I have a tech at work who I'll call Sarah. She is a really good tech. The problem is that she has an attitude with me. I have reported her at least twice and nothing ever gets done. It goes like this:
I always get my own admission VS, post-op, post cath, and blood VS. I very rarely ask a tech to do anything for me. They know what they are supposed to do and they do it. Yesterday I had a new patient that the physician had sent up from his office, he wasn't even allowed to stop at admitting, dx: viral meningitis. He was 80 years old and I was told that his temp was 103 and that I was to immediately start an IV, order labs, give IV Phenergan, get VS, etc, etc..... At the same time I had another admit come up from the ER. I asked Sarah to get the vital signs on the first patient while I was starting the IV. She brought the dinemapp in the room and said "since you're in here you can get them" I said no Sarah get the VS, she said " do you want me to show you how to operate the equipment, is that the problem?" and she promptly left the room. I was not only furious but embarassed in front of the patients family. I told my assistant nurse manager and she didn't say much.
This is the 3rd such similar incident with this CNT in about 3 months time. I have spoken to her directly also with no results. Any suggestions? What I'm thinking about is asking for a confrontation in the nurse managers office.
I would like to tell her that I think she does a good job but do not appreciate her reluctance to do something that I ask her to do because I only ask when it's really needed. I would like to tell her that she needs a refresher on what her job description entails. Should I mention that I am her superior, well that's not the word I want to use but you know, I'm over her, in charge......?
I want to tell her that if she wants to give the orders that she should go to school and get her nursing license. Thanks for any advice you can offer. We both work tomorrow and I'll let you know how it goes. Thanks.
Just wondering. In a LTC facility, what would you consider an ideal CNA? Do you mind questions
Happy to help. You don't have to work LTC to know what a great CNA is.
Get the vitals first thing. (The nurses can't give certain meds without knowing what they are.) Report anything that's out of normal so the patient can be treated quickly. Had one patient who wanted to walk to the BR. She stood up and nearly collapsed. Her BP was 44/20 and she needed immediate treatment.
Keep patients from falling. Falls constitute huge threats to patient's lives in LTC. If you know a patient is confused and might fall, keep that patient where he/she can be eyeballed frequently, not hidden away in some room somewhere. Use alarms, use distraction, use floor beds, whatever it takes to keep that patient safe.
Keep the patients clean, dry and repositioned frequently. This includes reporting any areas of skin that you might note that are non-blanching red. If a patient has an immobile hand, don't let it dangle; put a pillow under it to keep it from swelling. Prevent skin-to-skin contact. Keep the heels "floated"--that is, put a pillow under the legs so that the heels dangle off the pillow and don't touch the mattress. Check the heels for reddening and report any problems. Check the skin folds at the groin, under the arms, under the breasts for reddening. If a patient wears O2, look at the ears where the tubing sits for redness or open areas.
Encourage food and fluid intake. Elderly folks do better with smaller portions more frequently throught the day, which is why snacks are important. Please tell the nurse if anyone seems to have any runny nose, cough, pocketing of food, or difficulty swallowing while you are watching/feeding them in the dining room. These are all signs that the patient could be aspirating. Be alert to the confused patients and know what their diets and liquid consistencies are. Does it seem like someone has a hard time with certain consistencies? Maybe they'd eat better with a puree diet, for instance. Stay alert when on dining room duty. You might save a life. One confused resident was left alone in the dining room after breakfast and managed to get hold of a breakfast sausage, which he tried to eat, couldn't, and choked to death on. That was so unnecessary! All that needed to be done was to make sure one person stayed in the dining room while the other patients were transported back to their rooms.
Keep the head of the bed up for all tube feeders, again so they don't aspirate. Aspiration pneumonia is avoidable. It's also not pretty to see. The patient's temp goes up to about 104 in a matter of hours. And yes, they can and do die from this. So please have the nurse turn the pump off for a couple of minutes before you change and reposition a tube feeder.
Report any unusual behavior of the patients. Often, increasing confusion can signal a UTI. Drooping on one side can signal a stroke. Lethargy and confusion can signal a dangerously low blood sugar. If a patient complains that they have chest pain or shortness of breath, get help fast. If you notice sudden swelling in someone's extremities, do the same. Both shortness of breath and/or swelling in the extremities can signal an emergent CHF.
A great CNA, in other words, is alert to prevent problems and actively anticipates the health care needs of patients and cooperates with the nursing staff to keep the patients in the best health they can achieve.
I am constantly amazed at the fact that I can work my butt off helping to care for the nurses' patients, but yet very few nurses care to help me. It doesn't matter what I'm doing, the nurse (one of seven on the floor) wants me NOW, regardless of where I am or what I am doing. Healthcare is a team effort folks, and respect is a two way street. If you find that your CNAs have attitude, perhaps you should examine your own before pointing a finger.
Well all I will say here is lets hear from you when you are a NURSE and have your OWN work to do, then you may look at this differently. I have worked with aides who will having me do all their work PLUS mine while they hide in rooms. I will not tolerate laziness and I wish more nurses would stand up to the challenge of supervision.
A good aide is worth her weight in gold and I am always respectful...when they do their job.
The OP's story is NOT about HER bad attitude (she clearly made a legitimate and proper request: "please get vitals") Her story is about an insubordinate CNA who refused to do her job and defied her in front of a patient.
Totally unacceptable.
Are there nurses who take advantage of good CNA's? Yes...there are bad apples in each barrel CNA's AND nurses...but I don't read ANYTHING wrong in the OP's behavior, and I don't think CNA's need to come here and point a finger undeserved.
At my job I have been told that if a CNA has a "bad attitude" towards the nurse that the nurse should send her home immediately. He said nurses don't have to put up with any bad attitudes from the CNA's at any time.
That would be a fair rule, as long as it applied to the other positions within the facility as well.
I am constantly amazed at the fact that I can work my butt off helping to care for the nurses' patients, but yet very few nurses care to help me. It doesn't matter what I'm doing, the nurse (one of seven on the floor) wants me NOW, regardless of where I am or what I am doing. Healthcare is a team effort folks, and respect is a two way street. If you find that your CNAs have attitude, perhaps you should examine your own before pointing a finger.
I've had a few jobs like this, and thanks to that treatment, i always HAVE examined my own.
Happy to help. You don't have to work LTC to know what a great CNA is.
Get the vitals first thing. (The nurses can't give certain meds without knowing what they are.) Report anything that's out of normal so the patient can be treated quickly. Had one patient who wanted to walk to the BR. She stood up and nearly collapsed. Her BP was 44/20 and she needed immediate treatment.
Keep patients from falling. Falls constitute huge threats to patient's lives in LTC. If you know a patient is confused and might fall, keep that patient where he/she can be eyeballed frequently, not hidden away in some room somewhere. Use alarms, use distraction, use floor beds, whatever it takes to keep that patient safe.
Keep the patients clean, dry and repositioned frequently. This includes reporting any areas of skin that you might note that are non-blanching red. If a patient has an immobile hand, don't let it dangle; put a pillow under it to keep it from swelling. Prevent skin-to-skin contact. Keep the heels "floated"--that is, put a pillow under the legs so that the heels dangle off the pillow and don't touch the mattress. Check the heels for reddening and report any problems. Check the skin folds at the groin, under the arms, under the breasts for reddening. If a patient wears O2, look at the ears where the tubing sits for redness or open areas.
Encourage food and fluid intake. Elderly folks do better with smaller portions more frequently throught the day, which is why snacks are important. Please tell the nurse if anyone seems to have any runny nose, cough, pocketing of food, or difficulty swallowing while you are watching/feeding them in the dining room. These are all signs that the patient could be aspirating. Be alert to the confused patients and know what their diets and liquid consistencies are. Does it seem like someone has a hard time with certain consistencies? Maybe they'd eat better with a puree diet, for instance. Stay alert when on dining room duty. You might save a life. One confused resident was left alone in the dining room after breakfast and managed to get hold of a breakfast sausage, which he tried to eat, couldn't, and choked to death on. That was so unnecessary! All that needed to be done was to make sure one person stayed in the dining room while the other patients were transported back to their rooms.
Keep the head of the bed up for all tube feeders, again so they don't aspirate. Aspiration pneumonia is avoidable. It's also not pretty to see. The patient's temp goes up to about 104 in a matter of hours. And yes, they can and do die from this. So please have the nurse turn the pump off for a couple of minutes before you change and reposition a tube feeder.
Report any unusual behavior of the patients. Often, increasing confusion can signal a UTI. Drooping on one side can signal a stroke. Lethargy and confusion can signal a dangerously low blood sugar. If a patient complains that they have chest pain or shortness of breath, get help fast. If you notice sudden swelling in someone's extremities, do the same. Both shortness of breath and/or swelling in the extremities can signal an emergent CHF.
A great CNA, in other words, is alert to prevent problems and actively anticipates the health care needs of patients and cooperates with the nursing staff to keep the patients in the best health they can achieve.
I'm sorry, but I do believe that you are asking too much of a CNA. Many of the things you described are non delegable nursing functions, specifically lots of assessment stuff. Yes, it is great if they can let nurses know about changes in a ptient's status, and certainly, vitals that are not within normal limits must be related to the nurse, but checking skinfolds? I mean, CNAs are busy too.
I would expect a CNA to let me know about SOB, chest pain, and other pain too, but this post really makes it seem CNAs are responsible for assessment of the patient.
Yes, Mattsmom! You go girl ! At the hospital I would never be allowed to tell a CNA to go home. Not even on the weekend when there's no nurse manager around. When I worked in a LTC I did have that authority. I have only used it once in 30 years. I walked into a patients room only to see and hear a loud smack across the patients face! I said "out now" and then I called the police. She was prosecuted. I don't know about other states but here in Tennessee the LTC don't have to hire CNA's they pull people off the street, teach them the routine and call them aides. I think that should be against the law. In parts of Europe the "aides/CNA's" who work in LTC have to go to school for a year to be qualified to work with the elderly. I think here it's all about money. The LTC wants to take in all that medicare/insurance/private money and doesn't want to pay out. It makes me scared to get older. :angryfire
I'm sorry, but I do believe that you are asking too much of a CNA. Many of the things you described are non delegable nursing functions, specifically lots of assessment stuff. Yes, it is great if they can let nurses know about changes in a ptient's status, and certainly, vitals that are not within normal limits must be related to the nurse, but checking skinfolds? I mean, CNAs are busy too.
I would expect a CNA to let me know about SOB, chest pain, and other pain too, but this post really makes it seem CNAs are responsible for assessment of the patient.
Maybe it's different for CNAs in your state, but in mine, they are responsible to report all of the things I outlined. Checking skin folds is something that would easily be done while bathing the patient, something that the usual staff nurse has delegated to the CNA to complete. So yes, to me it IS a CNA function to check skin and report any alteration.
I'd actually be a tad horrified to find out that any CNA had been washing someone up without looking at what they were washing, wouldn't you? Furthermore, if checking skin folds is only a nursing function, why are we passing meds and charting and not checking skin folds?
They are not responsible for the assessment, and I never meant to imply that. That's why I said they should report to the nurse. The nurse would then be responsible for the assessment and following through with any necessary interventions.
I'm sorry, but I do believe that you are asking too much of a CNA. Many of the things you described are non delegable nursing functions, specifically lots of assessment stuff.
I think OP is right on. She describes exactly what a good CNA does.
Get the vitals first thing:
This I know everyone agrees with.
Keep patients from falling:
Everyone on the floor is responsible for keeping the patients from falling. I keen eye and open ears is everyones responsibility nowhere is it said it is the CNA's only responsibility.
Keep the patients clean, dry and repositioned frequently:
If you give the patient a proper bath and skin care then you will see any areas of skin that need reported. Nurses rely on the CNA for this information.
Encourage food and fluid intake:
The nurses don't feed the patients so we count on the CNA to let us know if there is a swallowing problem or aspiration risk.
Report any unusual behavior of the patient:
Basic, basic.....I don't see anything that signals assessment here. Anything out of the ordinary should be reported to the nurse, we don't ask CNA's to do a further assessment, we don't ask CNA's to call the doctor, administer any meds or provide any skilled treatment. "Report" the unusual only. We do the rest.
It's obvious to me that you don't know what assessment actually means. It's more than just keeping your eyes and ears open. And that's all that we ask you to do as you go about taking care of the patient. We take care of the rest. That's what we get paid for.
I'm sorry, but I do believe that you are asking too much of a CNA. Many of the things you described are non delegable nursing functions, specifically lots of assessment stuff. Yes, it is great if they can let nurses know about changes in a ptient's status, and certainly, vitals that are not within normal limits must be related to the nurse, but checking skinfolds? I mean, CNAs are busy too.
I would expect a CNA to let me know about SOB, chest pain, and other pain too, but this post really makes it seem CNAs are responsible for assessment of the patient.
Well ... In LTC its a little different . Iam a hosptial person all the way but i've been working in a snif for extra money ( pays better then hosptials) and the cnas do all that and more . I work on a sub-aute floor with 30 pts 5 CNAS and if were lucky i LPN nad 1 rn . They don't do skin assestment . Then CNA'S wash these PT they see the skin more .
["basic, basic.....i don't see anything that signals assessment here. anything out of the ordinary should be reported to the nurse, we don't ask cna's to do a further assessment, we don't ask cna's to call the doctor, administer any meds or provide any skilled treatment. "report" the unusual only. we do the rest. "
:)
thank you all for your answers. i agree that what you are asking for is not assessment, but observations. when i worked ltc (as an aide) some of the nurses ridiculed me for reporting these type of concerns: i became a target. i was a real pia... but i kept reporting anyway.
is there a problem in the medical field with "bullies"? i mean both nurses and aides?
you could be a cna/tech for 20 years and still not completely understand the role of a nurse until you become a nurse yourself. nothing annoys me more than "since you are already in the room you can do it yourself" attitude. it was also inappropriate and unprofessional for sarah to say those things in front of the family. once her husband graduates and comes home complainig everyday she will get the picture. i was a tech a long time too and a good one i might add, but the responsibilty that i have as a nurse now leaves me with very little patience to deal with people like that. i too, only ask for help when i really need it which is sad because if i have to do everyone else's job, i can't take care of the patient the way they deserve. oh well, same ol' thing, different day. i guess it's the same every where
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UM Review RN, ASN, RN
1 Article; 5,163 Posts
Happy to help. You don't have to work LTC to know what a great CNA is.
Get the vitals first thing. (The nurses can't give certain meds without knowing what they are.) Report anything that's out of normal so the patient can be treated quickly. Had one patient who wanted to walk to the BR. She stood up and nearly collapsed. Her BP was 44/20 and she needed immediate treatment.
Keep patients from falling. Falls constitute huge threats to patient's lives in LTC. If you know a patient is confused and might fall, keep that patient where he/she can be eyeballed frequently, not hidden away in some room somewhere. Use alarms, use distraction, use floor beds, whatever it takes to keep that patient safe.
Keep the patients clean, dry and repositioned frequently. This includes reporting any areas of skin that you might note that are non-blanching red. If a patient has an immobile hand, don't let it dangle; put a pillow under it to keep it from swelling. Prevent skin-to-skin contact. Keep the heels "floated"--that is, put a pillow under the legs so that the heels dangle off the pillow and don't touch the mattress. Check the heels for reddening and report any problems. Check the skin folds at the groin, under the arms, under the breasts for reddening. If a patient wears O2, look at the ears where the tubing sits for redness or open areas.
Encourage food and fluid intake. Elderly folks do better with smaller portions more frequently throught the day, which is why snacks are important. Please tell the nurse if anyone seems to have any runny nose, cough, pocketing of food, or difficulty swallowing while you are watching/feeding them in the dining room. These are all signs that the patient could be aspirating. Be alert to the confused patients and know what their diets and liquid consistencies are. Does it seem like someone has a hard time with certain consistencies? Maybe they'd eat better with a puree diet, for instance. Stay alert when on dining room duty. You might save a life. One confused resident was left alone in the dining room after breakfast and managed to get hold of a breakfast sausage, which he tried to eat, couldn't, and choked to death on. That was so unnecessary! All that needed to be done was to make sure one person stayed in the dining room while the other patients were transported back to their rooms.
Keep the head of the bed up for all tube feeders, again so they don't aspirate. Aspiration pneumonia is avoidable. It's also not pretty to see. The patient's temp goes up to about 104 in a matter of hours. And yes, they can and do die from this. So please have the nurse turn the pump off for a couple of minutes before you change and reposition a tube feeder.
Report any unusual behavior of the patients. Often, increasing confusion can signal a UTI. Drooping on one side can signal a stroke. Lethargy and confusion can signal a dangerously low blood sugar. If a patient complains that they have chest pain or shortness of breath, get help fast. If you notice sudden swelling in someone's extremities, do the same. Both shortness of breath and/or swelling in the extremities can signal an emergent CHF.
A great CNA, in other words, is alert to prevent problems and actively anticipates the health care needs of patients and cooperates with the nursing staff to keep the patients in the best health they can achieve.