Nurses behavior towards CNA's?

Nursing Students CNA/MA

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So i have a question; the other day I was having a pretty hectic shift. I had a total of eight patients, three of them were brand new admits that were just coming onto the floor. I also was told to move two of my patients to other rooms because they needed to move an unstable patient closer to the nurses station. That meant moving four different beds, plus the patient's belongings. I had to get my admit kits for two of the patients that had arrived, when the third one arrived. The nurse was in there with the patient, doing her assessment on him. She asked me to take his blood pressure, but I also had to check three of my patients sugars before they ate their dinners. The nurse got upset that I didn't check his BP when she had asked. I went in there and took it, while she was in the room with me. Isn't that something that she could have done, seeing that I was busy running around like a chicken with my head cut off? It's like she didn't even care that I was busy, she just wanted to tell me what to do, and for me to do it when she had asked. She then asked me to recheck his BP at a later time. During the time she had asked me to recheck his BP, he needed to use the bathroom. He was in there for a minute, and when he was finished, he needed my help, so I helped him clean up. While I was doing that, I noticed a stage II/III sore on his bottom. I asked him if the nurse had assessed his bottom when she was doing her assessment and he told me no. I told him that I was going to get her so she could look at his bottom and that I was also going to come back and get his BP. When I saw her, she asked me what his BP was and I told her that he was using the bathroom during the time she had asked me to take it. I told her that he had a sore on his bottom that I wanted her to check out and she then said that she wasn't trying to be mean, but when she tells me to check a BP, it needs to be done at that moment. I checked it, and she checked his sore. After that, we didn't end up talking to each other the rest of the shift.

Does she have that right to speak to me like that? Basically like I was her little slave and that I needed to do what she told me to do at that moment? I've never had any of the other nurses speak to me like that, and actually I've had nurses do something for me because they knew I was busy. It's like she just didn't want to do it. What is a CNA's/PCA's/MA's right when it comes to nurses talking down to them? I always do what my nurses ask of me, but I won't lie, there have been a few times where I have forgot something, but had always remembered a little bit later. These were things as small as bring the patient a blanket, or some new socks. Is there a way to handle these situations? Especially since I feel like she completely missed a big part of her assessment, which was the skin assessment, and if it wasn't for the fact that I had helped him in the bathroom, I would have never found that sore.

Specializes in Med-Surg.

I think based off of the information you've provided, that you both could have handled it better. Definitely sounds like a stressful/busy part of the shift.

It doesn't seem that she was aware of all of the tasks that you were trying to do. When she asked you to take the blood pressure, and you had other tasks, you probably should have asked which she wanted done first. If she wanted the BP that moment then she could have been more clear that it was priority over any other tasks. It would have been good for either of you to call another PCT or nurse over to help (maybe charge nurse) because you were both obviously very busy and needed some extra hands.

You were both stressed, busy, and unaware of everything else the other had on their plate. I'd let this moment slide and the next time a similar situation occurs be very specific about what tasks you need to do and ask what needs to be priority.

Kind of aside, I always ask patients if I can take their BP before they go to the bathroom so I don't get an elevated blood pressure reading as a result of them exerting themselves. If they are incontinent, I do BP prior to cleaning because turning/cleaning can cause pain and a falsely elevated BP. The only time I wait is if the patient is having urgency and about to have an incontinent episode. Then I take them to the bathroom first.

Hmm..but doesn't this communication go both ways? If the nurse didn't specify that she had concerns about the patient and failed to state she wanted bp ASAP then why would a CNA prioritize it above the known "unstable" patient? It seems like it was communicated to the CNA that the room switch was first priority.

Sounds like serious lack of communication and team work in that place.

I was not there and did not hear her tone of voice, but I personally don't think that the nurse acted out of line with you. It's also not something that I think you should take personally. Like you said, you often put your patient's needs above your own. Similarly, sometimes being polite becomes secondary to a hectic day and establishing a patient's stable vs unstable status.

It seems to me that a big issue here was the lack of follow through from you in response to her delegation. For example, when she asked you to order the patient's dinner and you were switching around the rooms. She probably thought you had followed through and ordered the dinner because you hadn't said otherwise until it was too late. I feel like in the future, when you are too busy to take on delegation, it would be helpful to make a statement like "I can't order the patient's dinner right this second because I am switching rooms for the unstable patient, but I would be happy to do that when I am done if it can wait." At least this way you cover yourself by communicating that the delegated task will not be done right this very second so the nurse is not surprised when it isn't done.

As far as the blood pressure goes, the nurse was probably prioritizing the ABCs. Having the new admission's blood pressure monitored was probably higher on the nurse's list of priorities than the blood sugars of the patients that she had already established as stable.

I figure I do the BP first quicker to do a BP than a blood sugar. Do burn your bridges let it go as a learned lesson. Best of luck.

I can only speak for my job, but I know that when we are asked to admit a patient, a complete set of vitals and weight and height are expected and required as soon as the patient is taken to their assigned room, no questions asked, because the attending and the patient's PCP as well as the assigned nurse needs that information right away.

From what I read and perceive from the information you have given, the nurse told you from the beginning of the admission she needed a BP; if a nurse makes it a point to ask that something specifically be done, it's usually with good reason. I know our nurses may be on the phone, hunting down orders, or prepping assessments when I am admitting a patient. They can't do it all; there are times they have to sit by the phone because they are waiting for a provider to call them to verify orders. They delegate because they need us as their second set of hands.

When in doubt, always verify what is needed and when. This job requires clear communication from everyone.

We all have times when we're pulled at different sides at the same time. And it becomes difficult to catch up with what we're supposed to do.

Personally, if I need my pts be ASAP.. I go ahead and take it with the manual bp machine at bedside. I hardly wait on a tech or CNA for that.

I work pretty well with my tech/CNA that if I say I need something ASAP, they know too well that I really do.... I help them clean pts when they're busy.. Afterall they're my pts too... I have worked with RN who will say point blank 'I don't wipe butts'! I like to at least do it once a shift with the CNA for those pts who are always on the bed.. That way I can assess their behind for sores and stuff...

I certainly agree that she could've been more understanding, on the other hand, you may also have to understand that most of her nursing judgement may be based on the Bp she needed ASAP..

Ngysun...

Wish more nurses were like you. Thank you :-)

I wasnt there but is it possible she saw more going on? Maybe she was focusing more on the pts overall health status and not immediate tasks?

If she was assessing, she was also anaylizing info . Sometimes, as Im listening to heart/ lung sounds, if iI think there might be trouble I could see myself asking for a tech to do ️

I agree completely ^^^

The nurse is the one who sees the big picture. (Overall health status) He/she then has to prioritize. It sounds like she really felt like she needed that BP from you while she proceeded with the rest of her nursing care.

Many times it seems to the outide looking in like we nurses have the time to do something that would take "just a minute." But if we did that throughout our whole day, we would never get our work done, because every patient thinks a task takes "just a moment." (CNAs can relate, I know lol)

When I get an admit, I have ZERO time for vitals. There is SO much for the nurse to accomplish with an admit. I have stayed many many times (as many other nurses have too) hours past my shift trying to complete my admissions.

The CNA'S have No idea the work that goes into it. So, no. I don't have the time to take the BP at that moment, and I HAVE to delegate it to a CNA. (While feeling badly about it, because I know you're swamped too.)

I certainly don't miss those times myself when I was a CNA. You were clearly working hard.

One suggestion. Did you ask the nurse, "Would you like me to get the BP first, or get the accuchecks before the patients start eating as the meals are coming now?"

Because THAT would have been perfect. The nurse could have then decided which is more important at that time (prioritize.)

As far as her missing an assessment on the patient's ulcer....it happens sometimes. (Dumb brain fart) She may well have remembered hours later, "oh crap...forgot to assess the patient's buttocks," but you, the observent CNA/tech that you are, caught it and brought it to her attention. Kudos!!!

If it were me, I would have graciously thanked you for reminding me, and thanked you at the end of the day for teamwork well done.

Specializes in Oncology, LTC, Rehabilitation.

I think the nurse should have taken the BP. Good communication is so important between the nurse and the CNA, and it is the nurses responsibility to make sure that communication is there. If I were the nurse, I would have known how busy the CNA was, because it would have been my business to know. I have been a nurse for over 20 years, and learned that following up on things that CNA's have told me, has saved many lives. And it would have taken the nurse about 3 minutes to take that BP, the CNA had her hands full. And as soon as I had gotten the admit done, I would have helped her either do the finger sticks, or/and help her move those people. It is a team effort, and sometimes our aides need a hand. And if a nurse takes her/his importance a little too much, it is not fair to anyone. You need to have a mutually respectful relationship between nurse and CNA, and helping them, when they need it, is the only way to do that. They need to know we are there for them as well!

Maybe the RN didn't know how to do a b/p check. I've come across several whom have no clue how to use a b/p machine much less do a manual check.

At my school it was a requirement to have taken a Cna course before being accepted into the nursing program. That being said it's usually obvious when your dealing with a nurse that's never been an aid before. I've run into some that didn't know how to put a brief on a pt, put a pt on a bed pan, take a manual bp. I even had one while I was a Cna delegate EVERY brief change because she said she couldn't handle poop and pee. Her words...

Specializes in ICU Stepdown.

Nurses like that are the worst!!! I would just try and stand up for myself (like I've done in the past) and told her that you cannot do everything she asks right when she asks it. If she wants it done on HER time she should do it herself. It's not your fault she failed to do her job properly.

Specializes in MICU, SICU, CICU.
Nurses like that are the worst!!! I would just try and stand up for myself (like I've done in the past) and told her that you cannot do everything she asks right when she asks it. If she wants it done on HER time she should do it herself. It's not your fault she failed to do her job properly.

Your uneducated comments are offensive, as is your inability to communicate in a professional manner.

Specializes in Oncology, Rehab, Public Health, Med Surg.
Nurses like that are the worst!!! I would just try and stand up for myself (like I've done in the past) and told her that you cannot do everything she asks right when she asks it. If she wants it done on HER time she should do it herself. It's not your fault she failed to do her job properly.

You do realize that the nurse is not asking for her own personal pleasure? That the nurse is a trained professional with critical assessment/thinking skills with the authority to delegate to another staff member for the good of the patient?

And before you start telling me it was because she was lazy, take a second look. We only have one side of this story. We don't know what was going on with the patient---

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