worried

[DedHedRN]

I recently graduated and got my first job in a ltc facility. I have for the most part enjoyed the job. Except.....

the last few weeks I have had this CNA working on my wing who makes me nervous as heck. I have this gut feeling that

my license is on the line when I work with her. She has done things like adjusting the O2 on a resident when I was trying to titrate it according

to the doctors order, then she freaks out that I had to turn it up. I was following the Dr. orders to titrate the 02 to keep resident sats above 90% after he breathed in

Some vomit and desated. She also has gotten hysterical that I wouldn't give a resident ativan, when she felt they needed it. My professional judgment was that the resident was temporarily ****** off for good reason and I felt the ativan would have been more of a chemical restraint, then a relief of anxiety, if used for that reason. So the latest fiasco was her giving a resident who is a major risk for aspiration who is on dr. ordered pudding thick liquids a glass of tap water and telling him and me that its ok that he drinks it as long as I am standing there to watch. I told her no and she put the glass up to his lips and gave him a drink anyway. I took the glass from her. I looked up the policy and proceedure of the facility because I seriously felt uncomfortable. Turns out rns are not allowed to determine pts swallowing ability at my facility. I am new to this place and this girl is making me nervous, I seriously don't want to work with her anymore. I have only been working at this place two months and its my first RN job. I am not even through my probationary period yet. The facility is short staffed enough as it is.. I don't know that I can get out of working with her. She doesn't listen to me though and I am really stressed about this. Anyone have any suggestions of what I can do?

[adoglover]

write her up to the DON and report that she is working out of her scope of practice by adjusting the 02 on a patient. If you have to get the administrator involved or report to the people who certify nursing assistants.

[vanburbian]

report to DON, and board of nursing.

Crazy.

[DedHedRN]

Sounds like good ideas, I will go in early to talk to the DON tommorow. They may even want to talk to me because tonight this same CNA got fired by a resident in my wing. I am sure it will probably be a big deal tomorrow.

[xtxrn, ASN, RN]

FWIW, CNAs can be sued individually for acting outside the scope of their practice- so not everything she does will put your license in the balance. Document that you noted O2 settings at the right ones (or add a treatment order to go in the treatment book for easy signing- you should be able to add a "check" order without too much trouble...that will help CYA should something happen). And let the DON know.

Education about the risks of changing O2 levels of COPD patients- and that raising it could kill them because it cuts the drive to take a breath- and that you have specific orders as a NURSE to titrate the levels.

Write up the violating of thickened liquid orders, and constant pestering about meds that are none of her business.

I'd be feeling creepy about this one also. Good luck :)

[gettingbsn2msn, MSN, RN]

Be careful with this one. In our state one can make a statement to the BON against an RN anonymously. So let say you write her up, she gets p*ssed off and turns you in! She makes some false claim that cannot be proven or disproven and there you go with your license on the line anyway. I would just get out of there ASAP if it were me.

[Double-Helix, BSN, RN]

You need to do something about this CNA. She is dangerous. Have you tried sitting down with her and explaining that she cannot legally titrate O2 and discuss the importance of following orders. You also should formally write up each of these issues, however I'm sure someone will ask why you waited so long to report it. So please speak to your DON about this CNA.

Be careful with this one. In our state one can make a statement to the BON against an RN anonymously. So let say you write her up, she gets p*ssed off and turns you in! She makes some false claim that cannot be proven or disproven and there you go with your license on the line anyway. I would just get out of there ASAP if it were me.

I don't actually think the BON would revoke someone's license for an anonymous, unsubstantiated claim. The OP has done nothing wrong and there is no reason for her to be worried or to leave her job. It's not that easy to lose your license. It's not going to be taken away because you offend a co-worker by reporting them. Are you suggesting that nurses should ignore unsafe coworkers for fear of losing their own license? How will we ever advocate for our patient's safety?

It seems like so many nurses, especially new ones, seem to think they can lose their license over just about anything. It's really not that simple. Please don't ignore unsafe practice or run from difficult situations because you are afraid someone will get mad, make a false claim, and you'll lose your license.

[xtxrn, ASN, RN]

Be careful with this one. In our state one can make a statement to the BON against an RN anonymously. So let say you write her up, she gets p*ssed off and turns you in! She makes some false claim that cannot be proven or disproven and there you go with your license on the line anyway. I would just get out of there ASAP if it were me.

If it can't be substantiated, the license is fine.

[Liz, RN]

Be careful with her... Ultimately you are the RN and have been trained to use clinical judgment. She does not seem safe in her practice and should be written up!!! Your liscence should be fine as long as you make sure that each of u are acting within your scope of practice. CNAs should not be adjusting O2. And have not been trained to make clinical judgements in regard to medications. And they certainly should NOT be acting against MD orders and giving a resident thin liquids when they have a risk of aspiration. Thin liquids under supervision does not stop that resident from aspirating and acquiring healthcare acquired pneumonia. Pudding thick liquids tells me that this person has already failed thin liquids,Honey thick liquids, and nectar thick liquids. She sounds very unsafe!!!!!!

[klone, MSN, RN]

Have you actually called a meeting with this CNA and sat down to talk with *her* about your concerns regarding her insubordination? I would do that before talking to the DON or BON or whatever. It's called conflict management and chain of command. You are the RN. She is the CNA. I know it's hard to address conflict with the person you're having issues with, especially as a new RN, but you have to talk to HER about it first. Address the issue head on. Don't skip links in the chain of command.

[Penelope_Pitstop, BSN, RN]

I think everyone has made some wonderful suggestions.

I wonder...how long has this CNA been in practice? Also, how do other nurses feel about her?

I know when I was a new RN, I felt like a fool compared to very experienced techs; however, I never had a problem like this one.

Is she just trying to be helpful but is overstepping her boundaries? If she is a good CNA, maybe a little sit down between her and the DON will change things. She most likely realizes that what she is doing is wrong, but if other nurses don't know or care what she is up to, she thinks she is doing it for the better of the patients.

I hope everything works out, and please keep us updated!

[DedHedRN]

I love my DON. I went to talk to her, and I then talked to the aid with her there to help. Things turned out fine, I said what I needed to and there were no problems with her tonight. :) :