When is it OK to delegate to a CNA?

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i'm a new rn, off orientation for 2 weeks now. one night i had a pt that i had just given morphine and protonix, when a few minutes later she had an adverse reaction. she had an "excrutiating" epigastric pain and nausea. she jumped off the bed and was pacing, running back and forth in her room, doubled over in pain. i spoke with the doctor who ordered zofran, and to monitor her for a few minutes. i had another pt that was aaox3, used a bsc was ambulatory, but a fall risk due to weakness and her meds. she called, so i went in there, and all she wanted was to sit on the chair. she had previously tried to get oob by herself when no one came to assist her in time. so i figured this is something simple i can do, then run back and check on the other pt, since she was beginning to feel better. as soon as i sat her on the chair, she decided that she needed to use the bsc. she was old and slow, and i really wanted to go check on the other pt. i poked my head out of the room, only to see the cna assigned to her with her head on the desk and her eyes closed, earphones in, and attached to her cell phone (she listens to music and sleeps). so i ask her to please assist ms so and so to the bsc because i need to go check on another pt. i then hear her mutter under her breath to a nurse sitting next to her, " why can't she do it? she's already in the room." i was livid! i assist my patients with toileting needs all the time, even when the cna's are available, and i have a ton of other things that are time sensitive and need to be done. i would have thought that the fact that this time i asked, would indicate to her that i really needed help. it's not like i could delegate assessment to her! does anyone else have cna's that act this way? was i wrong for delegating this task to her? the nursing judgement that i am developing more and more of each day tell me that i did the right thing.

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Yup i think you did you needed to go to the unstable pt and the transfer could be delgated.

however co workers like cna often will challenge you if they feel they are being overworked.

Cna often feel they run the unit and rn do nothing as i have gathered from reading a uk discussion. i laugh at this give me less pt and i do any task involved.

i personally would prefer all rn staffing if i had 4 pt.

]Always go with your gut but keep your pt safe.

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Specializes in Neurosurgical, Orthopedic, Wound Care.

You absolutely did the right thing.

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Specializes in LTC.

How can she complain if she's sleeping? That's ridiculous. I can see getting momentarily annoyed about the "already in the room" thing if she was also busy and didn't know about the other patient, but geez, she was doing nothing!

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Specializes in Med-Surg, School Nurse.

You did nothing wrong. I would at some point, either as you ask her or shortly after she has done the task explain to her (very briefly) why you needed her to tend to patient X while you would tend to patient Y. I've worked as an aide, and it always seemed like if there was BM, or another mess involved, the nurse asked me to tend to it.

Is it the norm for employees to listed to music via headphones? Seems very unprofessional to me. Same thing goes for any sort of non-breaktime cell phone usage.

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Wow! I am a CNA/Nursing Student in the progressive care unit. 1. I can't imagine having the opportunity to sit and listen to music... I'm lucky if I can sit and get my charting done; 2. You were asking for help so that you could attend to another patient. I see no problem at all in your asking for help.

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to top it off, i was so busy that night that i ended up working for 14 hrs, and didn't get to stop for lunch. i had 3 pt's that kept getting critical labs called in. i have noticed that this particular cna is often rude to nurses...once, i walked into the breakroom where she was the only one present and informed her that one patient was q6 hr, instead of achs blood sugars. she did not acknowledge me. so i said, "ok?" she didn't even bat an eyelid. so i informed the charge nurse. come blood sugar time, the charge nurse asks her for this pt's fsbs and she states that she was not aware that he was q6. i was glad i had informed the charge, who was also my preceptor of what had transpired. i'm learning real quick to develop tough skin and not to be too nice to people, especially those that will mistake my kindness for weakness.

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I am not sure where you are, but where I am hospital HR depts are always sitting on a stack of CNA apps.

Time to fire that one and hire a new one.

I have zero tolerance for stuff like that.

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does anyone else have cna's that act this way?

yes, b/c good cna's are hard to find and keep, due to the crap pay and work.

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Specializes in LTC, Home Health, Hospice.
yup i think you did you needed to go to the unstable pt and the transfer could be delgated.

however co workers like cna often will challenge you if they feel they are being overworked.

cna often feel they run the unit and rn do nothing as i have gathered from reading a uk discussion. i laugh at this give me less pt and i do any task involved.

i personally would prefer all rn staffing if i had 4 pt.

]always go with your gut but keep your pt safe.

as a cna/chha i have found that some rn's are wonderful to work with and appreciate the help that i give, on the other hand i have worked with rn's who do absolutely nothing regarding a patients needs..i have had an rn come out of a room come pull me away from taking care of another resident to give the one she just left a drink of water...what??? are you kidding me..you can't give them water..it took you 10 minutes to find me and pull me away from another patient to give someone you were just with a drink of water??.....we as cna's get really p..... off when this kind of stuff happens, plus i've also gone to the rn's to report a coc (a change in respiratory rate)..and they have told me to write it down and they will get to it when they have time...and the list goes on and on...sometimes in fact when there is a lazy rn..we do..sorry. just the facts thats all. i've had some really good ones, but also some really bad ones.

if you want us to take responsibility, then you should do as well.

sorry, but i've been burned by several rn's, this is just the tip on the ice berg..believe me..there is plenty plenty more.....

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Specializes in Utilization Management.

You can delegate to CNAs what is in their scope of practice and job description (which, obviously, assisting with ADLs is going to be in both). So, you should become familiar with CNA scopes of practice in your state and CNA job descriptions at your facility. That way you have something to back you up if they are unwilling to help and you won't risk delegating something inappropriate.

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You did the right thing. She is an assistant to the nurse and if you need assistance, that's what she is there for. From what you said everything went fine. Even though she felt a certain way, she did what you told her to. Where I work I have seen CNA's tell the nurses flat out "no, I'm not gonna do that". I am a CNA but I used to be a supervisor and people are not always going to like what you tell them and they will feel a certain way sometimes, but you can't take it personal. Just always be respectful and not overbearing and you will be fine.

Don't get yourself "LIVID" just because a person doesn't agree with you. Mixing emotion with the job as a supervisor is bad business. Don't feel hesitant to delegate, and don't do something that a CNA can do just because you don't want to ask. I assure you CNA's respect hard*** but respectful nurses, rather than soft, nice ones. Good luck to you.:redbeathe

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