Pet Peeve

Nurses Medications

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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.

Specializes in Post Anesthesia.

This whole issue is an arguement of semantics. I'm sure the CNA hasn't a clue what meds may be ordered and for what specific issues but "pt X in Rm 2218 needs a PRN" is shorthand at this center for "Mr. Jones is becoming aggitated and combative. l'm concerned for his and the staffs safety. Could you please see him to determine if there is something you can do to help him regain control? - Take the shorthand- the CNA aren't giving the pill, just telling you that behavior they have seen improved with pharmacological intervention is happening again and may require the same cure. That is part of thier job.

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Specializes in Psych.
Actually, yes. CNA'S can make observations and report that to the nurse, but legally only a nurse can assess. I trust the CNAS observations, therefore I immediately assess the resident, then I put into place an intervention. That is called the nursing process, which is not taught to CNAs. Again, it is the Attitude I get from SOME CNAs that gets on my nerves. I personally don't mind CNA's knowing what medications the patients are on, but if one would want to get technical, CNAs aren't even supposed to know what medications are given. It is a violation of HIPPA. I learned it the hard way when I was a sitter and I asked the nurse, "Did you just now give her Ativan?" The nurse replied, "she got what is ordered for her." I would never go to that extreme, because that was plain snotty. But it goes too far when a CNA snaps at me "he needs a prn because I'm not putting up with him like this."

Nah, my skills were always there, we just were not allowed to call them that. If they were not I would not have noticed patients with low blood sugar, or those whose SPO2 was too low. So yes I was just reporting my observations and then the nurses assessment would somehow match mine.

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Specializes in Psych.
This whole issue is an arguement of semantics. I'm sure the CNA hasn't a clue what meds may be ordered and for what specific issues but "pt X in Rm 2218 needs a PRN" is shorthand at this center for "Mr. Jones is becoming aggitated and combative. l'm concerned for his and the staffs safety. Could you please see him to determine if there is something you can do to help him regain control? - Take the shorthand- the CNA aren't giving the pill, just telling you that behavior they have seen improved with pharmacological intervention is happening again and may require the same cure. That is part of thier job.

And depending on their job responsibilities, may know what they have. Part of my job as a PCTA was to transcribe orders. The MT's I work with provide patients with a list of their medications as part of patient education, part of their job responsibility.

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I have a CNA who "checks" the IVs on all my patients, then will bring me into the room and tell me that "it needs changing." It'll be over something like having some dried blood around it, or if it's at a weird angle or looks like it's pressing into their skin. The patient and their families get all upset, thinking I knew something was wrong and just left it there.

She's driving me crazy!

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Specializes in ED; Med Surg.
I too was a sitter. It WAS exhausting work, because as you stated, I helped to keep from having the nurse come in in the first place. I did so by exactly as you stated. I was creative with ways to keep the patient calm.

Thank you for that! A lot of our sitters think that their job entails watching videos with headphones and calling out to tell us that "the patient just pulled out his NG tube". Sigh.

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This whole issue is an arguement of semantics. I'm sure the CNA hasn't a clue what meds may be ordered and for what specific issues but "pt X in Rm 2218 needs a PRN" is shorthand at this center for "Mr. Jones is becoming aggitated and combative. l'm concerned for his and the staffs safety. Could you please see him to determine if there is something you can do to help him regain control? - Take the shorthand- the CNA aren't giving the pill just telling you that behavior they have seen improved with pharmacological intervention is happening again and may require the same cure. That is part of thier job.[/quote']

No. These specific CNAs are speaking very rudely and just don't want to do their job. "Because I'm not dealing with him" says it all.

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I have a CNA who "checks" the IVs on all my patients, then will bring me into the room and tell me that "it needs changing." It'll be over something like having some dried blood around it, or if it's at a weird angle or looks like it's pressing into their skin. The patient and their families get all upset, thinking I knew something was wrong and just left it there.

She's driving me crazy!

And that just breaks the nurse - patient trust that needs to exist. If the patient or family hears this, they can mistakenly think the nurse is incompetent.

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I am quite shocked to hear some of the comments in here. I really appreciate the CNA's that let me know that patient xyz needs their PRN and the same CNA's appreciate me as I am proactive about making the correct assessment and decision. I also inform the CNA of my decision and reasoning. Most CNA's understand if I don't give a PRN, but then there's the odd one that is adamant about me giving prn imovane to someone wandering the halls and keeping out of other rooms at 2100 despite this patient having 30253892 risk factors for falling.

CNA's are our eyes and ears and make direct contact with the patients. They also don't have the education we have, so they might not know what they're saying.

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I'm not understanding. I believe I have made it clear that I value and trust the CNAs observations, and then reporting it to me. Drugs are not a cure all. They can be BETTER on them, but a person with dementia is still going to act like a person with dementia. I'm not going to keep them snowed to prevent them from standing up in the w/c because the aides don't want to "deal with it." I'll medicate them with PRNs PER orders. If I feel there needs to be a medication change due to short term efficacy, I call the doctor and inform him/her advocating for a change.

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They also don't have the education we have so they might not know what they're saying.[/quote']

Well this lends credence to my arguement. They don't know the nursing aspect, so leave that to me. ABSOLUTELY tell me of their behavior or anything else about them. I NEED my CNAs. The line is crossed when a CNA snaps in an ignorant tone "he needs a prn."

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Specializes in Transitional Nursing.

The nasty attitude is definitely not cool. I wonder though, if it would be better to say in front of random people in the hall that "mrs. jones is freaking out again" rather than "mrs. jones needs a prn" IF its a known fact that mrs jones gets prn ativan, etc. Could it be that said CNA just doesn't want to make it known that the resident is having an issue?

Believe it or not, we pick up on a lot and know a lot more than we get credit for. Especially if you consider the fact that many times, we've been with a patient for several years, 5 days a week, and seen dozens of nurses come and go on that hall. It does make the pt. feel like family and we do get a sense of what works for them and what doesn't. We can tell when they're about to hit the point of no return, and know from experience that now is the time for their prn, etc. Not from a medical standpoint, but similarly to how you would get to know what works for a family member if you weren't in nursing.

This does NOT give us the right to act like a nurse or tell a nurse what to do, and certainly its not the volume, but the tone. I'm just saying....

I know I have experienced working with nurses who seemed to feel threatened when I would bring something up, and I've worked with nurses who would ask me how the decub on so and so's sacrum was looking. Some valued my informal education, some didn't. Some tried to teach me and saw situations as a learning opportunity because they know I'm going to school for nursing. I am forever grateful for such nurses, the things I have learned from them are invaluable.

The ones who ask me to get room 22 a glass of water while I am elbow deep in poo just remind me how I don't want to be someday. :-/

Like I said before though, there's nothing worse than a know it all CNA who pretends they're an MD, I'm not saying CNA's are the same as nurses at all, but I am saying we can be very valuable and can know a lot more than is realized. We can also be dumb as a bag of rocks and not know the difference between a bedpan and a urinal....(yep, saw that once ). Seems like a few posters on this thread think all CNAs should be grunts who are seen and not heard, and that's a shame, because we can be quite helpful.

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The nasty attitude is definitely not cool. I wonder though, if it would be better to say in front of random people in the hall that "mrs. jones is freaking out again" rather than "mrs. jones needs a prn" IF its a known fact that mrs jones gets prn ativan, etc. Could it be that said CNA just doesn't want to make it known that the resident is having an issue?

Believe it or not, we pick up on a lot and know a lot more than we get credit for. Especially if you consider the fact that many times, we've been with a patient for several years, 5 days a week, and seen dozens of nurses come and go on that hall. It does make the pt. feel like family and we do get a sense of what works for them and what doesn't. We can tell when they're about to hit the point of no return, and know from experience that now is the time for their prn, etc. Not from a medical standpoint, but similarly to how you would get to know what works for a family member if you weren't in nursing.

This does NOT give us the right to act like a nurse or tell a nurse what to do, and certainly its not the volume, but the tone. I'm just saying....

I know I have experienced working with nurses who seemed to feel threatened when I would bring something up, and I've worked with nurses who would ask me how the decub on so and so's sacrum was looking. Some valued my informal education, some didn't. Some tried to teach me and saw situations as a learning opportunity because they know I'm going to school for nursing. I am forever grateful for such nurses, the things I have learned from them are invaluable.

The ones who ask me to get room 22 a glass of water while I am elbow deep in poo just remind me how I don't want to be someday. :-/

Like I said before though, there's nothing worse than a know it all CNA who pretends they're an MD, I'm not saying CNA's are the same as nurses at all, but I am saying we can be very valuable and can know a lot more than is realized. We can also be dumb as a bag of rocks and not know the difference between a bedpan and a urinal....(yep, saw that once ). Seems like a few posters on this thread think all CNAs should be grunts who are seen and not heard, and that's a shame, because we can be quite helpful.

AGAIN...I too was a CNA. And damn proud of it. I saw decline in the patient much earlier than the nurse would. One of many any examples was when I walked onto shift at 7 am (sitter at the time.) The patient was "sleeping." This was NOT normal for her. Her O2 was 91 (way below HER norm. She reacted in no way when I took her BP. Unusual for her. I tried to arouse her while calling out for help. Rapid response came...she had a new brain hemorrhage. So once again, I value what they bring to the table. I was one of them.

And AGAIN....I have stated repeatedly that I appreciate CNAs, value their opinion and most of them, their judgment.

I think so much of the defensiveness lies in that individual. It's narcissistic thinking, making everything about you. "You" in general.

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