Yelled at by NA for shaving pt.

nurse_wannabe · Jun 15, 2005

I don't think that the NA was consciously performing patient teaching per se. Since it is customarily the responsibility of the NA to perform personal hygiene, including shaving, she probably talked about it with the patient when she was discussing his care. You know, something like, "as soon as we get an electric razor in here for you we'll get you shaved." Or perhaps the family questioned her as to why he hadn't been shaved yet, and she had to tell them about the possibility of bleeding with the lovenox. I think both scenarios are acceptable.

leopold · Jun 15, 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.

Yeah, we did learn in school not to shave pts on anticoagulants. I even brought it up once in clinicals cause I had to shave a patient on anticoagulants and my instructor just said, "well, yeah, you're not really supposed to but I don't think it'll do any harm..." Nobody ever said anything about it at all at the facilities where I worked. Actually, after reading all these posts, I'm a little surprised about that.

Sounds like she just wanted to let you know who's boss. Once you get a little more comfortable you'll be able to handle her better.

Mystery5 · Jun 15, 2005

Sounds like she just wanted to let you know who's boss. Once you get a little more comfortable you'll be able to handle her better.

Yes, I agree. She was pulling a turf thing, I'm telling you. Just keep an eye on the situation, this CNA will do it again, I'll bet my bottom dollar. Be professional with her, but don't hesitate to give her direction. Be assertive!

Nellie Nurse · Jun 15, 2005

I really appreciate all of the input that I have received. One of my goals for my growth as a nurse is to develop more assertiveness when dealing with confrontation. I am going to keep my ears open and my mouth shut for a while and just observe how other people interact with her and what works. So far it seems that the nurses just let her do her thing.

Tweety, BSN, RN · Jun 15, 2005

The NA handled this situtation appropriately and professionally.

I disagree, it sounds like she could have handled it a bit more profressionally.

She was correct in advising the client and his family to use an electric shaver while on the Levenox. She was probably trying to avoid of the mixed message being conveyed with you using the razor. Consistancy in patient teaching is imporatant and even though you were probably not going to harm the patient by using the razor, the point was is it is contraindicated. The client might have tried it at home since the nurse did it and put himself at risk.

True enough. :)

sbic56, BSN, RN · Jun 15, 2005

SBIC56, the NA has no place doing patient teaching; it is outside the scope of NA practice to conduct patient education. Are you a nurse? If so then you know that the cognitve domain is withing the realm of RN practice. It is acceptable for the NA to reinforce. For example the RN educates the patient regarding the purpose of clear liquid diet to prep for tests, the patient asks for food, the NA may reply ' the doctor ordered and the RN instrcuted that you may have clear liquids only, you are being prepped for tests.' IT IS OUTSIDE OF THE NA PRACTICE TO CONDUCT PATIENT EDUCATION. The NA was trying to assert her authority over the OP.

Yes, this nurse has been at it for 24 years...long enough to know when to pick my battles and know that we all can learn from those who have been around longer. This is not an issue of an aide overstepping her CNA scope, but one of what is best practice. No need for the RN to feel that her authority is being threatened. The experienced NA just happened to know what was best for the patient and was reinforcing what she knew to be true about using a shaver over a razor on this patient. The new RN would be remiss to worry more about losing authority over doing what was best for the patient. I do think after reading further that the NA could have been a bit more discrete about how she spoke with the nurse. Tact is important.

sbic56, BSN, RN · Jun 15, 2005

I disagree, it sounds like she could have handled it a bit more profressionally.

Tweety

Yup, you're right...I didn't realize until reading on that the CNA was talking loud enough for the people in the hallway to overhear her. That's not cool. I thought she had taken the RN away from the bedside and told her privately. She should've been more discrete.

hafsa44 · Jun 15, 2005

We have a NA on our floor that likes to intimidate the us new nurses. She was out on leave for a long time and when she came back all the nurses at night were new. She felt the need to have a meeting with us an lay down the so called laws. I being the person that I am laugh the whole time. When I first started a year ago as a new nurse I was very passive now a year latter I'm much more assertive times have changed. She one day tried to confront me about the assignment but I clearly looked her in the face an kindly told her in so many word that I'm not the one and she do not want to get on my bad side. I left that at that and from then on we have had a good relationship I hold no grudges after I speak my peace. So you don't have to be nasty to get your point across but some things need to be nip in the bud and I'm a very happy person and I will not tolerate no one to ruin my happy moments.

evans_c1 · Jun 15, 2005

This was probably something the NA was very familiar with (being a NA for 15 years on that unit) so I think pt education was appropriate in this situation. I don't agree that pt education is outside of a CNAs scope of practice. It depends on the education, that's all. I certainly wouldn't expect a NA to educate a pt on medications - but telling a pt that "since you are on blood thinners, you should be careful not to cut yourself" is fine with me. This is pretty common knowledge. If she really wanted to undermine the OP's authority, she would have done it in front of the pt. But , obviously, this happened in the hall where other staff could hear - which could be construed as undermining - whether intentional or not.

I absolutely agree with pricklypear on this...I can relate actually. I am a nursing assistant who just finished my first year of nursing. I know I have a lot more to learn and I am open to that, but I think that education (from anyone in the health care setting) is crucial to promote a healthy lifestyle or behavior. Collaborative approach from ALL disciplines is necessary for this. I think it depends on the scenario of teaching however. I would not do "-ostomy" education of course, but this NA had every right to advocate for the patient and educate him on why he should not use a razor. I think we need to help each other (just like this NA was looking out for her new superior) by reinforcing thoughts and concepts. Well put prickly pear. Nellie: hang in there... I have made worse mistakes.

Bluespruce · Jul 26, 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.

I don't know how the NA's tone was when she told you this, but the heart of the matter was that basically you probably shouldn't have done this. It is pretty common at the large facility I work at that shaving w/non-electric razor is a no-no for a pt on a blood thinner. Anyways though, it doesn't sound like it was a big boo boo & I'd just move on & know better for next time. Also, give yourself a break - you're a newbie and you shouldn't be too surprised with yourself if you make a few mistakes.

Also, I think it's good to keep in mind that you & the NA are a team(just as u & the doctor are) - I wouldn't emphasize anyone's chain of command status too much. It's really important for the patients & for your sake that you & the NA can work harmoniously & helpfully with each other. I agree, a lot can be learned from experienced NAs but everything should be communicated respectfully.

Marie_LPN, RN, LPN, RN · Jul 26, 2005

Does your facility have a policy against shaving a patient while on anticoagulant.

Our policy is that we're supposed to use electric razors, unless shaving altogether is contraindicated by the MD.

UM Review RN, ASN, RN · Jul 26, 2005

Probably best to take her aside and tell her that no matter how valid the content of what she has to say, it's unprofessional to "correct" you in front of a patient.

It makes the patient have doubts about you as his caregiver. I had a couple of go-arounds with people about this, because they don't realize that the patient is listening and that disagreements as to their care only cause problems with the patient's ability to trust and respect the caregivers.

Very big deal.