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Discussion

Work as CNA through nursing school?

First, I'm not sure this belongs here or one of the nursing student forums; but it relates to professionalism rather than issues like should you try to work and go to school or will being a CNA help later in your nursing career (except so far as weighing the value vs risk.)

I'm starting an ADN program in August. For 3 months I've been working as an MHA (psych tech) in a 230 bed state psych hospital and some PRN as a CNA in a LTC. I love the work at the psychiatric hospital (I float and have worked on every unit except high risk females) but both jobs kind of scare me because it seems that CNAs are considered very dispensable - any hint of a problem and facilities will fire first and often report to BON. I've heard of people being cleared by investigation and still fired because it's easier than defending a lawsuit. The medical staff gives a pt some privilege they abuse and the MHA (CNA) watching them gets terminated.

i know nurses put their licenses at risk and can lose it all for a single mistake, but seems to happen less often. Probably both because you're better trained and harder to replace.

This was triggered because I was involved earlier in an intervention with a pt who was threatening injury to staff. I used a hold that I was immediately told by several other staff wasn't allowed. I released immediately. I will review my CPI manual when I get home but don't think it was in the CPI training. An "illegal" hold is considered abuse which is automatic termination and report to BON. I'd hate to have my nursing career off the rails before it starts over a lapse where I wasn't even properly trained.

My first thought is just do my job right, and don't want to be worried to the point of interfering with that. Am I right to be concerned, or am I making too much of this?

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    No calls from risk management. Thinking maybe what happened wasn't that terrible. Wasn't like I put them in a choke hold or joint hold. Still reviewing CBI and policy, might consult with one of the nurses who has a lot of experience in handling aggressive patients for tips on doing it safely for pt and staff

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    I doubt there is any policy that says you MUST engage in physical restraint of a physically violent patient. As such, you are better to be hands off and leave the patient in the room if necessary until the appropriate people arrive. If the patient is actively battering a worker or other patient, I think there is a lot more room to intervene if you are protecting the staff, other patients. But if it's just threats, Call security and leave the patient alone, try verbal deescalation of the situation. I have had to physically restrain patients before when I was a medic, but that is because they were physically attacking the Dr, or me/ partner etc. I have see a patient grab a scalpel and start stabbing herself in the ER. Wait for security and treat her injuries after she is not a danger to staff. (this resulted in a new policy at that hosp that all sharps were removed from all patient rooms when a staff member was no in the room). The bottom line is in the USA, everyone is so sue happy, common sense interventions often do not apply. CYA first then Staff safety, then patient safety. If the patient suffers injury then its on the facility for not providing the proper protections or the Dr for not ordering restraints, chemical sedation etc. If you don't intervene, or you remove yourself from a violent or potentially dangerous situation, all you have to say is you were in immediate fear for your safety or that of other staff. Seems to work in all these police shootings anyway.

    I would look at your policies from the perspective of what you MUST DO, not what you CANNOT DO.

    Remember the courts use " what would another similarly trained person in the same situation do?" view of your actions. So you may me a body builder, but the court will ask, what would the 95lb, 65 year old CNA/tech done in that situation? would they have tried to restrain the patient or would they have called security etc.

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