I have been working with an increasing amount of nurses who FLAT OUT REFUSE to change or toilet their patients. Is this a thing? Do your hospitals have policies or guidance on this topic?
I've brought this up to a few people unofficially and one answer I got was (from a VP) "the nurse may be too busy and you just don't know it." My thought is "If you know they are soiled or ask them to toilet them, why are they taking the time to find a CNA and not just doing it?"
Years ago someone was talking to a group and the toileting issue came up (different hospital) and this person asked us rhetorically how WE would feel if our nurse was in the room and we were soiled and they would not change us? Or if we asked to go to the toilet and they walk out and send in a CNA? I know I would feel pretty small.
***And don't assume that your nurses never clean patients just because they don't announce it to you.
Amen...
Honestly, I think some(or most) CNAs think RNs sit around doing nothing and shooting the breeze. They think all we do is give meds and chart, which is just a small part of what we actually do. The nurse, like you've been told, is most likely busy doing the work she has to do for her other patients that may be even more critical or time consuming. Part of our job is to delegate and that's what we're doing. I can't begin to tell you how many times I've needed help from a CNA with a patient, whether it's simply taking a patient to the bathroom, getting vitals on a patient while I do something else for this person that only my license allows me to do, or yes, changing or pulling up a patient up in the bed, etc. and what I got in return was a lot of back talk, eye rolling, or sucking of the teeth.
God forbid you ask some CNAs to do a little more than their scheduled vitals and washing Patient A and B for the shift. Or how about the ones who want to wash the patient while you're doing your med pass so she can trap you because she wants to leave the rest of night for listening to music or watching videos on her iPod or for sleeping. Yes, I work nightshift. From what I see, RNs are the ones running around throughout the shift making sure their patients are well cared for while the CNAs watch us.
So again, the RNs are most likely busy doing something else for their patients and can't help right that instant and not because they think they are too good to toilet or change a patient.
I work LTC. I have 26 patients. All of them need meds. Some are IV, some are tube feed, several are crushed, some are just slow taking them and need to be watched. That's just one part of my job, I won't bother writing the novel it would take to thoroughly describe my day. Sure, I'll help when I can but if I took even 5 minutes to help every one of those 26 patients with something the CNA can do I'd never get my work done
No one can deny that this happens and there are a few terrible people that have rn licenses. I would let anyone know if I work with you I am your colleague, not your friend, and usually I never as much as blur that line. I will be dependable and supportive and give you the upmost respect as my teammate, but if I see any colleague willfully engage in unethical behavior especially towards patients it's be nothing to me to report that to a manager, and if you are reprimanded it will not phase me in the least. Some people really don't believe that you will rat them out. Some will even try to involve you in their mayhem and assume you will just go along or look the other way (already have people trying to get me to help them cheat in nursing school, which is frankly hilarious to me, why would I help you get a grade you don't deserve so you can harm patients later, and make my grade not look as good on top of that?) Reporting unethical practices is part of my duty, I do not view it as throwing someone under the bus, but part of my responsibility and I would expect the same from others were I to violate the code of my career.
As far as tolieting, when I was a CNA I was usually very understanding of my very busy RNs. However I have known a few rns that truly would sit down and get on facebook or the phone (where I could both hear and see them do this) and let their patients sit in their stool for hours if I did not make sure they went to the bathroom. One time I came on to my shift and a poor pt had his osteomy blow out from overflowing stool. The rn from prior shift saw it and then snuck home and the cna tried to go home! I made her stay and also filed an incident report because the pt was crying, no one had touched his osteomy that entire day.
I know some CNAs are lazy but for the majority of my career as a CNA I've never been close to experiencing the amount 'lazy cnas' in proportion to the amount of you would have assume if your heard RNs complain about their CNAs. It would do you good to show your CNAs some respect. I've never noted this running to get on an ipod thing that you say, but I have heard CNAs been accused of these things when they were with other nurse's patients and that makes me angry. Unless you actually see the person doing the thing you are accusing them, making the accusation is inappropriate.
This may not be relevant, but as a case manager RN, I'm not allowed to do patient care, such as walking them/bathing/toileting. It's sometimes embarrassing to have to ask the family to put the call light on to request help.. if they already have, I'll call the tech directly. I have helped turn a time or two, but our job description doesn't include direct patient care. And that's probably a good thing, when we're trying to spend time finding resources for patients who don't have any funding, or nursing home placement.
I work as a CNA and currently am in nursing school, and I cannot think of a time at my facility when the nurse asked me to do something (toilet or change a patient) and I felt as though she should do it herself. On my psych unit we have one nurse to 40 patients and 4 CNAs. My nurse is busy, skips her breaks, and stays sometimes over 2 hours after shift to finish charting. It is my job to do what I can to help her so that she can do what I cannot.
The nurse (LPN, RN) is responsible for many more things besides cleaning and toileting patients (notice I didn't say other than cleaning and toileting patients) that you aren't aware of.
When it is a decision to change soiled bed sheets -vs- keeping another patient from unexpectedly coding and dying you bet he/she will chose keeping a patient alive every time.
What is wrong with you that you are complaining that someone else won't do your job for you anyway? Why should someone else do it instead? Can you pass meds, give narcotics, hang blood, or participate in a code?
You have no idea the amount of work squeezed into another occupation's job load everyday, and nursing is not known for a care free work environment. If the nurse doesn't finish ALL of that work - then document that they did said work - then they get the added pleasure of staying over on their own time to finish it. Should he or she also do your work too?
Yes, before you ask - I did work as a CNA before I became an RN. I cleaned the nastiest of GI bleeds that dripped right onto the floor, forming puddles under the bed. I've dug poop out of mouths, and from under nails. I've showered combative patients - one swipe of their talons able to render a person blind for life. And I've done it as both a CNA and an RN (as long as no one was coding and nothing else emergent was going on).
Maybe a few days spent shadowing a nurse will allow you to see why he/she asks you for your help doing your job, so he/she can do theirs? And if they lag behind and have to stay over to finish up - then you would get to stay behind too, just to get the most out of your experience.
Never assume you know what work someone else is responsible for - and a little more compassion and understanding for your coworkers would really only benefit everyone on the unit. If the nurse actually had time to toilet and clean patients you can bet there would be no such job title as CNA. This isn't a gift from upper management - they know this is an impossible task to expect a nurse to do everything alone.
Stop complaining and start being a part of the TEAM.
Specializes in Critical Care; Cardiac; Professional Development.
There are a lot of things I do as an RN that a CNA cannot do. I can, however, do anything a CNA can do. This means that if I have anything at all on my plate that I need to do that the CNA cannot, then the CNA will have to take care of the things we both can do.
Toileting patients is a cumbersome, unpleasant task and of course some people are going to avoid it; however, the gist of the original post seems to be that it takes longer for the nurse to task it to the CNA than it does to just do it themselves and therefore should be just doing it themselves. If that were true, CNAs would not have a job. It is their job to toilet the patient so nurses are free to do the tasks only nurses can do. Assessments, medication administration, chart review, charting, communicating with all other clinical staff, etc to name a few. Along with this, nurses do tasks that both CNAs and nurses can do as time allows. I was a CNA before I was a nurse. I have seen both sides of that coin. Both jobs are hard. Both are overworked. But I get really really tired of CNAs/medics/techs assuming that because the nurse tasks it to the assistant, that means they are lazy. I call BS. Come work the floor nurse's job and see how long you still think that.
Too often I see CNAs get the impression that RNs are there to assist them. It is the other way around.
I still say that the perspective from RN about being misunderstood by the CNA is pretty one sided. I hear the same amount if not more RNs make the same accusations that their CNA had nothing to do, speculating that. they were just "hiding", completely disregarding the fact that CNA has patients from several other nurses. It's okay if you want the CNA to understand your role but you better try understanding theirs. Most of my classmates did not work as a CNA and it does make a difference if you actually work as one as composed to taking the class.
Also the CNA is there to assist you. Not do all the work for you. That's why they get paid minimum wage and you make a tremendous amount more than them. They are not your slaves, and the reason it is called assisting is that in reality it is in fact your work. Things like getting annoyed that you have to help a 110 lb cna move a 300 lb man is inexcusable. I have been literally told to my face that I should be able to to that myself. CNAs are not your slaves and technically you do share their work. CNAs can't just pull the other CNAs from their patients to take care of yours either. If it's your patient, it's you and your CNAs job to participate in that care and you should not try to push it off on a CNA that is not in charge of that patient's care
I still say that the perspective from RN about being misunderstood by the CNA is pretty one sided. I hear the same amount if not more RNs make the same accusations that their CNA had nothing to do, speculating that. they were just "hiding", completely disregarding the fact that CNA has patients from several other nurses. It's okay if you want the CNA to understand your role but you better try understanding theirs. Most of my classmates did not work as a CNA and it does make a difference if you actually work as one as composed to taking the class.
Also the CNA is there to assist you. Not do all the work for you. That's why they get paid minimum wage and you make a tremendous amount more than them. They are not your slaves, and the reason it is called assisting is that in reality it is in fact your work. Things like getting annoyed that you have to help a 110 lb cna move a 300 lb man is inexcusable. I have been literally told to my face that I should be able to to that myself. CNAs are not your slaves and technically you do share their work. CNAs can't just pull the other CNAs from their patients to take care of yours either. If it's your patient, it's you and your CNAs job to participate in that care and you should not try to push it off on a CNA that is not in charge of that patient's care
Please come back after you graduate and start working as a nurse. A nurse can understand a CNA's role quite easily. Some of us are assigned to be the CNA on occasion ...and some of us work on units that don't even utilize CNAs.
A CNA is never assigned to work as a nurse and can only guess what it's like. "Nursing student" is also a role far removed from the reality of an actual working nurse. As a student nurse, I thought the CNAs did "everything" and the nurses had it easy. WRONG.
Specializes in Critical Care; Cardiac; Professional Development.
Also the CNA is there to assist you. Not do all the work for you. That's why they get paid minimum wage and you make a tremendous amount more than them. They are not your slaves, and the reason it is called assisting is that in reality it is in fact your work. Things like getting annoyed that you have to help a 110 lb cna move a 300 lb man is inexcusable. I have been literally told to my face that I should be able to to that myself. CNAs are not your slaves and technically you do share their work. CNAs can't just pull the other CNAs from their patients to take care of yours either. If it's your patient, it's you and your CNAs job to participate in that care and you should not try to push it off on a CNA that is not in charge of that patient's care
Well, no. We make significantly more than them because we have significantly greater education and significantly greater liability. A CNA can get another minimum wage job anywhere. A nurse who fails to intervene in a timely fashion for a patient going downhill, who fails to recognize a medication error or an order error, who fails to contact a physician in a timely manner or assess the patient as per protocol for their condition, etc etc can and will lose their ability to continue working. We don't get paid more because we should be doing more from the CNA point of view. Most of what a CNA is able to observe isn't even 1/4 of what a nurse is responsible for. That isn't being ugly. It is just a fact.
If you aren't an RN, you just plain do not know yet and that is okay. There is no sin in that. But at least admit you don't know yet. I would say at least 60% of nurses (and that is likely very conservative) worked as a CNA prior to becoming an RN. Most RNs know exactly what they are talking about when it comes to assessing the CNA role. Nobody is calling a CNA a slave, a word that so many like to toss around, but the truth of the matter is, CNAs are getting paid to be told how to assist. We do not share their work, as phrased above. Them doing their job is what makes us doing ours possible. While there are some nurses who "push off" care, the vast majority are just simply trying to stay afloat. The way that is accomplished is via delegation. I personally would never expect a 110 lb CNA to get a 300 lb patient up alone if they were unsteady. I would, however, expect them to then be able to use a bedpan if assistance in getting the patient up were not available.
I would suggest you revisit this when you get your nursing degree. You cannot know what you do not know.
Well, no. We make significantly more than them because we have significantly greater education and significantly greater liability. A CNA can get another minimum wage job anywhere. A nurse who fails to intervene in a timely fashion for a patient going downhill, who fails to recognize a medication error or an order error, who fails to contact a physician in a timely manner or assess the patient as per protocol for their condition, etc etc can and will lose their ability to continue working. We don't get paid more because we should be doing more from the CNA point of view. Most of what a CNA is able to observe isn't even 1/4 of what a nurse is responsible for. That isn't being ugly. It is just a fact.
If you aren't an RN, you just plain do not know yet and that is okay. There is no sin in that. But at least admit you don't know yet. I would say at least 60% of nurses (and that is likely very conservative) worked as a CNA prior to becoming an RN. Most RNs know exactly what they are talking about when it comes to assessing the CNA role. Nobody is calling a CNA a slave, a word that so many like to toss around, but the truth of the matter is, CNAs are getting paid to be told how to assist. We do not share their work, as phrased above. Them doing their job is what makes us doing ours possible. While there are some nurses who "push off" care, the vast majority are just simply trying to stay afloat. The way that is accomplished is via delegation. I personally would never expect a 110 lb CNA to get a 300 lb patient up alone if they were unsteady. I would, however, expect them to then be able to use a bedpan if assistance in getting the patient up were not available.
I would suggest you revisit this when you get your nursing degree. You cannot know what you do not know.
Sorry no, you aren't going to play the "get my degree card" as if I don't know what a nurse does. I'm not a teen thanks. I have 10+ yrs experience in a variety of clinical roles, from ER to Critical Care, even ones in working directly with surgeon. That's absolutely incorrect of you to say I don't know what a nurse does. In fact, plenty of people in other careers know exactly what a nurse does. Another card RNs like to play. Actually yes a CNA is a nursing assistant... meaning that they don't have a seperate role that cannot be done by a nurse, it is completely under the RN scope and expected of the RN if a CNA is unavailable. I am not saying you specifically are going ask me to move the pt by myself. Mainly I was saying that if you are RN you must understand that CNA has many pts... Also, it is not other CNAs responsibility to take care of your patients. I'm sorry if you can't get what you need done because workload is high, but it is not other CNAs responsibility to provide care when you are the designated caregiver and there's no way you can argue around that. If you don't understand that a CNA also has other things to do for other nurses, and abuse delegation that is treating them like a slave. I wasn't saying you specifically do this, but you sure got defensive like I was saying that you were. I do think you are quite insensitive however. And starting to dread employment as a nurse if this is the way other nurses expect me to also treat my CNAs, which I won't.
Also, I don't consider RN school "significantly" greater education than a CNA. ADN is a two year degree that doesn't required hard math or sciences. It is very condensed, but I know people with PhDs in stem areas that make less than rn. I would say they are "significantly" educated. Even so, I believe minimum wage for CNAs doesn't reflect the amount or importance of the work they do. As well, part of your RN pay is assuming you are participating in at least some cargiving measures that the CNA is doing and please don't tell me it's not true because I know for a fact it is.
From what I see, RNs are the ones running around throughout the shift making sure their patients are well cared for while the CNAs watch us. 
NurseCard, ADN
2,850 Posts
This is SO why I love my job. We do primary nursing at my hospital.
We don't even use CNA's. I mean, not that I don't love and respect
CNA's, and our hospital does hire a couple of them which we use when
we do get especially busy.
I love and would just as soon do primary nursing.