Problems with CNAs and Jeopardizing Nursing License

medsurgrnco, BSN, RN · Mar 19, 2008

I don't have my license in jeopardy. Just wondering how frequently CNAs have caused this level of problem for RNs. I've worked in several hospital units with CNAs who don't check incontinent patients, don't turn patients, don't report abnormal VS that are clearly abnormal, don't report low urine output, refused to check pt BP/HR when delegated outside normal VS timeframe, refused to give a pt with a low FSBS OJ and recheck FSBS in 15 minutes when delegated, etc. And charge RNs and managers don't care when informed about these problems. Informing CNAs of VS that I need to know about hasn't worked, as many still don't tell me, and CNAs frequently have had attitudes with me when I am less lax in this area than my coworkers. Since my license is on the line and it took a lot more effort/$ for me to get that RN license than it takes for a CNA to get their credentials, then hospitals/managers need to support RNs with competent CNAs. CNAs should know what VS are abnormal, both through CNA training and through hospital training.

squeakykitty · Mar 19, 2008

I don't have my license in jeopardy. Just wondering how frequently CNAs have caused this level of problem for RNs. I've worked in several hospital units with CNAs who don't check incontinent patients, don't turn patients, don't report abnormal VS that are clearly abnormal, don't report low urine output, refused to check pt BP/HR when delegated outside normal VS timeframe, refused to give a pt with a low FSBS OJ and recheck FSBS in 15 minutes when delegated, etc. And charge RNs and managers don't care when informed about these problems. Informing CNAs of VS that I need to know about hasn't worked, as many still don't tell me, and CNAs frequently have had attitudes with me when I am less lax in this area than my coworkers. Since my license is on the line and it took a lot more effort/$ for me to get that RN license than it takes for a CNA to get their credentials, then hospitals/managers need to support RNs with competent CNAs. CNAs should know what VS are abnormal, both through CNA training and through hospital training.

With CNAs like this, and managers who don't care, go up the chain of command. those CNAs can be reported to the state for neglect, and they should be before they harm someone.

ChristineN, BSN, RN · 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.

I wonder what about the facilities that do not require their aides to be certified? I've worked as an aide for 16 months and I've never been certified. My employer doesn't require it. Can the state do anything against negligent aides that are not certified?

bollweevil · 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.

CNA's accountable how? They don't have a license to lose. What discipline can be taken against them? Do they lose their certification?

chadash · Mar 19, 2008

Could we subtitle this thread as "over worked and under trained"?

Seems to me that nurses are saddled with enormous responsibilty for co workers who are not adequately trained.

pagandeva2000, LPN · Mar 19, 2008

One of the issues I am noticing is that while nursing homes take the time to recertify the CNAs, the hospitals do not. But, many of them wish to see that they graduated and have an active CNA certification when they hire them. Because they cannot recert themselves the same way that nurses have to every so often, they count on the nursing homes to do it by working with them per diem (if they have the time to actually go). Otherwise, they have to pay the price to retake their boards again. When I was one, it was close to $200...don't know how much it is, now.

This, to me, is a bad practice, because what is there to report if the CNA cert is now inactive?? Who would you report it to? Also, it sort of locks the CNA/tech into the hospital, not having many options to work elsewhere if the thing expires, and they don't have the time or the money to recert again by taking the exam over again (both parts, no less). It may be true that the web sites provide the information for CNAs as well as nurses who did not do their jobs, but, if they were NEVER certified, how does this happen?

In fact, many techs were trained as medical assistants, who are not state certified, but due to their education, they are more than qualified to take on the position as a tech. But, since it is not regulated, I don't know what can be done to solve the problem regarding reporting someone who was hired this way to the state. This leaves no accountability or responsibility for them, in my humble opinion.

CT Pixie, BSN, RN · Mar 20, 2008

CNA's accountable how? They don't have a license to lose. What discipline can be taken against them? Do they lose their certification?

In Connecticut, all CNA's have to be registered with the State CNA registery. If there is a claim filed against them (negligence, abuse etc) it goes to the State for an investigation, and from there if its deemed that they were guilty of said charges, YES, they loose their certification and are unable to work as CNA's or HHA's. They loose their bread and butter so to speak.

Having been a CNA since the mid 80;s, and seeing what I have seen done by a lot of CNA's, I'm a bit leary (when i am licensed..is it June yet??) of leaving important vitals to be done by the CNA. A med dependant on a BP? Oh I'm pretty sure I'll be the one to do it myself. I'll make the time to take it myself.

Just an example, I was at a clinical site doing med pass. Mrs X's med was to be held with a BP lower than XXX/XXX, the aid assigned to the pt was told by her floor nurse to get the pts BP for us. She huffed and grumbled about it but ended up snatching the cuff and scope off the desk and went to the pts room. She was back in a flash..too soon in my opinion, giving me the slightly high BP but not alarming (pt had HTN). My instructor and I headed into the pts room to administer the med and my gut told me to take the BP myself. I got something like 90/70 but the CNA had given me me something way way higher. Trying to give the benefit of the doubt, I grabbed the cuff and stethescope she used and lo and behold, the steth was broken and the cuff's knob was tightly closed..uhh so how did she take this bp?? When her floor nurse confronted her the CNA blatently stated "I WAS going to take it but the stethescope was broken and I didn't feel like walking all the way down the hall to get a new one, then walk all the way back to take the BP, then all the way back again to give it to the student" She was written up and discipline. And shoots daggers at me everytime she sees me. Oh well.

I have seen (and reported) numerous CNA's over these many years who make up vitals (uh exaclty how did you do that BP w/no cuff or scope? And exactly how did you do the pulse and resp with no watch on you or a clock in the room? And that O2 sat you just gave, umm do you have super medical powers that allow you to see how much O2 is in the blood and hense you don't need the machine??) I've also reported CNA;s for not toileting pts, changing them, turning them, FEEDING them, bathing them..and the list goes on. I was so tired of hearing "I don't have time to do all that stuff". Yet, I was able to all that was required and expected and then, some as were many other CNA's who did the job correctly. Yup, I was tagged the nasty B word by the bad apple CNA's, I was called "rat" "narc" and all the othe wonderful names you can think of. But at the end of the day, I have to go to sleep at night with a clear conscious. I can sleep knowing I did what needed to be done to protect the patient. And I don't care who calls me what for doing the right thing.

leslie :-D · Mar 20, 2008

yeah ct, i have to agree with you.

i do vs myself.

yes, there are aides who i do trust w/my life, and are Godsends to nsg/pt care.

but it wouldn't be right for me to delegate to those i trust, while the shabbier ones are doing notably less.

however, those cna's who take their job seriously, often anticipate my needs and do it themselves....

as i do for them.

but rather than risk jeopardizing my pts, or jeopardizing my licensure, i'd much rather do these tasks myself.

really, it's no biggie.

leslie

squeakykitty · Mar 20, 2008

I wonder what about the facilities that do not require their aides to be certified? I've worked as an aide for 16 months and I've never been certified. My employer doesn't require it. Can the state do anything against negligent aides that are not certified?

I always thought that aides were required to be certified. Maybe the state of PA is different?

squeakykitty · Mar 20, 2008

CNA's accountable how? They don't have a license to lose. What discipline can be taken against them? Do they lose their certification?

They can, at least in California. I thought is was federal law that they have to have training and be certified to work as a CNA.

Ms Kylee · Mar 20, 2008

In PA, you only have to be licensed as a CNA for Long Term Care. For Acute Care, you don't need a license.

I feel really awful about all of you nurses that have bad aides that don't report abnormals. I guess I'm strange because I report everything to the patient's nurses--- blood sugars, abnormal vitals, bruises that weren't there the day before, rashes that I find, etc. Most of the time, the nurse will tell me they are aware of what I have reported, but I have gotten a few saying they didn't know what I have reported off to them. I also don't have a problem asking the nurses to help me when I have to turn and reposition or pull patients up in bed. Most times, they need to assess skin anyway, and this provides the perfect time for them to do so.

ChristineN, BSN, RN · Mar 20, 2008

I always thought that aides were required to be certified. Maybe the state of PA is different?

I'm not sure about PA law here. All I know is that when I've talked to my employer on hire as to whether or not certification was required I was told that it was optional and that if I wanted it I would have to pay out of pocket.