Nursing Assistants Responsibilities-I Need Help!!

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I had an event happen at work and would like some feedback or advice from all of you. I have been a nurse now for just over 5 yrs and during that time have worked critical care right from the start. I had two out of three of my patients the other day needing a lot of attention including a spastic family member. I went to one room to check a blood pressure when I needed to be in another room at the same time I am sure you get the picture. While I was in there she asked for the bedpan (which she had been on several times and not having a BM) I was so busy I ask that she put the light on for help from a nursing assistant, apparently the patient complained and I was remrimanded and told I should have taken care of it that it took just as much time to put her on the bed pan as it would take for an assistant to come in. I was so frustrated I said I have two critically ill patients what do you want me to do? Was not a good conversation with an assistant manager. Later I asked the assistant about it and she replied well if you were in the room you should have taken care of it. My reply was I always help you when you need it and she agreed, I said I really wish you guys could walk a day in our shoes to truly understand what we are up against. She is an excellent assistant but I did her job at one time and it does not compare to the reponsibility a nurse has. What do you think?

Specializes in Utilization Management.
I will probably get flamed here, but I am agreeing with the original poster. Ill start off by saying that you will never hear the words "that is not my job" out of my mouth, the PCT's that I work with all say that I am one of the few nurses that really helps them out and does not abuse them. I rarely ask them to do anything other than EKG's, most other patient care issues i ALWAYS offer my assistance unless I am truly too busy with a sick patient.

It seems like the OP is the kind of nurse that helps out and does not sit on her butt and let the CNA do all the work. This night she had 2 patients who were sick, and needed her attention at all times. Lets call this woman patient X and the other patient, Y. She is in X's room doing something, now this woman needs a bedpan. Maybe she is 300 lbs and needs the assistance of 3 to get her on it. Maybe the bedpans are all the way down the hall and not near the room. It does not take "1 minute" to put all patients on the bedpan like some have said. It can be a 10 minute project in some cases. Now lets think about patient Y. She works on a cardiac floor. Maybe this patient was having runs of v-tach, or was on pressors and had a b/p that need to be recycled q5min. Maybe he needs like 10 meds to be given now. How do you know that while she was in the room with X, that the monitor wasnt beeping in Y's room, which needs immediate investigation? Those 5 minutes that it takes to get the bedpan and get her on it could mean its too late for patient Y.

If there are only 2 staff members in this situation who are able to help, the RN and the CNA, guess what..The CNA cannot go monitor patient Y, give him his meds and assess his condition while the nurse is giving the bedpan. So the OP made the choice to delegate to the CNA. That is the only logical thing to do in this situation. Now if the nurse was sitting on her behind while the CNA was running around then I would feel differently. Some other posters have said that in previous facilities the RN's would give bedpans and the OP doesnt. That is totally irrelevant. We are not questioning her willingness to help out, but the decision for the nurse to not do it at that time was based on nursing judgement, which the CNA obviously did not understand.

I have been in the above situation with 2 unstable patients, and sure the PCT's have complained, but most of them are knowlegeable enough to understand why I was not able to do it at that time and are more than willing to help. Nobody went to complain on me, but even if they did it wouldnt get very far because anyone with common sense can understand that situation if they were there and totally aware of everything going on at that time, which we were not able to totally do from the post, but anyone who cares for cardiac patients can imagine a situation above, and know that its not uncommon for that to happen.

I agree completely. This has happened to me as well. You CNAs just don't know how awful it makes us feel to have to choose between putting a patient on the bedpan for the umpteenth time or going to the patient in the next room in respiratory distress. :(

Everyone has to prioritize and delegate. It seems harsh to have to let someone wait when they have to have a BM. Yet we know full well that letting a patient soil the bed doesn't quite compare to letting another patient DIE, does it.

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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.
So the OP made the choice to delegate to the CNA.

I am not seeing in this thread where anyone delegated to the CNA, what i've seen is where a pt. was told to ring the bell for the CNA, so she could be helped with the pan. Telling the pt. to ring the bell is not delegating to the CNA.

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Specializes in Utilization Management.
I am not seeing in this thread where anyone delegated to the CNA, what i've seen is where a pt. was told to ring the bell for the CNA, so she could be helped with the pan. Telling the pt. to ring the bell is not delegating to the CNA.

It's an indirect delegation because if only you and the CNA are working that room, then if you can't answer the call bell, the CNA is expected to.

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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.
It's an indirect delegation because if only you and the CNA are working that room, then if you can't answer the call bell, the CNA is expected to.

Assuming the CNA is not busy in someone else's room at the time for who knows how long, which is why i disagree that telling the pt. to ring the bell is an indirect delegation to the CNA. If the CNA is in someone else's room (usually, door shut, don't hear any bells), it could be at least 5 minutes before they know they were "delegated" to put this pt. on the bedpan.

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Specializes in Utilization Management.
Assuming the CNA is not busy in someone else's room at the time for who knows how long, which is why i disagree that telling the pt. to ring the bell is an indirect delegation to the CNA. If the CNA is in someone else's room (usually, door shut, don't hear any bells), it could be at least 5 minutes before they know they were "delegated" to put this pt. on the bedpan.

Yeah, but once again, you're choosing to put someone on a bedpan rather than save someone's life.

Or, you put someone on the bedpan and the CNA doesn't answer it promptly and then you have a patient with evil-looking lines all around their butt.

It's not a perfect situation so there can't be a perfect answer. If there was another option for this OP I'd sure love to hear it, because I have to deal with this kind of problem occasionally, and I would love to have the best of both worlds--that is, having the patient on and off the bedpan safely and successfully, while at the same time, having the patients who need prompt lifesaving attention cared for immediately.

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Yeah, but once again, you're choosing to put someone on a bedpan rather than save someone's life.

Or, you put someone on the bedpan and the CNA doesn't answer it promptly and then you have a patient with evil-looking lines all around their butt.

It's not a perfect situation so there can't be a perfect answer. If there was another option for this OP I'd sure love to hear it, because I have to deal with this kind of problem occasionally, and I would love to have the best of both worlds--that is, having the patient on and off the bedpan safely and successfully, while at the same time, having the patients who need prompt lifesaving attention cared for immediately.

I dont think it was a matter of saving someones life..lets not get too far away from the original post...it was an important situation, a critical one. The thing here is..none of us was there that day and I am sorry for the nurse who posted this and got blasted by everyone(including me)..she was just looking for validation I guess...just stand by your decision and if it was the right decision then there is no need to seek out validation, although its always nice to have it.We have all been in situations. I am sure, where someone was not being helpful, appreciative, a team player..for whatever reasons, we have all worked with the lazy and the hard working..I think the CNA could have worked this out with out a report to management..I mean really, this is where animosity and communication breakdown happens between a nurse and a CNA..the CNA could have explained herslef to the nurse..who knows where she was anyway..was she available?? was with another patient who had another busy nurse with another critical patient?? who knows..maybe she wasnt doing a thing and felt like being difficult...

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my error in thinkinh it was the assistant who complained, it was the patient...I guess we could use a hospital stay every now and then to see what they see...as a patient, it doesnt really matter what else has to be done..she had to go on bedpan.this same scene p out in so many different ways with so mnay different outcomes everyday somewhere. Playing the "my job is harder" game really sucks and its a pissing contest with no winners. I hardly complained to my husband about my job because he is a firefighter and a fire in July has got to beat my job some days..LOL

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Delegation is defined as assigning or entrusting (powers or functions) to another. Entrusting means to trust and/or commit with confidence. This does include relying on another's decision making capability and their judgement.

What the CNAs duties are were "assigned" long before I started working at a facility or unit in the form of a job description, who was hired ("entrusted")was not determined by me, it was determined other people (NAM, HR). When a CNA performs their duties, be it performing VS, chemsticks, or basic care, our SBONs consider that "delegation," whether or not I as a nurse specifically requested they perform any of these functions, I will still be accountable and responsible for the "delegation" of these functions. As to trust and/or commit with confidence, our SBONs and state legislatures don't seem to think there should even be a reasonable expectation of performance when we "delegate." IMO, we are "delegating" by the thinnest defination of the word to start with and in the most passive means the majority of the time, meaning there are duties we expect them to perform based on their job descriptions without specifically instructing them to do so.

The thing is, I have very little say in a lot of what is "delegated" to UAPs, that will be determined by others (SBONs, the facility, state legislature/nurse practice act, etc). I didn't participate in their training or evaluate the effectiveness of their training when they are hired, yet I can be held accountable for the evaluation, appropriateness, and follow-up of "delegating" to a CNA. When a CNA "forgets" to inform me of an elevated BP (for example), it will not be the CNA's actions called into account in a legal situation, it will be mine. OH and the real beauty part, no matter what was going on, no matter how busy I am, no matter how short-staffed the unit is, it will not hold water as a legal defense.

We are considered to act within a "supervisory" capacity when it comes to delegation by SBONs, facilities, state legislatures, etc. At my facility, that means, essentially, 2 CNAs have 5 "bosses" to answer to, not including the NAM and the rest of middle/upper management. Now, is it reasonable to expect 2 people to have this many "supervisors?" In the true sense of the word "supervisor," that is not how a CNA functions on a unit functions per se. The CNA has a job description with duties that are outlined that they follow based on an assigment plan, with the nurses at times specifically delegating certain jobs that falls outside of the assignment plan.

When we function as a team, that is when the majority of the time, it works out best for our patients and each other (nurses and CNAs). I think we all have experience in regards to how it can be when we don't.

Sorry for the long-windedness folks. It just that "delegation" is one of the many rock-and-hard-place situations I feel that nurses have to deal with.

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You made the right choice. Some how it always gets back to the nurse.

All the nurses that disagree with this, please do me a favor. If I am ever one your patients in need of medical care, please take care of me before putting a patient on the bedpan, a difference in a few seconds could be the difference between life and death. And likewise, if I am one of your patients that needs the bedpan and you have a patient with a medical issue, please see them first.

It seems that nurses have a an open job description, in addition to having tasks that only they can perform, they are expected to do everyone else's job. I don't go to a restaurant an ask the bartender to seat me, I don't go up to the hostess and ask them for a beer, I don't walk up to a bank teller and ask them for a loan. I am not saying that nurses should not help out, but I most definitely think we need to prioritize our work. Medical care vs bedpan, medical care for sure. Asking for the bedpan is no different than patient asking for pain medication. The tech has no problem telling the nurse a patient needs pain medication, but for some reason the tech has a problem with the nurse telling them the patient needs a bedpan.

Techs always think the nurse is being lazy, they have no idea. I understand that techs have a lot of patients, but just how many are self care. I don't think any one has ever died because they had to wait for a bedpan, or were delayed in having a bath.

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Yikes....I can't beleive we have debated this issue this far. If it was a simple roll over and stick the pan under issue, then yes..I would have put her on it and told her to ring for help when done. Now if it was more involved and I KNEW the aid would be in to help in a few minutes I might have also told her to press the bell for an aid too. I think the OP mentioned this was a critical care unit? I'd prioritize my care too. If the other pts were in need of assistance ASAP, they would have taken priority.

Now...here is another issue. Was the pt constipated? Having S/S of a uti? Was there another underlying need that should be addressed?

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Specializes in Utilization Management.
You made the right choice. Some how it always gets back to the nurse.

All the nurses that disagree with this, please do me a favor. If I am ever one your patients in need of medical care, please take care of me before putting a patient on the bedpan, a difference in a few seconds could be the difference between life and death. And likewise, if I am one of your patients that needs the bedpan and you have a patient with a medical issue, please see them first.

It seems that nurses have a an open job description, in addition to having tasks that only they can perform, they are expected to everyone else's job. I don't go to a restaurant an ask the bartender to seat me, I don't go up to the hostess and ask them for a beer, I don't walk up to a bank teller and ask them for a loan. I am not saying that nurses should not help out, but I most definitely think we need to prioritize our work. Medical care vs bed pan, medical care for sure. Asking for the bedpan is no different than patient asking for pain medication. The tech has no problem telling the nurse a patient needs pain medication, but for some reason the tech has a problem with the nurse telling them the patient needs a bedpan.

Techs always think the nurse is being lazy, they have no idea. I understand that techs have a lot of patients, but just how many are self care. I don't think any one has ever died because they had to wait for a bedpan, or were delayed in having a bath.

Bravo! Well said!

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Hey!

I have been on both sides of the coin.A CNA and now a LPN for 17 years. I am a traveling nurse now and heres what iv'e noticed in many states..CNA's rule the roost..It sucks that I get out of report and have to put out fires just to start my night.After report I'm checking charts for new orders that have gone unoted,faxing pharmacy for the meds from the unoted orders and trying to update my MARs to avoid a med error..and have CNAs coming to me telling me my pt needs pain meds(which they only know from answering a lousy call light from the desk).Can any of those "chores" be delegated to a CNA..NO!!

Once I get through the first 10 minutes of hell..I look over and see the CNA's still sitting @ the desk. Why aren't they taking pt's to the BTR,getting ice water, giving coffee and blankets out before heading down the hall for 8pm vitals?

I finally find the next few minutes to give the pain meds,introduce myself to pt's and finally start my "routine". When CNA's are trained they should be taught to hit the floor and check on pt's find out what they need and get it! To be told by a CNA "i'm getting vitals now,I'll get it in a few" infuriates me! I am expected to drop what I'm doing and provide pt care on a regular basis..why shouldn't the CNA's be expected to do the same? I pass HS meds and spend the majority of my time being asked for ice water or help to the BTR.Get real! I will be lucky to pass all my meds inside the window..not to mention if assessments aren't done before the HS med pass you have to wake them up or god forbid something was missed that was serious.CNA's need to do their own job! I do mine and help readily with turning pts(some places pt's are only turned if you go get the CNA and HELP her),BTR runs,bedpans,HS snacks because I provide good care.I do believe in and practice Team Nursing, but come'on it's getting ridiculous when a nurse is called to a managers office for not putting a pt on a bedpan..if there are CNAs they should work as hard as everyone else or go to school so they can be overworked and underpaid as a nurse.I'm tired of having to check my own HS glucoses,pass my HS snacks and get ice water.I will do this occasionally but I will go to the CNA and remind her she is also part of the team. If you let them slide and do their job then you are either to meek for confrontation and will be doing their job forever..until you lose your license for not doing YOUR job.Is "I was a putting a pt on a bedpan an acceptable excuse in a courtcase? CNA's need to do there share and I will help but I will not be taken advantage of..or reprimanded for not doing their job. I am a good nurse and have satisfied pt's..I provide quality care even if I have to confront and "delegate" to slow moving,inflexible CNA's. Just my thoughts

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