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.
I think this is confusing because the OP is talking about two entirely different settings.
CNA's in LTC who do not have any specialized training aside from their CNA cert and whose job description is almost entirely ADL work. The CNA here does ADL work because that's what is needed of them. They can't pass meds or chart. In this setting the nurses are usually consumed with med administration and charting. CNA will lock out on time, nurses are staying late to chart. No one has it easy working in LTC, it's an incredibly difficult job where everyone is overworked and understaffed.
Then she is talking about PCT's in the ED who are highly specialized and receive advanced training to be able to do more skills and tasks than required of a CNA. They may appear to practice more independently here, because they are following standard protocols that allow them to. OP has also said many of these PCT's already are licensed nurses (LVN's) and other professionals (paramedics) and people who hold other certifications (EMT's).
The problem is that you can't compare these two because they are entirely different.
OP has also stated her daughter is a 17 year old CNA who is treated badly. I think as a mother it would be really difficult to be unbiased about that.
Her original topic was about LTC but it has really branched off... Now we are discussing various settings and qualifications/expectations of PCT's...
Okay, I agree with your perspective. I have delegated in this manor in LTC. Which is something I am not use.to. I am an ER nurse. Nothing is planned out. We ALL FALL into place, without a word being said.
Now as far as the EKG thing. I will give an example. Some techs to exactly by policy. Everyone over 16 with chest pains, everyone over 30 with pain from waist up. Anyone with numbness, tingling etc..EKG. A senior tech will recognize a patient as a frequent flyer, with non controlled panic disorder, same symptoms as a MI or TIA. Hospital policy would say EKG. She uses her judgement and decides her time is better spent elsewhere.
This was all just food for thought. Carry on as you please. I am done.
Much calmer post. Thank you. But here's the thing. That senior tech who decides that he or she will disregard hospital policy because they think they know better will be burned at the stake when the frequent flyer comes in actually having an MI and the EKG wasn't done.
As far as delegating in the ED when I was working in one we delegated all the time. That's how we kept the patients moving. It was never an issue. When I ran a codes I delegated/instructed through the entire thing. Sometimes I didn't say please. Nobody cared. We all had the same goal...providing the best care we could to the patient.
Yes it's pissing me off that everyone is telling ME what happens at MY ER.
Last story. I had a nurse tell me a story, which happens to her friend. Her friend is a nurse, she pissed off an aide. The aide was a vindictive bihh. She took some of her personal xanax, placed it in the jacket (which was on the back of her chair) of said nurse. The aide then went to the ADON, told her she seen the Nurse pocket a parients Xanax. Guess who got this nurse out of possibly losing her license? Another CNA.
Is it just a coincidence that in the thread "My tech" "My CNA" someone using the name amandaconfused1 posted a similar threat, asserted that techs do triage, read EKGs, that delegate means an elected official and that nurses can not write up a tech, only a manager can and oh yes, nurses are on "power trips" but choke on "monkey skills" in a code?
Both you and and Amanda are looking for CNA employment opportunities in Jacksonvlle FL. Just soul sisters or a coincidence? I think not.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Read what I have written. I AM AN ER NURSE. My daughter is 17 and works PRN as an aide. SHE IS TREATED LIKE CRAP! I started working at an LTC facility as an experiment. My experiment is over, they are getting my notice next week.
The techs in my hospital are , CNAs, EMT, Corpsman, LPN and paramedics. They ALL hold the same title.
YES EVERY SINGLE NURSE AND SOME P.As And DRs will call them technical nurses. It is an inside term. *** is so hard to understand. I am so glad NONE of my co-workers are such defensive babies. Wow!
No need to get so testy, or so strident. Calm down. Step away from the keyboard.
Is it just a coincidence that in the thread "My tech" "My CNA" someone using the name amandaconfused1 posted a similar threat, asserted that techs do triage, read EKGs, that delegate means an elected official and that nurses can not write up a tech, only a manager can and oh yes, nurses are on "power trips" but choke on "monkey skills" in a code?
Both you and and Amanda are looking for CNA employment opportunities in Jacksonvlle FL. Just soul sisters or a coincidence? I think not.
Once again, your screen name is, at least partially, quite appropriate.
Wow, I just re-read that thread, and the posters are eerily similar. Both work with corpsman and LPN's in the ED. Neither understand the definition of delegate. Both make threats about PCT's setting up nurses. Both talk about chain of command and CNA titles. Both talk about ED and LTC as areas that they have worked in. They also each offered to have users message them and they would reply with where they work to prove themselves.
When I started in nursing we had team nursing it was wonderful, LPN/CNA for 15 patients and an RN in charge. worked great. If a CNA is busy doing something and they are told to do something that can be just as easily done by the person telling them or asking them to do it, that person should just do it. One thing that has always irked me is to see an RN come out of a patients room and go in search of an aid to get the patient on a bedpan or a glass of water or whatever, instead of doing it themselves, is egregious. Unless they are headed for an emergent issue. I think those who become authoritarian tend to have insecurities they are trying to compensate for to make themselves feel better, and all this is the root of lateral violence. Every member is important from maintenance, dietary to administration. Everyone has a roll that is needed in order to provide the patients/residents with quality, safe care, which is reciprocated by patient satisfaction.
Not one person said that the CNA's work under your license. In fact, those of us who mentioned it at all were pretty clear that nobody works under our license. Not sure why you aren't getting that. But, regardless, we are ultimately responsible for those patients assigned to us and that includes the care rendered by the CNA's.
Your techs in the "front" are not using their "judgement" to get EKG's. They have been trained that if a patient complains of A, B or C then they are to get one. This is called a protocol.
Your distaste for delegation leads me to believe you don't really understand what it is. As the RN you are supposed to have the big picture when it comes to your patients as a whole. At any given time you should be able to prioritize their needs based on your education and training as a nurse. This education and training goes way beyond what a CNA or even one of your techs has. So if you your CNA is getting started on vitals but you know Mr. Brown's blood sugar has been all over the place you use your skills to prioritize and ask the CNA to get a FSBG first before doing her vitals rounds because you know clinically it's more important. That is delegation and team playing because you are including the CNA in the plan of care and trusting her to do an important task while you attend to other things. In this case delegation is appropriate and positive.
Now if your CNA is playing Candy Crush Saga on her phone and you have to tell her to do her job that's an entirely different story. This is not delegation this is babysitting and you would be right to decline her as a teammate.
I have read many different posts that Rn/LPN's are not responsible for who they delegate too. Be very clear as to what your state board specifies. In Arizona it is very clear that the RN/LPN is responsible for who they delegate too and that they delegate within the scope of practice. I do know there are some states that do not specify this in the rules, but some states do. So just be sure you know your states rules and regs.
I have read many different posts that Rn/LPN's are not responsible for who they delegate too. Be very clear as to what your state board specifies. In Arizona it is very clear that the RN/LPN is responsible for who they delegate too and that they delegate within the scope of practice. I do know there are some states that do not specify this in the rules, but some states do. So just be sure you know your states rules and regs.
Apparently you didn't see my earlier post on the legalities of delegation in my state. However, this is good information for others who may not have even considered that there are laws that dictate delegation in most states.
Karou
700 Posts
I think this is confusing because the OP is talking about two entirely different settings.
CNA's in LTC who do not have any specialized training aside from their CNA cert and whose job description is almost entirely ADL work. The CNA here does ADL work because that's what is needed of them. They can't pass meds or chart. In this setting the nurses are usually consumed with med administration and charting. CNA will lock out on time, nurses are staying late to chart. No one has it easy working in LTC, it's an incredibly difficult job where everyone is overworked and understaffed.
Then she is talking about PCT's in the ED who are highly specialized and receive advanced training to be able to do more skills and tasks than required of a CNA. They may appear to practice more independently here, because they are following standard protocols that allow them to. OP has also said many of these PCT's already are licensed nurses (LVN's) and other professionals (paramedics) and people who hold other certifications (EMT's).
The problem is that you can't compare these two because they are entirely different.
OP has also stated her daughter is a 17 year old CNA who is treated badly. I think as a mother it would be really difficult to be unbiased about that.
Her original topic was about LTC but it has really branched off... Now we are discussing various settings and qualifications/expectations of PCT's...