I got ripped a new one by a nurse the other night. I was working a 5-9 pm shift with my partner, it was our job to give the evening showers (this is a LTC facility). 15 minutes before my shift was over I was assigned to check on Mr. B, a resident who was on 'comfort care' because of non-compliance with care procedures and refusal to get out of bed, be bathed, or eat anything. He reportedly had a very large decubitus ulcer on his coccyx and was always belligerent and abusive to staff; he had recently hit his granddaughter who visited. Mr. B had a large wet spot on the front of his hospital gown that appeared to be urine.....an odd thing in a man with an indwelling catheter. It took both me and my partner to just change his gown because of how violent he was. I asked the nurse, an LPN who'd recently been reprimanded for something reported by one of the CNA's, I don't know what it was for. My partner and I had to, as gently as possible, reassure Mr. B as we held his hands back so that the nurse could check on his catheter. He slipped out of our grasp and grabbed ahold of the catheter giving it a good yank. Fortunately we got his hand off the catheter long enough for the nurse to get a puzzled look on her face.....it appeared there was something wrong but she couldn't tell exactly what. She mentioned that perhaps he needed a new catheter. She made a snap decision and ordered us to 'just put an incontinence pad underneath him and we'll tell the NOC shift. I don't have time to do a catheter before my shift is over, I have residents who need insulin right now.' It was nearly 2 hours before her shift was over, by the way. I just stared at her for a moment. He needed a complete linen change as he was lying in a wet substance and already had a large bed sore, but we were just to put a 'bandaid' over him and pass the whole mess on to the NOC shift. I thought her attitude sucked and I had a discussion with my 5-9 partner about it, she agreed. I would have been willing to stay past my shift to assist with the nurse taking care of the catheter change and even brave his fists during the linen change but I was overruled by Nursing Protocol.
The next day this LPN took me aside privately and got all red-faced as she told me that all the other nurses who heard about this told her to report me!!! Report me for what??! I asked....she said.....CNA's are not supposed to dictate to a nurse what the protocol is.....insulin is more important, according to her, than changing a catheter. OK fine, I said, but I didn't go blabbing and complaining to the nurses behind her back like that -- apparently someone overheard the conversation after the incident and went around telling everyone that I was 'all upset' and arguing with that nurse about how to do her job. I informed this LPN that I only discussed this with my partner and someone else who overheard was spreading intrigue the other nurses. Good grief!! Apparently if you don't like something a nurse does, or just don't understand 'Nursing Protocol' you're liable to get reported. Heck I better just keep my big yap shut from now on....or at least avoid that particular LPN. I think she was already on the defensive for getting upbraided about something. I apologized and reassured her that I have yet to report anyone and I don't plan on ever doing it unless a resident is being neglected or abused. After this incident I've tried extra hard to be nice to this nurse, because she talk to me privately about this instead of reporting me and I appreciated it. I still think I didn't really do anything wrong, other than project to her during the incident that I didn't agree with her 'protocol' and that just passing stuff you don't want to do on to the NOC shift is not cool.
I would have, if I were the cna, changed the pt's linen and gown. That is well within my scope of practice as a cna and what I believe I should do in that situation. The nurse can deal with her/his responsibility, but I would make sure mine was covered. I would then let the on-coming cna know that "I changed Mr. B; however, his foley is leaking and the nurse has not changed it yet. So, he will probably be wet again."
Insulin is important and a foley change requires a doctor's order. Maybe the patient has standing orders for this maybe they don't. The foley may just need to be flushed. Again, this requires a doctor's order. As a nurse, if it is at the end of my shift, I would let the on-coming nurse know that I discovered Mr. B's foley may need changing/flushing. If I have more time or I know that the on-coming nurse is already going to be swamped, I would go ahead and take care of that task after I give report.
I was working a 5-9 pm shift with my partner, it was our job to give the evening showers (this is a LTC facility). 15 minutes before my shift was over I was assigned to check on Mr. B, a resident who was on 'comfort care' because of non-compliance with care procedures and refusal to get out of bed, be bathed, or eat anything. 
He reportedly had a very large decubitus ulcer on his coccyx and was always belligerent and abusive to staff; he had recently hit his granddaughter who visited. Mr. B had a large wet spot on the front of his hospital gown that appeared to be urine.....an odd thing in a man with an indwelling catheter. It took both me and my partner to just change his gown because of how violent he was. I asked the nurse, an LPN who'd recently been reprimanded for something reported by one of the CNA's, I don't know what it was for. 
My partner and I had to, as gently as possible, reassure Mr. B as we held his hands back so that the nurse could check on his catheter. He slipped out of our grasp and grabbed ahold of the catheter giving it a good yank. Fortunately we got his hand off the catheter long enough for the nurse to get a puzzled look on her face.....it appeared there was something wrong but she couldn't tell exactly what. She mentioned that perhaps he needed a new catheter. She made a snap decision and ordered us to 'just put an incontinence pad underneath him and we'll tell the NOC shift. I don't have time to do a catheter before my shift is over, I have residents who need insulin right now.' It was nearly 2 hours before her shift was over, by the way. I just stared at her for a moment. He needed a complete linen change as he was lying in a wet substance and already had a large bed sore, but we were just to put a 'bandaid' over him and pass the whole mess on to the NOC shift. I thought her attitude sucked and I had a discussion with my 5-9 partner about it, she agreed. I would have been willing to stay past my shift to assist with the nurse taking care of the catheter change and even brave his fists during the linen change but I was overruled by Nursing Protocol.
OK fine, I said, but I didn't go blabbing and complaining to the nurses behind her back like that -- apparently someone overheard the conversation after the incident and went around telling everyone that I was 'all upset' and arguing with that nurse about how to do her job. I informed this LPN that I only discussed this with my partner and someone else who overheard was spreading intrigue the other nurses. Good grief!! Apparently if you don't like something a nurse does, or just don't understand 'Nursing Protocol' you're liable to get reported. Heck I better just keep my big yap shut from now on....or at least avoid that particular LPN. I think she was already on the defensive for getting upbraided about something. I apologized and reassured her that I have yet to report anyone and I don't plan on ever doing it unless a resident is being neglected or abused. After this incident I've tried extra hard to be nice to this nurse, because she talk to me privately about this instead of reporting me and I appreciated it. I still think I didn't really do anything wrong, other than project to her during the incident that I didn't agree with her 'protocol' and that just passing stuff you don't want to do on to the NOC shift is not cool. 
jb2u, ASN, RN
863 Posts
I would have, if I were the cna, changed the pt's linen and gown. That is well within my scope of practice as a cna and what I believe I should do in that situation. The nurse can deal with her/his responsibility, but I would make sure mine was covered. I would then let the on-coming cna know that "I changed Mr. B; however, his foley is leaking and the nurse has not changed it yet. So, he will probably be wet again."
Insulin is important and a foley change requires a doctor's order. Maybe the patient has standing orders for this maybe they don't. The foley may just need to be flushed. Again, this requires a doctor's order. As a nurse, if it is at the end of my shift, I would let the on-coming nurse know that I discovered Mr. B's foley may need changing/flushing. If I have more time or I know that the on-coming nurse is already going to be swamped, I would go ahead and take care of that task after I give report.