Yelled at by NA for shaving pt.

meownsmile, BSN, RN · Jun 14, 2005

I see nothing wrong as long as you were careful. Some patients dont use electric razors at home either, so does that mean they shouldnt shave for weeks while they are on anticoagulants? No,, reasonable care is sufficient.

Peoples gums bleed sometimes while they are on anticoagulants, but that doesnt mean we tell them to quit brushing their teeth. Just use a soft toothbrush.

grannynurse FNP · Jun 14, 2005

Yesterday at work I was shaving a patient's face when the NA that I was working with asked me to step out of the room. She says to me " I specifically told the family that he could not be shaved with anything but an electric razor because he is on Lovenox." Now I know that I am new to this unit and I am still in orientation but I felt confident 1. That I would not cut the patient's face, 2. That if I did cut the patient's face that he would not bleed to death. Does your facility have a policy against shaving a patient while on anticoagulant. Any input would be appreciated. I tried to look for a policy for my institution but I couldn't find one. I can see telling the family to use an electric razor for home use but I don't feel as if I was endangering the patient by giving basic care. This is just frustrating. This NA is very good with patients but she is also very opinionated and tries to tell everybody what to do. I don't want to do anything that would make our working relationship bad because I am the newbie and I plan on staying on this unit for a very long time. Anyway I don't know why I've been thinking about this incident for the past two days. I guess its because I feel like this encounter could happen again in the future. And if it does... what should my response be? Note: I am not a very assertive person and people with strong personalities tend to intimidate me. Thanks again for any insight.

Is it a unit or facility policy that patients be shaved with an electric shaver? If it is, then you were in error. However, even if it isn't, no matter how careful one is, you can still nick the skin. And while the patient certainly will not bleed to death, it is hard on his nerves as you stand there trying to stop the blood. Sorry, I was on coumadin for a year. And I am also a diabetic. finger sticks four times a day would lead to bloody messes. I din't need a transufsion but there sure were times when it looked like I was bleeding out. :uhoh21:

Grannynurse :balloons:

evans_c1 · Jun 14, 2005

I think our facility policy states that you must use an electric razor..but i disagree. as long as you are careful it should not be a prob..but accidents do happen. I think it is especially not a prob if they are on lovenox or any other LMWH. Mind you, you dont even have to monitor INR or PTT w/ lovenox users..that should count for something. Heparin may be a different scenario.

suzanne4, RN · Jun 14, 2005

If your facility has a policy in effect, and you go against it, you are setting yourself up for a multitude of problems.

rjflyn, ASN, RN · Jun 14, 2005

Basic nursing care from way back in nursing school. If a pt is on a blood thinner they should be using an electric razor. Does that mean they all do well no but it does mean that we should however.

Rj:rolleyes:

pricklypear · Jun 14, 2005

I think our facility policy states that you must use an electric razor..but i disagree. as long as you are careful it should not be a prob..but accidents do happen. I think it is especially not a prob if they are on lovenox or any other LMWH. Mind you, you dont even have to monitor INR or PTT w/ lovenox users..that should count for something. Heparin may be a different scenario.

Not having to monitor INR or PTT with lovenox does not mean it has any less anticoagulation effect. Lovenox acts on different parts of the clotting cascade than coumadin or heparin - and there isn't a specific test for it's use, except maybe a bleeding time. Electric shavers SHOULD be used - especially with pts on lovenox - since you don't really know how it is affecting their clotting ability. Would you shave someone who was known to have a critically high INR or PTT? Why would you take the chance with lovenox?

BTW, it is our policy, also, to use only electric shavers on pts on anticoagulant therapy of any kind.

Tweety, BSN, RN · Jun 14, 2005

There's also the issue of being yelled at by this person. That is not appropriate. She should not be yelling at you, and should not be telling everyone what to do unless she's been designated supervisor.

You have a chain of command to use for this type of behavior I'm sure. I would first try to deal with it one on one. Explain to her that whenever she has a problem to with you, not to yell, but to take you aside and speak to you profressionally. Also, let her know you have a supervisor and it isn't her.

Good luck.

pricklypear · Jun 14, 2005

Did the person really yell, or just tell the OP? Sounds like maybe the OP just felt threatened by being corrected. I remember once (a loooong time ago!) when I was an aide, before nursing school, a nurse got on my case for massaging a pt's leg. He said it was cramping, and wanted it massaged, so I did it. I just felt so insulted that she took me outside the room and informed me I was wrong and why! But now, knowing what I do, and having had a pts complain of leg pain that turned out to be a LARGE clots, I know she was absolutely right. She didn't yell at me, but I perceived it as confrontational. I think this is more a case of who was right?

Mystery5 · Jun 14, 2005

I'm assuming NA stands for Nursing Assistant???

I would be careful with this one, if that is the case. Some CNA's like to intimidate new nurses with this type of domineering manner. It's hard, then, to rein them in down the road. I've had this problem with one in particular where I work. She's an older CNA, and likes to boss around everyone. She would summon me in a room without telling me why, make demands that I call the doc, etc. I finally started taking a different approach with her in order to instill a more respectful manner from her.

OTOH, you can learn a lot from CNAs, esp experienced ones. The trick is not to let them domineer you. Be sure and assert your authority now and then, just to make sure she knows who is in charge. You don't have to be mean, but you'll regret it if you let them walk all over you.

pricklypear · Jun 14, 2005

I'm assuming NA stands for Nursing Assistant???
I would be careful with this one, if that is the case. Some CNA's like to intimidate new nurses with this type of domineering manner. It's hard, then, to rein them in down the road. I've had this problem with one in particular where I work. She's an older CNA, and likes to boss around everyone. She would summon me in a room without telling me why, make demands that I call the doc, etc. I finally started taking a different approach with her in order to instill a more respectful manner from her.
.

You're right Mystery. I should have read a little more carefully to realize that the OP is an RN. I agree - the issue is a CNA trying to assert authority over the RN. Which I do think needs to be nipped in the bud. Nellie Nurse - you may be new, but you are the nurse, and the decision is ultimately up to you. But I still think you should not be using a razor - if for no other reason than to teach the pt the importance of not using one at home (if he goes home on anticoagulants).

Tweety, BSN, RN · Jun 14, 2005

Did the person really yell, or just tell the OP? Sounds like maybe the OP just felt threatened by being corrected. I remember once (a loooong time ago!) when I was an aide, before nursing school, a nurse got on my case for massaging a pt's leg. He said it was cramping, and wanted it massaged, so I did it. I just felt so insulted that she took me outside the room and informed me I was wrong and why! But now, knowing what I do, and having had a pts complain of leg pain that turned out to be a LARGE clots, I know she was absolutely right. She didn't yell at me, but I perceived it as confrontational. I think this is more a case of who was right?

The title of the thread is "Yelled at by NA for shaving pt. ". Which may be dramatic, but I'm taking it literally for now. Perhaps the original poster can qualify if it truly was yelling or really just rudeness and bullying.

But you're right, sometimes when we are being chastised we turn it against the person doing the educating. But there are proper ways to inform a person their techniqe is wrong.