Some days it just stinks to be an aide

Published

I'm feeling really guilty about something that happened at work 2 weeks ago.

I'm an aide that primarily works on med surg but if ICU is open (really small hospital) I float up there as I'm the only aide with the most experience there.

We had 1 pt(the only one) who was post op bowel resection. On a PCA. While the nurses were in report I got a set of vitals. BP was low, sure the guy wasn't moving around much but a BP of 70/30 is cause for concern. His RR were only 8 and his pulse was irregular (checked radially) and in the 130's. I prompty notified the nurse of his vitals. He was responsive to a degree but he had just had surgery during the night and this was at 0700. I knew that low RR could be d/t the PCA and that our protocol is that any RR below 12 means that the PCA is immediately dc'd and the dr called.

The nurse shrugged her shoulders. I repeatdly checked on this pt during the time I notified the nurse and the time we called the code. Thankfully, we never lost a pulse but he was reintubated.

I don't know why I feel guilty. I notified the nurse immediately of the problem. Management has issues with aides charting anything in nurse's notes that doesn't deal with how far a pt ambulated. And I don't feel that as an aide that I can chart these kinds of observations. I guess I should have gotten in her face and yelled at her and told her to take a look at her pt. I have to follow chain of command.

I charted the vitals so there is a record of that. But, if the nurse comes back and says she was never notified, what could happen to me? I don't plan on becoming a nurse. In fact my major is political science but that doesn't mean I don't care about the patients and my certification. And I always notify the nurse of abnormal VS, BS, etc but usually I get a shrug as if to say "so what, I see that all the time". I work weekends only so we are a close bunch and I know who is going to do something about an abnormality and who isn't but that doesn't change the fact that I tell them.

It sucks being an aide because when you do notice something is wrong with a patient some nurses (and not all) just don't listen. Sometimes you know what should be done but you can't do a darn thing about it because you are just an aide.

Is there anything else I could have done in this situation?

Up Vote Up Vote ×
Specializes in Med-Surg.

It is a part of the nurses assessment to be aware of her/his patient and their vital signs. The excuse "the aide never told me" doesn't fly. CNA's rarely get into any kind of long-term trouble when a patient crashes because iit's always the nurse that is accountable. (I'm sure though there are many stories to the contrary that CNA's will chime in here.)

CNA's sometimes are the real eyes and ears and good nurse always listens to their CNA. I can't tell you how many times a CNA has told me "come look at this patient, something's not right" and they've been right on the money that the patient was in danager. In fact when I hear that out of a CNA, I run.

Good job. As you say, you follow the chain of command. If you feel a nurse is endangering a patient by ignoring you, then you have to go further, charge nurse, administorator on duty, etc. (I know you work in a small hospital but I'm sure there's a chain of command beyond the nurse you're working with. Just be aware there might be consequences to account for afterwards.

Up Vote Up Vote ×
Specializes in Medical and general practice now LTC.
I'm feeling really guilty about something that happened at work 2 weeks ago.

I'm an aide that primarily works on med surg but if ICU is open (really small hospital) I float up there as I'm the only aide with the most experience there.

We had 1 pt(the only one) who was post op bowel resection. On a PCA. While the nurses were in report I got a set of vitals. BP was low, sure the guy wasn't moving around much but a BP of 70/30 is cause for concern. His RR were only 8 and his pulse was irregular (checked radially) and in the 130's. I prompty notified the nurse of his vitals. He was responsive to a degree but he had just had surgery during the night and this was at 0700. I knew that low RR could be d/t the PCA and that our protocol is that any RR below 12 means that the PCA is immediately dc'd and the dr called.

The nurse shrugged her shoulders. I repeatdly checked on this pt during the time I notified the nurse and the time we called the code. Thankfully, we never lost a pulse but he was reintubated.

I don't know why I feel guilty. I notified the nurse immediately of the problem. Management has issues with aides charting anything in nurse's notes that doesn't deal with how far a pt ambulated. And I don't feel that as an aide that I can chart these kinds of observations. I guess I should have gotten in her face and yelled at her and told her to take a look at her pt. I have to follow chain of command.

I charted the vitals so there is a record of that. But, if the nurse comes back and says she was never notified, what could happen to me? I don't plan on becoming a nurse. In fact my major is political science but that doesn't mean I don't care about the patients and my certification. And I always notify the nurse of abnormal VS, BS, etc but usually I get a shrug as if to say "so what, I see that all the time". I work weekends only so we are a close bunch and I know who is going to do something about an abnormality and who isn't but that doesn't change the fact that I tell them.

It sucks being an aide because when you do notice something is wrong with a patient some nurses (and not all) just don't listen. Sometimes you know what should be done but you can't do a darn thing about it because you are just an aide.

Is there anything else I could have done in this situation?

All I can say is if you notified the RN then you did what is required and the responsibility is with her.

Up Vote Up Vote ×

I agree with Tweety. You guys are my eyes and ears and I value your input. I appreciate when a CNA informs me of abnormals and while I might not appear at times to be taking notice, I assure you I do. Not always is there a necessity to take any action, but I do pay attention.

I think you should discuss this with your manager and tell what happened. If such an incident were to occur in the future and you feel a patient could be at risk, as tweety said go up the chain and contact the supervisor.

Please don't be too hard on yourself. You sound like a great CNA, and an asset to your patients.

Up Vote Up Vote ×

You did a good job. When I was a tech I had a pt. that wasn't responding to me. Even after sternal rub. I checked the blood sugar it was 40's or something like that. The nurse I told was on the phone with something personal. I grabbed another nurse and they fixed it. That nurse took a leave of absence for personal reasons. Moral to the story..... Always do what you need to do for the person in the bed. If they can't talk, do the talking for them. You did what you needed to do. Go up the chain if you need to because that is helping the pt. in the long run. Any nurse with some brains would have prevented the code. Some days I begin to wonder. :)

Up Vote Up Vote ×
Specializes in Hospital Education Coordinator.

Another option would be to institute the chain of command. That would mean telling the primary nurse you do not feel comfortable about the patient and want to let the charge nurse or house supervisor (or whatever your facility's policy states) know about the situation. Then do it. Also, document your findings with the appropriate time. It is appropriate to feel a little guilty about this simply because you were involved on some level. In my opinion you are turning the negative into a positive by learning from the experience so you will know what to do next time. Good luck!

Up Vote Up Vote ×
Specializes in Jack of all trades, and still learning.

What you did was totally correct. The only other thing I can add is that if you are concerned re: documentation, why don't you write down the incident at home noting times, assessments and actions, so that if it is ever brought up, you have a personal record to refresh your memory should your actions ever be questioned. (Of course it goes without saying you don't write the patient's name on it...it is not a legal document but a personal reference only)

You may have felt 'guilty' because you knew what should have been done, and you cared. Don't beat yourself up because of someone else's inaction

Up Vote Up Vote ×
Specializes in MSICU starting PICU.

WOW so I work in a MSICU and our aides do turns, linens, make a-lines and gather supplies we may need throughout our shift. Our assistants do not assess the patient, no vitals no finger sticks no bedpans as this is not something that is done in our unit. They essentially do no pt care, unless the RN is right next to them. I would say that you have a lot of responsibility and in this situation you did what was appropriate. I hope i do not sound like I do not appreciate my assistants because I could not do it without them. I just never realized how involved assistants can be at other hospitals.

Up Vote Up Vote ×

I think a pat on the back is in order, no need to feel quilty. You may have saved that patients life with your attention.

Up Vote Up Vote ×
Specializes in ER/Trauma.

Bethin: I understand your frustration. You did the right thing.

This reminds me.

I just had a discussion with my tech last night.

She was feeling over-whelmed and stressed out (can't blame her. She is often the only tech on floor even when we end up having 33 patients!)

I could see that she had something on her mind and I encouraged her to share.

She was still very hesitant - so I pulled her aside to a quiet area of the floor and asked her to tell me. She was still very apprehensive and asked "you want the truth? Straight up?"

I said "Tell me all and I promise I'll listen without interrupting or passing judgement".

She confided that she feels frustrated by the lack of "work ethic" shown by some of the nurses on the floor. That many a time she sees the techs running their butts off while the RNs just sit and chart, chart, chart and not do anything but pass meds.

I couldn't address her concerns that night (fully intend to address 'em tonight LOL) but I made sure that I thanked her for bringing these concerns to me and that if in the future she ever needed to approach anyone, she could always run it by me (she's new to the floor).

My techs are my anchors. Good tech Vs bad tech is all the difference between tolerable night Vs horrid night.

cheers,

Up Vote Up Vote ×

It wouldn't hurt to write "Notifed Nurse Smith, time" next to the VS where you record them to make you feel more comfortable. And thanks for being such a conscientious aide. I always told my assistants how I relied on them to let me know what was going on.

Up Vote Up Vote ×

Thanks to everyone for your replies.

I took your advice and wrote down what happened in case something does happen. I just needed some reassurance that I did everything that I could to the best of my abilities.

Up Vote Up Vote ×
+ Join the Discussion