Workload split between RNs/CNAs

fab4fan · Jul 31, 2005

Let's forget about the issue of whether or not a task is menial.

Helping a pt. with toileting is an excellent opportunity to assess your pt. You can observe skin integrity, mobility, and endurance. You can assess urinary output and look for signs of UTI. You can observe the stool for sx of blood, content, whether the pt is constipated/has diarrhea, etc.

So there are plenty of critical assessments that can be made helping a pt. with a bedpan/to the BR.

grimmy, RN · Jul 31, 2005

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!

i remember this, too - i was a pct (cna) during my last 2 years of nursing school, and i've seen both sides of this issue. i will be forever grateful that i was a pct for that time because it really helped me ace the nclex and understand what was happening in clinicals. it also helped to give me some perspective on what kind of nursing i wanted to do. at a very basic level, imho, the rn must find a way to do some of those "menial" tasks - its part of assessment. even when i was doing my externship in icu, i found the basic care of a patient crucial in writing accurate assessments of the pt. now, in the or, assisting to position the pt allows me a great vantage point for assessing the skin and preventing future problems.

grimmy, RN · Jul 31, 2005

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.
thoughts?

the point of being able to do cna duties is many-fold: you can teach these skills to orientees, family-members, etc. but, you should already be able to do any of these skills efficiently. i think one of the hardest things to learn as a new rn is time organization. it is not at all easy.

while cnas ought not come to expect rns to double-check every single cna duty, as an rn i do check cna duties whenever possible. there are times when i will not have the time to double-check everything, and no one cna or rn is perfect. i work with some wonderful pcts who are very knowledgeable, but i can never expect them to do the job without oversight.

some doctors will do my job. several physicians i know do prep patients, and manage to position them well, but again, i doublecheck, whenever possible. it is a team effort in the or. we don't doublecheck to give anyone an inferiority complex. we want the best outcome for the patient. of course, there are physicians that come into rooms, ripping away curtains without delicately checking first to see what is happening, and then they don't put the curtain back (which really infuriates me) :nono:

the fact of the matter is: your license is at stake. i will allow medical students to put in foleys, but i am watching them like a hawk. we all know that nosocomial infections (particularly utis) are notorious. until you are fairly confident of your ulp's skills and abilities, their reliability and integrity, check as much as you can. even when you do get confident, don't get complacent. keep checking. it's not about being a nosy-body. its about the well-being of the patient. their safety is paramount, and that is your job.

rach_nc_03 · Jul 31, 2005

another thing to keep in mind is that the role of the nursing assistant is largely determined by state regulations, hospital policy, and unit needs. I worked in an adult ICU during school as a nursing assistant, and I had many different responsibilities- yes, I helped bathe patients and change beds when they had bowel movements (very little ambulation happening, most of these patients were ventilator-dependent and sedated); I also did vitals, measured urinary output, inserted foley catheters in newly admitted patients; checked blood glucose levels; lots of direct patient care stuff...I also stocked in-room carts.

I'm now on orientation as an RN in the PICU of the same hospital. While this unit staffs nursing assistants, they have no direct patient contact- they stock the in-room carts and cover for the unit secretary when she's away from the desk.

I've never worked in long term care, but my understanding is that type of setting has different divisions of duties as well. As other posters have said, though, in any setting, as an RN you *will* be sometimes doing things one usually expects a nursing assistant to do.

HuggyPuglet · Jul 31, 2005

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!

Yes, I see where you are coming from (unfortunately). I am a nurse, and I've seen other RNs where I work do the same thing, as if they can't be bothered with such "menial" tasks as a simple bedpan or vital signs.

The unfortunate thing is they miss out on hands on patient care, and the opportunity to see their patients as human beings, not just names on a chart or lines on an assessment form. There is a real patient underneath all that paper. All one has to do is look - and touch.

hollyster · Jul 31, 2005

In the CCU we have no Techs,LPNs or CNAs. RN is responsible for all pt care.

I agree an earlier poster that cleaning a pt is a great time for skin assessment

and repositioning.

I do not believe that any task in pt care is menial.

fergus51 · Jul 31, 2005

I don't believe any task is beneath me, and I will help out when I can. That said, I also expect others to do their jobs and not rely on me too much. RNs sometimes take on more and more and more and more until they can't get their work done because they are so busy doing everyone else's job.

Nancy428 · Aug 1, 2005

I work with an LVN who thinks that CNA's are nothing.She calls us on the phone to do her job,when all the other nurses just do it.She called me one time to assist a res. to brush her teeth,when the res. was more than capable to do it herself,all she needed to do was get her the toothpaste and toothbrush...it seems she loves to call us all day,to just give us something to do.It's funny how all the other LVN's just do their job,they know what they have to do,and they do it..but NOT HER.To me,she is not a good nurse at all.But,there are good nurses,and there are not so good nurses out there.

smk1, LPN · Aug 1, 2005

having just passed my cna test (yeah! need those extra points for nursing school admission), I have some thoughts. When we did our clinicals at the nursing home, I was shocked to see many RN and LPN's not willing to even get a galss of water for a patient. We were not supposed to ask the nurses questions or speak to them really because they were so "busy". Now I am not doubting that they were busy, however these nurses would roll their eyes at you when you smile or try to ask a brief question like "where is the linen closet". I had one rudely tell me to "mind my own business, i already know what is going on." when i politely asked if there was anything that I could do for the patient we could all hear screaming and sobbing from her room. the entire time we were there, there were 2 nurses, 1 RN and 1 LPN that were nice to us. The LPN on the alzheimers unit allowed us to take vital signs and feeding and we got to practice nail care, foot care and catheter care. She also let us know of things that could be done if we had a chance and told us what to report to her. Most of the other nurses that we saw just wanted us to silently clean up messes, change briefs and do pericare. I don't have a problem doing those things but leaving a patient in a messy attends for over an hour until one of the "aides" takes care of it is a bit neglectful. These same nurse got mad when we reported redness and what looked like the beginning signs of pressure ulcers to them. They just said "we already know that and it's fine!" Because of their attitude, I know of more than one person who called the state ombudsman to report the neglect that we saw. I was never upset about doing the ADL stuff, inmho that is the stuff that CNA's should be focusing on the most, instead of trying to do more and more skilled tasks.

AtlantaRN, RN · Aug 1, 2005

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

On a busy med/surg unit we had a few nurses come and go because they just couldn't be "bothered" by helping a patient to the commode, or put a bed pan under them. It's one thing if you have an emergency and you HAVE to leave the room, but the few nurses that are gone would ALWAYS tell the patient "i'll get your tech" and then go sit their butts down...

My philosophy is do what you can and work as a team. It saves everyones back and builds respect.

atlantarn

Nancy428 · Aug 1, 2005

On a busy med/surg unit we had a few nurses come and go because they just couldn't be "bothered" by helping a patient to the commode, or put a bed pan under them. It's one thing if you have an emergency and you HAVE to leave the room, but the few nurses that are gone would ALWAYS tell the patient "i'll get your tech" and then go sit their butts down...
My philosophy is do what you can and work as a team. It saves everyones back and builds respect.
atlantarn

Yes..that is the way it should be....TEAMWORK.

expectant · Aug 1, 2005

CNAs and PCTs (the title and particular tasks they can do are determined by the hospital) do things that the RN is able to delegate to them. Being able to delegate it does not mean that you will never have to do it, too.

The RN has to do things that CNAs and PCTs legally cannot do. The RN will have to do some of the "menial" things because the CNA can't be everywhere at once. Changing a patient can be a great chance to assess skin and being in the room for something small like emptying a foley can give you a couple minutes to talk to and educate your patient.

As long as my CNAs are working as hard as I am, I never mind doing menial stuff right alongside them.

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