Hi everyone! This is my very first post...(after being a follower/reader of posts for a while!) I am a fairly new grad and have worked on a hectic med surg floor for about 7 months. Everyday is filled with the struggles of being a new nurse: time management, prioritizing, handling emergencies, making sure pts receive the correct medication ON TIME, & putting out fires in every direction with unhappy pts/family members/doctors. The list goes on and on. I truly feel like I am doing the best I can (and trust me I am my own worst critic.) I always make sure all my pts needs are met before I chart/take a break. Most shifts I miss my lunch and am lucky if I am able to use the restroom! This being said, there seems to be a new motto on my floor.."The RNs are lazy and think they are too good to do the CNA's job." We just had a staff meeting (with all CNAs, LPNs, and RNs), which, in a nutshell, bashed the RNs ONLY for not answering call lights, leaving pts dirty, and refusing to toilet them. My manager was ALL ABOUT this, nodding her head and agreeing with the cnas who were complaining. She's now put into place a rule that no nurse can walk past a call light, beeping iv pump ect. and if it is witnessed one can get written up. Doesn't matter if I am on my way, narcotics in hand, to medicate a pt, or en route to hang blood, I have to not only answer the call light, but meet that pts need, meaning taking away care from my own pts. I completely understand the need for call lights, and that it could be something very important. Truth is though, that each nurse is only one person, has their own huge pt load and the cnas are there for a reason...to assist the nurses! Now I can only truly speak for myself but I know my fellow RNs on the floor are for the most part on the same page. We actually do spend a huge amount of our shifts doing cna work! I toilet pts, empty ready to burst foleys, I never leave a pt dirty unless it is to get a cna to help me clean then up. I had a pt who definately needed two people to help clean him up, boost and turn him. I asked a cna to help me (very politely) and all I got was eye rolling. She even said "I have too many pts and don't have time." And walked away. So I had to get another RN to help me. The part that infuriates me most is that said cna, (and honestly most of the others ones) can be seen talking on their cellphone, hiding in various spots on the floor, and they NEVER miss a break or lunch, and in fact take extended lunches! Most of the RNs including myself have gone to our manager recounting this behavior and NOTHING gets done. It is to the point now where its just a waste of time to complain and I just suck it up, keep my mouth shut, and do my job. Does this sound familiar to some of you or is this something unique to my floor? I in no way think I am above doing to basics of caring for my pt and I hope I am not coming off that way. I am just sick of running around like an idiot all shift! Am I wrong for thinking every worker should be accountable for completing their job responsibilities? On my unit, however, it seems to just be up to the RNs to do everything!!
I could be wrong but aren't CNAs there to assist the NURSE, and not the other way around? I've read on this site a lot of CNAs getting upset because RNs/LVNs don't do enough to help them out and while I think it's always good to help each other out and work as a team why is it the NURSES job to help out the CNAs? It just seems like CNAs are called nurses aids for a reason. :/
I think this is never ending. That's how it is everywhere I think. When nurses don't clean someone up ,or ask and aide to do it, or to fill a water pitcher, or get a patient a meal tray it's not like we cannot do it. It's just that we can't do that AND our job too. I can do an aides job but she cannot do mine. Some aides think nurses think they are too good to do this work but that's not the case most times, now there are some nurses that are like that. But, if I ask and aide to do something it's because I'm doing nurse work that NEEDS to be done and and aide cannot do it. We have aides all the time that walk past call lights, hide in the utility room when a call light does off, takes many many breaks and I get NO break but the minute I ask them to do something I'm a lazy nurse that thinks I cannot do and "aides" job. I hate when managers agree with this.
As a charge nurse on my floor once put it "nurses are a dime a dozen", finding someone willing to do the job of an aide- and do it well- for the amount of money they make is truly a monumental task.
I definitely get the sense from our manager she values the aides more than the nurses. I think that's why she seems to like me more than some of the other RNs.. because I was an aide on our floor first.
I could be wrong but aren't CNAs there to assist the NURSE, and not the other way around?
YES.
Getting back to the original complaint, the CNA's running the floor. The interesting thing is that CNA's are not allowed to do anything without RN supervision. The RN delegates and the CNA is responsible for telling the RN if they are unable to perform a task and why (ie: not enough training, busy - and why they are busy, etc.). So in reality, the RN is the one running the floor, not even the nurse manager. You have a license to protect and you have every right to run the floor according to many organizations. If your nursing manager is that unaware of how the dynamics on a floor should work, please refer her to the following:
According to the National State Board of Nursing (NCSBN) “Delegation is the process of transferring, to a competent individual the authority to perform a selected nursing task in a selected situation” (2005). Although a nurse can delegate a task, the RN is still accountable for the patient and the outcome of the task no matter who the nurse delegates to. Delegation decisions should be based on the:
•needs and stability of the patients
•complexity of the task
•predictability of the outcomes
•available resources to meet those needs.
So if you are delivering blood to a patient (which is a timed process) the CNA, according to your delegation authority, needs to toilet, answer call lights, etc., because you are performing a task they are not licensed to do. You have a priority task, and your judgement defines which task is the priority. Nursing tasks are not delegated or addressed by a first come first serve basis, they are about priority and patient safety.
Delegation of task assignment is based on nursing judgment.
The ANA (2005) states “The decision of whether or not to delegate or assign is based upon the RN’s judgment.” The NCSBN (2005) goes even further by stating that “Since UAP’s (CNA's) do not have a legal scope of practice, they do not have the authority to perform the function until the nurse delegates something to them.”
Think about that for a minute.
Your CNA cannot perform any nursing function unless you delegate the task to them.
How does that statement reflect your culture or your unit policy? Are your CNA’s in report with you every morning? Are you able to give your CNA a full patient report before the CNA starts the shift? Can you ensure that your CNA only completes the tasks on the patients that you have assigned? Do they care?
RN's should help when they can, no question about it. However, they are not only responsible for the tasks they delegate to the CNA, but they are also responsible for pt. teaching, medication administration, doctor's orders, assessment evaluation of all delegated and non-delegated task completion, pt. outcome, and so on. CNA's cannot perform pt. teaching and evaluation, assessment and planning phases of the nursing process, and as a result, they are responsible for completing what has been assigned to them.
Even the nurse manager has to adhere to those rules. They cannot override a bedside nurse and assign the CNA to do tasks unless he/she takes responsibility for them. So for the nurse who thinks the CNA's run the floor. YOU tell the CNA what needs to be done and they need to tell you why or why not it can't be done. That is their responsibility. If your nurse manager wants to write you up for not answering a call light when you have a priority, she is going against ANA, NCSBN, and probably your own state nursing board's guidelines and rules.
Sorry for such a long post but I am passionate about this subject.
Specializes in Med Surg, SSU, ED, P/NICU, Epilepsy.
If you have 20 patients, I would think your quarrel should be with the schedule, not with the nurse.
This is true, but when the nurse has 2-3 each (I work at a peds hospital) they can get their own vitals on at least one kid each, and maybe throw a kid in the shower. So many days I get "Gosh Lisa, you seem so busy... When you get a chance can you________" And then they turn back to their online shopping or talking about wedding plans. OR, when I ask "can I help anyone with anything?" when I have a half of a free second, (usually at about 11:15, about 15 minuted before I start noon vitals) I have one or two nurses, who arnt busy, so they walk around to the others looking for things I can do "Lisa's really borde, she's looking for something to do..." (then goes back to her shopping). Before I know it there's a list, and I don't get to lunch until 2:30.
That being said, I also work with CNA's who can't be bothered for anything, to the point where RN's stop asking them to do anything at all. The approachable one's pick up the slack here too.
There are lazy people on both ends. Staffing, at least where I'm from, just gets worse. We all need to help out. (and fill out all the staffing forns we can!)
Is this true? Because where I work, RNs are also expected to help with such tasks. If an RN is not in the middle of a more pressing task, then they would be expected to clean it up themselves. "Those who find the mess, clean it up" is the rule in our unit.
Yes it is true. I do not make up things to post on this site.
Specializes in Med Surg, SSU, ED, P/NICU, Epilepsy.
One time our DON fired an RN who cleaned up a resident's puddle of diarrhea instead of summoning a CNA to do the task. That is the difference between CNA tasks and RN tasks. Not many CNAs get fired because they did an RNs task instead of summoning an RN to do it.
Well this is just stupid... Not you, but if it is in fact what happens, your workplace in in for a world of $*. For ANYONE to leave diarrhea on the floor while she waited for someone else to become available is just unsanitery. More importanly, if I notice a patient needs a new IV, and the nurse is busy, I dont pull it ant put in a new one my self. For that I would absoultly get fired! And if it were a med?! I'd go to JAIL!!! A CNA CANNOT DO RN TASKS!! That is why you people go to nursing school. You however are perfectly capable to clean up poop, or wipe a butt, if we are with someone else
I would be looking for another job. This place isn't realistic and more importantly their guidelines are dangerous to your license and more importantly the patients.
Have them put this in writing that you have to stop to answer a call light and give out water and blankets with blood and meds in your hand. They won't do it because they know they can't. They are setting you all up to fail. There is no way you can comply with this request.
Management has their priorities out of order and you can't succeed in that environment. Do what is best for your license and patients. Look for another job pronto. The inmates are running the asylum.
Why, just the other day, I sat down for the first time in ten hours to just take a breather, and a nurse chatting about her new boyfriend asked me to empty the commode in bed 1.
"But how did you know there was urine in there?..."
I am not a CNA, nor an RN yet (Waiting to hear if accepted into an RN program this fall, and if not plan on CNA to get some experience). Either way I will do everything I can for the patients care. I do not have control over others, only myself. The patient should come first no matter what, not a petty dislike of a co-worker. Although in reference to the OP, that policy is quite extreme and does not sound like something that should fall under a Hospitals policy. It is never good when the person in charge takes a side.
joanna73, BSN, RN
4,767 Posts
Remember that we are all there for the patients/ residents, right? That's the bottom line, and everyone has a job to do.