Pet Peeve

Published

This is random but I just wanted to get this off my chest. First, before a CNA gets offended, I have to say I love CNAs. I was a CNA myself, and it is hard, under appreciated work. My pet peeve? I work in a LTC/SNF. The aides are constantly saying with an attitude "he needs a prn."

It's not the aides job to tell me what med to give and when. I simply want to hear what observations they made of the resident, then I, the nurse, will assess the resident and decide what action I feel is best to take. I remember one specific time, a CNA told me her resident needed her "prn." This resident had no psychotropic meds. The CNA snottily said "well the doctor needs to know he needs one." No, the doctor needs to know my assessment, and he/she can decide from there the best course of action to take. Many types of sedatives are contraindicated in the elderly especially combined with their diagnoses, which could cause an adverse reaction or even make the resident more agitated.

I just want to hear from the CNA what he/she observed, and I will take it from there. I've only experienced this at one place, so once again, no offense to CNAs. Just a handful at my facility.

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Please... stop with all the disclaimers. Loving CNA's is not required.

You have pinpointed the problem. The CNA's are telling YOU what THEY want.

Be assertive, look them straight in the eye and say exactly what you said here.

ONCE.

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Please... stop with all the disclaimers. Loving CNA's is not required.

You have pinpointed the problem. The CNA's are telling YOU what THEY want.

Be assertive, look them straight in the eye and say exactly what you said here.

ONCE.

Thank you. I am going to do just that.

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Please... stop with all the disclaimers. Loving CNA's is not required.

You have pinpointed the problem.

ONCE.

By "love" I mean "respect and greatly appreciate them" I didn't want all CNAs on the board to start something. Disclaimers can prevent bickering.

I get your point about being assertive. The new place Im working for, the CNAs test the "new" nurses to the building. I cut that out immediately while still maintaining a good teamwork environment.

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Specializes in ED; Med Surg.

What's even worse for me is the 1:1 sitters. Most are not even CNA's and they try to tell me how to manage my patient. "Oh his lungs sound terrible, I think he needs a neb"...ummm, NO. Let me assess my patient and I will do what I think necessary. When you graduate from nursing school and get your own license, then you can assess your patients to your heart's content!

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Specializes in Psych.

When I was a CNA I told the nurse that the patient was in need of a PRN, I could see the signs that he was revving up. I was told basically what you said here, she was the nurse and she would make that decision. So 15 mins later when I was getting the crap beat out of me, she finally decided that it was appropriate to medicate him. Glad I got to be the punching bag, because I was only a CNA.

As a nurse, I have asked another nurse to medicate a pt because of threatening behavior ( towards me, so it wouldnt be a good thing for me to give it) and been ignored. That was an interesting night to say the least. When any of my coworkers tell me they think so and so needs something, I listen to them. They are on the floor more than I am and notice the minute changes I may miss.

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Specializes in Skilled Nursing/Rehab.

Heh heh heh... I am working as a CNA in a 1:1 right now with a nonverbal pt who can be combative when he gets upset. He is suspected of having pneumonia and a little bit ago he started tossing and turning and sort of crying... I put the light on and when a nurse came in, I asked if we could check his O2 sats. I then told her about his behavior change and that I was trying to figure out what might be bothering him. I wonder if I annoyed her because I had a suggestion... :wacky:

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Specializes in ED; Med Surg.

Oh, I def listen to my CNA's. Just not the 1:1's...unless they are CNA's! :)

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If I know you have done everything they could to redirect or soothe a pt then I will certainly get a PRN.

If you just come up to me and have make no effort at all to connect or engage the pt, then I will suggest some nonpharm interventions.

Hell, I'll even show you what I mean if you're skeptical (and don't doubt my gero whispering skills again;)... honestly, I want to teach everyone the Art of Gero Whispering, but you'll never learn it if you keep running to the nurse for a PRN!!)

When a pt is on a 1:1, the sitter's job isn't just to watch the pt and call for help, but to find ways to prevent having to call for help in the first place: engage them in a conversation-- even in it's not nonsensical, play some music, fuss over them: smoothe the bedding or... *gasp* give them a back rub... the list is endless and full of things that would make you go, "Yeah, right, Hygiene!", but you'll see how you need to allow yourself to be creative and slightly courageous.

Somebody else on AN pointed out that sitting is "exhausting if you're doing it right" (sorry, I don't remember who said it) but they were spot on! If someone thinks they're just going to read a book all shift because the nurse is going to give a PRN... well, no, that's wrong.

I expect staff to do their jobs before the PRN's come out... and that includes myself!

The techs may not always realize what medical issues-- on top of some serious meds-- the pt may have. I will try to explain that, sometimes, adding more meds (PRN's) on top of that can actually be rather scary.

And what does anyone do when the doctor refuses to order an PRN? Well, it's back to developing, utilizing and honing those soothing and redirecting skills... and I'll be right there with you until we can find something that works... and hopefully, no one gets a punch in the nose in the process.

But don't just tell me to give Bubba a PRN because he tried the door or poured his coffee on the floor... let's see if we can figure this guy out first.

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Specializes in Oncology, Ortho/trauma,.

Just making an observation but I was wondering that when you call a Doctor do you not make recommendations for care? I only ask this because after assessing/working with a pt and you notice something don't you call the doctor and say " Hey I noticed this, would you like me to order this....ect?"

In effect isn't this what your CNA's are doing with you?" I notice pt is doing this, you might want to do this?" or " So and so is hurting, they need a pain pill"

If it is not an appropriate intervention at the time all you have to say to your CNA is something like "Thanks, I will go and check on them and see what we can come up with for a plan of action." or you could go into technical aspect of pharmacological meds and interactions and why that might not be a good idea.

I guess my point is I am not above anyone recommending any kind of intervention about a pt be it CNA, Respiratory, or even family. If it is not feasible or not safe it is a teaching moment. If it is part of their orders and the pt warrants it after I asses the situation, I'll do it or call for an order, no big deal.

Now if this is an attitude issue as in the CNA is saying it disrespectfully then that is a conversation you need to have privately with them and expectations you have for working together. You teach people how to treat you.

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Specializes in ortho, hospice volunteer, psych,.
When I was a CNA I told the nurse that the patient was in need of a PRN...

They are on the floor more than I am and notice the minute changes I may miss.

Maybe if you had asked the nurse to assess the patient and her behavior instead of demanding that a PRN be given, she might have responded very differently. Nurses are taught to assess their patients for many things. I'm not trying to be rude, but CNAs aren't. CNAs are a vital part of the team. You're our second and third pair of eyes, which is invaluable, but you are not trained to assess patients.

When you see me (and my counterparts) sitting down at the nurses station with a cup at my hand, I'm not just sitting on my rump warming the chair. The cold tea may well be the only liquid I've had in the last 10 hours. I might be charting the blow up Mrs. Smith had in group an hour ago. I might have called Dr. Jones and am checking lab slips while I wait for a call back. BUT...

If you tell me your patient is out of control again and needs an assessment, I'll finish the word I'm in the middle of writing and come with you... right now.

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Specializes in Psych.
Maybe if you had asked the nurse to assess the patient and her behavior instead of demanding that a PRN be given, she might have responded very differently. Nurses are taught to assess their patients for many things. I'm not trying to be rude, but CNAs aren't. CNAs are a vital part of the team. You're our second and third pair of eyes, which is invaluable, but you are not trained to assess patients.

When you see me (and my counterparts) sitting down at the nurses station with a cup at my hand, I'm not just sitting on my rump warming the chair. The cold tea may well be the only liquid I've had in the last 10 hours. I might be charting the blow up Mrs. Smith had in group an hour ago. I might have called Dr. Jones and am checking lab slips while I wait for a call back. BUT...

If you tell me your patient is out of control again and needs an assessment, I'll finish the word I'm in the middle of writing and come with you... right now.

So my assessment skills only started when I had the RN behind my name instead of the PCTA? Funny, how I don't notice that. I'm glad the other nurses I worked with on a regular basis trusted that when I said so and so is revving up and needs something, they believed and trusted me. Maybe it was because at the time I was in school for my RN that they trusted me, but they trusted the others on the unit also. And guess what, if the patient had COPD or DM, I would say hey Joe is acting up, do you want me to check his blood sugar for you, or get a set a vitals? I didnt always ask for a PRN. The nurse that I had the incident with was a float staff, who wouldnt have known how the patient was. I knew that when he started getting snippy with staff, unless a PRN was given ( I worked geri-psych at the time) he was going to start hitting and punching people. She did assess the patient and stated " he is not severely agitated." So nothing was given and a little later he required IM vs PO medication. Had the nurse trusted my evaluation ( since as a CNA I couldnt assess) of the situation may have been different.

I guess maybe I have a different perspective because I work in psych.

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