RNs can a CNA save an RN's hide?

Nurses General Nursing

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Or is any defense from a CNA not relevant?

Specializes in orthopedic/trauma, Informatics, diabetes.

If it's not documented, it didn't happen.

CNA/NCA work under the RN's license. It is up to the RN to make sure that Is & Os are documented, Q2H turns, etc. 

A good NCA is worth their weight in gold!  I work with some that are AMAZING. Others, not so much. 

As far as "saving an RN's hide", they certainly could. For example, if a pt needs to be turned Q2H and it isn't documented, and the pt develops a pressure injury, the RN is the one that it may fall on. We have a "just culture" policy where rarely is an issue completely one person's fault. 

I am not sure what hypothetical situation you are asking about but an NCA will def make your life better. 

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The CNAs can make or break my shift. There are some I love to work with, and I know they'll get their stuff done, alert me if there's something I need to know, and not bother me with stuff I don't.  There are others that I know I'm going to have to double check on, and give very specific instructions because they won't take the initiative to do things themselves.  I hate micromanaging. 

CNAs often notice things before I do.  Skin breakdown is a big one, since there's so much personal care involved.  Because they're the first line to answer call bells, they very often know how a patient ambulates before I do, and can alert me to safety concerns.  They're taking routine vital signs, so a good CNA will let me know about a fever or high/low BP.  On the other hand, I've occasionally had CNAs just enter SBP 190 into the computer without giving me a heads up, and I find out about the new hypertension hours later.

As for vouching for an RN, a CNA is going to be at least as good and probably better than a "regular" person.  If a family member complains the nurse did/didn't do something, the CNA who was in the room can obviously back the RN (assuming the complaint is false).

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Specializes in Urgent Care, Oncology.
2 hours ago, mmc51264 said:

CNA/NCA work under the RN's license.

Nobody works under the RN's license other than the license holder. 

Why do people keep spreading this myth? CNAs are certified and held accountable to their own standards and actions. 

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Specializes in orthopedic/trauma, Informatics, diabetes.

It is up to us to delegate. Nurses work from the top of their scope to the bottom of their scope, which includes the duties of an NCA. If we don't have and NCA, we do all the tasks. 

As the RN, it is up to me to make sure that a BG gets taken, that a pt gets turned, that VS outside normal limits are attended to. 

Yes, an NCA is held accountable for their actions, but the nurse is held accountable too. 

When we have new NCAs hired, it is the RN that signs off on their tasks, not another NCA. RNs are responsible for making sure they can demonstrate proficiency. 

Maybe it's different where you work. 

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1 hour ago, mmc51264 said:

When we have new NCAs hired, it is the RN that signs off on their tasks, not another NCA. RNs are responsible for making sure they can demonstrate proficiency.

Do you mean " copy and paste" charting? All healthcare system go by the same policies you mention. What is suppose to be done and what is actually done are 2 different things. I've noticed where a RN charted that  all these things for the patient where done, when none were actually done. Maybe the RN planned on doing these tasks. Point is that the RN charted they were done (betting they assumed the CNA did or will do them) verification is far from their mind. It is a chart that is now done. Later if questions are asked the RN can go back to chart. Hopefully the CNA charted as well, but CNAs don't chart what they don't do.

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Specializes in Peds/outpatient FP,derm,allergy/private duty.

As I understand the question, can a positive relationship between nurse and CNA benefit the nurse (and by extension the patient)? Yes.

As VivaLasViejas said, CNAs can spot things nurses may not due to the amount of time they spend with the patient. I would want a CNA to feel free to share that information with me. I haven't personally known any nurses who dismiss, or diminish, roll eyes etc but I do know if it were me I might hesitate before speaking up if I thought the result would be getting barked at or made to feel my observations weren't important due to my position.

Most of the time it won't be a "save your hide" thing, but those things have nasty way of biting you in the backside just when you least expect it.

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51 minutes ago, nursel56 said:

I would want a CNA to feel free to share that information with me.

That's nice to hear. I do hope that all RNs feel the same way. I know that is not always the case, and some CNAs are afraid or hesitant to go to a RNs in fear of being barked at with a "I KNOW ALREADY!!". The CNA doesn't know if they heard or not in the midst of the RN's stress.

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Specializes in orthopedic/trauma, Informatics, diabetes.
On 10/8/2020 at 10:31 PM, DesiDani said:

Do you mean " copy and paste" charting? All healthcare system go by the same policies you mention. What is suppose to be done and what is actually done are 2 different things. I've noticed where a RN charted that  all these things for the patient where done, when none were actually done. Maybe the RN planned on doing these tasks. Point is that the RN charted they were done (betting they assumed the CNA did or will do them) verification is far from their mind. It is a chart that is now done. Later if questions are asked the RN can go back to chart. Hopefully the CNA charted as well, but CNAs don't chart what they don't do.

Seriously?? You are accusing me of falsely documenting? Of teaching to copy and paste so that the CNA can also document falsely. Oh-no, you are saying that the RN is the one charting falsely and that the CNA will not chart what they don't do (but the nurses will).

How dare you assume the way I work, teach, chart, lead. You just insulted every nurse that does their job properly, which I guarantee is much more than those that don't. I do chart audits. 

Not sure where you work or what your title is, but you are way off base. I am sure it happens, but not the majority. 

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Specializes in CRNA, Finally retired.

I still have no idea what the OP is talking about:(  Most disjointed  original post ever.  

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I agree with you subee. It sounds like a personal situation that has nothing to do with us. 

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