scope of practice issues for CNA'S/LVN'S

chadash · Jun 14, 2006

It is wise to never do anything you feel unsafe doing, if you believe you might do harm because you have no experience in that area. Tubes and such can be very intimidating. Not totally sure what they were asking you to do, but you are the best judge of your capacity.

I remember a nurse chiding me for using a hoyer for a very small, very contracted lady. She said I should have been able to just lift her. My judgement was that I was more likely to cause skin tears, and discomfort by lifting her by hand. I chose to cradle her in a sling. My best judgement, like it or not.

buildingmyfaith57 · Jun 15, 2006

It is wise to never do anything you feel unsafe doing, if you believe you might do harm because you have no experience in that area. Tubes and such can be very intimidating. Not totally sure what they were asking you to do, but you are the best judge of your capacity.
I remember a nurse chiding me for using a hoyer for a very small, very contracted lady. She said I should have been able to just lift her. My judgement was that I was more likely to cause skin tears, and discomfort by lifting her by hand. I chose to cradle her in a sling. My best judgement, like it or not.

but you know chad there are alot of places here that would not let you pick up anyone my yourself its either hoyer lift or stand up lift or a gait belt. but the bigest thing is they do request you to go by the care plan. none of this i'll do what i want. that is how i got fired.

pickledpepperRN · Jun 15, 2006

Here is the California law for acute care. I don't know the regulations for a group home.

http://www.rn.ca.gov/practice/pdf/npr-b-29.pdf

I won't do anything unless my competence has been validated. We need to be taught, practice, and be observed doing a procedure correctly before performing it independently.

I can't understand why anyone would have to go before the bosrd for not doing a procedure for which they are not competent.

This explains floating and competency validation:

http://www.rn.ca.gov/practice/pdf/npr-b-21.pdf

squeakykitty · Jun 15, 2006

It is wise to never do anything you feel unsafe doing, if you believe you might do harm because you have no experience in that area. Tubes and such can be very intimidating. Not totally sure what they were asking you to do, but you are the best judge of your capacity.
I remember a nurse chiding me for using a hoyer for a very small, very contracted lady. She said I should have been able to just lift her. My judgement was that I was more likely to cause skin tears, and discomfort by lifting her by hand. I chose to cradle her in a sling. My best judgement, like it or not.

This is so true. Once, I had a resident who was a Hoyer transfer, who needed to be bathed in the tub instead of the shower, so I asked, and got help on how to go about getting her in the tub. I wanted to be sure it could be done safely without tipping the Hoyer over.

buildingmyfaith57 · Jun 15, 2006

This is so true. Once, I had a resident who was a Hoyer transfer, who needed to be bathed in the tub instead of the shower, so I asked, and got help on how to go about getting her in the tub. I wanted to be sure it could be done safely without tipping the Hoyer over.

i thank god for hoyer lifters. but i will not do one by myself period. and another thing about the hoyer lift is when i see someone being lifted out of the wheel chair into bed when that bed and wheel chair is about 50 feet away from the bed. and the resident is about to fall out of it. have any of you ever experience that?

emeraldjay · Jun 16, 2006

This whole thread reminds me of one of the "brainless wonders" we had at our facility. She gathered up several treatments and told the CNA's there's the treatments, go to it. Then, she proceeded to call the shift supervisor to complain that the aides were refusing to do these treatments. :trout: Fortunately she no longer works at our facility.

We have another one that prefers the CNA's to do the trach cares and replicare dressings than do it himself, walked away when told Mrs X needed a trach change leaving the CNA to assist the RT then told the supervisor he knew nothing about it, seems to spend more time looking for others' med errors than preventing his own.:angryfire I wanted to choke him when he asked what he was supposed to measure when looking at an order for a treatment r/t a stage two, hmmm I dunno, could it be the wound that needs the treatment? :uhoh3:

pickledpepperRN · Jun 16, 2006

Decades ago when I was a new CNA the LVN charge nurse asked me to irrigate a Foley catheter. She called me "stupid" when I told her "No, I don't know how so I think a licensed nurse needs to do it.'.

She then said, "You are not hired to think, just do as I say."

I gave my notice the first week on that job.

Too bad some are still risking patients like this. If it happened now i would write the facts with direct quotes. Explaining why I didn't obey, date and time it, keep a copy, and give the other to my direct clinical supervisor.

On my copy I would write who I gave it to, the time, and their response.

I didn't know to do that then.

squeakykitty · Jun 16, 2006

Decades ago when I was a new CNA the LVN charge nurse asked me to irrigate a Foley catheter. She called me "stupid" when I told her "No, I don't know how so I think a licensed nurse needs to do it.'.
She then said, "You are not hired to think, just do as I say."
I gave my notice the first week on that job.
Too bad some are still risking patients like this. If it happened now i would write the facts with direct quotes. Explaining why I didn't obey, date and time it, keep a copy, and give the other to my direct clinical supervisor.
On my copy I would write who I gave it to, the time, and their response.
I didn't know to do that then.

That's in the LVN scope of practice in CA, not in the CNA's. Writing down the facts, what people said, why you didn't do it, etc. is a good idea. And go up the chain of command, all the way up to the owner of the facility or the state if necessary, if no one else is willing to do something. The owner would probably do something to keep from getting sued, or being fined by the state.

squeakykitty · Jan 9, 2008

Today I ran into a former CNA that worked at the place, and she asked me if I ever had any problems with the DON (the one that wrote the CNA up for neglect for not passing meds)

Luckily I never did have problems with that DON, but maybe I left just in time. Come to find out, the DON was fired for flipping out and cussing in front of the residents, and was diverting drugs. She was described as a psycho. I get I was just lucky nothing happened to me.