Teaching a CNA how to chart

AutumnApple · Jul 7, 2016

I use a bit of wisdom from D. Carnegie when educating.

He states that people are more receptive to doing something when they understand how it benefits them. For your project, this means statements like "Good charting will save the RN's time and make the facility more compliant" are not helpful. That doesn't directly affect them.

"Learning how to chart properly will reduce the amount of time you have to spend chasing RNs around to tell them things, they'll know where to look themselves." That is more motivational.

Role-play is very effective as well. Pretend you are the patient, have them take your vitals ( or whatever) and chart it. Look at their work and critique it.

roser13, ASN, RN · Jul 7, 2016

I'm wondering if CNA charting would be covered in your P&P's? I ask because I have worked in areas where CNA's are not allowed to chart, with the obvious exception of vitals, BS, etc. I never knew why but I always assumed it was due to the potential liability issues of someone without significant training in proper charting technique....what you say (and how to say it), and what you don't say.

I can just imagine an aide innocently charting that Mr. Smith fell to the floor when Nurse X forgot to do X, Y or Z.

Here.I.Stand, BSN, RN · Jul 7, 2016

As a CNA I only charted data -- VS, BGs, I/Os, in LTC number of times certain behaviors observed (care plan specific, e.g. for Mr. J it was spitting). Everything was on flowsheets, never in narrative notes. What did you have in mind for CNA notes?

MunoRN, RN · Jul 8, 2016

It's not really appropriate to have CNA's charting "progress notes", it's one thing to have them chart observations in a narrative form, but a true nursing progress note, which involves applying the nursing process to a patient in written form is not within a CNA's scope.

cocoa_puff · Jul 8, 2016

As a CNA, I charted VS, turning and repositioning, bathing, I&Os, but I couldn't write "nursing notes." If I noticed something, I told the nurse who would write the note.

BuckyBadgerRN, ASN, RN · Jul 8, 2016

I'm not sure progress notes are appropriate for a CNA to chart.

I started a job as the DOC at an assisted living facility and I am trying to get my CNA's to start charting (they only have been writing in a communication book little notes to each other but nothing on legal documents). I just need help or advice on the best way to teach them how to write progress notes since none of them have any experience charting!
Thanks!

chacha82, ADN, BSN · Jul 8, 2016

As a cna I started with paper charts, filling in vitals, Is and Os, if someone was changed or turned in bed. I received very good advice from the nurses: "Give yourself credit for what you did. If you didn't chart it, it didn't happen, and do NOT chart before you do something." Excellent advice. As far as progress notes go, CNAs do not have the assessment or background (IMO, and I was a CNA years before being an RN) to write progress notes. It's enough of a struggle to get some of the CNAs to keep the bed alarm on: "He looks OK to me." :no:

Buyer beware, BSN · Jul 8, 2016

I use a bit of wisdom from D. Carnegie when educating.
He states that people are more receptive to doing something when they understand how it benefits them. For your project, this means statements like "Good charting will save the RN's time and make the facility more compliant" are not helpful. That doesn't directly affect them.
"Learning how to chart properly will reduce the amount of time you have to spend chasing RNs around to tell them things, they'll know where to look themselves." That is more motivational.
Role-play is very effective as well. Pretend you are the patient, have them take your vitals ( or whatever) and chart it. Look at their work and critique it.

And if these enlightened techniques don't get the CNAs motivated, there's always the old stand-by threats of job loss that involve but are not limited to: defamation, false witnees, bad evaluations, unsaid possible direct responsibility for the foreclosure of their homes and the possible starvation of their children. The list is provacatively endless. And I must say that down through the years I have seen many nurses as well as CNAs step up their game rather than suffer the consequences of any of the aforementioned infamy. So with all due respect to Mr.Carnegie and his seminal work "How to Win Friend and Influence People," the medieval approach to staff management seems to have been unfortunately chosen as the default approach to expeditious staff management. Much to our own collective infamy as caregivers.

AutumnApple · Jul 8, 2016

And if these enlightened techniques don't get the CNAs motivated, there's always the old stand-by threats of job loss that involve but are not limited to: defamation, false witnees, bad evaluations, unsaid possible direct responsibility for the foreclosure of their homes and the possible starvation of their children. The list is provacatively endless. And I must say that down through the years I have seen many nurses as well as CNAs step up their game rather than suffer the consequences of any of the aforementioned infamy. So with all due respect to Mr.Carnegie and his seminal work "How to Win Friend and Influence People," the medieval approach to staff management seems to have been unfortunately chosen as the default approach to expeditious staff management. Much to our own collective infamy as caregivers.

Lol

Maybe I've been reading too much Game of Thrones but I can't stop thinking you probably strike a resemblance to Ramsey Bolton.

I find throwing the comment 'Your ability to perform this skill, or not, will be included on annual reviews' effective if timed well and used sparingly. This does though use Carnegie's advice still lol

FurBabyMom, MSN, RN · Jul 8, 2016

I was never a CNA (STNA in the state I resided in). I would have had to have been certified or completed state testing, but the regulatory agencies in the state I resided in at the time waived the testing requirement for students enrolled in pre-licensure nursing programs. We had to have finished our first clinical skills based course to be eligible for this exemption. Conversely we were allowed to take the STNA exam following the first clinical skills class in school (as opposed to taking a separate STNA program). We had to submit documentation from our school certifying all the things we'd learned, that we'd passed the school skill based exams. The facility employing us then had their own competency checklists for us.

Most of our charting was on flowsheets - hourly rounding, vitals, blood glucose monitoring, I&Os, turn/repositioning, 1:1 or 1:2 sitter forms (patient observations documented at minimum q15 minutes (sleeping, awake, agitated, things like that). Some units within the hospital system I worked in were on electronic medical records (ED, ICUs (adult and NICU), PACU, select inpatient "floor" units), most floors were on paper charting. While we were on mostly paper we had CPOE throughout the system, and printed our "worklists" from the CPOE program (each patient's VS frequency (including parameters set by providers), code status, lab draws as applicable, turn/reposition orders, accuchecks if needed, activity and diet orders).

We WERE allowed to write observations down as an entry in the nursing notes section. I was in the house-wide float pool. If something was missed and had been delegated to the PCA/SNA the first person to be thrown under the bus would be the float PCA/SNA. Honestly worse than the unit managers and staff was the float pool manager - that woman had no mercy on anything. We were encouraged to write pertinent information down. Any time any patient had vitals outside of the "accepted parameters" - you can believe I wrote who I notified in the notes section (patient's primary RN with name or if they were unavailable, the charge RN with their name and time). Patients who tried to refuse lab draws, turns, vitals, etc - that was documented and it got a similar entry in the notes about the RN being notified. If patients had complaints - for example I went in to get vitals and they complained of chest pain - I would call their nurse. Depending on the nurse sometimes they wanted us to document the initial complaint and our actions, others they put it in their notes (and as an RN, I've done it both ways too). It's not assessment to document a quote from a patient.

As a PCA/SNA, I had a situation where I had to document WAY more about a patient - but that *was* the night I was sitting 1:1 with the patient the patient in a fit of rage busted a hole in the wall and attempted to kill the staff in the room. But that was documenting the behaviors observed - example hitting, kicking, spitting, etc. I don't remember if the patient was criminally charged or not (we had to fill out a hospital police report because of the nature of the incident - both property damage, and the threat of violence / patient having staff cornered in the room and threatening to use the phone and/or remote to beat staff). Ah...memories...

BSN16 · Jul 9, 2016

It's not really appropriate to have CNA's charting "progress notes", it's one thing to have them chart observations in a narrative form, but a true nursing progress note, which involves applying the nursing process to a patient in written form is not within a CNA's scope.

At my hospital aids are allowed to put in a nursing progress note because it is appropriate to a certain extent. For example "Ambulated patient. O2 dropped down to 88 with activity". this is technically related to the progress of a patient and isn't appropriate for an RN, who didn't walk the patient, to chart this.

But it also says the title of the note maker after their name.