Problems with CNAs and Jeopardizing Nursing License

BrokenRNheart · Mar 19, 2008

Not yet, but insubordinate techs have made life miserable on the job.

I have worked with some wonderful techs but then there are others that just make our jobs worse.

No wonder nurses are leaving the career.

Techs, politics, staffing...

ChocoholicRN · Mar 19, 2008

I didn't have a BON action against me, but I did have a huuuuuge problem when a CNA did not report abnormal vital signs to me. I was getting my AM meds together and there were 2 nursing students shadowing me. I was explaining to them how anytime we give a cardiac med we check the persons BP and HR. Well, I went to go check this pt's BP and the doc was in there and looked pretty involved, so I went to the tech to find out what the BP was. It had only been about half an hour from when she took it to when I was giving the med. I come to find out that she recorded a BP of 75/49 and didn't tell me!! I was furious and reported this to my nurse manager. I find out about two minutes later that the reason the doc was in the room was because the patient was going down hill and was trying to determine what was causing the sudden drop in BP. Before you know it, this woman has 4 liters of fluid running and is being whisked off to the ICU. Now i'm not saying this could have been prevented had the aide told me about the low BP, But I could have taken action much sooner if I had known about this. This particular CNA and I tend to butt heads so I try to avoid her unless necessary, but this was unacceptable. I really wish sometimes that CNA's got to experience a day in the life of a nurse so they know exactly how insanely busy it is on the floor for us, even with an excellent CNA.

ohmeowzer RN, RN · Mar 19, 2008

i had a big problem with a CNA which just PO'd me... she was doing nothing.. no baths, no vital signs and spoke on her cell phone. i asked her to get vital signs for me.... ya know what she said " you are the RN at the end of the day it is your job to do this work and make sure it is done, not me ( meaning her the CNA)" , she then proceeded to tell me in the end if the vitals or baths arn't done .. the nursing board would come after me not her for neglience ... she said to me .. it was all up to me , don't ask her to do anything.. needless to say i wrote her up .. and ya know they suspended her and i saw her leaving after her counseling walking out the door .. she said to another CNA " look they gave me days off and i get a vaction " and laughed.... and she is right because it does all come down to me if the CNA's don't work or want to work , and neglect patients ... i went through 5 years of nursing school and yes as a RN i am accountable for all she dosen't want to do... and i don't work there anymore.. but from what i hear she works there .. and i am stretching the word "work" , she is just collecting a paycheck... grrrrrrr

allnurses Guide · Mar 19, 2008

Way back when in my grad year, my head nurse called me to task for not doing anything about a 102 fever in a patient ( the residents jumped on her when they found it). I whined the aide hadn't told me about it, she very bluntly said it was my job to review my patients' bedside charts and know what was going on. She was right, I knew when they did vitals, and could easily have looked for the VS when I was assessing my patient.

It wasn't life threatening the way jerzytech's patient was, though. But it wasn't addressed for several hours either (we had standing orders for blood cultures for fever).

pagandeva2000, LPN · Mar 19, 2008

I had a situation just today, where I came to relieve an RN for lunch, and she told me that there was a patient in our clinic whose chart was placed in her office for nurse counseling an hour ago (we have a high volume of patients and it takes time to get to them as well as to take care of them...making it longer). When she checked the computer chart, she saw that there was an order for Clonidine 0.1 mg PO Stat for a hypertensive patient. She told me she went to the doctor and asked him why she wasn't alerted, doc says that he told the tech to take the chart straight to her office, and she didn't. Before I administered the medication, I decided to check the vital signs, and the machine recorded 237/115 (recorded by the tech). I see the patient's age and weight: 72 years old, 98 lbs. Then, I see that the tech recorded her 'manual check' which, was 205/103 (yeah, right...no manual has odd numbers). We were able to audit the chart to see who actually recorded it, and it was the tech that denied it to the RN. Now, I have to get this poor woman with an unsteady gait who had already waited for over one hour only to tell her that her blood pressure was extremely elevated and I had to administer this oral medication and she was to wait an additional hour before I can check it again, as ordered. We were livid!!

When I was a CNA working in a nursing home, I saw once where a non-verbal patient's ankle was fractured, no one reported it for about two shifts, and it was discovered on the evening tour. The state was called and two LPNs were questioned regarding this. Many times, we do not have access to the patients in the same manner that the CNAs have, and I really cannot comprehend why a person would not do a simple thing like REPORT IT TO THE NURSE...they don't have to do ANYTHING else but tell us...but they give us a hard time.

Our techs in the clinic are responsible for scheduling appointments for referrals from the provider. If the patients do not need nurse counseling, the techs send them home. Goodness forgive if we don't get it. One time, I saw that a patient had a very low Hgb and Hct, and was referred for a GI appointment ASAP. The tech give the next available in 6 months. I know that the techs do not have access to know the problems of the patient, however, the consult specifically stated in CAPITAL letters ASAP. At least, they could schedule it, but, now, I had to, because to find the tech, then argue with them, for no results...I could do it myself.

Now, they decided to take away overbooking access from most of the employees, including nurses. While I can understand that, now, how do we book these ASAP appointments, after we, the clinicians, see the issue, but cannot just send a patient to a clinic with no appointment. They will be turned away. But, with computerized charting, they can see which nurse accessed this chart, and we can be held liable if we did not intervene. We have some very good techs, but then, there are some that are questionable, at best. They do not stock the rooms, but we can be blamed if the providers do not have what they need. They are supposed to draw blood, but many of them don't want to do it. It really sucks.

What I do think should happen is if they are certified, they should take the accountability of their own personal actions because we cannot be everywhere at once.

Virgo_RN, BSN, RN · Mar 19, 2008

Has anyone had a Board of Nursing action against their nursing license which resulted from CNAs not providing proper care to patients, not informing you of abnormal VS, etc?

No, I have not. It is a scary thought that I could be held responsible for someone else's actions.

3rdcareerRN · Mar 19, 2008

No. However, it would not surprise me to be held responsible, if I did not perform my lawful supervision as an R.N. My state's (TX) Nursing Practice Act defines in great detail that the R.N. is responsible for both the patient and lesser-licensed and unlicense personnel delegated to perform patient care. Perhaps on the hospital floor it becomes easy to forget that -- in fact -- you are delegating to CNAs.

Best wishes for an outcome in your favor!

grannyNan · Mar 19, 2008

You are responsible for supervision of the CNA but, they can be held accountable for the care they give or don't give too. Every month our board of nursing posts discipline actions taken against both RN's and CNA's for not doing their jobs.

stephlucasrn2008 · Mar 19, 2008

I may or may not be qualified to reply to this post but...

I am graduating from nursing school in June and have worked as a clinical / monitor tech on an interventional cardiac unit (mostly post-caths and OHS pts.). And this situation is one of the reasons I decided to go into critical care as a graduate (and the fact I absolutely love critical care medicine).

I started in this position 3 days after graduating high school and a nurse aide training program. I have always been very vigilent in reporting things to the nurse (even if I was scepitical). I do my very best to help my RN's and fellow techs when I am not busy, and I don't take a break in the morning until all of my baths are done and my pts. trays are collected. However, I have come to hear several times, that RN's wish techs were like me.

I know of techs I work with that make up BP's and glucs. Take pts. off their O2 to ambulate them to the bathroom (pts. in resp failure, when we get them). There have been times where I have heard techs failing to report pain, chest pain, SOB, or low SPO2s. Scariest of all, some of them are in nursing school. And... drawing PTT's from the arm that heparin is running in or drawing a K+ level from the arm running K-riders.

I don't know whether this is pure ignorance or laziness, but I think the staff educators need to have a more comprehensive orientation program. Right now, 2 weeks and a class on how to do a 12-lead and venipuncture.

Don't even get me started on some of the monitor techs I sit with...

Again, this is a contributing factor for me going into critical care... THE PATIENT IS MINE, MINE, and MINE... And I know that I am primarily the only one caring for them (aside from other RN's and the docs), and I feel that I can trust myself to take an accurate BP before giving a pressure med...

Thank you and have a good day!

Stephanie

leslie :-D · Mar 19, 2008

i don't know what they learn in a tech/cna course, but i wouldn't expect an asst to know the implications of vs, unless i had given specific directions to report any variables.

as an rn, i feel and am responsible for anything that is delegated.

when i delegate any task, i am always communicating what i want reported back to me.

ultimately, it is our responsibility.

and being the one who is responsible, i ensure i get the data i need.

i value my license, and know the hundred ways it can be jeopardized.

i will not let that happen.

leslie

shellsgogreen · Mar 19, 2008

The techs on my unit are pretty good about reporting anything abnormal, but you know what, this thread is a great reminder, as you never know.

We as nurses make mistakes, so it is certainly fair enough to say that this may be one reason for a good tech to not report anything out of the ordinary.