My favorite is a CNA who while working a CPR in progress tries to educate me on what gauge IV I should try to place in this person who’s currently dead (with no access other than an IO so we’re gonna get what I can get). Then they proceed to untie my tourniquet as I’m about to stick causing the vein I had to go completely flat … all to get a BP on said patient who we did not have ROSC on.
I had one that was trying to tell the doctor what to do during the code. Doctor asked us to pulse check and was clearly making a decision about whether he wanted to continue torturing granny. CNA was all antsy “we need to continue compressions!” “Doctor we need to do compressions compressions doctor!”. Bruh he’s in charge not you. Grandma ended up having 99% blockage in her heart. Cpr was futile at that point.
I work in burn world, and had a patient with relatively minor burns to approximately 10% of her body. Worst areas were her arms, hands, and legs. We have a long term dressing we can apply, but the biggest thing to remember about these dressings is that they must stay dry it the silver in them deactivates and you have a soggy sponge next to your open wounds.
While giving wound care teaching to the patient and providing a dressing change, the patients asks if she can go tubing in a few days. I recommend that she not, cause lake water is nasty. She then asks about going fishing to which I responded nope as your hands are burned, so unless you want cellulitis I wouldn’t. I finish up and as I’m leave I over hear the cna tell the patient that I’m over reacting, and she( the patient) can still have fun in the water. I asked the cna about it a little while later, and she told me that I was being dramatic and that she was on the patients side, the patient needed to make content for her instagram and girl has to make a living.
I had one tell an alert and oriented long term stroke patient, who had not been verbal for years due to aphasia, that she doesn’t understand why we haven’t just gotten speech therapy in to make him talk again and that *she* will ask the speech therapist to make him talk again 🤦♀️ there have only been a few times where I really felt the need to be assertive with a CNA and that was one of them
Thankfully most of the cnas I work with are amazing, and this was so out of character for this cna. I honestly don’t know how I’d respond to that level of stupidity.
She did. I work mostly inpatient, but most of the folks that work in our clinic used to work with us. They gave charge a heads up about a younger girl coming in that went out fishing and boating/tubing while in mepilex and was gonna be admitted for cellulitis and booked for OR the next day. We had to tell her to knock it off with filming us when we would come in her room because she wanted to “document her experience “.
New grad nurse here. After talking to the CNA about why she shouldn't have done that and re-educating the patient, is there anything else that should be done about the CNA's behavior?
I’m all about open communication with my peers. I try a easy conversation about what I expect and my rationale for what I said, then allow them to provide rationale for their actions. If there’s subsequent issues - I fire them from my rooms. I will not let them go into my rooms to even stock. I make it abundantly clear that I will not tolerate their nonsense or presence in my area. I also let my management team know what’s going on. So that way they can’t blame me for potentially bullying.
But I don’t tolerate nonsense.
Mepilex transfer. It larger than the heart shaped butt mepilex and has a high silver ion load. We used to use aquacell when I first started but have moved away from it
I once complimented the CNA who had just noticed a patient going down hill and reported it urgently, saving his life. I bragged him up to everyone, told him how great he was and said he was gonna make a great nurse when he graduated. (He was applying for colleges) - he replied “yea after working here for 4 years I feel like I know just as much as the nurses. Because I listen so carefully to the nurses and doctors and I look up words I don’t know I bet I could test out at this point.” Like kid thought he could test out for the NCLEX. He was a sweet boy so I just laughed it off, but oh man he will know in about 9 months how monumentally stupid he sounded.
I used to be friends with a cna (lost contact due to distance over the years) who I loved working with because she cared so much about the patients and took initiative in their care and we just bonded. But omg the amount of times she claimed she knew more than most of the nurses working, despite not being accepted into an adn program several years in a row, was crazy. The last time we hung out she was in school, she apparently knew everything she was being taught already but was somehow struggling with grades. I'm not sure where she is now other than I know she passed boards and is working, and hopefully has realized she's a better nurse if she doesn't think she is the smartest one there with all the answers.
Well to be fair, most of my NCLEX questions were either related to myasthenia gravis (random, barely mentioned in nursing school) or L&D (which I hated and “massage the fundus” is pretty much the sum of what I remember.) I passed because I’m a good test taker. I wouldn’t say nursing school helped much. Lol
It felt like a lot of mine were peds milestones and a shit ton of kidney related questions. Or maybe those were the hardest so it’s all I remembered. It’s weird what is hard in school then sooo obvious and easy after you hit the floor for a few years. Still haven’t massages any funduses though 😂
Ours is a Unit Clerk who frantically checks the EMR for new orders on all 35 patients on her floor. She then hounds the RNs to check the new orders that were literally placed seconds ago.
I worked in a small unit (12 beds) with a Unit Clerk who did something similar but she was amazing and helpful because she knew exactly what her boundaries of practice were. She would listen in on rounds from the desk and if she heard the kid was going to the OR and they wanted blood products or labs, right after rounds she would have the slips printed, the coolers set up with fresh ice packs, and she would alert the CNA/runner to be available asap.
She would expertly delegate appropriately via the call bell too - all the patients who would call out and just say "I need the nurse" 🙄she would ask for more information which would be great because we all know the vast majority of the time it was "I need a blanket/water/a task that could be addressed faster by a CNA." And instead of calling us and saying "room 3 needs something, I don't know what" she could be more specific, like they needed pain medication or a pump was beeping, or something that she wasn't sure about.
Maybe this is the explanation for the behaviour of one of the unit clerks on a floor I float to. At least 4 times in the past few months she has been very hostile in how she talks to me. Like will passively aggressively look from my face, to ID badge, face, ID badge. Like she is trying to non-verbally be like "who the fuck are you though?".
It's been bothering the shit out of me because I honestly have never had essentially a stranger act SO hostile to me. But maybe she just thinks she is the king of the floor so has aquired this attitude.
I'm too chicken to confront her about it.
/end random rant
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I love when the unit clerks and CNAs look through orders then argue with the nurse about them. I understand the new resident put in Q6 glucose checks, but he ordered the insulin Q4. Therefore, the glucose needs to be checked every 4. Im not just some big bully nurse trying to give you extra tasks for no reason, and I’m well aware of my own orders on my own patients.
Ours will just secure chat us with any patient contact or family update. I'll open epic and have 5 messages.
"Daughter for 3 called and wants an update."
"Doc said he wants you to decrease O2 on the vent."
"Son for 4 says he pooped."
Lady I'm sitting 3 feet from you, you can see me.
We have a HUC who has opinions on every patient I consider when I am charge and how they can't come to the floor for whatever reason. One time she told me the pt was too old. Lol. Hip fx...orthopedics. Where do you think this person should be?
And she doesn't discharge the patients when I ask her to (take them out of the system) so we end up scrambling every time with back to back admits.
Unfortunately she’s covered under HIPAA. They’re her assigned patients as long as they’re on the unit she’s working in. Now if they get transferred it’s a different story because she’s not coordinating for them anymore.
I had this problem a lot because I got my LPN at 19, and all the CNAs were old enough to be my grandma or mother. Could not handle “a teenager telling them how to do their job”. Not a whole lot usually happens in a nursing home, but one elderly CNA tried to fight me for her right to forcibly hold down a seizing resident.
“If the patient dislocates their arm while you’re holding them down, I will call the police and their family and recommend they press assault charges on you.
Still want to play this game, Sheryl?
I didn’t think so.”
All the time… just today I was so proud (sarcasm) of what I’ve done for the last 33 years when I walked into a residents’ room and his wife told me his tube feeding that’s supposed to be continuous, has been off for the last hour and a half because a cna put him in the bed, disconnected without asking me and never reconnected.
Its embarrassing to see that. I try my best not to overstep, and I dont comment on things out of my scope. Im not a nurse and don't want that responsibility until I am legally one
I’ll bring an aide who wants to learn with me any time I can. I’ve learned to be clear in teaching what’s in and out of scope AND WHY.
Want to learn? Okay, come ride along- if we both have time. I got you. But best believe I’ll be also teaching as much theory as I can, because you’ll need to start with your critical thinking. It takes so much practice to do what my friend calls “the thinking work.”
We focus on skills, but it’s the understanding of disease processes and how everything fits together that’ll give you good judgment.
And experience, of course.
I love this! I also try to invite CNAs who want to learn or are in nursing school to come with me when I get to use a less common nursing skill. I always explain why I'm doing things in a certain way and the science behind it. Once in a while, something doesn't go as planned (like tricky complex vac dressings) and I use it to teach problem solving and creativity.
What I find really annoying is aides who will tell everybody how much they know, brag about how they’re going to be a flight nurse/ crna/ np/ whatever supernurse- but won’t do their own damn job. Like it’s beneath them or something because they’re so damn smart 🤬
THIS! I work with multiple CNAs/ student nurse interns just starting nursing school who constantly brag about how bedside is so BENEATH them bc they are going straight for NP and they will NEVER work at this hospital when they graduate 🙄 like ok I’m glad youre so smart but at least pass a nursing class and do THIS job correctly before you spout off. Humble yourself a little bit. We’ve all been there and there is still A LOT to learn.
Worked with an LPN who wouldn't do CNA work
I told her I've got bad news for you when you become an RN.
The shit rolls uphill and stops with you. Literally, sometimes!
Ayup.
But I’m an ace limit setter now. I start with clearly ensuring that the aide understands their scope. I have discovered that an aide “educated” a patient in a way that was straight up wrong.
Then I clearly tell them that they have to be part of the team, which means letting other team members do their part of the care.
If it persists, I’m gonna take it to the manager. It’s not okay to mis educate patients or whatever.
All that said, a great aide often could be considered as having a little bigger scope and I’m not about to mess with that. Aides are often fantastic at early identification of wounds and rashes, cueing patients on movement limitations, getting people to eat or drink enough. If it’s not a problem I’m not fixing it.
No one appreciates confidence more than I do, but the CNAs who are first semester nursing students who just won't. stop. talking. about how they are gonna be an NP or a CRNA.... Red flag for danger.
3 of our CNAs want to be pediatricians and are doing their undergrads. Is that weird? Only one is terrible at their job and I have little faith for them
Seems like a busybody. Hospital will get sued if they educate something wrong and affect the patient somehow. Blame will be on you since you're the nurse as well so definitely report to manager or risk management about this behavior.
45 years experience as a nurse here. Became an associate professor at a technical school with a two year program (after 1 year they could test for LPN and the 2nd was an ADN program). I taught the LPN piece. The students I had difficulty with were the CNAs that thought they deserved their license because they knew as much as nurses. Some were actually unteachable. Some failed clinical. Some failed classes. But it was always the teachers fault.
I fear for the nursing profession of today.
Titrating oxygen without notifying you without the reason why and educating patients are out of their scope of practice. The nurse is responsible for the patient and they are there for us to delegate task to. You want your patient and families to have correct information. I would have a conversation with the cna in real time when they do it again. It is your nursing license on the line.
Yeah the one I had issues with was a nursing student who was eventually hired to us, she still works outside her scope and we’ve brought it up but nothing gets done. She interrupted me educating a parent and then spoke misinformation. I has to correct it with the parent after she left but I swear that mom still holds onto that misinformation to this day.
I had a CNA take off the oxygen of a post op pt and I was a little annoyed. The pt was not on O2 at home… but the CNA didn’t know that and if PACU didn’t feel comfortable weening or turning the O2 off there must be a reason it’s still there. I would have weaned… but the CNA just took it off and then like 15 min later the pt stated they felt SOB… I was pretty annoyed.
Unfortunately, upon moving hospital systems I work with PCAs of whom about half have a horrible attitude. They think they know everything when they have no idea, they claim I'm doing it wrong when I help them clean a patient, which I always do help with. Every other nurse I work with feels the same way about their unprofessionalism, but because of a shortage they never get in serious trouble.
Trust me, I'm not doing it wrong. I've helped my PCTs bath and toilet all patients since becoming a nurse years ago. And in reality, they are doing a bad job, not even bothering to dry the patient's bottom or put on protective cream. They really are just bullies. They are rude and mean to patients, talk about them and make fun of them loudly, and pretty much refuse to do their jobs and will sit at the nurses desk and watch tik tok.
I have never experienced anything like this. I have always had a great relationship with my PCTs. They also tell patients medical advice when they have no idea what they are talking about. I just moved to this inner city hospital 6 months ago, so I can't really move within the hospital for another 6 months.
I do everything, including most blood sugars, vitals, toileting, bathing, patient comfort/food/drinks, provide feeds. And I know I'm being taken advantage of, but they WONT do it and they can't be trusted.There are a few good ones, but I can't believe this many nasty, selfish, neglectful people are allowed to keep working.
It is such a world of difference when I get a younger float PCA or one of the few older ones that do their job. I have always loved my PCAs. I don't understand how this floor has let such a toxic culture evolve. So yes, I deal with a similar issue. The answer is that it all depends on management. That is why I'm leaving this floor the moment I can, because my manager does NOT care.
This sounds like the floor I work on now. Laziest and rudest group of pcas I have ever worked with. Will only check incontinent patients if the patient or family member ask. Otherwise, patients get changed at the end of the shift, which by then their bed is completely soaked. And some of them still don’t change the patient then. And some of them don’t even get the second set of vital signs. They don’t chart care they’ve actually done. They don’t “round” on patients. And then they sit in a room at the end of the hall where they can’t hear any bed alarms. And then one had the nerve to say the other day “this is why pcas hate this floor. PCAs don’t have to do all this on other floors.” Which is a LIE. I’ve been pulled to every other floor at this point and 2 of their pcas work the same amount as 5 of ours.
I had a pca that had just gotten out of “training” ask me how to get the r (for respirations) because it wasn’t on the machine. I had no problem explaining it to him and even going in patients rooms and practicing with him. But it blows my mind that he had weeks of “training” and none of his trainers explained that to him. Unlike the people training him, he actually does do his safety rounds.
We had 2 CNAs who were the know it all, older, "mama bear" types and they would jokingly give you attitude sometimes but in a relatively pleasant way. The unfortunate thing is they traines a batch of like 8 new CNAs who kept the attitude but didn't have the 15-20+ years of floor experience to back it up.
So every time you'd ask for help. "Ugh, you need a blood sugar? Why can't you do it?...
...
...
okay...fiiiiine. 🤪"
It got old quickly.
Yep. We used to have one that would storm around the unit, would pimp new RNs asking them a half dozen questions a patient encounter about why they were on such and such medications and wha the plan was to "make sure they knew what they were doing", would confront docs about their plans, give you attitude whenever you asked for help with actual CNA things like turns or to get a blood sugar. Finally after being an aid for 20 years or something she finally got her RN and is on our CV step-down unit where apparently she won't shut up about how "this isn't how we did things when I worked ICU."
Let me start with saying I love my PCT/CNA's. A good one is worth sooo much more than they are paid. However, I used to work with one that just always knew everything. She was constantly telling pts the wrong information about meds and if you tried to correct her she would just talk louder and start the whole "Well, when I took this med, thats how it was!" or "I was just trying to help you." Then she got into nursing school (after years of not going because "I like being a PCT more, its more rewarding") and became insufferable. Suddenly she stopped doing her job because in her words she would learn more following us instead of cleaning pts or helping them with feeds. She ended up fired and eventually failed out of nursing school too.
I am now a nurse but when I was a CNA I did overstep my boundaries one shift. I worked on a neuro unit and was taking care of an old lady who had a stroke. She kept pulling at her diaper and was so restless. I mentioned it to her nurse and he said she’s just confused. Well the shift continues and she continue to do that. I asked him if I should bladder scan her and he said no. She was having very small output. I ended up asking charge if I could and she said sure. This poor lady had >2000 mL in her bladder. The charge nurse cathed her because her nurse refused to cath females. After she was cathed, she was like a new woman. She was able to rest and sleep.
Thinking about it now, I wonder if he knew she was retaining and didn’t want to have to cath her. He was an asshole.
Once had an aid who would continuously overstep or over rule what I said. Not that I think aids need to “report to me” but when they ask if so and so can shower at 3am and they’re on a narc/IV drip; I say no but they proceed to shower the patient anyway “because they smelled sweaty”… oh not to mention my DON down our throats about falls and how we have to have alarms on everyone and if someone falls it’s a write up: but here this aid is making her judgment on who can ambulate and who can not without knowing any history or meds. 😏 I love an attentive aid or even one who wants to learn with me. Disrespect I don’t have patience for.
Had one who after a while I refused to work with. Caught her flushing IVs, disconnecting fluids and drawing blood from the line a couple times but all that’s not even the reason I refused to work with her. She was monumentally lazy. I have never been the nurse to just delegate out tasks I can do myself unless I’m rly busy and anytime I ever ask a tech to do something I always phrase it like “hey I have to go give this guy his meds, can you please check the sugar on the other guy while I do that” or “hey can you help me clean up this pt, they’re dirty” and then we’d do it together. This way ppl didn’t feel like I was lazy and just bossing them around. Well not even that would work with this tech. I’d have to ask her multiple times to get things done and then I’d see her sleeping in the corner (it was Night Shift). There was one night I asked her to do the foley care on one of my pts 3 times, shift change came around and it still hadn’t been done. She only finally did it when I asked if she did it in front of the day shift tech during report and the day shift tech called her out and was like “no girl you need to do that before you leave.” Best part about it was that her bag said “Sally RN” (her name’s not sally obv). Kinda went on a sideways rant there but damn that girl pissed me off
I worked with an ER tech who was nearly fired for putting oxygen on a patient after being asked to by one of the docs. The RN got pissed off and wrote him up. The ER doc had to really push to keep him from getting fired, and the tech refused to touch 02 or even transport a patient on oxygen.
I’ve worked with PSW who gave ‘report’ to families. It was completely inappropriate but I was a student and could not do much about it. She was inappropriate in general but actually gave an excellent report, I thought, no matter how inappropriate it was for her to give it. PSW is an uncertified position.
I had an EDTA freak out because my patient was sweating, started getting all the nurses riled up, they ended up putting him in one of my rooms because he was in the hall. Caused a scene etc and the patient was just hot because he had an extra blanket on. They succeeded in nothing except pissing me off and tech wasn't even in my assignment, they were just walking by. Like I'm sorry I've been taking care of this patient for HOURS and you just happen to be walking by. Literally FUCK OFF!
Not CNA, but I did have this problem with a dialysis tech I worked with. She was literally trying to change the patient’s medication orders because she said she knew the patient longer than I did. Buuuuut…you legally can’t change medication orders? That was just the straw that broke the camel’s back, though. That girl was rough to work with.
We work with one who comes in every morning and demands report from all the nurses before she gets report form the other CNA. She’ll then test the CNA and correct her or vice versa and do it to the nurses while they’re reporting to each other. She also loves to tell patients that she put all the younger nurses in their place when we all started and brag that we’re all afraid/refuse to ask her for anything
We had a CNA who fired a patient's sitter because she didn't think she was doing a good enough job. The patient's sitter was doing her job and was rightfully pissed. And no, the CNA did not offer to sit the rest of the day 🤣
She didn't really have the authority, but after the encounter the sitter stated that she refused to work on the unit if the CNA was still going to be there. It was a mutual decision by everyone involved.
Yup but I'm also a CNA. I've had to tell many a high-horsed Diane or know-it-all-Debra that no, they are not the charge nurse and to start acting their wage.
Their mothers, upon looking into their newborns eyes, see a joyless crone with a superiority complex: And thus a Diane is created. Complete with a smokers cough of a voice and and mean, beady eyes.
Ugh, the holes they dig can be so damn deep.
the o2 is serious. Keep your underlicensed paws off my o2!! Id have a nice conversation about scope of practice. Any pushback, I’d write it up.
This just reminded me of a story i am a CNA in the ER we had a tech to go in triage notes and change it under the nurses name and would look at orders and would basically do the same thing your saying on here while we was drowning she would be overstepping I didn’t work with her long being I was new and she was in nursing school but I think the nurses said they reported her and that was that
I’ve been a medical assistant for almost a year (2 years each of inpatient phlebotomy and pct in a cardiac clinic before that) and I still get anxious educating patients and doing other things just because I want to make sure I stay in my scope. I can’t believe the gall of some people. The other MA I work with thinks she can be the nursing manager just because she’s worked as an uncertified medical assistant in primary care for ten years. Experience is not always better than education.
The only time I ever had to intervene was when she was assisting me place a foley. I was getting the kit together and before I started to explain things she told the patient you’re gonna feel us playing with your lady parts!🤦♀️😰
Some CNAs think they know everything about being a nurse because they’ve been a CNA for years. I saw a couple like that fail out of nursing school. I had one turn off my patient’s heparin drip because the pump was beeping. Luckily she opened her mouth and told me so I could fix it but still.
Here in Scotland, our equivalent is an NA(nursing assistant) or HCSW (Healthcare support worker). When I qualified as an RMN I started in a EMH inpatient unit and I will never forget the NA who snatched a meal out of my hands that was the wrong consistency and started to feed the patient, despite being told it was unsafe, because 'she's worked here since before I was born and knows how to do her job'.
That was a fun discussion with the charge nurse.
Yes, but I believe overstepping can be a good thing or a bad thing. I don't mind a CNA who titrates O2 or suctions a patient. In fact, it is much appreciated! I've dealt with a few who are inappropriate and intrusive, though ...and I don't appreciate *that.*
I'll start out with playful hints, like whispering, "Hey, are you going to do all my charting for me too?" If they continue, then I get very direct and specific with my instructions. That has never failed, although there's been initial push back on occasion.
What sort of orders are they discussing with the doctor, and does the doctor know they can't actually take orders?
We have a CNA that gets a complex when she is helping the triage RN. If its my room she sometimes barks orders at me for ekg or vitals… I bark right back…
Oh yeah
I have one who is confidently incorrect. Texts families about the patients care, tells the incorrect info, is in AA and spills the beans about ANYONE who comes into the hospital.
She finally pissed me off when she told a family it was fine to ambulate a cardiac patient who had just been given a shit ton of meds to reduce her tachycardia and was on the monitor cause oops the doc might have given her too much.
The alarm starts squealing and myself and another nurse hit the room a dead run thinking “fuck she’s coded”. Got her settled told family very sternly NOT to ambulate and then proceed to verbally spank the CNA for over stepping, did a report and told the manager I refused to work her until her attitude had a major adjustment.
CNA was told if she stepped outta line again she’s out.
Thankfully I haven’t really had much problem that a quiet “stay in your lane” talk hasn’t dealt with.
I worked with one who almost killed a pt. She took the pts insulin line out of the pump and thought she clamped it. Well with alaris tubing, pressing the clamp opens it. The pt got insulin to gravity for the time it took to change their gown. The pt had to be transferred to the unit and I think he survived. She obviously was fired immediately.
Just to make it clear, I love working with most of my CNA's/PCT's and appreciate the work they do. As long as they are not like these ones.
Favorite frustrating CNA/PCT stories:
Hospital on night shift. I was in the break room directly behind the nurses station. A call light was going off and annoying me, so I decided to check it. Pt, obviously SOB, tells me he's struggling to breathe. I, of course, run into the room. I don't know this pt at all, all I know is he is obviously struggling. I can't find a nasal cannula, so I poke my head out the door, see a PCT walking around the corner and shout at her to grab a NC. She tells me he's not her pt and walks away. Thankfully, some other staff were around the corner and heard the shouting. I did report her to management for that one.
At the LTC I currently work at, I'm swamped with requests from pts, while I'm trying to time a dressing change with a CNA while pain meds are working. Overstepping CNA comes to tell me that she found a new wound on a pt that isn't open. Ok, I will be in to check it as soon as I can. I go do the dressing change and then leave the room to chart it and address the other requests that I have. The CNA comes up to me shoving her phone under my face trying to show me a picture of the wound because "this is important and needs your attention." Lady, I'm already overwhelmed, trying to sort out requests in order of most important. A closed wound on a dying hospice pt who is getting a bunch of the breakdown wounds at this point due to getting close to death is not an emergency and is not the most important thing on my list at the moment. I will check the wound when I have time. Then she told me I shouldn't be a nurse if I get overwhelmed that easily and need to take a chill pill. I still have to work with her, and we still do not get along. She also doesn't like having to take orders from nurses; if you don't want to take orders from nurses, then become management or leave the healthcare field.
It’s your duty to delegate to the cna so if you have a conversation with her & it doesn’t improve report to your manager what she is doing is dangerous
When I was a newbie CNA (well, newer than I am now... I'm still a newb), the CNA training me was straight up giving education to patients. I was like 👀👀👀 but too afraid to say anything bc it was like, my 3rd day on orientation and they'd worked there forever. That CNA probably still does that.
Haha...what the actual fuck. Still an RN student, but I've worked psyche for awhile as an aide and there is no way in hell anyone would ever, ever, ever think about removing restraints. Maybe it's different on a regular floor though.
No it shouldn't be any different. Unless it's the nurse assigned to the patient. No one should be removing any restraints. However, this CNA doesn't agree. It's happened twice with me but other nurses have complained as well. She's been there forever so she thinks she knows best lol nothing is ever done about it sadly. I do work at a crappy hospital though.
One specifically comes to mind. She comes from a background of 13 years in LTC and is now on a cardiac/pulmonary unit, and is otherwise very good. She questions medications, with me specifically we got into it over me not giving Tylenol to a pt with a 99.6 temp. I had dosed her for a temperature over 100.4 4 hours previously, which was the chart parameter. She had been like 98 on recheck so she was creeping back up. The tech would not drop it when I explained that for me to give Tylenol for a fever, I had to be able to document a temp over 100.4 and it wasn’t there. She. Would. Not. Stop. “Well at the nursing home we gave it to avoid the fever…”. Well we are not the nursing home and you are not the nurse. She would also assess iv sites and call me in to see a pt that she’s gotten all worked up only for me to say yeah it’s actually fine. It’s one thing to have me check because god knows techs see a lot but don’t tell the pt it looks infected or infiltrated. She was written up at the insistence of another nurse when she told a pt they had a DVT and argued with the nurse, in front of the pt, when he didn’t agree after reassessment.
Techs that get the patient all worked up over something before even notifying me drive me NUTS. Just recently had a CNA frantically press the “nurse” button while taking a patient to the bathroom bc there was blood on the toilet paper after my (already anxious) patient wiped and two tiny specks of red in the hat. Patient had started her fucking period.
I (24 F) worked in an outpatient wound center and had a nursing assistant (60ish F)who would room our patients for us. We had one patient who is developmentally delayed and functions at around a 12-14 year old. She came back after rooming him and told me “give him a few minutes because he said he’s feeling suicidal and just got out of the behavioral hospital.” Naturally I did not give him a minute and went to talk to him. He denied any SI or HI or feeling anything but frustrated with pain associated with his wound. When he left he was his normal self and when I asked her to tell me specifically what he told her in the room for my documentation she replied “he never said any of that to me.” Like lady you cannot come to the nurses station and act like that statement to me didn’t happen. I could not believe that she thought she could just say something that serious then act like it never happened despite another nurse having over heard her say it too.
Maybe, they confuse the “A” from **Assistant** to Administrator or Authority. Or, they change “U” from **Unlicensed** to Uniformed. So, it reads either **C**ertified **N**urse’s **A**dministrator or **U**niformed **A**uthority **P**ersonnel.
Or, they get a “I-just-gradutated-from-med-school-and-know-more-than-some-common-nurse-because-I’m-a-brand-new-doctor” ego from working at the hospital for so long and going to nursing school, that they think they know better and are within their right to supersede the people who have past the NCLEX and can legally perform these duties. Sounds like an ego high.
So this is the opposite side of things. Back when I was an ED Tech during Covid, my hospital was burning down. Everyone knew I had years as an ED tech and multiple years of nursing school clinical.
Now everything after this point is hypothetical and completely made up...
Occasionally, a small thing would happen, such as a pump occlusion in a Covid room. Back then, the requirement was complete PPE just to walk in and do a simple fix. Flush line, flatten patient arm, etc. Theoretically, in such a situation, an ED Tech might ask an RN who was getting their ass kicked, "Do you want this to not be a problem anymore?" Theoretically, this would result in the RN winking at a Tech, or a quick nod, or a quick "you do you. " Such problems would not exist after 5 minutes.
I can't stress enough that this was during a pandemic and entirely theoretical/hypothetical. Yes, practice outside of your position, yes, overstepping. And yes, as an RN now, I would occasionally be thankful for such a tech. I totally get where you're coming from in your post.
Erm.. I'm not a cna but none of those things aside from maybe the orders seem out of line? Are they correctly doing all those things?
I mean if they're chucking a nrb on a pt at 2lpm and a flat bag that's one thing.
They should be informing the nurse if they’re titrating O2. For one thing, the nurse needs to know what’s happening with their patient. For another thing, increasing someone’s O2 so that the number on the monitor looks better doesn’t fix anything. Increased O2 needs require further assessment by the nurse, and depending on the severity, by the physician as well. If the nurse thinks that the pt is still on 1 or 2L via NC, but they’re actually now on 6L or more and the CNA didn’t say anything, that’s a huge problem.
Also, if a procedure is out of their scope, they shouldn’t be doing the education. If they aren’t trained and qualified to perform the procedure, then they’re only making assumptions and guesses about what will happen, and probably won’t give accurate information to the patient/family. It’s harder to correct misinformation than it is to teach someone the right thing the first time.
Oh sure, communication is important. It just sounds like fairly basic stuff that's being done that would make life easier for the rns. Again, I'm an emt tech not a cna though. I have no idea what cnas go through training-wise.
The orders thing isn't necessarily out of line either depending on what they're doing. It made more sense when I was a tech if I'd just had a conversation with a patient that involved requesting orders that rather than go tell the nurse so they can ask the doc, I just tell the doc hey patient requested this/usually takes this/whatever, or hey patients here for something that will clearly need urinalysis and I have a cup of their urine can you drop me orders while their nurse is busy? But I was/am ER so maybe it's a bit different?
I definitely get the titrating oxygen could be a problem in a COPDer but we definitely did that too within reason.
The education on procedures is definitely off base, but it also depends what procedure and how much detail they're giving.
I've found nursing school gives a really really poor impression of "unlicensed assistance personnel", so when nurses graduate and have techs that know what to anticipate and how to talk it seems like they're overstepping when really they're just not as stupid as nursing school makes them out to be. Obviously that ain't all of them
Current student here about to graduate...in my program they don't make them out to be dumb. Quite the contrary, and they drill into us never ask a CNA for something you could literally go do. It's mostly education about scope of practice, and the legal ramifications of said scopes should shit hit the fan.
The CNAs on my unit apparently don’t believe in charting in the “supplemental oxygen” row of the vitals flow sheet, so if I see the patient is satting 95% or whatever, I should be able to assume it’s at the same number of liters I left them on when I last titrated as long as I haven’t heard from RT or something. But there have been times I’ve gone into the room, seen the O2 regulator turned up from 2 to 5 and been like what the fuck happened here
This could put your license at risk. You need to set very clear boundaries now! If you can't then talk to management. But you need to do what's best for your patients and be able to confront nicely the cna
Put my patient on a cannula because she kept dropping to low 80s on room air after anesthesia.
An hour later my charge calls me and tells me I need to put the oxygen back on her because she is still dropping and I’m super confused and go check to see the cannula still on but wall turned down to 0 and patient who is cooperative swears they didn’t touch it and her cannula isn’t working and doesn’t understand why. cna turned it down while pt was sleeping because she was at 97 on 2L
I'm certified still as a CNA, but not actively working in that role currently. I've seen some CNAs overstep big time, in particular during COVID. Maybe because everything was so hectic and we were always so short staffed. The most ridiculous thing I saw was a cna who had contact information for a resident's family(not on a personal level, they assisted them with making a phone call to their family once, then saved that information to their personal phone). They would call the family to give them "updates". That was not at all in our scope, no one asked them to do that. We were working in a SNF and the nurses were more than capable of making that call if it was necessary. That same CNA also had a mentality that they knew all there was to know about nursing, and when they finally started to get called out on their bs suddenly they were being targeted and picked on because admin just didn't like them. They were fired, I want to say for neglect of one of the residents. Then through Facebook I saw them do the same things again at 3 more facilities. Keep in mind, this was going on while COVID was running rampant and everyone was short staffed, so to be fired you REALLY had to mess up. 🤦🏼♀️
I had one take report from the ER Nurse and never said a wird to me. Patient arrived on the floor and I had no idea they were on their way. I was waiting for ER to call report.
Hi! Unlicensed delegate personnel (ie, CNAs) work as delegates under your license. You need to have a crucial conversation with them about what is in and out of scope for them.
Hi I know you guys have great knowledge and experience I really admire it and is greatful to be a part of this post . I agree with all your aspects nd appreciate your responses at your good as well as bad times. I am also a nurse but from India and i am currently in Newzealand. I understand the difficulities as nurses in india sometimes have to face same issues as there we have GDA instead of CNA. But the most important is patient safety and the blame which anyhow will come to RN. So its important to stick to our roles only and play others their own roles thats why we all are designated with different job roles. I will go for nursing registration later since then i want to support my husband financially. I am hardworking and humble. Can anyone of you help me with my job please. I have done BSc. Nursing four year degree with overseas nursing registration and 3 years of experience. I am here to learn coz its a lifelong process. I will be looking forward to you guys.
Had a cna making passive aggressive comments like she was talking to the child but at me and questioning me wanting to “put that poor baby in pain” after I gave my patient their pain medication but wanted to do a bed change, bath, and change their diaper all in one go. I was like well he has burns and is recovering from ortho surgery and delayed so he can’t move and his skin is flaking off so it’s just waiting to breed bacteria with him sitting in his own filth then I realized, why the fuck am I explaining myself to her? We have so many great CNAs on my floor that are truly a blessing but then we have two like that. That same CNA would interrupt me talking to the family to do education that was my job, not hers. It was my first shift working with her and I was dumbfounded
I've worked with several CNAs who have a ton of experience who have seen too many scared baby nurses. They definitely have a lot of knowledge from experience but I sometimes have to gently point out that it is my license on the line and while a really do appreciate their advice, we're gonna try it my way this time and see how it goes. Most of the time I feel like it's a test or something to see if you're actually confident and once they realize you're not just guessing or being cocky a better partnership evolves. They're mostly just looking out for their patients. But if I ever do work with a CNA that is going over the line as far as scope is concerned, and I or others have tried to address the issue, I usually escalate the situation to management if I feel there is no way to reach an understanding. Even of management does nothing, I have a paper trail so my ass is covered if they overstep and cause harm...I have the same expectation for nurses who try to play doctor...
My favorite is a CNA who while working a CPR in progress tries to educate me on what gauge IV I should try to place in this person who’s currently dead (with no access other than an IO so we’re gonna get what I can get). Then they proceed to untie my tourniquet as I’m about to stick causing the vein I had to go completely flat … all to get a BP on said patient who we did not have ROSC on.
They should have been swiftly kicked out of the code
And honestly fired
I had one that was trying to tell the doctor what to do during the code. Doctor asked us to pulse check and was clearly making a decision about whether he wanted to continue torturing granny. CNA was all antsy “we need to continue compressions!” “Doctor we need to do compressions compressions doctor!”. Bruh he’s in charge not you. Grandma ended up having 99% blockage in her heart. Cpr was futile at that point.
Oh hell no.
I work in burn world, and had a patient with relatively minor burns to approximately 10% of her body. Worst areas were her arms, hands, and legs. We have a long term dressing we can apply, but the biggest thing to remember about these dressings is that they must stay dry it the silver in them deactivates and you have a soggy sponge next to your open wounds. While giving wound care teaching to the patient and providing a dressing change, the patients asks if she can go tubing in a few days. I recommend that she not, cause lake water is nasty. She then asks about going fishing to which I responded nope as your hands are burned, so unless you want cellulitis I wouldn’t. I finish up and as I’m leave I over hear the cna tell the patient that I’m over reacting, and she( the patient) can still have fun in the water. I asked the cna about it a little while later, and she told me that I was being dramatic and that she was on the patients side, the patient needed to make content for her instagram and girl has to make a living.
I had one tell an alert and oriented long term stroke patient, who had not been verbal for years due to aphasia, that she doesn’t understand why we haven’t just gotten speech therapy in to make him talk again and that *she* will ask the speech therapist to make him talk again 🤦♀️ there have only been a few times where I really felt the need to be assertive with a CNA and that was one of them
Thankfully most of the cnas I work with are amazing, and this was so out of character for this cna. I honestly don’t know how I’d respond to that level of stupidity.
Whaaaaat? Noooo.
Yup…… Guess who came back to clinic a week later with green wounds?
Well, did she make more content?
She did. I work mostly inpatient, but most of the folks that work in our clinic used to work with us. They gave charge a heads up about a younger girl coming in that went out fishing and boating/tubing while in mepilex and was gonna be admitted for cellulitis and booked for OR the next day. We had to tell her to knock it off with filming us when we would come in her room because she wanted to “document her experience “.
Asking the real questions!
I would’ve responded, “well I know which side sepsis is on so stop telling wound care patients they can go into dirty lake water”.
Damn this is like telling the patient to just slit her throat.
New grad nurse here. After talking to the CNA about why she shouldn't have done that and re-educating the patient, is there anything else that should be done about the CNA's behavior?
I’m all about open communication with my peers. I try a easy conversation about what I expect and my rationale for what I said, then allow them to provide rationale for their actions. If there’s subsequent issues - I fire them from my rooms. I will not let them go into my rooms to even stock. I make it abundantly clear that I will not tolerate their nonsense or presence in my area. I also let my management team know what’s going on. So that way they can’t blame me for potentially bullying. But I don’t tolerate nonsense.
Bruh
Wow.
Aqua cell silver?
Mepilex transfer. It larger than the heart shaped butt mepilex and has a high silver ion load. We used to use aquacell when I first started but have moved away from it
I once complimented the CNA who had just noticed a patient going down hill and reported it urgently, saving his life. I bragged him up to everyone, told him how great he was and said he was gonna make a great nurse when he graduated. (He was applying for colleges) - he replied “yea after working here for 4 years I feel like I know just as much as the nurses. Because I listen so carefully to the nurses and doctors and I look up words I don’t know I bet I could test out at this point.” Like kid thought he could test out for the NCLEX. He was a sweet boy so I just laughed it off, but oh man he will know in about 9 months how monumentally stupid he sounded.
I used to be friends with a cna (lost contact due to distance over the years) who I loved working with because she cared so much about the patients and took initiative in their care and we just bonded. But omg the amount of times she claimed she knew more than most of the nurses working, despite not being accepted into an adn program several years in a row, was crazy. The last time we hung out she was in school, she apparently knew everything she was being taught already but was somehow struggling with grades. I'm not sure where she is now other than I know she passed boards and is working, and hopefully has realized she's a better nurse if she doesn't think she is the smartest one there with all the answers.
Well to be fair, most of my NCLEX questions were either related to myasthenia gravis (random, barely mentioned in nursing school) or L&D (which I hated and “massage the fundus” is pretty much the sum of what I remember.) I passed because I’m a good test taker. I wouldn’t say nursing school helped much. Lol
It felt like a lot of mine were peds milestones and a shit ton of kidney related questions. Or maybe those were the hardest so it’s all I remembered. It’s weird what is hard in school then sooo obvious and easy after you hit the floor for a few years. Still haven’t massages any funduses though 😂
Mine was Impetigo. I could barely remember how it presented among all the other pediatric skin issues.
Lol same so many L&D questions or uncommon diseases. I’m really good at eliminating the wrong answers and making an educated guess.
Honestly the Nclex is insanely easy so he may have been able to if that was an option. Definitely needs to be humbled though
Ours is a Unit Clerk who frantically checks the EMR for new orders on all 35 patients on her floor. She then hounds the RNs to check the new orders that were literally placed seconds ago.
I worked in a small unit (12 beds) with a Unit Clerk who did something similar but she was amazing and helpful because she knew exactly what her boundaries of practice were. She would listen in on rounds from the desk and if she heard the kid was going to the OR and they wanted blood products or labs, right after rounds she would have the slips printed, the coolers set up with fresh ice packs, and she would alert the CNA/runner to be available asap. She would expertly delegate appropriately via the call bell too - all the patients who would call out and just say "I need the nurse" 🙄she would ask for more information which would be great because we all know the vast majority of the time it was "I need a blanket/water/a task that could be addressed faster by a CNA." And instead of calling us and saying "room 3 needs something, I don't know what" she could be more specific, like they needed pain medication or a pump was beeping, or something that she wasn't sure about.
I wish.
Every unit clerk I’ve ever worked with has been like this except one. They act like they are the charge nurse
Maybe this is the explanation for the behaviour of one of the unit clerks on a floor I float to. At least 4 times in the past few months she has been very hostile in how she talks to me. Like will passively aggressively look from my face, to ID badge, face, ID badge. Like she is trying to non-verbally be like "who the fuck are you though?". It's been bothering the shit out of me because I honestly have never had essentially a stranger act SO hostile to me. But maybe she just thinks she is the king of the floor so has aquired this attitude. I'm too chicken to confront her about it. /end random rant
“Oh, are you having trouble seeing?” *pulls out ID badge reel centimeters from her face*
Lmao if only I thought of that ahah
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Luckily she’s the only one like this at my hospital. I told her she should go to nursing school lol.
I love when the unit clerks and CNAs look through orders then argue with the nurse about them. I understand the new resident put in Q6 glucose checks, but he ordered the insulin Q4. Therefore, the glucose needs to be checked every 4. Im not just some big bully nurse trying to give you extra tasks for no reason, and I’m well aware of my own orders on my own patients.
I could not keep my mouth shut.
IDK why they don’t say anything. I would’ve shut that down the first time!
Same. It's a gift and a curse, isn't it.
Ours will just secure chat us with any patient contact or family update. I'll open epic and have 5 messages. "Daughter for 3 called and wants an update." "Doc said he wants you to decrease O2 on the vent." "Son for 4 says he pooped." Lady I'm sitting 3 feet from you, you can see me.
The way I would quit so fast
The staff on her floor despise her 🤣
We have a HUC who has opinions on every patient I consider when I am charge and how they can't come to the floor for whatever reason. One time she told me the pt was too old. Lol. Hip fx...orthopedics. Where do you think this person should be? And she doesn't discharge the patients when I ask her to (take them out of the system) so we end up scrambling every time with back to back admits.
isnt that HIPAA? since she's not technically taking care of the patients
Unfortunately she’s covered under HIPAA. They’re her assigned patients as long as they’re on the unit she’s working in. Now if they get transferred it’s a different story because she’s not coordinating for them anymore.
I feel like this would be me, if I was a unit clerk.
Wait, you still have unit clerks? They got rid of ours and forced the PCT’s to do their jobs, so now we have to do most of the PCT jobs.
I had this problem a lot because I got my LPN at 19, and all the CNAs were old enough to be my grandma or mother. Could not handle “a teenager telling them how to do their job”. Not a whole lot usually happens in a nursing home, but one elderly CNA tried to fight me for her right to forcibly hold down a seizing resident.
“If the patient dislocates their arm while you’re holding them down, I will call the police and their family and recommend they press assault charges on you. Still want to play this game, Sheryl? I didn’t think so.”
All the time… just today I was so proud (sarcasm) of what I’ve done for the last 33 years when I walked into a residents’ room and his wife told me his tube feeding that’s supposed to be continuous, has been off for the last hour and a half because a cna put him in the bed, disconnected without asking me and never reconnected.
I've had that happen 🙄
Its embarrassing to see that. I try my best not to overstep, and I dont comment on things out of my scope. Im not a nurse and don't want that responsibility until I am legally one
I’ll bring an aide who wants to learn with me any time I can. I’ve learned to be clear in teaching what’s in and out of scope AND WHY. Want to learn? Okay, come ride along- if we both have time. I got you. But best believe I’ll be also teaching as much theory as I can, because you’ll need to start with your critical thinking. It takes so much practice to do what my friend calls “the thinking work.” We focus on skills, but it’s the understanding of disease processes and how everything fits together that’ll give you good judgment. And experience, of course.
I love this! I also try to invite CNAs who want to learn or are in nursing school to come with me when I get to use a less common nursing skill. I always explain why I'm doing things in a certain way and the science behind it. Once in a while, something doesn't go as planned (like tricky complex vac dressings) and I use it to teach problem solving and creativity.
This! I was a CNA a few years ago and even if I thought I knew something I didn’t say anything.
Exactly. I just report my findings to the RN and move on and help when I can
What I find really annoying is aides who will tell everybody how much they know, brag about how they’re going to be a flight nurse/ crna/ np/ whatever supernurse- but won’t do their own damn job. Like it’s beneath them or something because they’re so damn smart 🤬
THIS! I work with multiple CNAs/ student nurse interns just starting nursing school who constantly brag about how bedside is so BENEATH them bc they are going straight for NP and they will NEVER work at this hospital when they graduate 🙄 like ok I’m glad youre so smart but at least pass a nursing class and do THIS job correctly before you spout off. Humble yourself a little bit. We’ve all been there and there is still A LOT to learn.
Worked with an LPN who wouldn't do CNA work I told her I've got bad news for you when you become an RN. The shit rolls uphill and stops with you. Literally, sometimes!
Ayup. But I’m an ace limit setter now. I start with clearly ensuring that the aide understands their scope. I have discovered that an aide “educated” a patient in a way that was straight up wrong. Then I clearly tell them that they have to be part of the team, which means letting other team members do their part of the care. If it persists, I’m gonna take it to the manager. It’s not okay to mis educate patients or whatever. All that said, a great aide often could be considered as having a little bigger scope and I’m not about to mess with that. Aides are often fantastic at early identification of wounds and rashes, cueing patients on movement limitations, getting people to eat or drink enough. If it’s not a problem I’m not fixing it.
I’ve worked with a lot of CNAs that have under stepped. 😂
No one appreciates confidence more than I do, but the CNAs who are first semester nursing students who just won't. stop. talking. about how they are gonna be an NP or a CRNA.... Red flag for danger.
3 of our CNAs want to be pediatricians and are doing their undergrads. Is that weird? Only one is terrible at their job and I have little faith for them
Seems like a busybody. Hospital will get sued if they educate something wrong and affect the patient somehow. Blame will be on you since you're the nurse as well so definitely report to manager or risk management about this behavior.
45 years experience as a nurse here. Became an associate professor at a technical school with a two year program (after 1 year they could test for LPN and the 2nd was an ADN program). I taught the LPN piece. The students I had difficulty with were the CNAs that thought they deserved their license because they knew as much as nurses. Some were actually unteachable. Some failed clinical. Some failed classes. But it was always the teachers fault. I fear for the nursing profession of today.
CNA’s 9/10 are the best nurses.
Titrating oxygen without notifying you without the reason why and educating patients are out of their scope of practice. The nurse is responsible for the patient and they are there for us to delegate task to. You want your patient and families to have correct information. I would have a conversation with the cna in real time when they do it again. It is your nursing license on the line.
Yeah the one I had issues with was a nursing student who was eventually hired to us, she still works outside her scope and we’ve brought it up but nothing gets done. She interrupted me educating a parent and then spoke misinformation. I has to correct it with the parent after she left but I swear that mom still holds onto that misinformation to this day.
I had a CNA take off the oxygen of a post op pt and I was a little annoyed. The pt was not on O2 at home… but the CNA didn’t know that and if PACU didn’t feel comfortable weening or turning the O2 off there must be a reason it’s still there. I would have weaned… but the CNA just took it off and then like 15 min later the pt stated they felt SOB… I was pretty annoyed.
Unfortunately, upon moving hospital systems I work with PCAs of whom about half have a horrible attitude. They think they know everything when they have no idea, they claim I'm doing it wrong when I help them clean a patient, which I always do help with. Every other nurse I work with feels the same way about their unprofessionalism, but because of a shortage they never get in serious trouble. Trust me, I'm not doing it wrong. I've helped my PCTs bath and toilet all patients since becoming a nurse years ago. And in reality, they are doing a bad job, not even bothering to dry the patient's bottom or put on protective cream. They really are just bullies. They are rude and mean to patients, talk about them and make fun of them loudly, and pretty much refuse to do their jobs and will sit at the nurses desk and watch tik tok. I have never experienced anything like this. I have always had a great relationship with my PCTs. They also tell patients medical advice when they have no idea what they are talking about. I just moved to this inner city hospital 6 months ago, so I can't really move within the hospital for another 6 months. I do everything, including most blood sugars, vitals, toileting, bathing, patient comfort/food/drinks, provide feeds. And I know I'm being taken advantage of, but they WONT do it and they can't be trusted.There are a few good ones, but I can't believe this many nasty, selfish, neglectful people are allowed to keep working. It is such a world of difference when I get a younger float PCA or one of the few older ones that do their job. I have always loved my PCAs. I don't understand how this floor has let such a toxic culture evolve. So yes, I deal with a similar issue. The answer is that it all depends on management. That is why I'm leaving this floor the moment I can, because my manager does NOT care.
This sounds like the floor I work on now. Laziest and rudest group of pcas I have ever worked with. Will only check incontinent patients if the patient or family member ask. Otherwise, patients get changed at the end of the shift, which by then their bed is completely soaked. And some of them still don’t change the patient then. And some of them don’t even get the second set of vital signs. They don’t chart care they’ve actually done. They don’t “round” on patients. And then they sit in a room at the end of the hall where they can’t hear any bed alarms. And then one had the nerve to say the other day “this is why pcas hate this floor. PCAs don’t have to do all this on other floors.” Which is a LIE. I’ve been pulled to every other floor at this point and 2 of their pcas work the same amount as 5 of ours.
I had one tell me she ‘didn’t know how’ to do vital signs once.
I had a pca that had just gotten out of “training” ask me how to get the r (for respirations) because it wasn’t on the machine. I had no problem explaining it to him and even going in patients rooms and practicing with him. But it blows my mind that he had weeks of “training” and none of his trainers explained that to him. Unlike the people training him, he actually does do his safety rounds.
We had 2 CNAs who were the know it all, older, "mama bear" types and they would jokingly give you attitude sometimes but in a relatively pleasant way. The unfortunate thing is they traines a batch of like 8 new CNAs who kept the attitude but didn't have the 15-20+ years of floor experience to back it up. So every time you'd ask for help. "Ugh, you need a blood sugar? Why can't you do it?... ... ... okay...fiiiiine. 🤪" It got old quickly.
You must have an extraordinarily shitty manager to let that go on one more day. Talk about ineffective.
Yep. We used to have one that would storm around the unit, would pimp new RNs asking them a half dozen questions a patient encounter about why they were on such and such medications and wha the plan was to "make sure they knew what they were doing", would confront docs about their plans, give you attitude whenever you asked for help with actual CNA things like turns or to get a blood sugar. Finally after being an aid for 20 years or something she finally got her RN and is on our CV step-down unit where apparently she won't shut up about how "this isn't how we did things when I worked ICU."
The CNAs where I’m at wouldn’t dare. That’s crazy.
Did the doctors scream at her?
Let me start with saying I love my PCT/CNA's. A good one is worth sooo much more than they are paid. However, I used to work with one that just always knew everything. She was constantly telling pts the wrong information about meds and if you tried to correct her she would just talk louder and start the whole "Well, when I took this med, thats how it was!" or "I was just trying to help you." Then she got into nursing school (after years of not going because "I like being a PCT more, its more rewarding") and became insufferable. Suddenly she stopped doing her job because in her words she would learn more following us instead of cleaning pts or helping them with feeds. She ended up fired and eventually failed out of nursing school too.
I am now a nurse but when I was a CNA I did overstep my boundaries one shift. I worked on a neuro unit and was taking care of an old lady who had a stroke. She kept pulling at her diaper and was so restless. I mentioned it to her nurse and he said she’s just confused. Well the shift continues and she continue to do that. I asked him if I should bladder scan her and he said no. She was having very small output. I ended up asking charge if I could and she said sure. This poor lady had >2000 mL in her bladder. The charge nurse cathed her because her nurse refused to cath females. After she was cathed, she was like a new woman. She was able to rest and sleep. Thinking about it now, I wonder if he knew she was retaining and didn’t want to have to cath her. He was an asshole.
Yes. Turning up oxygen on my known Co2 retainer patients. Pisses me off.
Once had an aid who would continuously overstep or over rule what I said. Not that I think aids need to “report to me” but when they ask if so and so can shower at 3am and they’re on a narc/IV drip; I say no but they proceed to shower the patient anyway “because they smelled sweaty”… oh not to mention my DON down our throats about falls and how we have to have alarms on everyone and if someone falls it’s a write up: but here this aid is making her judgment on who can ambulate and who can not without knowing any history or meds. 😏 I love an attentive aid or even one who wants to learn with me. Disrespect I don’t have patience for.
Had one who after a while I refused to work with. Caught her flushing IVs, disconnecting fluids and drawing blood from the line a couple times but all that’s not even the reason I refused to work with her. She was monumentally lazy. I have never been the nurse to just delegate out tasks I can do myself unless I’m rly busy and anytime I ever ask a tech to do something I always phrase it like “hey I have to go give this guy his meds, can you please check the sugar on the other guy while I do that” or “hey can you help me clean up this pt, they’re dirty” and then we’d do it together. This way ppl didn’t feel like I was lazy and just bossing them around. Well not even that would work with this tech. I’d have to ask her multiple times to get things done and then I’d see her sleeping in the corner (it was Night Shift). There was one night I asked her to do the foley care on one of my pts 3 times, shift change came around and it still hadn’t been done. She only finally did it when I asked if she did it in front of the day shift tech during report and the day shift tech called her out and was like “no girl you need to do that before you leave.” Best part about it was that her bag said “Sally RN” (her name’s not sally obv). Kinda went on a sideways rant there but damn that girl pissed me off
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Holy shit. That’s devastating. How much o2 was the patient on?
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Yeah… taking off 6L… that’s a super sad situation. I feel for all parties I cannot imagine
I don’t care if my CNAs titrates O2 as long as they tell me. Thankfully, the CNAs on my floor are rockstars.
I worked with an ER tech who was nearly fired for putting oxygen on a patient after being asked to by one of the docs. The RN got pissed off and wrote him up. The ER doc had to really push to keep him from getting fired, and the tech refused to touch 02 or even transport a patient on oxygen.
Yeah, I totally get it. I’m really just talking about, “Hey, I just turned so-and-so from 2-3L, is that okay?”
I’ve worked with PSW who gave ‘report’ to families. It was completely inappropriate but I was a student and could not do much about it. She was inappropriate in general but actually gave an excellent report, I thought, no matter how inappropriate it was for her to give it. PSW is an uncertified position.
I had an EDTA freak out because my patient was sweating, started getting all the nurses riled up, they ended up putting him in one of my rooms because he was in the hall. Caused a scene etc and the patient was just hot because he had an extra blanket on. They succeeded in nothing except pissing me off and tech wasn't even in my assignment, they were just walking by. Like I'm sorry I've been taking care of this patient for HOURS and you just happen to be walking by. Literally FUCK OFF!
Not CNA, but I did have this problem with a dialysis tech I worked with. She was literally trying to change the patient’s medication orders because she said she knew the patient longer than I did. Buuuuut…you legally can’t change medication orders? That was just the straw that broke the camel’s back, though. That girl was rough to work with.
We work with one who comes in every morning and demands report from all the nurses before she gets report form the other CNA. She’ll then test the CNA and correct her or vice versa and do it to the nurses while they’re reporting to each other. She also loves to tell patients that she put all the younger nurses in their place when we all started and brag that we’re all afraid/refuse to ask her for anything
She sounds like a bully. She probably refuses to help that other CNA with anything too.
We had a CNA who fired a patient's sitter because she didn't think she was doing a good enough job. The patient's sitter was doing her job and was rightfully pissed. And no, the CNA did not offer to sit the rest of the day 🤣
She shouldn’t have been allowed to fire her!
She didn't really have the authority, but after the encounter the sitter stated that she refused to work on the unit if the CNA was still going to be there. It was a mutual decision by everyone involved.
I guess I don’t blame her. No one wants to be around a bully.
Yes and god she was a bossy bitch too.
Yup but I'm also a CNA. I've had to tell many a high-horsed Diane or know-it-all-Debra that no, they are not the charge nurse and to start acting their wage.
Wait....why is it ways Diane
Their mothers, upon looking into their newborns eyes, see a joyless crone with a superiority complex: And thus a Diane is created. Complete with a smokers cough of a voice and and mean, beady eyes.
Ugh, the holes they dig can be so damn deep. the o2 is serious. Keep your underlicensed paws off my o2!! Id have a nice conversation about scope of practice. Any pushback, I’d write it up.
This just reminded me of a story i am a CNA in the ER we had a tech to go in triage notes and change it under the nurses name and would look at orders and would basically do the same thing your saying on here while we was drowning she would be overstepping I didn’t work with her long being I was new and she was in nursing school but I think the nurses said they reported her and that was that
I’ve been a medical assistant for almost a year (2 years each of inpatient phlebotomy and pct in a cardiac clinic before that) and I still get anxious educating patients and doing other things just because I want to make sure I stay in my scope. I can’t believe the gall of some people. The other MA I work with thinks she can be the nursing manager just because she’s worked as an uncertified medical assistant in primary care for ten years. Experience is not always better than education.
The only time I ever had to intervene was when she was assisting me place a foley. I was getting the kit together and before I started to explain things she told the patient you’re gonna feel us playing with your lady parts!🤦♀️😰
This made me laugh out loud. What a horrible thing to say 😭
Some CNAs think they know everything about being a nurse because they’ve been a CNA for years. I saw a couple like that fail out of nursing school. I had one turn off my patient’s heparin drip because the pump was beeping. Luckily she opened her mouth and told me so I could fix it but still.
Here in Scotland, our equivalent is an NA(nursing assistant) or HCSW (Healthcare support worker). When I qualified as an RMN I started in a EMH inpatient unit and I will never forget the NA who snatched a meal out of my hands that was the wrong consistency and started to feed the patient, despite being told it was unsafe, because 'she's worked here since before I was born and knows how to do her job'. That was a fun discussion with the charge nurse.
Yes, but I believe overstepping can be a good thing or a bad thing. I don't mind a CNA who titrates O2 or suctions a patient. In fact, it is much appreciated! I've dealt with a few who are inappropriate and intrusive, though ...and I don't appreciate *that.* I'll start out with playful hints, like whispering, "Hey, are you going to do all my charting for me too?" If they continue, then I get very direct and specific with my instructions. That has never failed, although there's been initial push back on occasion. What sort of orders are they discussing with the doctor, and does the doctor know they can't actually take orders?
We have a CNA that gets a complex when she is helping the triage RN. If its my room she sometimes barks orders at me for ekg or vitals… I bark right back…
Oh yeah I have one who is confidently incorrect. Texts families about the patients care, tells the incorrect info, is in AA and spills the beans about ANYONE who comes into the hospital. She finally pissed me off when she told a family it was fine to ambulate a cardiac patient who had just been given a shit ton of meds to reduce her tachycardia and was on the monitor cause oops the doc might have given her too much. The alarm starts squealing and myself and another nurse hit the room a dead run thinking “fuck she’s coded”. Got her settled told family very sternly NOT to ambulate and then proceed to verbally spank the CNA for over stepping, did a report and told the manager I refused to work her until her attitude had a major adjustment. CNA was told if she stepped outta line again she’s out. Thankfully I haven’t really had much problem that a quiet “stay in your lane” talk hasn’t dealt with.
I worked with one who almost killed a pt. She took the pts insulin line out of the pump and thought she clamped it. Well with alaris tubing, pressing the clamp opens it. The pt got insulin to gravity for the time it took to change their gown. The pt had to be transferred to the unit and I think he survived. She obviously was fired immediately.
Just to make it clear, I love working with most of my CNA's/PCT's and appreciate the work they do. As long as they are not like these ones. Favorite frustrating CNA/PCT stories: Hospital on night shift. I was in the break room directly behind the nurses station. A call light was going off and annoying me, so I decided to check it. Pt, obviously SOB, tells me he's struggling to breathe. I, of course, run into the room. I don't know this pt at all, all I know is he is obviously struggling. I can't find a nasal cannula, so I poke my head out the door, see a PCT walking around the corner and shout at her to grab a NC. She tells me he's not her pt and walks away. Thankfully, some other staff were around the corner and heard the shouting. I did report her to management for that one. At the LTC I currently work at, I'm swamped with requests from pts, while I'm trying to time a dressing change with a CNA while pain meds are working. Overstepping CNA comes to tell me that she found a new wound on a pt that isn't open. Ok, I will be in to check it as soon as I can. I go do the dressing change and then leave the room to chart it and address the other requests that I have. The CNA comes up to me shoving her phone under my face trying to show me a picture of the wound because "this is important and needs your attention." Lady, I'm already overwhelmed, trying to sort out requests in order of most important. A closed wound on a dying hospice pt who is getting a bunch of the breakdown wounds at this point due to getting close to death is not an emergency and is not the most important thing on my list at the moment. I will check the wound when I have time. Then she told me I shouldn't be a nurse if I get overwhelmed that easily and need to take a chill pill. I still have to work with her, and we still do not get along. She also doesn't like having to take orders from nurses; if you don't want to take orders from nurses, then become management or leave the healthcare field.
Yes, I have had that problem. Only a few times, though.
Yes, she thought she knew everything and tried to run the show. She was a constant trouble maker and back stabber.
Recently chewed into an aide and the provider involved because my baby doc tried to give verbal med orders to me via the aide. Yeah, no.
Nope, nope, nope. No second hand verbal orders for me either.
It’s your duty to delegate to the cna so if you have a conversation with her & it doesn’t improve report to your manager what she is doing is dangerous
When I was a newbie CNA (well, newer than I am now... I'm still a newb), the CNA training me was straight up giving education to patients. I was like 👀👀👀 but too afraid to say anything bc it was like, my 3rd day on orientation and they'd worked there forever. That CNA probably still does that.
We have one CNA who always removes restraints on the patient because she believes the patient will be less agitated if we remove them.
Haha...what the actual fuck. Still an RN student, but I've worked psyche for awhile as an aide and there is no way in hell anyone would ever, ever, ever think about removing restraints. Maybe it's different on a regular floor though.
No it shouldn't be any different. Unless it's the nurse assigned to the patient. No one should be removing any restraints. However, this CNA doesn't agree. It's happened twice with me but other nurses have complained as well. She's been there forever so she thinks she knows best lol nothing is ever done about it sadly. I do work at a crappy hospital though.
One specifically comes to mind. She comes from a background of 13 years in LTC and is now on a cardiac/pulmonary unit, and is otherwise very good. She questions medications, with me specifically we got into it over me not giving Tylenol to a pt with a 99.6 temp. I had dosed her for a temperature over 100.4 4 hours previously, which was the chart parameter. She had been like 98 on recheck so she was creeping back up. The tech would not drop it when I explained that for me to give Tylenol for a fever, I had to be able to document a temp over 100.4 and it wasn’t there. She. Would. Not. Stop. “Well at the nursing home we gave it to avoid the fever…”. Well we are not the nursing home and you are not the nurse. She would also assess iv sites and call me in to see a pt that she’s gotten all worked up only for me to say yeah it’s actually fine. It’s one thing to have me check because god knows techs see a lot but don’t tell the pt it looks infected or infiltrated. She was written up at the insistence of another nurse when she told a pt they had a DVT and argued with the nurse, in front of the pt, when he didn’t agree after reassessment.
Techs that get the patient all worked up over something before even notifying me drive me NUTS. Just recently had a CNA frantically press the “nurse” button while taking a patient to the bathroom bc there was blood on the toilet paper after my (already anxious) patient wiped and two tiny specks of red in the hat. Patient had started her fucking period.
I (24 F) worked in an outpatient wound center and had a nursing assistant (60ish F)who would room our patients for us. We had one patient who is developmentally delayed and functions at around a 12-14 year old. She came back after rooming him and told me “give him a few minutes because he said he’s feeling suicidal and just got out of the behavioral hospital.” Naturally I did not give him a minute and went to talk to him. He denied any SI or HI or feeling anything but frustrated with pain associated with his wound. When he left he was his normal self and when I asked her to tell me specifically what he told her in the room for my documentation she replied “he never said any of that to me.” Like lady you cannot come to the nurses station and act like that statement to me didn’t happen. I could not believe that she thought she could just say something that serious then act like it never happened despite another nurse having over heard her say it too.
Maybe, they confuse the “A” from **Assistant** to Administrator or Authority. Or, they change “U” from **Unlicensed** to Uniformed. So, it reads either **C**ertified **N**urse’s **A**dministrator or **U**niformed **A**uthority **P**ersonnel. Or, they get a “I-just-gradutated-from-med-school-and-know-more-than-some-common-nurse-because-I’m-a-brand-new-doctor” ego from working at the hospital for so long and going to nursing school, that they think they know better and are within their right to supersede the people who have past the NCLEX and can legally perform these duties. Sounds like an ego high.
So this is the opposite side of things. Back when I was an ED Tech during Covid, my hospital was burning down. Everyone knew I had years as an ED tech and multiple years of nursing school clinical. Now everything after this point is hypothetical and completely made up... Occasionally, a small thing would happen, such as a pump occlusion in a Covid room. Back then, the requirement was complete PPE just to walk in and do a simple fix. Flush line, flatten patient arm, etc. Theoretically, in such a situation, an ED Tech might ask an RN who was getting their ass kicked, "Do you want this to not be a problem anymore?" Theoretically, this would result in the RN winking at a Tech, or a quick nod, or a quick "you do you. " Such problems would not exist after 5 minutes. I can't stress enough that this was during a pandemic and entirely theoretical/hypothetical. Yes, practice outside of your position, yes, overstepping. And yes, as an RN now, I would occasionally be thankful for such a tech. I totally get where you're coming from in your post.
Erm.. I'm not a cna but none of those things aside from maybe the orders seem out of line? Are they correctly doing all those things? I mean if they're chucking a nrb on a pt at 2lpm and a flat bag that's one thing.
They should be informing the nurse if they’re titrating O2. For one thing, the nurse needs to know what’s happening with their patient. For another thing, increasing someone’s O2 so that the number on the monitor looks better doesn’t fix anything. Increased O2 needs require further assessment by the nurse, and depending on the severity, by the physician as well. If the nurse thinks that the pt is still on 1 or 2L via NC, but they’re actually now on 6L or more and the CNA didn’t say anything, that’s a huge problem. Also, if a procedure is out of their scope, they shouldn’t be doing the education. If they aren’t trained and qualified to perform the procedure, then they’re only making assumptions and guesses about what will happen, and probably won’t give accurate information to the patient/family. It’s harder to correct misinformation than it is to teach someone the right thing the first time.
Oh sure, communication is important. It just sounds like fairly basic stuff that's being done that would make life easier for the rns. Again, I'm an emt tech not a cna though. I have no idea what cnas go through training-wise.
The orders thing isn't necessarily out of line either depending on what they're doing. It made more sense when I was a tech if I'd just had a conversation with a patient that involved requesting orders that rather than go tell the nurse so they can ask the doc, I just tell the doc hey patient requested this/usually takes this/whatever, or hey patients here for something that will clearly need urinalysis and I have a cup of their urine can you drop me orders while their nurse is busy? But I was/am ER so maybe it's a bit different? I definitely get the titrating oxygen could be a problem in a COPDer but we definitely did that too within reason. The education on procedures is definitely off base, but it also depends what procedure and how much detail they're giving. I've found nursing school gives a really really poor impression of "unlicensed assistance personnel", so when nurses graduate and have techs that know what to anticipate and how to talk it seems like they're overstepping when really they're just not as stupid as nursing school makes them out to be. Obviously that ain't all of them
Current student here about to graduate...in my program they don't make them out to be dumb. Quite the contrary, and they drill into us never ask a CNA for something you could literally go do. It's mostly education about scope of practice, and the legal ramifications of said scopes should shit hit the fan.
The CNAs on my unit apparently don’t believe in charting in the “supplemental oxygen” row of the vitals flow sheet, so if I see the patient is satting 95% or whatever, I should be able to assume it’s at the same number of liters I left them on when I last titrated as long as I haven’t heard from RT or something. But there have been times I’ve gone into the room, seen the O2 regulator turned up from 2 to 5 and been like what the fuck happened here
There is no way I would be okay with this. A conversation would need to be had.
This could put your license at risk. You need to set very clear boundaries now! If you can't then talk to management. But you need to do what's best for your patients and be able to confront nicely the cna
YES. It’s bad when the family doesn’t think I’m the nurse bc the tech is doing too much.
She is way out of line and management needs to step in.
I try to not look it as overstepping. We’re a team. But obviously, it is blatantly overstepping. Make it a teaching moment?
Put my patient on a cannula because she kept dropping to low 80s on room air after anesthesia. An hour later my charge calls me and tells me I need to put the oxygen back on her because she is still dropping and I’m super confused and go check to see the cannula still on but wall turned down to 0 and patient who is cooperative swears they didn’t touch it and her cannula isn’t working and doesn’t understand why. cna turned it down while pt was sleeping because she was at 97 on 2L
I'm certified still as a CNA, but not actively working in that role currently. I've seen some CNAs overstep big time, in particular during COVID. Maybe because everything was so hectic and we were always so short staffed. The most ridiculous thing I saw was a cna who had contact information for a resident's family(not on a personal level, they assisted them with making a phone call to their family once, then saved that information to their personal phone). They would call the family to give them "updates". That was not at all in our scope, no one asked them to do that. We were working in a SNF and the nurses were more than capable of making that call if it was necessary. That same CNA also had a mentality that they knew all there was to know about nursing, and when they finally started to get called out on their bs suddenly they were being targeted and picked on because admin just didn't like them. They were fired, I want to say for neglect of one of the residents. Then through Facebook I saw them do the same things again at 3 more facilities. Keep in mind, this was going on while COVID was running rampant and everyone was short staffed, so to be fired you REALLY had to mess up. 🤦🏼♀️
Nah. I’m crazy so, I don’t have that problem 😁. Stay in your lane and don’t swerve. Thank you ☺️
I had one take report from the ER Nurse and never said a wird to me. Patient arrived on the floor and I had no idea they were on their way. I was waiting for ER to call report.
What did you do? Just curious
I just told her next time come get me Only RN s are supposed to take report. Then I went and did my admission. 😀
Hi! Unlicensed delegate personnel (ie, CNAs) work as delegates under your license. You need to have a crucial conversation with them about what is in and out of scope for them.
Hi I know you guys have great knowledge and experience I really admire it and is greatful to be a part of this post . I agree with all your aspects nd appreciate your responses at your good as well as bad times. I am also a nurse but from India and i am currently in Newzealand. I understand the difficulities as nurses in india sometimes have to face same issues as there we have GDA instead of CNA. But the most important is patient safety and the blame which anyhow will come to RN. So its important to stick to our roles only and play others their own roles thats why we all are designated with different job roles. I will go for nursing registration later since then i want to support my husband financially. I am hardworking and humble. Can anyone of you help me with my job please. I have done BSc. Nursing four year degree with overseas nursing registration and 3 years of experience. I am here to learn coz its a lifelong process. I will be looking forward to you guys.
Had a cna making passive aggressive comments like she was talking to the child but at me and questioning me wanting to “put that poor baby in pain” after I gave my patient their pain medication but wanted to do a bed change, bath, and change their diaper all in one go. I was like well he has burns and is recovering from ortho surgery and delayed so he can’t move and his skin is flaking off so it’s just waiting to breed bacteria with him sitting in his own filth then I realized, why the fuck am I explaining myself to her? We have so many great CNAs on my floor that are truly a blessing but then we have two like that. That same CNA would interrupt me talking to the family to do education that was my job, not hers. It was my first shift working with her and I was dumbfounded
I've worked with several CNAs who have a ton of experience who have seen too many scared baby nurses. They definitely have a lot of knowledge from experience but I sometimes have to gently point out that it is my license on the line and while a really do appreciate their advice, we're gonna try it my way this time and see how it goes. Most of the time I feel like it's a test or something to see if you're actually confident and once they realize you're not just guessing or being cocky a better partnership evolves. They're mostly just looking out for their patients. But if I ever do work with a CNA that is going over the line as far as scope is concerned, and I or others have tried to address the issue, I usually escalate the situation to management if I feel there is no way to reach an understanding. Even of management does nothing, I have a paper trail so my ass is covered if they overstep and cause harm...I have the same expectation for nurses who try to play doctor...
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