So I started as a CNA and worked my way up, minus LPN. I now find myself with a BSN and a blur of my days as an aide.
I recall feeling underappreciated and lower than dirt. I remember being "told" to complete tasks and not asked.
Once I became an RN, I left LTC and thought I would never look back. I am an ER nurse. As a social experiment, I decided to work PRN in a LTC facility.
Let me just say WOW! Nurses are constantly jumping down the aides throats, for EVERYTHING! Please do no say "CNAs are lazy,.worthless, uneducated and conferntational". Please do.not say that these things are not said behing the CNAs back. They are! You smile in their face and talk about their incompetence, when their backs are turned.
The techs in the ER are not micromanaged, they are trusted to complete tasks. They do EKGs, blood draws, insert IVs,.splint as well as straight cath. I have watched the techs execute CPR and save lives! Our team work is outstanding. They are part of the medical staff. Although they cannot present themselves as nurses to the patients we all refer to them as "technical nurses"
We do not have the ability to write them up, we do not have the ability to reprimand in ANY way. That is up to the ANM and NM ONLY. We educate them if they need help understanding certain tasks. In the same respect I have been educated by them as well.
They do not just do slave work,.they do valuable work and they do it proficantly. They are respected as knowledgeable co workers, not monkey workers.
I have worked in other parts of the hospital and every other type of nursing field. LTC seems to be the only place I see that. I want opinions on why this is. Also, if CNAs were called PCTs (not nursing assistance, essentially nurses B****) as well as allowing them on the job training, to have a little more responsibility, that "real" nurses see as more than just crap work (pun intended). Lastly, not allowing every LPN, RN to write them up. Do you believe.this would make for an easier, more respectful (between every title) atmosphere.
But there is ALWAYS an option. They are able to say no
What if they are in the middle of ambulating an unsteady patient, and you say Ms. Jones needs, such and such now. The aide cannot say no? Also,if they aren't doing anything, they have the option, still, to say no. It might cost their job,but it is an option.
In my mind, and please do not get defensive, you aren't anyone's superior unless you are in a managerial position.
Always say no? I can't always say no, how can they? Sometimes we can say no. Sometimes we should (like in your example). But if you are ever asked or told to do something within your job description, and it's safe, there is no reason to refuse it and say no. That's nurses, PCTs, pizza delivery drivers, anyone. In healthcare we are a team and if you refuse to do something without good reason then you are a poor employee and need a serious discussion with your manager.
I mean... I can say no to paying my bills, going to work, or filing taxes but that has major consequences.
This is exactly what I am saying. If we have competent employees, delegation is not needed. I do not check to make sure the techs do their job correctly. I am not required. I also do not feel the need to. They are competent and if I felt they weren't, I would take my concern up the chain of command because they would need to seek employment elsewhere. I need all staff to save lives! Not f**k up!
Most nurse practice acts say you are required to follow up and check tasks that you have delegated to a CNA. Is there anywhere that this isn't a standard and requirement? I mean, the responsibilities of delegating are literally taught in nursing school...
Big yawn. There seems to be one post every day or two by someone with an overwhelming sense of entitlement and inflated ego who can not accept that CNAs and PCTs work under the delegation and supervision of the Registered Nurse. Most of these people can not spell "delegate" and come here to trash Registered Nurses who are simply asking them to do the job they were hired to do. It is too bad that we can't report posts that are rude mean and dumb.
This is regulated by your State's Nurse Practice Act. It is the law. It spells out the scope of an RN license to practice and the scope of an unlicensed certified nursing assistant and they are definitely not equal. Techs in hospitals do not work under their own credentials in nursing care areas; that is absurd.
These are not difficult concepts. Please refer to Boards of Nursing Forum if you need clarification.
An ER team of physicians, PAs, NPs, RNs and techs, who are usually ex military medics and corpsman who understand chain of command, is not remotely similar to a LTC facility and a lone LPN or RN responsible for 20 to 40 residents, the CNA staff and the staff's behavior as well.
I had the same experience in LTC. My only answer is that those nurses who delegate out of convenience truly ARE on a power trip. I think sometimes they feel "less than" for whatever reason and sometimes they're just jerks who truly don't think they should have to do "CNA work". Many absolutely DO feel that CNAs aren't smart or worth much, probably because they never did the job themselves. ALL nurses should have to work at least a few weeks as a CNA just to get an idea of how incredibly exhausting and demanding it is. (Yes, I KNOW nursing is also exhausting and demanding, but the pay is higher and it's not as hard on the body).
Now, it obviously also happens that CNAs can be lazy and disrespectful and certainly lots of nurses do their best, but the ones who don't surely make it unforgettable.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I can tell you are really passionate about this topic. I started out as a CNA in LTC, worked at the same facility later as an LVN, and now work in a hospital as an RN.
How many LTC/NH facilities have you worked in? I ask because I have only worked at one (for four years) and I never saw that kind of attitude towards CNA's. When I was a CNA, I was always treated with respect by the nurses (LVN's, our only RN's were the DON and ADON). We worked together as a team because we had to in order to survive in that environment. LVN's did delete to me, which was always appropriate. I wasn't always asked to do things, sometimes I was told, and that was okay with me because it was always fair and something important that I was being told to do. In LTC, the LVN's literally were next up in chain of command from the CNA's. That's because the LVN was responsible for anything the CNA did, including tasks that they delegated.
As a CNA in LTC, our facility would not allow us to take vital signs, check blood glucose, do catheters, or pass medications. Other facilities may train CNA's to do that though. In all honesty the CNA's would have never had time to do any of those tasks anyway because they had 2 CNA's to 30 residents. LVN's spent the entire shift passing meds to 45 residents and staying late 1-3 hours charting.
I was proud to be a CNA, I liked that title. I think PCT would be confusing in LTC. You have residents, not patients. So RCT? I don't know. I wonder how other CNA's feel about that title? I liked that I was "certified" because it's self explanatory that since I was certified, I had training and passed a certification to be qualified. Anyone can be a PCT in the hospital (don't need CNA cert) and I really think CNA's should be proud that they are certified.
On a side note, ED is fantastic and their PCT's receive a lot of extra training to be able to do more tasks. I work on a med surg floor and they don't even allow PCT's to insert catheters or do IV's/phlebotomy.
Edited to add that everywhere I have worked CNA's/PCT's and nurses can all write each other up. Although it's not exactly a write up, it's an incident report type of thing. Anyone can e-mail our manager with a complaint either.
In my state, "Patient Care Tech" or "Clinical Technician" is a protected title and requires a year of classes AND a CNA license. I'm not sure what type of education CNAs get -- we don't have any in our ICU. I'm responsible for their evaluations, so I see the feedback that our nurses provide on each tech. I have to say that some techs are awesome: work hard, know their stuff and have a good attitude. Others are lazy, hide from the nursing staff, profess not to know anything about anything so they don't have to DO anything and have a lousy attitude. Their evaluations reflect their feedback.
As far as delegation -- some nurses do it well and others not so much. The clin techs have the right and means to give feedback on THAT, and that is reflected in the evaluations the nurses are given from their evaluator. Unfortunately, the peer review process is anonymous, and I don't think that gives us the best outcomes. It is my belief that if you're going to give feedback on someone which affects their evaluation and thus their raises, you ought to be held accountable for it. I cannot call the process unfair, however. The peer review on both clin techs and RNs is anonymous, the peer reviews provided by both clin techs and RNs is anonymous and everyone is given information on the process when they go through orientation. So it's applied equally to everyone and you know about it in advance.
In my state, "Patient Care Tech" or "Clinical Technician" is a protected title and requires a year of classes AND a CNA license. I'm not sure what type of education CNAs get -- we don't have any in our ICU.
I didn't know that it was a protected title in some states. I have only ever lived in Texas. I did a quick Google search to see the different requirements for PCT positions and was really surprised at how different it varies from state to state.
I know my hospital/unit has hired a couple of people as PCT's with no health care background who get on the job training. They usually want someone who has a CNA cert and experience as a PCT though. The uncertified PCT's were hired by networking and having good connections.
I think a better question is why some CNAs think the RNs are delegating with a power trip.
I worked as a CNA for a year while I was in school, and no one ever delegated with a power trip to me. Mostly because I was on top of my job. Half of the time, the things they were asking me to do I was already on my way to do or I had just done, but not charted yet.
Funnily enough, some of my coworker CNAs talked about the RNs acting just like you're talking about; that the RNs were on a power trip, that they were "out to get" all the techs, etc.
I figured out pretty quickly that if I did my job and was helpful, no one talked down to me because they were grateful I was there. On the other hand, some of my coworkers who took two lunches and hid in the break room with their cell phones got mad about being talked down to.
So, this is just my personal experience, but the techs who were "talked down to" deserved to be taken down a peg because they weren't doing their jobs. If I could work with exactly the same people and never have a problem with a single nurse, it's not that the nurses are being rude. It's that the nurses have to ride the techs to get the tech tasks done because otherwise the tasks don't get done.
ER and LTC are two totally different worlds. I have seen quite a few threads lately describing tasks a CNA performs that in my experience are WAY outside a CNA scope of practice. Obviously what a CNA can and cannot do must vary wildly by both state and facility rules. But then I also see CNA and PCT used almost interchangeably as titles and from what I've been reading they are not even close to the same. But then I am basing this on what I know a CNA is able to do.
I work in LTC and I will admit we do have a nurse or two that is a little more bossy than they probably need to be with the CNA's but that being said where I work the CNA scope of practice is so limited that the things that they can do, they really need to do or the nurses would never get our jobs done.
Karou
700 Posts
Always say no? I can't always say no, how can they? Sometimes we can say no. Sometimes we should (like in your example). But if you are ever asked or told to do something within your job description, and it's safe, there is no reason to refuse it and say no. That's nurses, PCTs, pizza delivery drivers, anyone. In healthcare we are a team and if you refuse to do something without good reason then you are a poor employee and need a serious discussion with your manager.
I mean... I can say no to paying my bills, going to work, or filing taxes but that has major consequences.