I need some advice before I decide to go to the powers that be. I moved to a new hospital at the start of the year. I do a lot of agency so I am able to see how things are done on multiple units. One thing that struck me the most, is that a lot of units do not include CNAs in the patient hand off. So literally there is a whole workforce looking after patients that literally have no clue what is going on with them apart from
Dietary requirements
Mobility
Cognitive issues
Continence needs
And that is pretty much it. There is so much more going on with patients than just this and CNAs spend the most time with them.
This information is provided by ANOTHER CNA
Things get missed!!!
It is the first facility ever where I have worked where you do not give CNAs a full detailed patient report. I find it super unsafe. I can already list range of issues that I have witnessed with this system.
Specializes in Psychiatry, Community, Nurse Manager, hospice.
12 hours ago, Bri1231 said:
Do I get paid to take charge of the unit on some shifts. No. So it is like I never bring who gets paid to do what into nursing. When I do take charge I give out the assignments and then I take one patient from each nurse and charge and have four patients. Personal choice but do I get paid for that. No.
Now I will give you a true scenario. Patient coded and everyone went to attend same code. No one canceled the code alert so it continued to ring. At the same time a sitter was assisting a patient to the bathroom and in that bathroom the patient collapsed. She pulled the coder and no one responded fast. She made the decision to perform CPR immediately. Same sitter was a RN who left practice years earlier due to stress and workload to raise a family and help care for her mother. Was having a break from nursing proper. Now imagine if she had performed CPR on a patient with a DNR. Or did not perform at all. She saved that patients life. See. Not all sitters are just sitters and you would be very surprised at some of their backgrounds.
So I will continue to included all of my CNAs in pretty much every aspect of patient care. I will of course not bother saying oh this patient needs labs because of whatever reason. But you learn lessons in this job.
Scope can be kicked to the sidewalk if it is justified. And you know what. Twenty years and I have yet to have a serious error with a patient thanks to a CNAs quick thinking which I always always thank them for. I value them so much. They provide nursing care. Just not at a level that we do.
So as of next week there is a four week trial of patient report to include CNAs. And I welcome that with open arms.
Well yes, when I am charge I get paid to be charge. But that is beside my point.
It seems like you think you are showing respect to CNAs you work with by giving them information that they may or may not be able to use appropriately.
I think this is a mistake. It is your job to know what is outside the scope of the unlicensed personnel. As their clinical supervisor you should make sure you are not delegating tasks to them that are outside their scope explicitly or implicitly, and I think you are doing just that when you give them information outside of their responsibility.
Do I get paid to take charge of the unit on some shifts. No. So it is like I never bring who gets paid to do what into nursing. When I do take charge I give out the assignments and then I take one patient from each nurse and charge and have four patients. Personal choice but do I get paid for that. No.
That has nothing to do with this. Being CN is within the RN scope of practice and is also likely part of your official job description in one way or another. Whether your employer pays you more to do that part of your job description is between you and them and their policies.
16 hours ago, Bri1231 said:
Now I will give you a true scenario. Patient coded and everyone went to attend same code. No one canceled the code alert so it continued to ring. At the same time a sitter was assisting a patient to the bathroom and in that bathroom the patient collapsed. She pulled the coder and no one responded fast. She made the decision to perform CPR immediately. Same sitter was a RN who left practice years earlier due to stress and workload to raise a family and help care for her mother. Was having a break from nursing proper. Now imagine if she had performed CPR on a patient with a DNR. Or did not perform at all. She saved that patients life. See. Not all sitters are just sitters and you would be very surprised at some of their backgrounds.
If your sitters have current BLS certification, they should do what they are trained to do. If they aren't trained, their job is to summon help. Period. You, the RN, cannot pass any (legal) responsibility to a person who is not trained, not licensed, etc., etc., and you do not limit your responsibility or increase their responsibility based on the amount of report you give them. The story about the RN-acting-as-sitter has nothing to do with this; the details of that scenario do not apply to what we're talking about. If all of your sitters are properly trained to provide BLS care and expected to provide it as part of their role, there is no problem with them knowing a patient's code status. Just the same, they must notify you immediately with any patient concern, whether the end up providing any compressions or not -- and your job is to still assess your patient at the expected intervals, not just figure your patient is fine because you gave the CNA a thorough report and the CNA is sitting with the patient and hasn't summoned you or reported any findings to you. [I'm not saying you would do that, I'm saying that you have to be very careful when thinking about how much CNAs can help you with your RN role. And you also have to recognize the pitfalls involved in the POV you are trying to advance here.]
16 hours ago, Bri1231 said:
Twenty years and I have yet to have a serious error with a patient thanks to a CNAs quick thinking which I always always thank them for. I value them so much.
Hopefully we all value nursing assistants/techs/CNAs. But valuing them and appreciating them and recognizing their major contributions, treating them with basic human kindness, etc., doesn't have anything to do with this. Lots of people are good at their hired roles, but that doesn't mean they can be granted the duties limited to a different licensed role to perform independently on your say-so, due to your philosophies. That's just the way it is.
I really think you are taking personal offense to our advice that is not personal opinion but rather based on the legal aspect. Saying that you haven't seen any CNA make a serious error also has nothing to do with this; the main reason for that is because the CNA role is not involved in higher-risk decision-making to begin with. They do make lots of lesser errors (and yes, sometimes other disciplines with increased accountability also make errors) and they also often do things in a manner that is not consistent with appropriate nursing assessment; that's why the nurse retains the responsibility for appropriate nursing assessments and interventions.
Give them the information they need to do their job to the best of their abilities and all is well. But don't mix up them doing their job with you doing your job. No one is trying to disrespect NAs/techs - we know that some of them provide exceptional patient care and also that we would be in big trouble without their help.
I don't think it's a good use of time for them to stand around while nurses talk about whether a, b, d was followed up or whether the doctor ordered x, y, z or a variety of other stuff mentioned or discussed in nursing report. But hopefully your trial will lead to improved communication in the end. ??
That has nothing to do with this. Being CN is within the RN scope of practice and is also likely part of your official job description in one way or another. Whether your employer pays you more to do that part of your job description is between you and them and their policies.
If your sitters have current BLS certification, they should do what they are trained to do. If they aren't trained, their job is to summon help. Period. You, the RN, cannot pass any (legal) responsibility to a person who is not trained, not licensed, etc., etc., and you do not limit your responsibility or increase their responsibility based on the amount of report you give them. The story about the RN-acting-as-sitter has nothing to do with this; the details of that scenario do not apply to what we're talking about. If all of your sitters are properly trained to provide BLS care and expected to provide it as part of their role, there is no problem with them knowing a patient's code status. Just the same, they must notify you immediately with any patient concern, whether the end up providing any compressions or not -- and your job is to still assess your patient at the expected intervals, not just figure your patient is fine because you gave the CNA a thorough report and the CNA is sitting with the patient and hasn't summoned you or reported any findings to you. [I'm not saying you would do that, I'm saying that you have to be very careful when thinking about how much CNAs can help you with your RN role. And you also have to recognize the pitfalls involved in the POV you are trying to advance here.]
Hopefully we all value nursing assistants/techs/CNAs. But valuing them and appreciating them and recognizing their major contributions, treating them with basic human kindness, etc., doesn't have anything to do with this. Lots of people are good at their hired roles, but that doesn't mean they can be granted the duties limited to a different licensed role to perform independently on your say-so, due to your philosophies. That's just the way it is.
I really think you are taking personal offense to our advice that is not personal opinion but rather based on the legal aspect. Saying that you haven't seen any CNA make a serious error also has nothing to do with this; the main reason for that is because the CNA role is not involved in higher-risk decision-making to begin with. They do make lots of lesser errors (and yes, sometimes other disciplines with increased accountability also make errors) and they also often do things in a manner that is not consistent with appropriate nursing assessment; that's why the nurse retains the responsibility for appropriate nursing assessments and interventions.
Give them the information they need to do their job to the best of their abilities and all is well. But don't mix up them doing their job with you doing your job. No one is trying to disrespect NAs/techs - we know that some of them provide exceptional patient care and also that we would be in big trouble without their help.
I don't think it's a good use of time for them to stand around while nurses talk about whether a, b, d was followed up or whether the doctor ordered x, y, z or a variety of other stuff mentioned or discussed in nursing report. But hopefully your trial will lead to improved communication in the end. ??
Thank you for the reply. First of all I am not taking this personally I have come on here to get advice from everyone to figure out a better way to deal with patient report and I am taking all of the advice on board.
I refer to the CNA making a serious error part. This you have read wrong. I stated that I have not had any serious errors with a patient thanks to a CNAs quick thinking. In other words the CNA picked up on a clinical issue and reported it back to myself and I was able to act. This is what I meant. There is no legal scope for thinking! I otherwise may have walked into disaster in a patients room on a few occasions. Beacause I spend way less time with a patient that assistants do.
It is a hard one because as some people have decided to point out we have scope, legalities, RN assessment. Twenty years later you know I could write a book on all of this with my eyes closed.
I will bring this all back to the original point. More places than not have provided a FULL PATIENT REPORT to RN and CNA at the START of a shift. The places that did, teamwork was better, patient care was better and there where less issues. The places that provided a need to know report at the START of each shift. Well, the shift could be scatty to say the least. Especially in my current hospital.
You mention NAs standing around while nurses discuss x, y, z. For example I would not call my CNAs and say I just need to tell you that the doctor called and changed this patients orders, or the lab called and reported, whatever it may be.
I am specifically talking about the beginning of a shift. In order for patients to have appropriate, holistic based care from the entire 'NURSING' team. The RN and CNA must have the full report. Anything after that first intital report is a need to know basis I totally agree.
Hopefully the trial will work ? I will keep you all updated and please anymore advice or suggestions please let me know. I really do take it all on board. It is what nursing is about. We all have to chip in to make things better.
As promised here is a quick update on the new report system.
All nursing staff RN/CNA in patient report at the start of the shift and report starts with
Safety brief
Patients at clinical risk ( unstable/VS issue)
Patients at risk of developing pressure ulcers
Patients with NGT in situ and exact placement as measured before the end of the shift
Patients with chest drains in situ
Patients with Central Lines in situ
Any other relevent concerns to highlight.
Then the patient report for every patient on the unit is handed off to the entire oncoming shift by the charge nurse. It is all done in around fifteen minutes give or take.
At 12pm there is a post MDT patient review update for RNs only then we update our CNAs with anything relevent to their input in regards to patient care.
So far so good. No issues. All going very smooth.
Everyone knows all the patients on the unit and any relevent specific issues to be mindful of.
Does anyone on here have anything to add or take away?
FolksBtrippin, BSN, RN
2,325 Posts
Well yes, when I am charge I get paid to be charge. But that is beside my point.
It seems like you think you are showing respect to CNAs you work with by giving them information that they may or may not be able to use appropriately.
I think this is a mistake. It is your job to know what is outside the scope of the unlicensed personnel. As their clinical supervisor you should make sure you are not delegating tasks to them that are outside their scope explicitly or implicitly, and I think you are doing just that when you give them information outside of their responsibility.