Workload split between RNs/CNAs

DusktilDawn · Jul 30, 2005

As an RN you are responsible for the care your patients receive and as such you will be held accountable both professionally and legally.

Even if you have the hardest working CNAs working with you, they cannot be every place at every time. There will be times that you will have to place a patient on a bedpan, provide them water, or empty a urinal, etc. In other words, you cannot avoid the "menial" tasks. As an RN you will be responsible for delegating tasks to CNAs or LPNs appropriately.

There are threads concerning RNs working with "difficult" CNAs and there are just as many threads concerning CNAs working with "difficult" RNs. People are just venting their frustrations.

Marie_LPN, RN, LPN, RN · Jul 30, 2005

I thought this kind of stuff would be reserved for the CNAs and/or LPNs, and that the RN had more of a supervisor role (This is not to say the RN does not also directly care for patients though)

Depends on who's available at the time to do something. As it's already been said, you can't avoid the menial tasks.

wa-rn · Jul 30, 2005

Well, that is a myth that nursing students & some RN's still believe in.

As a nurse, I still do nurse aide work, from getting VS to changing an incontinent pt. Our job is to make the pt comfortable be it with a pill or repositioning. Sometimes, I have to play both roles in the same shift because there is no CNA...when a pt asks for bedpan, a good nurse does not leave the room and look for an NA, he/she puts bedpan under pt & tells NA to follow up on it.

It is a misconception that RN's do not have to do aide work; we learn aide work too...

Marie_LPN, RN, LPN, RN · Jul 30, 2005

Any nurse that thinks they will not have to do "aide work", will make enemies REALLY fast.

DusktilDawn · Jul 30, 2005

Speak those 5 words as a nursing student within ear shot of CNAs and be assurred that they not be impressed. Remarks like that on a unit creates hostility.

Alpha 13, if as a nursing student you observe another student saying "Isn't that the aide's job", continue to observe how little help the CNAs will provide to that student.

happygirl202 · Jul 30, 2005

I am a senior nursing student that is working as a CNA per diem on the evening and night shifts. Some nurses go above and beyond and pitch in with the "menial" tasks, however, think about, if you're a patient in that bed, the initials after your name truly nothing, unless you receive the best care; whether it is from a CNA or RN.

Being a CNA has been a "wake-up call," and as stated above, although I work with some great nurses and CNAs, I hope I do not forget about these issues when I am an RN.

DLRN · Jul 30, 2005

Hey guys, I have yet to start nursing school for my RN, so I apologize for my newbie question. Just browsing the board it seems RNs are doing a lot of the menial tasks like cleaning up after the patients. I thought this kind of stuff would be reserved for the CNAs and/or LPNs, and that the RN had more of a supervisor role (This is not to say the RN does not also directly care for patients though) Am I wrong in my thinking that there is some hierarchy in the nursing positions? Am I just going to be a better paid CNA? I hope someone can clear this up for me.
Thanks

As A GREAT nurse not just a good nurse,you should be there for the whole patient,from just listening to changing beds to just getting your pt some ice water,its you.I remember in nursing school I recieved clinical recognition because I had a 2 day post c-section who had to go to the bathroom really bad and the pt before her had urinated just a little on the seat,I tried to find housekkeeping but couldn't,so I obtaines some cleaner,donned my gloves,and cleaned the seat myself so she could go.If not the end result may have been a urinary tract infection,it could surely have hurt her,but cleaning the bowl didnt hurt me. The funny thing was that I had no idea the pt had told my nursing instructor what I had done,which I thought was pretty nice.But Always remember that and you will be a great nurse not just a good one!Thats what my instructor had told me,and now being an RN I think of it often.

Tweety, BSN, RN · Jul 30, 2005

It depends on the unit. Many units have the nurse as the primary nurse, providing the majority of the work and patient care.

Other units like mine have a high RN to nurse ratio and a lower CNA to patient ratio. I work with a CNA all to myself, but I have 7 patients. I count on the CNA to do all the baths, toileting, getting them out of bed, feeding, accu checks, while I assess medicate, chart, teach, discharge/admit, do dressing changes, etc. But we work as a team, if a patient calls for toileting and I'm available, or the CNA is busy, I take care of the patient. If the patient is heavy, we do the care together. If I assess a patient and get them out of bed, I'll make the bed real quick.

The first thing you learn in RN school is the CNA stuff, but you go beyond that. So you, you're not going to be a well paid CNA. But the first semester is the backbone of patient care. Pay attention and do it well, and do it often.

Good luck!

justmanda · Jul 30, 2005

Hey guys, I have yet to start nursing school for my RN, so I apologize for my newbie question. Just browsing the board it seems RNs are doing a lot of the menial tasks like cleaning up after the patients. I thought this kind of stuff would be reserved for the CNAs and/or LPNs, and that the RN had more of a supervisor role (This is not to say the RN does not also directly care for patients though) Am I wrong in my thinking that there is some hierarchy in the nursing positions? Am I just going to be a better paid CNA? I hope someone can clear this up for me.
Thanks

Unfortunately, since your license is on the line, you are responsible for making sure your patient is cleaned and turned so they don't get bed sores. My friend was just fired (been an RN at my hospital for 8 years) because her CNA left a patient on the bedpan for a long period of time and didn't take them off (causing a large bruise around her bottom). My friend didn't even know they were on the bedpan in the first place, but it was reported to the family and they threatened a law suit. Do not ever check the box on your patient flow sheet that your patient was turned if you didn't either DO IT yourself or witness it being done....even if your CNA told you she did it. They could report you to the board for fraud. It sux that we cannot consider a delegated task as a completed task, but legally we can't. The nurse will always be the one to hang.

don_rhonda · Jul 30, 2005

I am a senior nursing student that is working as a CNA per diem on the evening and night shifts. Some nurses go above and beyond and pitch in with the "menial" tasks, however, think about, if you're a patient in that bed, the initials after your name truly nothing, unless you receive the best care; whether it is from a CNA or RN.
Being a CNA has been a "wake-up call," and as stated above, although I work with some great nurses and CNAs, I hope I do not forget about these issues when I am an RN.

Ouch! This subject really hits a sore spot! I am a CNA (3 yr), and will be a nursing student this fall. I believe that it should be a requirement to become a CNA before becoming a nursing student. It gives one a whole different outlook on levels of nursing. I don't consider anything menial when it comes to patient care, and it consistently takes team work for patient care. Nothing is worse than having a RN take 10 min to track me down, just to get a patient to a BSC or toilet!!! Does this really happen? ..... YES!

CoosRN · Jul 31, 2005

This is my first post so please don't fire off at me. This thread got me to register because something was bothering me while reading it. I may not have said things totally the way I want, but if I waited until then I'd never send it!

I have no argument with the replies to the original post. I understand that we are there for the patient and when the patient requires assistance, assistance is what we give. I also understand that there are often problems with employees giving it there all, whether they be Doctors, RNs, LPNs or CNAs. Employee problems need to be addressed, but once they are, I believe the issue raised still exists. My questions are these:

1) As an RN on the floor, often overwhelmed by the RN responsibilities of a large patient workload, should we be expected to perform CNA responsibilities that might be at the expense of properly performed RN responsibilities?

2) As a CNA on the floor often overwhelmed by patient workload, should the CNA expect and grow accustomed and dependent on the RN to insure CNA responsibilities get accomplished?

3) Do the Doctors perform nursing duties when the RN is busy with another patient? Ok, so I'm getting a bit silly, but Docs could do it, couldn't they? They don't - they generally demand, most in a firm but professional way that a nurse be paged immediately. They get the right person there to do it and I doubt that many are worried about friendships or what the nurses think - rather they are concerned with the patient.

I know some might say the answer is that the RN is responsible for both and that you have to get it all done, but I've seen too often that critical assessment responsibilities get less attention, even no attention because the risk might be small, in order to help with toileting or a diaper change that is so obviously needed. Believe me I understand that both need to get done, but I worry about hospital administrators taking advantage of blurred responsibilities and not addressing critically important staffing issues.

Thoughts?