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!
It's not just techs/CNA's. We've had some LPN's fired for continuing to access ports after they were told it wasn't in their scope. There have also been some issues with LPN's doing IV pushes, another big no-no for our state.
Their excuse is always the same, "I've been doing it for years". That doesn't negate the fact that they are overstepping their boundaries, though.
i have worked where cnas also 'worked their way up a ladder'
but this never included changing dressing or to do anything a nurse was going to have to chart on
another place i worked at had an can doing dressing changes because they were funded to have a wound care nurse but it was cheaper to use the aid
she was a wonderful person but she was allergic to latex so she was useing HOUSEHOLD GLOVES and went from patient to patient, guess what mrsa ran rampant from wound to wound from resident to resident when there was a lot of mrsa state sent a team down to investigate, when they were there a nurse and the adon did wound care in front of them
state people could not find a link between the residents they had different aides, different nurses even the housekeeping carts were different
the day nurses were questioned and they all said that they didn't handle the wound changes but as far as i know none of them rolled over on the don/adon
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.
I understand. My take on this was she was simply trying to help out, rather than a being a 'wannabe'. I've worked with plenty of experienced techs who have the occasional lapse in judgment. God knows I have had my share of duh! moments.
I am HUC/NA/ERT 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. 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
What is a HUC/NA/ERT???
The nurse should not write anything about the incision, pertaining to the incident in the notes but and incident report should be written.
(...in some states...CNA's can do wet-to-drys...with proper direction, of course...just thought I'd throw that in there!)
I really didn't know this, how interesting. Guess it would depend on the wound, stage, etc. Would the responsibility if something went wrong with the wound be under the nurse or the CNA?
to explain again....I didn't accept or delegate the dressing change to the tech. I went through my chain of command and conferred with the charge nurse....right after the incident happend. While conferring with the charge nurse the surgeon showed up to assess the dressing.
To be honest as both a CNA and now a nursing student I believe that CNAs are actually under-educated. I have learned more in three weeks of nursing school then I ever learned as a CNA. Also sometimes nurses make it look so easy it could be assumed(falsey by the way) that anyone could do some of the tasks nurses do. Some CNAs have no idea about the nursing process(at least I didnt) assesment techniques, or what they are actually looking at. Also I dont think many understand the actual legal ramifications that could happen by operating out of their scope of practice. Maybe some CNAs didnt have to work hard for their certification(I DIDNT). I AM working hard now and I would take my license a lot more serious than i have. I am not making excuses for the CNA or the nurse b/c they were both wrong, with the nurse being ultimately responsibile. I am just stating some underlying causes. i bekieve the more informed a CNA is the more likely s/he would better perform their jobs.
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!
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 :)
Thanks, That last line has my ribs hurting from laughing soooo hard, I do hope you find a fufilling job that you do want, LOL! THAT WAS CUTE and BRUTAL HONESTY!!!!!!
I have a question that might be better placed on another thread -- if so, I ask for moderater advice.
Question: What can patients and their families do to prevent (or deal with) situations like the one described by the OP? I'm assuming they do this with civility yet being respectfully assertive. How can they do this without the potential of being labeled "bad patients" or "difficult?"
jackson145
598 Posts
It's not just techs/CNA's. We've had some LPN's fired for continuing to access ports after they were told it wasn't in their scope. There have also been some issues with LPN's doing IV pushes, another big no-no for our state.
Their excuse is always the same, "I've been doing it for years". That doesn't negate the fact that they are overstepping their boundaries, though.