mazy

I'm old and I never want to leave bedside nursing. Hopefully I won't get pushed out by someone who thinks I belong at a desk.

I absolutely agree with the point that management needs to be supportive of nurses disciplining CNAs. Unfortunately, I have worked with CNAs who wouldn't have any problem being sent home, even knowing that they won't get a paycheck. Add in a dramatic confrontation with a nurse in front of everyone and the day is a total win. If they are allowed to come back, even if they have to jump through a lot of disciplinary hoops to do that, the only thing they understand is that the nurse did the most extreme thing possible to enforce discipline and they still got to come back to work and now what is the nurse going to do? I have seen this kind of thing happen too many times. And seen good nurses go because of it. The problem is a CNA with a history of insubordination that has gotten so bad that the only way to get the message across is to have them sent them home. If all disciplinary measures have been exhausted that it's come to this, then it's time to find someone else. There are plenty of perfectly good CNAs out there looking for work. I agree with sunny, the most important thing management needs to do to support their nurses in disciplining CNAs is to go that extra mile and weed out the bad ones and nurture the good good.

Doesn't sound like a good facility, especially if Medicare is ranking them poorly. If it's a rehab facility, and not just long-term care, you will be drowning with only a 1 RN to 20 patient ratio, especially if you only have two CNAs. GrnTea makes a good point, you could pick up some per diem shifts and see how it works.

Someone on this site once pointed out that all the highly dramatic things that we see doctors doing on TV as they are supposedly doing patient care are actually the meat and potatoes of the nurses job. For whatever reason, people find it more appealing to watch a doctor obtain a urine specimen or place an IV than a nurse. Things that make me go Hunh? Watching a doctor on Grey's pull out a packet of sterile gloves, open it up, pull out the gloves, flap them around, blow on them, smack them up and down on the table for good measure and then put them on; hospice patients on tele; critical patients without lines or O2; people freaking out when someone pulls off their EKG leads -- as if it's going to kill them; people pulling out their IVs without any mess; and patients waking up from year-long comas completely rested and able-bodied. MASH was definitely a great show though, I loved Major Hoolihan.

To me it sounds like they are putting the nurses in an untenable position. Why is management making you do their job? It seems like a set-up that will create an adversarial environment between nurses and CNAs, when they should be problem-solving and finding ways to make the units go smoothly. You guys are all front line staff and the management should be doing whatever they can to promote a healthy team environment. If that can't happen it is on them to look at their staffing and hiring practices, and additionally address discipline problems and find ways to create a positive working culture. Making the nurses do their dirty work is just wrong. Not to mention the fact that if you send a CNA home, now your unit is working short. No one wins with that. Except management -- one less paycheck to worry about; they've got a unit that is drowning and understaffed, but now they can just blame the nurse for sending the CNA home. I wouldn't want to be in your shoes.

I agree with nursel56. This is not a big deal. Agencies keep a long list of potential staff, much more staff than they even have work for. You can put yourself on the inactive list and if something else comes up that looks interesting you can make yourself available. On another note, Maxim is not a very good or reliable agency anyway. If you do accept a case make sure you nail down the salary before accepting.

I had a job interview back when I was first starting out where I went in to interview one person, then another, then got in to talk to another, and so on. Every person I talked to asked me how I felt about conflict in the work place. I had been a CNA so I knew all about personality clashes in healthcare so I kept giving decent enough answers about how to navigate conflict situations. But then I started getting really frustrated, because I was thinking "why do they keep asking me this?" And I kept trying to give articulate responses, but I was getting tired -- it was a really long interview and was starting to feel like an interrogation -- and finally the last person in the chain asked me again "how comfortable do you feel with conflict" and I just blurted out "I'm not comfortable with conflict AT ALL." Well. I didn't get the job, but by that point I didn't want it. Forty nine patients per nurse is an absolutely insane ratio and you are better off not being in that facility. There's a lot to be said for knowing your own limitations and being able to advocate for your own best interests.

You don't get your LVN license until you pass the NCLEX, so if you complete an LVN program you will get your certificate or diploma, then proceed on to take your licensing exam, and then you will be a Licensed nurse. Make sure, when looking into the programs, that they are accredited and if you want to continue with your education I would suggest you look into whether the credits you get can be transferred over to another school. First place to start is on your Board of Nursing website, which should have a list of all accredited nursing programs in the area.

I'm a happy LPN and I understand the sentiment of the OPs post. I don't like the way it was presented. It does come across as whine-y to write what seems like a sonnet about why "I'm sorry you don't like me because..." and then to make it seem like one is being victimized by certain perceptions from another group, which then serves to make belittling generalizations about the group that you are complaining about. I have had experiences where RNs have looked down on me, or it could be CNAs or other LPNs, but every where you go you can find someone who is going to look down on you for one reason or another. More often it's an issue with the general public being unimpressed, and what can you do about that? There's not much I can do except to make it a point to treat the people around me with respect for the jobs they do; wherever that job lands them in the hierarchy of healthcare, we're a team. I'm also out there in the world daring to exist as a "woman of a certain age." Talk about feeling looked down upon. Life isn't fair. You do the best you can to be the best person you can be and try not let it get to you -- live by example and treat others with respect.

Agreed. I am actually shocked by these posts about facilities where clean caths are acceptable. In all my years I have never heard of such a thing. My mind is boggled. At first I was kind of conflicted about how the OP handled this situation, but after reading all of these posts I think she did the right thing. Management needs to be reminded that if they are aware of these practices, the issue needs to be addressed, not just because of one nurse, but because the facility is promoting a culture where infection control is not being taken seriously. We nurses should never resign ourselves to a situation simply because that's the way things go and there is nothing to be done about it. If I were working in a facility where there were no resources to do sterile caths, I would be asking a whole lot of questions about it. I'm not sure I would even be comfortable staying there.

It probably would have been best to put him to bed and cover the site well with a towel, and place some additional chux under the patient. A colostomy change is not life or death. And it was late and the patient was probably very tired and should have been put in bed. Nurses are under enormous pressure to transition both in and out of their shift and get report done so that the incoming shift can take over. Sometimes a colostomy change takes a few minutes, sometimes a complication can come up and the nurse will be stuck there for a lot longer. As a result the incoming nurse will not be able to assume the floor and will not be able to handle any other urgent issues that come up during that time. Nurses rely on CNAs to be able to take the initiative in situations like that. So it sounds like you wanted to do right by your patient, but were not aware of what the nurses were thinking or coping with. Sometimes what looks like a nurse charting is something a lot more urgent that requires immediate follow up. Hopefully next time you will know better.

The case could be made that the posting did not violate HIPAA but that doesn't mean the poster should not be disciplined in some way. She seems to be OK with that and willing to learn from the mistake, so kudos to her. As much as our employers -- and in this case the school -- would like to govern and micro-manage our professional and personal lives, the fact is that they can't. So the onus is on us as professionals to govern ourselves and to know what kind of behavior crosses the line, even if it is allowed or not expressly forbidden. Even if no one has written a rule or laid out consequences for this, that, or the other. No one can come up with a policy that explores every single possible type of behavior that could possibly be construed as inappropriate or in what way. We would have to sign off on a thousand page legal document if that were the case -- every single time we walk onto a new job or new study program or a new clinical rotation. We're already drowning in paperwork as it is. We're human, we make mistakes. We're also in a profession that requires us to have a heightened sense of accountability and a lot less wiggle room to be our naturally flawed selves -- at least in public. That's the nature of the job. Our patients need to be able to trust us to be looking out for their best interests, our employers need to know that we are up to the task. There are hundreds of applicants out there for every nursing job, so best strategy to survive in this market is to keep private lives and thoughts and impulses private. May not be fair, but it is what it is.

Danskos. You can't wear them to dance though...

From the behavior you described I have a feeling that even if you were an RN, or a BSN, or an MSN, or any level on the nursing spectrum she would have found a way to put you down -- from your level of education, where you went to school, years on the job, what department you work in (ICU? Med-Surg? ER?, L&D? Geriatrics? which is more hardcore?). Don't lose any sleep about it. She wanted ownership of the experience and was being a snot about it. Most people aren't like that.

Judging from his posts on this site I'm going to say that he sounds lonely. Lots of ideas but not a lot of people to talk to about them. Good thing that this board is open to everyone. But. There are ways to engage with others and there are other ways.