Why don't nurses listen to cna's

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I have been working at this place for awhile and I knew my pts, I was on the same hall every night. I had this one pt he was deaf and I knew some sign language and he told me that he has not been urinating for awhile I told the nurse,she does not do sign at all and she just goes in there and gives meds and I told her that he is trying to tell her that his bladder is hurting she says "ok" and goes about her night, the next day I come in and ask him if he has urinated yet he says no and he has not in three days, by this time his left side is very edematous. I told the nurse that I think his kindney's are failing she rolled her eyes and said ok and then I told her that I think she should have him sent out to the hospital he has not urinated in three days and she said "you are just an aide, when did you go to nursing school or med school". I told her I have been in the med field for several years and also I know my pts I see him every night and I see changes and he is telling me it hurts. Well anyway I was off the next day I was off and when I came back they said he died of kidney failure. I went strate to the charge nurse and told her what happened and the nurse would not listen to me. What could I have done? I begged her to send him out and the more I begged the more she would not listen to me. This was six yrs ago and I still feel horible about it. I am now getting ready to go to nursing school and I vow to myself that I will always listen to the cna's that I work with in the future.

Specializes in MED SURG.

I do understand how the nurse got offened by me telling her what to do. I didn't mean it in any way to offened her. I worked with is particular nurse for about a yr and a half and I know what kind of a nurse she was. We worked night shift together at a "deaf" facility and she did not know sign language and there was a comunication problems between her and the pt and the day nurse didn't know sign language eaither. The pt was not on dialysis and he was not a renal pt. He was asking me if they were going to help him and I told him all I could do was tell the nurse. When I came back after he died I talked to the charge nurse and she said it was not in the report and she did not know anything about it, the nurse did get written up because she didn't mention it to the Dr. or in the report. I didn't want to go to the charge nurse at first because I figured she would have done something and I figured it would have made things worse. I got spoken too also because I didn't go to the charge nurse to report what happened, I told them I reported it to the nurse several times and she should have taken it from there.

So no, I was not trying to do her job, I was just trying to save the resident.

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Specializes in LTC, SNF, PSYCH, MEDSURG, MR/DD.

i know how you feel, when i was a cna i had similar situation. my pt had not had a bm in days ( i had been on a different floor the past weeks), and my nurse wouldnt do anything.

"he likes it when we digitally remove the bm" was her excuse. i went to the charge and the supervisor. they said the same thing.

i was astounded. when i came back the next day and still got the same response, i took my break and called the ombudsman & the state inspectrs. the came the next day, but it was too late.

poor mr brown had started vomiting fecal matter & died during the night. he had been ten days without a bm.

so i always listen to my cna's. even if i already know what you are telling me or if i think its not important at that moment, i always listen.

good nurses listen.

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I do understand how the nurse got offened by me telling her what to do. I didn't mean it in any way to offened her. I worked with is particular nurse for about a yr and a half and I know what kind of a nurse she was. We worked night shift together at a "deaf" facility and she did not know sign language and there was a comunication problems between her and the pt and the day nurse didn't know sign language eaither. The pt was not on dialysis and he was not a renal pt. He was asking me if they were going to help him and I told him all I could do was tell the nurse. When I came back after he died I talked to the charge nurse and she said it was not in the report and she did not know anything about it, the nurse did get written up because she didn't mention it to the Dr. or in the report. I didn't want to go to the charge nurse at first because I figured she would have done something and I figured it would have made things worse. I got spoken too also because I didn't go to the charge nurse to report what happened, I told them I reported it to the nurse several times and she should have taken it from there.

So no, I was not trying to do her job, I was just trying to save the resident.

Most CNA's and you're one of them really are out there working because you love working with patients and you enjoy helping them. You acted out of kindness and I commend you for that. Your job was to help the patient. But again, you did nothing wrong, you reported your findings to the NOC nurse. Your job isn't to make sure that the nurse is doing your job, your job is to report to the nurse. What you can do is follow up with the patient, but don't say did your nurse do this or did your nurse do that etc etc. What you want to say is "hey how are you doing? Have you been able to urinate yet?" Then they will say yes or no, then from there you can report to your nurse "Oh so and so patient just stated that he hasn't been able to urinate yet. I just wanted to let you know" and leave it at that. You've done your job, this way you're vague and it forces the nurse to either 1. ask you some questions or 2. Go check it out. If the patient is able to and starts complaining about a certain nurse, then it is your job to report it to the higher ups. This part is really sticky because sometimes I don't know if I should just tell the nurse her/himself or should I go to the higher ups, it really does depend on the nurse.

Good luck in your studies, someday you will make a wonderful nurse! :up:

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i know how you feel, when i was a cna i had similar situation. my pt had not had a bm in days ( i had been on a different floor the past weeks), and my nurse wouldnt do anything.

"he likes it when we digitally remove the bm" was her excuse. i went to the charge and the supervisor. they said the same thing.

i was astounded. when i came back the next day and still got the same response, i took my break and called the ombudsman & the state inspectrs. the came the next day, but it was too late.

poor mr brown had started vomiting fecal matter & died during the night. he had been ten days without a bm.

so i always listen to my cna's. even if i already know what you are telling me or if i think its not important at that moment, i always listen.

good nurses listen.

I've noticed that a lot of nurses like to stay away from manually removing feces. I never questioned it because even some of the best nurses would stay away from that at all costs. When I was in nursing school I had a patient who I noticed hadn't had a BM in 4 days. I reported it to my clinical instructor, and she said "go tell the charge nurse and document your findings". For our clinical rotations we were required to chart on a notebook and turn it in at the end of the day to our instructor. Anyway, I too thought nobody was doing anything about it. My clinical instructor said that you don't really want to manually remove feces because (I can't remember that part of the anatomy for the life of me) you can cause a person to be incontinent by the bowels if it's done 1. Wrong or 2. You accidentally puncture the nerve (I wanna say vagus nerve) that stimulates the bowel (nurses please help me, I forgot) movement. I can see my instructor explanining it to me, but I can't explain in words. Now I'm going to have to do some research so I can explain it better. But there is a reason why nurses try to stay away from that as much as possible.

I've noticed too that there are some patients who wont deficate on purpose because they like for the nurses to manually remove them. Now the best way to handle that situation is to give them what they have ordered. MOM, Colace etc, whatever they may have. Then of course you have to check your patient to see how they're responding to the medication that you're given. Sometimes ambulating can help with fecal impaction. I've noticed that in a few patients, but it's more for bowel sounds. If you find that the stool is very soft, yes most likely you wont remove it manually. Just monitor it to see if it's making its way out. But when it's not moving or when the feces is hard, then you have to manually remove it. Of course you chart and document your findings. But you can't let someone suffer because they like for you to remove it manually. You have to remove it if everything else that you've tried doesn't seem to work.

I'm glad that you called the Ombudsmen and the state because something like that definately needs to be reported. Even though the patient likes for it to be removed manually we as nurses and nurses aides are not there to judge the person, we're there to do our job and to take care of the patient and treat them with dignity and respect!

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Thanks for sharing your story. As a new RN I vowed to always listen to and value any CNA I work with. You have a very challenging job, and I know because as a student, we have to do the CNA's job as well as the RN's job. There is a reason why as a student we don't get more than 3 patients and that is because there isn't enough time to do all the care that a CNA does AND what the RN does.

We have always been told to use the chain of command when a problem comes up. If the RN shrugged it off, you need to go to the supervisor, and if they didn't listen go to their supervisor and so on until someone listens. You should not have had to even tell this nurse in the first place that your patient didn't urinate for 3 days. That is one of the first questions that are supposed to be asked at the start of every shift when assessing a patient. ("Are you urinating okay", and "when did you last have a BM"?) sign language or not, these questions need to be asked! These kinds of stories make me angry and I will remember this for when I finally get a job. Thank you. I have to say that I have learned a lot from the CNA's as a student, and I will continue to do so as a RN. There is no harm in checking something out. If it turns out not to be a problem then big deal. Nobody lost anything and no harm came to the patient. It is always worth checking.

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You should not have had to even tell this nurse in the first place that your patient didn't urinate for 3 days. That is one of the first questions that are supposed to be asked at the start of every shift when assessing a patient. ("Are you urinating okay", and "when did you last have a BM"?) sign language or not, these questions need to be asked!

It all depends on the facility and your patient load. In the hospital, yes I hear the RN's asking their patients that all the time. But here in California, where we have patient to nurse ratios, they will ask those types of questions because they have to do their on shift assessment and they may have no more than 4 patients depending on the unit. If you're working the the LTC Facility, it's not going to happen when you have 25 patients or more to pass meds to. You don't do daily assessments on patients, rather you will do weekly summaries. Usually when the nurses are giving their meds, they will do a quick scan on the patient, but they're not going to do a full on assessment.

In the LTC Facilities you rely a lot on your CNA's to be your eyes & ears. So yes, sometimes you as the CNA are responsible for telling your nurse that your patient hasn't urinated in 3 days if that's what the patient told you. But at the sametime, it should have been reported earlier and that nurse should have received a report from the previous nurse that the patient hadn't urinated in 3 days. Why the patient waited 3 days to report it to someone is beyond me.

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Specializes in LTC.

well...im an LPN....worked as a cna for over 5 yrs..had similar problems also...but one post on here just caught my eye....the one where the worker got 1500 ml of dark urine from a spc? OMG...in 2 mins....no no no nono.........that will throw a person straight into SHOCK!!!!! if it comes out like that it needs to be clamped off and on to drain slower.....but anyway....did that pt live through all that? and as for the one who was deaf....if i had been that nurse i would have checked for bladder distention..all it woulda took is a quick call to the doc to get a catheter in...the doc i work for usually says put in a foley and if over 100 cc is out leave it in.......that may have fixed him for a while....he would have at least been relieved of his pain i would think. but...then again....one is not at work 24/7.....did you ever ask any other aides if this man had voided on their shift? and how do you know that this nurse didnt put the patient down for the md to look at? its possible that he had voided at some other point prior. was this a dialysis patient? there are alot of holes here ...thats why im trying to understand the deal fully. renal failure is not something that will kill someone in a day from my experience. this guy couldve been eat up with cancer or had a massive heart attack .....who knows. however....as a nurse i would have been so proud of you for even taking the time to pay attention like that to your patients and i would have heeded your word and looked into it further. good aides are hard to find. and once you go through nursing school....and get into the actual work field as a nurse you will see a whole other side of this area that you never knew existed. put on your seatbelt and get ready for a sometimes very bumpy ride.

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Specializes in CAMHS, acute psych,.
..one post on here just caught my eye....the one where the worker got 1500 ml of dark urine from a spc? OMG...in 2 mins.....did that pt live through all that?

Sorry - my fault - that was a typo. It should have said 20mins. I have corrected the post. Thanks for pointing that out Sasha2lady. In any case, 1500mls in 20mins is still a terrible thing. Yes the poor guy survived the experience - and felt great relief, afterwards.

Best wishes

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The advice that LatinaVNstudentRN2b gave was good - just report what you see to the nurse - don't offer any diagnosis etc. - that's what my CNA instructor is telling us (I'm in CNA class right now).

Don't know if anyone here has mentioned it yet, but one thing I plan on doing is documenting things like this. In a sort of personal diary type thing that I don't show anyone. I would document that on such and such shift at xxxx hrs, I was told by patient x that he/she hadn't urinated in three days and was in pain, and I immediately told the RN on duty. I might never need to mention it to anyone, but it's there and documented just in case.

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If you're going to keep a personal diary don't use the patients full name. Write down initials instead. Don't offer anything but what you see, becareful not to use words that imply things. "Patient X.Y. stated he hasn't urinated in 3 days. RN T.U. notified." and that's it. The reason why you want to use initials is that incase your notebook is lost and someone finds it and starts to read it. What if someone elses family member found it and started to read it, all that falls under HIPPA which you would be liable for it. When I was a CNA in LTC facility I always kept a journal like that, and I used initials instead of names, I would keep my vital signs in there to see their trend. If anything out of the oridinary happened, I'd write it in there but I was careful not to let my personal feelings take over. So you have a good idea about keeping that journal, just use initials when using it.

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Specializes in MED SURG.
A good point is brought up. It's never okay for an aide to diagnose. As an aide we can't only report signs/symptoms the resident is experiencing. I've had aides document that so and so has a UTI b/c they are urinating frequently, even though a urine dip wasn't done. Said aide just documented that. Appropriate charting would be that resident is urinating frequently. And all that should be reported to the nurse is that resident is urinating frequently. The nurses I know, most of them would suggest getting a hat and getting a sample. This same aide demands nurses send residents to the hospital and nothing makes a nurse more mad than an aide saying that. At least in the settings I work in. The nurse then brings out her claws, which may have happened.

I was not trying to diagnose the pt, last I checked neither can nurses. But I did end up being right when I told the nurse "he might be going into fenal failure" I was trying to help the pt. To answer some of your questions:

Was he a renal failure pt? NO

Was he on dialysis? No

Did he wait 3 days to tell anyone? No, He told me on the 3rd day, he tried to tell them when he was first starting to have pain but they blew him off.

Very few people knew sign language there, and I was one of he few that knew how. So many of them would just give meds and go. And the aide that was on the opposite shift did not know sign language eaither. He did tell me that when he first told them he wrote it down on paper.

They should have known something by the change in him. He used to be self care and was able to get up and down when he pleased, to not being able to get up at all and running fever. IT WAS NEVER DOCUMENTED!!!

No I was not telling her how to do her job, I was telling her to do her job!

we as people that take care of people in the health care field we have to remember that its not just a job we are all patient advocates and it is all of our resposibility to do what ever possible to save the life of pts that can be saved.

Ok, if I told the nursethat he had not urinated and she had done anything at all (do straight cath, check on him, call Dr. etc.) I wouldn't be so ******. all she did was tell me "your just an aid what do you know" what I did know is the was a man in pain, no one listening to him, half of his body has edema with fluid leaking from him, his testicals were extremly swollen. No I am not a Dr. but as an aide I do know that something is not right. She just walked away and let him die.

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If you're going to keep a personal diary don't use the patients full name. Write down initials instead. Don't offer anything but what you see, becareful not to use words that imply things. "Patient X.Y. stated he hasn't urinated in 3 days. RN T.U. notified." and that's it. The reason why you want to use initials is that incase your notebook is lost and someone finds it and starts to read it. What if someone elses family member found it and started to read it, all that falls under HIPPA which you would be liable for it. When I was a CNA in LTC facility I always kept a journal like that, and I used initials instead of names, I would keep my vital signs in there to see their trend. If anything out of the oridinary happened, I'd write it in there but I was careful not to let my personal feelings take over. So you have a good idea about keeping that journal, just use initials when using it.

Thanks for the advice - I will remember this.... :-)

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