Wannabe Nurses

[BUTTERFLY63]

we have had a couple of incidents on our med-surg unit with 2 of our techs. one which involved me! i had a patient that was in for dehiscence of a surgical wound. i walked into the patients room and the tech said "you don't have to worry about doing the dressing change i already did it." i said "did you reinforce it or change it?" she said that she changed it. we walked out of the patients room and i asked her if she changed the packing and she said yes!!!!!!!

i told her only nurses can change dressings and especially packing. she said "i know" i told my charge nurse what happend. in the mean time my patients doctor (surgeon with a god complex) shows up. removes the dressing and it was not packed correctly and we had specific orders to pack it with dry gauze not wet. and he wanted individual 4x4 packed in it not the 4x4's in the boat because the individual 4x4's are more fluffy and absorb more . i know, just giving you an idea of what i was dealing with. so the surgeon/god threw a fit and i told him what happend. i wasn't going to take the fall for that tech. anyways the tech got suspended without pay for 2 days and is on probation. the tech is not a new tech. she's been working as a tech for more than 10 years so she knows better. i have no idea why she thought she could get away with doing that. i haven't seen her since this incident.

another incident with a different tech happend and another nurse. the nurse got a post-op patient. she didn't know they came up for surgery. the tech walks in the room and sets them up with frequent vitals. the recovery room nurse starts giving her report and they assess the patient and go over doctors orders. the tech didn't inform her that she was the tech or let the nurse know the patient was in the room! so the nurse walks by the room and sees the patient in the room. she introduces herself and asks where the recovery room nurse is. they told her the nurse amy (not her real name) was already in here and took report from the

recovery room nurse, which made the real nurse feel stupid and made her look like she didn't know what she was doing!

the charge nurse talked to the recovery room nurse and said the tech didn't identify herself as the tech or say that she would get the nurse. she took report! so this tech is in trouble for impersonateing a nurse. this just happend so i don't know what is going to happen to her!

scary....huh!

[leslie :-D]

nurses need to know what they can safely delegate.

for you to accept the tech doing the dressing, is ultimately your responsibility, and therefore, your fault.

obviously, the surgeon ordered a specific dressing, which was not done.

furthermore, the nurse needs to evaluate the wound, esp where it was dehisced.

sorry, but that is on your shoulders.

if a tech told me what s/he had done, i would have thanked him/her for wanting to help, but, would have added that the nurse must be consulted first:

and at that point, you should have redressed the wound.

as for the other incident, it 'sounds' like the tech impersonated a nurse, which is waaaay out of line.

don't you guys wear name tags to identify yourselves?

leslie

[Alex_RN2b09]

I'm going to have to agree with earle here the first thing I would have done if an aide told me they dressed a wound would be to assess the would and their method hopefully no harm was done to the patient. Second would be to redress the would properly, yes is was wrong of the aide to preform that task but there is no reason the surgeon had to come on the floor and see it improperly dressed.

[ohmeowzer RN, RN]

i had a CNA turn off a heparin gtt and give the pt a shower with PE's. i walked in the room and the pt was in the shower and the pump was turned off , no oxygen PICC line not covered .. i was soo mad , i asked the CNA why didn't she ask me first before turning off heparin and dragging this poor woman out of bed with no oxygen.. with PE's... the CNA said " i thought it was okay and i am just doing my job" well i did my job and she was fired... i work in a acute care unit and the CNA who has worked there for 3 years knows better than this... i swore like a sailor on leave that day...

[Ruper]

Butterfly, I took it from your post that you really hadn't had a chance to rechange the dressing before the doc came in. It sounded to me like you went to speak with the charge nurse and cool down a bit (which could all happen in about 5 minutes).

For this tech to do this after 10 years of experience, she has probably done other things that weren't in her scope of practice. hmmmmm. Attention to her acts was over due.

Sounds like the second situation was handled as it should have been. I have seen many hospital employees without their name tags even though it is policy to have one on. If the tech acted as though she was the nurse for this patient ..... she's gone!

Ruper

[chadash]

I have to agree with the original poster that the nursing assistant was out of line to change a dressing without being instructed to by the nurse. It is best if you find a yucky dressing to find the nurse, ask "what should I do, or how can I help you with the dressing?" The NA does not have the doctor's orders, or the ability to assess the wound....

The taking report: I help set the person up to help the nurse, and sometimes catch the first vital sign if she is tied up, but NEVER take report from the folks from OR or ICU....

I do get tired of saying : I'm a NA, let me get the nurse for you.

Alot of these problems can be addressed with good communications, some meetings to discuss roles etc. I don't think the NAs mean to be such pains, might even think they are being helpful. Teach!

Oh, by the way, I do not WANABE a nurse, I don't even wanabe a Nursing Assistant :)

[pagandeva2000, LPN]

Butterfly, I took it from your post that you really hadn't had a chance to rechange the dressing before the doc came in. It sounded to me like you went to speak with the charge nurse and cool down a bit (which could all happen in about 5 minutes).

For this tech to do this after 10 years of experience, she has probably done other things that weren't in her scope of practice. hmmmmm. Attention to her acts was over due.

Sounds like the second situation was handled as it should have been. I have seen many hospital employees without their name tags even though it is policy to have one on. If the tech acted as though she was the nurse for this patient ..... she's gone!

Ruper

I agree with you, Ruper; it sounds as though most of this happened too quickly before she had a chance to properly intervene. What happens often is that the CNAs and techs that do this usually do not inform the nurse until it is too late (IF they report that they have done this AT ALL)...leaving the nurse to blame. I'm sorry, we do not have eyes and ears in the backs and sides of our heads. Sometimes, it is really hard to control wild cards. :angryfire

[FireStarterRN, BSN, RN]

This is similar to my experiences. I find it's the more experienced CNAs who are nurse wanabees. Some of them feel as if they've been around long enough and know more than the nurses. Sorry, but it's a big pet peeve of mine, some of these CNAs have strong personalities and are stubborn. They can really be hard to deal with.

[Kunzieo]

(...in some states...CNA's can do wet-to-drys...with proper direction, of course...just thought I'd throw that in there!)

[femmefatale]

I dont get how CNA wannabe nurses take charge of situations that are better left for the professionals. I am HUC/NA/ERT (graduating in May 08 ) and so I can do a lot more than CNA but you'd never catch me doing extra stuff that a nurse should do just because its not within my boundaries. I think it just doesnt occur to them the responsibility and accountability that goes along with one's action esp when it comes to patient care and all that pertains to them esp if its not within their scope of practice. The nurse had to probably write a note about the incision. what was she supposed to write since a tech did it?? redo it?:icon_roll

[EmmaG, RN]

My ex-hospital had a CNA/tech ladder. They were trained to do tasks such as trach care, simple dressings and so on. This is not to say the CNA here wasn't out of line. However, I think it's a bit harsh to proclaim them 'wannabe nurses'. I think it's quite possible they felt they were simply helping you out. A 'thank you, but...' while calmly explaining why she shouldn't have done this would have been more productive, IMO. As it is, she is going to feel defensive and angry rather than having learned from this experience.

[Simba&NalasMom, LPN]

My ex-hospital had a CNA/tech ladder. They were trained to do tasks such as trach care, simple dressings and so on. This is not to say the CNA here wasn't out of line. However, I think it's a bit harsh to proclaim them 'wannabe nurses'. I think it's quite possible they felt they were simply helping you out. A 'thank you, but...' while calmly explaining why she shouldn't have done this would have been more productive, IMO. As it is, she is going to feel defensive and angry rather than having learned from this experience.

I agree with you to a point. It is good to give people the benefit of a doubt in general. However, this tech had 10 years experience, which should be more than enough time to learn her scope.