RNs Don't Help CNAs

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Specializes in Tele, ICU, Staff Development.

Dear Nurse Beth,

I am a nurse aide, and a nursing student, working athospital in the Las Vegas area.

I've been working at this hospital for over a year and could not be more disappointed in the lack of teamwork between RN's and CNA's. RN's are quick to leave a patient's room if a patient needs to be cleaned, needs ice/water, needs assistance ambulating, etc. I am constantly drenched in sweat, walking quickly up and down hallways to ensure patients needs are being met, but RN's are calmly sitting at thenurses station talking about their personal issues. I prefer to handle hostile situations as diplomatically as possible. I've learned first hand that reacting negatively will result in RN's banding together as quickly as our nation does during a time of crisis. There are so many forums, articles, meetings that relate to advocating for the Nurses against Doctors, but what about us? What would be the best way to handle this without causing an uproar?

Nurses abuse and take advantage of the aides, the aides become disgruntled, employee morale drops, which then trickles down to the patients.

Patients are MY top priority, as they should be everyone else's in this environment.

Help?

Dear No Teamwork Between CNAs and RNs,

I've always had a heart for nursing assistants because they are the most under-recognized group in nursing. Typically they are the "underdogs" in that they don't have status, a voice, or bargaining power in facilities. Often the lowest paid in nursing, they are given heavy workloads.

I firmly believe they contribute to patient satisfaction more than most anyone. It's disheartening to see hospitals stretch their patient loads to the breaking point.

Many, many nurses love and respect our nursing assistants. But it's true that some nurses avoid helping with personal care. We all know that.

It's also true that when a nurse may appear not directly involved with patient care, she/he is involved with aspects of care that only nurses are responsible for. This cognitive work may not always be apparent to the onlooker. Nurses, too, are overworked, and may be conserving energy to focus on the next three admits and discharges coming their way.

It's important to build trust between CNAs and nurses, and as a nurse, I have always believed it's my responsibility to do so.

Thank you so much for your point of view. You are right- patients are our top priority, and together, we can achieve the best outcomes. I know you will remember this when you become an RN.

Best wishes,

Nurse Beth

nurse-beth-purple-logo.jpg

Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

I was an ER tech before I became an ER nurse. What you are describing is your unit culture, and I am sorry it has become what it is. I was "raised" in healthcare with this philosophy: as a nurse, my patient's care is 100% my responsibility. Whether it's toileting, eating, bathing, labs, EKGs, meds, ambulating, etc. - all my responsibility. I am at work to work, not socialize. And if I have other staff to help me accomplish tasks for my patient, what a great day for me! It sounds like your unit culture needs a reality check, or you need a new unit that appreciates your hard work.

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Specializes in Med/Surg/.

For 15 yrs we did total pt care until we started get CNAs. We still did TPC but also had some help because there would be 1 CNA. As time moved on more CNAs. Nurse coming in in the 90's on mostly never did TPC so evolving to let CNAs do all of the toileting,feeding,fetching. There are really more RNS/LVN now that do little PC. I have watch Nurses sit in the NS on their phone while lights go off. I am sure many of us could go on and on. Now that the hospitals are all RN mostly I'll exclude the LVNs. I have not had the patience for that for quite a few yrs and have been known to tell a Nurse to get up and take care of her own pt as the CNA has enough to do.( That's the nice version). These Nurses now a days need to stop and think and know, to make it work, they do need to be on occasion the CNA for their Pt. It is a very rare night that we can't take the time to answer the light and assist your pt on the bedpan/BR/turning,rearranging,changing. I hear more excuses and they get better every year. Sorry after 40 yrs I have more stories than you can shake a stick at and have been from east/west coast doing it. This is a condensed version

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Specializes in Med/Surg/.

OH and PS here this is a generalized version so no nasty comments if you are exempt here.

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I agree with Pixie, RN. I started out in 1970 as a "house orderly". About the only time RNs appreciated anything I did was chest percussions during CPR. When I graduated in 1974, RNs did full pt. care with help from LVNs and Aides, (CNAs). When in charge of a shift, it didn't take a genius to figure out, if I may use a politically incorrect term " the nursing chain of command ", that the LVN's and CNA's are your best allies. They see the pt. more often and can report what is going on. It is even more important today to ask them, (LVNs, CNAs, Med Techs, etc) questions and listen, because we might only see a pt. twice a day. The best to all of you.

And yes, Florence Nightingale sat at the desk next to me.

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Specializes in Med-Surg.

This is something I see constantly at work and it is something that is unfortunately supported by management. I am an old school nurse and ultimately my patient's care is my responsibility, not to mention that waiting for things to get done ruins my workflow for the shift. I have encouraged CNA to request the assistance of the RN for baths, repositions, and toileting as CNAs are responsible for the care of all the patients on the unit and if we all sat waiting for this one person to do everything then most items would never be done.

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At the risk of virtue-signaling, when I finish my RN work, I check with my CNA(s) to see what they need. I've worked with the same CNAs for awhile, so they have a good sense of my work habits, and also of the flow of the floor. I've had shifts where I simply couldn't pitch in with their work, but they know it was because we had about eight disasters back-to-back or whatever. Or changeover night, they will be more busy than usual. But we usually work it out...

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Specializes in Tele/medsurg.

I think both sides are overworked. I do think nurse should help out when possible, me personally if I see my CNA running around like crazy and I'm done giving meds and no one is calling me and I don't need to do anything urgently I'm not gonna load up more work on the CNA or ignore the call light until they get it, I'll get up and do it myself. Its a shared responsibility. And I have seen RN's and LVN's who don't feel this way. Recently I had a patient who was dirty and the CNA had just gone to lunch. I wasn't busy so I wanted to change the patient but they were too big for me to move on my own so I ask another CNA to help, she tells me to ask the LVN because its not her patient, I ask the LVN he tells me to wait until the CNA comes back from lunch. So just let the patient be dirty for 30 minutes even though we both had the time to change him!

In that case I can see where CNA's are coming from its frustrating and not working as a team.

The flip side that I think a lot of CNA's don't see is that while THEIR duties are shared work, OURS are not. If he/she is slammed they can ask me to help clean a patient or feed them etc. If I'm slammed I can't ask them to pass my meds, hang my IV's, call the MD etc. No matter how much work I have piled on I still have to do it all and find a way to manage my time to do it because no one will do it for me...

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Don't take this the wrong way. But, I've never seen a CNA/PCA on my unit, not take a lunch break. As a matter of fact, almost all, routinely take an hour for lunch. If by chance I do get a break, there is a 95 % chance it will be interrupted and I won't have time for another. The CNA on the otherhand is never obligated to stop their break and take care of the patient or respond to phone calls.

Some RNs too see CNAs laughing and playing, texting, watching TV on their phones, listening to music loudly, using computers to shop for personal items, in CHARTING areas?? I've had CNAs outright tell me, "get it yourself" (blanket, soda, etc.), and they have no idea that I have late meds, two phone calls to make to MDs, two elevated BPs to treat stat, telemetry calling to say a patient is in Vtach etc... No matter how much I and some RNs help, the CNAs still complain to management. Lucky for them, management listens, thus, giving CNAs more power/worth than RNs.

At the end of the day though, CNAs are at the utmost importance to me. I can tell you how much I truly appreciate that extra attention and tenderness you give to OUR patients! You're an important extra set of eyes. The CNA may be the first to see bloody stool, report abnormal vitals, save a patient from falling or even see that "something is different" about the patient. CNAs are an equally valuable member of the nursing team!

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Specializes in ICU; Telephone Triage Nurse.

Beth, that was so diplomatic. I guess that goes to show that everyone is over worked, but don't always recognize the work others have to do also. Having a bit of trust in those you work with goes a long way.

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Specializes in Emergency Room.

I agree with you. Unfortunately this issue in nursing will never end. I've worked on both sides, there is always room for improvement.

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Every time when I see a topic like this, it makes me wonder why a nurse aid complains about her/his workload to a floor nurse. Each floor nurse has NO capability to put more nurse aids on the floor at all.

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