Refusing to change/toilet pts

mmc51264, BSN, MSN, RN · Sep 5, 2017

I wonder if some nurses realize that were are expected to work to the top of our scope as well as the bottom. It IS part of our job. Ultimately it is up to the nurse to make sure these things are done.

I love the nurses that spend 20 min looking for the CNA (who is usually already really busy) to tell them to something that would have taken the nurse 5 minutes, if that.

I try to help all the time and the aides laugh at me because I suck at making beds with pts in them-but at least I try!

allnurses Guide · Sep 5, 2017

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.

This is bizarrely high emotion. There is nothing in my post that states I neglect the CNAs I work with.

An ASN degree required 3.5 years of education, not two. The nursing portion of it takes two; the rest is done outside of the degree, prior to starting nursing school. Nurses are also required to continue our education to maintain our licensed status. Increasingly hospitals are requiring BSNs for their nurses, the balance of which is now averaging about 50/50. A CNA certificate is earned in a matter of weeks. Not years.

There is a difference between stating a nurse has significantly more education than a CNA and that they are "significantly educated". You are correct, a Ph.D. has more education than an ASN level nurse. They are more significantly educated than the nurse. The nurse is more significantly educated than the CNA. Why is this a sticking point and why does the amount of money earned even figure in? The Ph.D., the RN and the CNA all have a job to do and all had to get their level of education to do it. Jobs pay according to the market demand...meaning...the more people have the qualifications to do that job, the less the job pays.

You are exactly right. What a CNA does is under the nurse's scope and what a CNA does is under the nurse's delegation. My point is that the fact that delegation is performed does not equate to laziness on the part of the nurse.

I am going to leave you with the rest of your post. You cannot tell anything by how I treat CNAs by my post, merely about what the expectations are. I am no longer a floor nurse. I work in education, work with both CNAs and nurses as well as ancillary staff. You can treat the CNAs (they will not be "your" CNAs, they will work alongside you) however you like. However, if you are not good at delegating you are going to struggle with your work flow on the floor.

I do wish you luck.

CelticGoddess, BSN, RN · Sep 5, 2017

What she said above!

LovingLife123 · Sep 5, 2017

I get irritated every time I see one of these posts. Whether it's a CNA or a Tech, ADLs are your job. That is the bulk of what your job is. I don't get the complaining about nurses. ADLs are a small part of our job. And while toileting a patient is not at all beneath me as I do it every single shift, it is why the CNA has a job. My job is to delegate what I can to you, the CNA.

I was a tech before becoming a nurse. Never once did I complain or even remotely think the nurse should be doing my job. Never. Now, in my RN job, I do the primary care for my patients. It is a lucky day if we have a tech and then, all the other nurses are clamoring for their assistance. I do the toileting, feeding, baths, etc, on about 85% of my shifts.

It is a fact that while I can do the tech job they cannot do mine. It's that simple. If I had a tech all the time you bet they would be doing turns, oral care, toileting, all the things that are in their scope of practice. Heck, I would probably get out on time and I could do a heck of a lot more for my patients if I was freed up to actually do the care that they need.

It irritates me when people say ADLs are not beneath you and I don't know where in nursing school you were taught that. We were not taught that in nursing school, but we were taught to delegate and who to delegate to. If I remember correctly I had probably about 5 questions about delegating to UAPs on NCLEX. Delegating and prioritizing your day is a big part of being a RN.

And I won't ever feel guilty for calling up a tech and saying, Hey, so and so in room such and such needs to be toilette and bath done. Never. It's what they are paid for. It's their job.

operations · Sep 5, 2017

I was only annoyed that you keep telling me that I have accused you of being bad to your CNAs twice now, when in fact I've said the opposite in my post. You are telling me I'm attacking you when I'm not.

The bit about the pay and education level is a side discussion and it wasn't really relevant to the conversation. It was only to point out that CNAs do a lot of work and have little pay. My jobs have all payed well but I am sensitive to the fact my CNAs I work with sometimes are making less than McDonald's workers. In my opinion their work is so valuable, even though their education is minimal, and the burden of being responsible for someone's care takes way more out of a person than flipping burgers and pushing the buttons. Because of this I also understand that I can't expect a person making 9 bucks an hour to always perform like me, a professional making (hopefully one day) 30+. Now pay a CNA a greater amount and my expectations are naturally going to be higher.

The main points of my discussion was that

1. Nurses scope of practice includes CNA's work, as a nurse will be responsible for those duties in CNAs absence

2. CNAs who are not in charge of a patient are not responsible for the care of that patient, however the nurse of that patient is. I couldn't tell you how many times a nurse would ask me to go ask another CNA to help give care to my patients, as if it was not their responsibility. Sometimes that would work but at the end of the day the other CNA is only helping out. It is the nurse's patient and ultimately is it the responsibility of the nurse to participate in helping her CNA with that care.

3. CNAs on med surg floors have multiple nurses. Just as a nurse is busy doing very important tasks and may not be available, CNAs are sometimes busy with other nurse's patients.

operations · Sep 5, 2017

I get irritated every time I see one of these posts. Whether it's a CNA or a Tech, ADLs are your job. That is the bulk of what your job is. I don't get the complaining about nurses. ADLs are a small part of our job. And while toileting a patient is not at all beneath me as I do it every single shift, it is why the CNA has a job. My job is to delegate what I can to you, the CNA.
I was a tech before becoming a nurse. Never once did I complain or even remotely think the nurse should be doing my job. Never. Now, in my RN job, I do the primary care for my patients. It is a lucky day if we have a tech and then, all the other nurses are clamoring for their assistance. I do the toileting, feeding, baths, etc, on about 85% of my shifts.
It is a fact that while I can do the tech job they cannot do mine. It's that simple. If I had a tech all the time you bet they would be doing turns, oral care, toileting, all the things that are in their scope of practice. Heck, I would probably get out on time and I could do a heck of a lot more for my patients if I was freed up to actually do the care that they need.
It irritates me when people say ADLs are not beneath you and I don't know where in nursing school you were taught that. We were not taught that in nursing school, but we were taught to delegate and who to delegate to. If I remember correctly I had probably about 5 questions about delegating to UAPs on NCLEX. Delegating and prioritizing your day is a big part of being a RN.
And I won't ever feel guilty for calling up a tech and saying, Hey, so and so in room such and such needs to be toilette and bath done. Never. It's what they are paid for. It's their job.

I was confused about this post. You are upset about CNAs and it makes no sense based on what you said.

1. You are saying "no one said that ADLs are not beneath you in nursing school". But if you asked a professor directly "y know, are ADLs beneath me or are they CNAs work?" what would they say? I know this because it's already been discussed in my school and the answer is that ultimately it is your responsibility but you should delegate 'appropriately' (never once has anyone said anything resembling " as much as possible"

2. On the other hand, it is quite apparent that you don't think that CNA's work is beneath you if you are doing it as much as you say. So why would you be upset by the above statement? Makes no sense.

3. Your problem on the floor is that the CNAs are too busy assisting other nurses,correct? Is it the CNAs fault for that? Sounds like they are doing their job to me. Are other RNs overly relying on the CNA to do work which they should also be participating in, so that she can't give all RNs equal attention? I think so which brings us back to the original point that ADLs having nurse participation is completely appropriate.

I actually also remember when I was a CNA the issue faced when one nurse delegated more than another. Then the other nurse would think you were playing favorites and now all kinds of cold wars are going on, when I'm just trying to help and do as I'm told. How should I respond to that? No win for the CNA. At least maybe at that particular job.

Well, I just want to learn to delegate "appropriately". My goal is not to see how much the CNA can do for me, but maintain the standard, I guess. And use situational awareness in that regard.

TeeKay12 · Sep 6, 2017

It's my license on the line. It's my job to make sure my patients are cared for to the best of my and my staff's ability - and that includes toileting, cleaning up feces or urine, and bathing if that's what needs done. Yes, it's hectic on the floor, but by making sure I help out when I can, I've garnered the respect and the helpfulness of my support staff.

Purple_roses · Sep 6, 2017

I was only annoyed that you keep telling me that I have accused you of being bad to your CNAs twice now, when in fact I've said the opposite in my post. You are telling me I'm attacking you when I'm not.
The bit about the pay and education level is a side discussion and it wasn't really relevant to the conversation. It was only to point out that CNAs do a lot of work and have little pay. My jobs have all payed well but I am sensitive to the fact my CNAs I work with sometimes are making less than McDonald's workers. In my opinion their work is so valuable, even though their education is minimal, and the burden of being responsible for someone's care takes way more out of a person than flipping burgers and pushing the buttons. Because of this I also understand that I can't expect a person making 9 bucks an hour to always perform like me, a professional making (hopefully one day) 30+. Now pay a CNA a greater amount and my expectations are naturally going to be higher.
The main points of my discussion was that
1. Nurses scope of practice includes CNA's work, as a nurse will be responsible for those duties in CNAs absence
2. CNAs who are not in charge of a patient are not responsible for the care of that patient, however the nurse of that patient is. I couldn't tell you how many times a nurse would ask me to go ask another CNA to help give care to my patients, as if it was not their responsibility. Sometimes that would work but at the end of the day the other CNA is only helping out. It is the nurse's patient and ultimately is it the responsibility of the nurse to participate in helping her CNA with that care.
3. CNAs on med surg floors have multiple nurses. Just as a nurse is busy doing very important tasks and may not be available, CNAs are sometimes busy with other nurse's patients.

I understand your frustration. I remember one shift I had as a CNA where I literally cleaned up HUGE diarrhea explosions from an adult male every hour on the hour. I cleaned up twelve mighty poops that day. I know what it feels like to have to do all the gross, under-appreciated jobs all day long and it felt so frustrating that I wasn't getting paid more...which is why I went to nursing school. If you don't like being delegated to and don't like your pay, get your education and move up the ladder.

ETA: also, you really and truly do not understand what it's like being a nurse. Nursing school paints about half the picture. When I was in nursing school and working as a CNA, I kept thinking about how I couldn't wait to work on a unit where I would have enough help from aids to be able to focus on nursing-specific related tasks. But what I've found is that I'm actually paranoid. I have too many patients to provide very much "daily care," but some of the aids are bad enough that I worry about skin break-down issues. I'm actually considering transferring to the ICU or PCU when I get enough experience--I actually like the idea of having less patients and doing total care for them, because that way I'll know exactly what's going on with my patients. Just wait. You'll see how frustrating it can be on the floor.

LovingLife123 · Sep 6, 2017

I was confused about this post. You are upset about CNAs and it makes no sense based on what you said.
1. You are saying "no one said that ADLs are not beneath you in nursing school". But if you asked a professor directly "y know, are ADLs beneath me or are they CNAs work?" what would they say? I know this because it's already been discussed in my school and the answer is that ultimately it is your responsibility but you should delegate 'appropriately' (never once has anyone said anything resembling " as much as possible"
2. On the other hand, it is quite apparent that you don't think that CNA's work is beneath you if you are doing it as much as you say. So why would you be upset by the above statement? Makes no sense.
3. Your problem on the floor is that the CNAs are too busy assisting other nurses,correct? Is it the CNAs fault for that? Sounds like they are doing their job to me. Are other RNs overly relying on the CNA to do work which they should also be participating in, so that she can't give all RNs equal attention? I think so which brings us back to the original point that ADLs having nurse participation is completely appropriate.
I actually also remember when I was a CNA the issue faced when one nurse delegated more than another. Then the other nurse would think you were playing favorites and now all kinds of cold wars are going on, when I'm just trying to help and do as I'm told. How should I respond to that? No win for the CNA. At least maybe at that particular job.
Well, I just want to learn to delegate "appropriately". My goal is not to see how much the CNA can do for me, but maintain the standard, I guess. And use situational awareness in that regard.

I get irritated when CNAs get on this site as complain that nurses feel CNA work is beneath them, when that is totally not the case. It honestly makes me think what the Techs on my unit think to themselves when I call them to come and help me with something. And the threads always revolve around cleaning up patients. Always. I see these threads once a week.

I do primary care on my patients. Like I said, we hardly ever have Techs. I'm in icu and have at most two patients. It's still very busy and I could use a tech most days. Are you questioning that I say I do total care 85% of the time? I personally think that the people who come on here to complain, should not be complaining as it is the job they are paid for. That's their job.

Where do I say I'm upset the Techs are too busy helping other nurses? Absolutely no where. Why would that upset me?

Your a nursing student, right? I think until you walk in the shoes of a RN for a bit, you can't critique my responses. Maybe you should reread my post because you seem to be missing my point.

ComeTogether, LPN · Sep 7, 2017

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 have 30 patients, I can't participate in a lot of patient care and that is my facilities issue, not mine. I do the very best I can with the "tools" I have and most of the time, that means my CNAs are getting help from the other CNAs to do patient care. It's me, and me alone who can assess my patients, call 911 (like i did tonight) for a patient who is seizing, pass meds, check blood sugars and give insulin corresponding to those blood sugars. You have a serious attitude problem, IMO.

This nurse will NEVER delegate out of convienience and I do much more for my patients than anyone ever realizes, because I don't bother telling the CNAs when I've changed someone or put them to bed or toileted them. Honestly, I've probably forgotten about it by the time I would see said CNA anways.

We all work as a team, most of my CNAs are good and they know I will help if I can. They also know they can call on me for a boost, a transfer or whatever else they may need, but most of the time they don't. This ensures when they do, I am right there to help.

If not all nurses are helping you, you need to take it up with those nurses. If its a pattern, maybe you should make sure your expectations aren't unrealistic.

remotefuse · Sep 7, 2017

I never understood the concept of ALWAYS being too busy to do something. I worked on a super busy medsurg floor for over 2 years and I could always make time for whatever I wanted to.

Sour Lemon · Sep 7, 2017

I never understood the concept of ALWAYS being too busy to do something. I worked on a super busy medsurg floor for over 2 years and I could always make time for whatever I wanted to.

"Super-busy" is relative.

My current job is a mini utopia compared to others I've had, yet some nurses still find it incredibly busy. If I hadn't previously worked in "hell", I would probably find my current job busy, too ...maybe even "hard".