Published
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.
Don't ever think that of yourself. You might not have credits attached to what you know, but you're a treasure trove of knowledge, chadash.You'll get the formal education when the kids are a little bigger.
That is so sweet of you to say, but I am a bit older than you and now I have to wait for the grand kid to get a bit older!:balloons:
Thanks for the encouragement.
Suesquatch- you may not have the piece of paper, but I am guessing your years of experience probably beat the heck out of degrees!! You should say that you have no FORMAL education, becuase God knows, you have been educated for years on the job!! Plus, we have all seen those people who have the degree and we sit there in wonder shaking our heads trying to figure out how someone that is such an idiot actually managed to graduate!! How the heck did THEY get to be boss, lol!
In VT while working as a legal aide, after so many years you can take the bar and become a lawyer without any education. They see the value of OJT!
Wow, so I just read all the respsonses here and I am suprised!
Im a nursing student and we've been told time and time again, its your liscense don't take any chances with it. Weve also been taught about delegation and how important it is to know what each different health care professional can legally do. When CNA's start doing "little things" that theyve "always been allowed to do" (that are nurses duties) the lines between the personnel start to get blurred and that can only lead to confusion and a sticky situation.
Secondly, if you do not have R.N. or L.P.N behind your name you ARE NOT a nurse and it is illegal to represent yourself as such.
Don't do anything YOU are not comfortable with. If you feel more comfortable ambulating your pt. for the first time you do it!
With all that said, just remeber to be professional. State the facts and keep emotion out of it. It all basically comes down to what is legal and what is not. Do what you need to do to protect yourself but be professional about it (which im sure you will:))
This is actually one of my pet peeves. Unless you have gone to school and taken the NCLEX exam, you are not a nurse. But of course a hospital or nurse manager are not going to correct your aide. The more "nurses" they have running around the floor, the better patients feel about their care. And they less they are lickly to notice the lack of RNs. The aides at our institution call themselves one of the "nurses" but when I introduce myself I make sure there is clarification that I am the nurse. Sit down and confront your aide. But remeber although she isn't an RN she is an important part of the nursing team. Make sure you let her know how much appreciate the hard work and compassionate care she gives and not just what you don't like. Nobody likes to be told they aren't doing anything right
This is actually one of my pet peeves. Unless you have gone to school and taken the NCLEX exam, you are not a nurse. But of course a hospital or nurse manager are not going to correct your aide. The more "nurses" they have running around the floor, the better patients feel about their care. And they less they are lickly to notice the lack of RNs. The aides at our institution call themselves one of the "nurses" but when I introduce myself I make sure there is clarification that I am the nurse. Sit down and confront your aide. But remeber although she isn't an RN she is an important part of the nursing team. Make sure you let her know how much appreciate the hard work and compassionate care she gives and not just what you don't like. Nobody likes to be told they aren't doing anything right
I so agree with you. I have been struggling with how to word this, not to offend any fellow NAs, but experience does not equal education. It does enhance your understanding of what you are doing and why, and how to work smart as an aide, and make less mistakes. BUT it just isnt that simple. I have looked at samples of NCLEX, and the knowledge base, the assessment skills and the understanding of pharmaceuticals...gosh, I don't even know what I dont know. It's just like, if I know how to turn on the stove, that does not make me a cook. Before RNs and LPN's are able perform these seemingly simple task, they are required to discipline there understanding of all the less obvious reasons and implications behind that action.
sorry if I am beating a dead horse.
I have worked with other NAs who have called themselves nurses, and they knew even less than I did (I mean the ones that called themselves nurses, most aides knew far more than I!)! I wondered if they understood what they were saying, and if you would set the NCLEX in front of them and let them try to answer a few questions, the light bulb might turn on...
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.
Jalvino, I think what you are dealing with is a situation has been allowed to happen. Others have allowed these behaviors probably because Martha is good at her job.
Originally posted by ELKMNin06When CNA's start doing "little things" that theyve "always been allowed to do" (that are nurses duties) the lines between the personnel start to get blurred and that can only lead to confusion and a sticky situation.
This pretty much sums up the situation. Lines have been allowed to be crossed and Martha no doubt feels that you are trying to rein her in. It's very hard in these situations to put those boundaries back in place.
Others no doubt have heard her refer to herself as a nurse and no doubt have heard others refer to her as a nurse, unfortunately they have let this slide for too long. Martha no doubt feels entitled to refer to herself as nurse because of her experience, and because others have let it go, it has only reinforced that sense of entitlement to that title. A problem with assuming a title you haven't earned, is the idea that you are qualified to make decisions you lack the capability to actually make. This puts patients at risk. For instance, if patients believe that she is a nurse, they may be addressing c/o or symptoms with her that should be addressed by an RN, she may also be using her own judgement (her unqualified judgement) when it comes to reporting these changes. You didn't mention whether you discussed the issue with your charge nurse about Martha referring to herself as a nurse. This is a serious issue that puts both you and the hospital at risk. I think your charge nurse and nurse manager would back you up on this one, if not, then you need to take it higher.
You may want to review your policy and procedures in regard to post-op ambulation, in most settings (that I've worked) it is standard for the patient to be ambulated the first time by a nurse or with a nurse present. In which case, Martha would be violating policy and procedure.
In essence, whether Martha likes it or not, YOU ARE HER SUPERVISOR. You are responsible for what is delegated to her. When you make it clear to her what you are delegating to her and she still chooses to do what she wants, that is INSUBORDINATION. A big isssue here is being able to trust Martha with what has been delegated to her. When you've made it clear and specified that you wanted to do A,B, & C, and you would appreciate it if she to do X, Y, & Z, you've set forth with her what you have delegated to her. When she chooses to disregard you, it is a big deal, how can you trust her? How do you know what she is really doing or has done? She's just shown that not only does she not respect your position, she has also shown complete disregard for your judgement and substituted her own in it's stead.
I noticed that you discussed the issues with your charge nurse, why not discuss them with your manager. State your concerns objectively and seek his/her counsel in how best to deal with it. Discuss how you would like to proceed in the matter. Expect that Martha may be resentful and take things that are a practice issue as personal, you need to be prepared for that.
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.
yes, she probably knows she is out of her scope of practice. however, i remember the beginning of the story when the na stated, "well a lot of the other nurses appreciate it when i do ____ and trust me do ____. maybe that's true when you develop solid teamwork and strong relationships -- but this blurs boundary lines and makes for too much inconsistency. this issue detracts from a smooth-running floor where rules and structure benefit people, because everyone knows exactly what is or is not expected from them. i know people want to go home on time, and nurses definitely deserve respect with the ability to delegate. it gets too confusing as to who does what for whom; therefore, it would be a better business practice among employees to implement fair expectations across-the-board.
HealthyRN
541 Posts
I believe that you are absolutely correct in being concerned about this, despite what your charge nurse says. As part of my last quarter in nursing school, we are covering legal implications of nursing practice. Remember, it is YOUR license on the line. Delegation of tasks to nursing assistants is something that is often an issue in the court cases that we have reviewed. You are legally responsible for the activities that you delegate to the NA. It is also up to you how much or how little you want to delegate and what the stipulations are. This is part of nursing judgement. We are taught that communication is the key with this. You must make it very clear exactly what you want and expect from the NA. Obviously, a certain amount of teamwork and trust needs to be involved because you can't do everything. In some cases, the NA may share a certain amount of liability because they have a responsibility of reporting abnormal observations in order for you to assess the patient. I am not a nurse yet, but I would never allow an NA to ambulate a post-op patient for the first time without being present. That is a very important part of your assessment and it is a high risk situation. I also agree with you on the peri-pad. The NA should have put it aside for you to assess.