Yelled at by NA for shaving pt.

Tony35NYC · 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.

I agree.

DusktilDawn · Jul 27, 2005

Although the NA was correct concerning the use of the electric razor on this patient, there was no need for her to discuss the situation loudly and where others could hear.

The only purpose I can see for anyone to handle a situation by discussing/reprimanding loudly and in the presence of others is to deliberately humiliate another person in order to make themselves appear important.

Taking someone aside and quietly discussing the situation away from where others can hear is the best way to handle it.

NoCrumping · Jul 27, 2005

I think the NA is just one of those know it all people who thrive on correcting wrongs. I think you should have just explained to her, that you know the risks of bleeding while on anticioagulants and the precautions that should be taken, and explained to her what you told us.... that you were confident you wouldnt cut him, and if he did, he would not bleed to death!!! And you could have thrown in a "good observation" to thye NA....did you explain to her that the pt understood he shouldnt use one alone at home?? I agree , you need to be assertive with these people and let them understand, tactfully, that you are in charge. Because, believe me, in my career,I have noticed, that there is no person more jealous of a new RN than a CNA that has been one for many many years. And I also agree that it is NOT the scope of a NA to educate the patient. Yes she happened to be right in this instance, but she doesnt know everything, and what if she gives wrong info? Does she know enough to know what she doesnt know? No, she doesnt, and even if she does, the nurse practice act (at least in the 3 states i am licensed in) do not allow her to do it. And, this was education regarding a medication. Its just not their job, period.

NoCrumping · Jul 27, 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.

Oh yeah, I agree totally.... I was so hung up on the other parts of the post, I forgot to mention this aspect....and I didnt realize it was loud and in ear shot of patients...... an even more of a big deal.....

URO-RN · Jul 27, 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.

:yeahthat:

broke1 · Jul 27, 2005

I think the NA is just one of those know it all people who thrive on correcting wrongs. I think you should have just explained to her, that you know the risks of bleeding while on anticioagulants and the precautions that should be taken, and explained to her what you told us.... that you were confident you wouldnt cut him, and if he did, he would not bleed to death!!! And you could have thrown in a "good observation" to thye NA....did you explain to her that the pt understood he shouldnt use one alone at home?? I agree , you need to be assertive with these people and let them understand, tactfully, that you are in charge. Because, believe me, in my career,I have noticed, that there is no person more jealous of a new RN than a CNA that has been one for many many years. And I also agree that it is NOT the scope of a NA to educate the patient. Yes she happened to be right in this instance, but she doesnt know everything, and what if she gives wrong info? Does she know enough to know what she doesnt know? No, she doesnt, and even if she does, the nurse practice act (at least in the 3 states i am licensed in) do not allow her to do it. And, this was education regarding a medication. Its just not their job, period.

I believe the role of the NA is different from facility to facility and even state to state. The NAs in our hospital do much of the patient education on admit, during their stay and at discharge. They are trained to do so in a 200 hour in-house course. Obviously the NA cannot educate on many things, some of which are directly related to medications and their effect on the patient. However, the RN on the team is responsible for letting the NA know of such things like blood thinning drugs as they do change the way the NA performs their patient care.

Some NAs may be jealous or envious of RNs for whatever reason. Many are nursing students themselves and may possess the knowledge of the medication and many simply do not wish to have the responsibility that comes with RN. In our facility, the NAs and the RNs have their own patient care responsibilities that often overlap by design. NAs do not report to RNs because they are RNs. They report to the Nurse Manager just as the RNs and LPNs do.

UM Review RN, ASN, RN · Jul 27, 2005

NAs do not report to RNs because they are RNs. They report to the Nurse Manager just as the RNs and LPNs do.

Wow. That's different. Could you show me where in your Nurse Practice Act it says that?

Because in FL, the CNA reports to and is directed by the RN or LPN she's working with, then Charge, then Unit Manager. Chain-of-command and all that. Even if a CNA is not working directly with an RN, if an RN gives a CNA a specific instruction, she is to carry it out (or take it up the chain-of-command) or she could be written up for insubordination.

lna2rn · Jul 27, 2005

This post has been going on for a while and nobody answered my question. Maybe this is a good example why some NA's feel the need to remind the nurses of facts that have been told to them. We know that you have alot of responsibilty and alot of much more critical patients than the one who is on anticoagulants. If the aide was rude, loud, or impolite in any way she should be reminded on professionalism in the workplace. Most RN's that I work with work with me, and ask my opinion. I do not make the decision but sometimes because I am with the patient more I may know something she does not. I hope all RN's strive to learn to work with the aide and do not treat them like a personal servant.

txspadequeenRN, BSN, RN · Jul 28, 2005

I would have ask her who she thought was in charge of the unit.

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.

txspadequeenRN, BSN, RN · Jul 28, 2005

She was not correct in educating the family on any thing to do with medications. That needs to be directed to the nurse on the unit. This NA has overstepped her boundaries and should have been pulled to the side and this situation should have been settled then. The OP is a RN and I am sure she is more than aware the patient is on Lovenox , this is the type of thing you pass on from report to report until it's over.

The NA handled this situtation appropriately and professionally. 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.

broke1 · Jul 28, 2005

Wow. That's different. Could you show me where in your Nurse Practice Act it says that?
Because in FL, the CNA reports to and is directed by the RN or LPN she's working with, then Charge, then Unit Manager. Chain-of-command and all that. Even if a CNA is not working directly with an RN, if an RN gives a CNA a specific instruction, she is to carry it out (or take it up the chain-of-command) or she could be written up for insubordination.

As I indicated, things are done different state to state and so on. Our Facility is part of a consortium of hospitals with 18,000 employees. Even though we all fall under corporate guidelines, each hospital still differs from the rest. One example might me NAs in one facility can draw blood while in another they cannot. Our NAs incert Foleys while thay cannot in some of the other facilities.

Don't misunderstand, the RN is still the team leader and issues instructions and has the final say. My point was merely in our facility, the NA would be the one shaving the patient, therefore our nurses give them full reports that are pertinent to their job. Educating a patient on shaving practices while on blood thinners is basic information and totally within the relm of our NAs to teach. No matter what your position, no one has the right to chastize another team member, either above or below them, in the chain of command while within in front of the patient. The aid was wrong for what she did but not for the original education.

sbic56, BSN, RN · Jul 28, 2005

She was not correct in educating the family on any thing to do with medications. That needs to be directed to the nurse on the unit. This NA has overstepped her boundaries and should have been pulled to the side and this situation should have been settled then. The OP is a RN and I am sure she is more than aware the patient is on Lovenox , this is the type of thing you pass on from report to report until it's over.

I thought this thread was buried long ago! Anyway....the RN was new, the NA was experienced and corrected her. I did not realise when I first posted that the NA spoke in the presence of others to the new RN, I thought she took her asside. I do agree whe should have been more tactful. I don't quibble about rank when there is something to be learned or best practice assured, which was the case to me here, though tact is important.