed. But, in the right way. I learned a valuable lesson on respecting CNA's and tech's. They can be your best friend or your worst enemy. Plus, she may have some serious self-esteem/ego issues.
Marie_LPN, RN, LPN, RN
12,126 Posts
Not really because, as it's been said, it's unsolicited advice, i.e. suggesting what someone else should do with their life, when that person never asked for it.