NursingLink

I appreciate what your saying. However i think you were way harsh in your words. How would you like it if someone wrote the same thing except saying LPN need to learn their role and no matter how long you've been an LPN it does not give you the right to do the things an RN does. Perhaps the person thought they were being helpflul. As an aide who is now going through nursing school i can tell you often the nurses come to know you and will indeed tell the more responsible aides to go ahead and do certain things. It may not be right but who's realy at fault. I work in an ICU and you can't tell me the aide was able to suction the patient and disconnect the alarm without that patients nurse knowing. Who's fault is it really. I say the nurse as well. I know nurses are busy but it's funny when they need you help some of them treat you as a "cheap nurse" but then are so quick to remind you when you do something wrong that you are just an aide.

First of all i appreciate everything that my aide does for me. Also i was an aide for 5 years prior to getting my license, so I know what it is like to be an aide. But, when i was at that level in my career I would have NEVER thought about suctioning a patient or disconnecting a vent. Responsible or not it was outside of their skill level.

Now for the nurse that was overseeing the aide, she will probably never have any type of disiplinary action taken against her because that would look bad on our company. hopefully, they will make the nurse responsible as well.

I just have one question. How did the aide learn how to do such tasks?

Princess: I think sexy nurse was not harsh enough with her words.

cdnurse: All i'm really trying to convey here is if we want to prevent things like this from happening the the rules need to be clear cut. I think mistakes are made when some nurses get understaffed and busy and allow people to take certain responsibilities that they otherwise would not have. A point i also would like to make is anytime a patient is suctioned or the vent is disconnected the vent almost always sounds alarm a loud alarm. No one would die from a vent being disconnected unless it was left that way for awhile and if it was not hooked back up correctly it still should be alarming. Where was the nurse? In the ICU where i work if an alarm goes off someone investigates! And yes i do think in healthcare we all need to work better together. Remember without the nurses doctors could not do there jobs and without the LPN's alot of places the RN's jobs would be harder and without the aides the small things we take for granted such as baths, personal attention and feeding would not get done. We all need each other and clear cut rules.

Please correct me if I am wrong, but from my understanding I believe the point PrincessQ was making when she said sexynurse263 was "being harsh" was mainly directed toward the blanket statement " I learned that STNA’s need to learn their role a little better!" That statement gives the impression that because of the action of one, all are guilty of such poor judgement. Sexynurse, I don't believe that you believe that yourself. However, the implication is there. (Please don't take offense, but might I suggest an apology to those outstanding NAs operating within their roles, providing great care that the RN/LPN role does not always leave time for.)

I don't think anyone will disagree with you that this assistant was acting way beyond her scope. There are *legal boundaries* she accepted when she became a NA. Did I miss something or should I just assume that the nurse delegated this task to her? By the correspondence above, I am led to believe that this is either what happened or what you believe to have happened. If that is the case, then most certainly the nurse was in breach of her scope by delegating skills not in a NA's scope. If not, the nurse should be reprimanded for not having more control of her team, but I fail to comprehend anything more severe. The NA caused a patient death because she disregarded the boundaries of her role. I believe in second chances, but this person knew the role and disregarded it; her time in nursing should be over.

I hope this discussion point encourages each member on every level of the nursing team to reflect on how we could & should appreciate our fellow staffers. But also, it emphasizes how the nurse really needs to step up, be in touch with her team, & be clear in what is expected.

Oh, and Indiangirl36, you sound way too compassionate to be a lawyer :) We need you to stick around in nursing.

RN2B: i AGREE WITH YOU TOTALLY. I don't really want to be a Lawyer. I Love Nursing! And to squirmals: It can only begin with us. Remember: IT TAKES BUT ONE. If we continue to work together and believe that nursing can be all it can be, then the patients win! I understand completely where you are coming from, and unfortunately there are those few who only come to work to collect the check. Let us remember how true KARMA is. Also sometimes its not what we say its how we say it. So maybe try a different approach. Don't give up the fight for excellence in nursing!

Excuse me, Veronica2008 , but I was referring to RN's I think you should reread my message and truly see it for what it is and then you won't be defensive. I know that the aides work HARDER than we do b/c I was one for 7yrs. Therefore I am well aware of the backbreaking and emotional workload. Did you not realize that squirmals is an RN? If you did then I don't think you would have been as upset. As far as ' collecting the check' I meant the enormous amt of money to be made as an RN, not an aide ( the pay for CNA's is ridiculous for what you all do), since the RN makes a substantially higher amount. My message to squirmals was about ' doing unto others as you would have them do unto you'. GET IT? Its all about caring for the patient and not placing them in harms way just b/c you THINK you have experience. Most nurses are appreciative of their aides, but you still have those few who are just there for the money. I appreciate and respect the aides tasks and the comfort they provide for the patients. The nurse's job is so focused on trying to make sure that the patient is getting the correct med, dose and the outcome and unfortunately we don't have alot of time to spend with our patients. Its not that most of us don't want to, believe me, the vast majority want to have that one on one time but sometimes the patient requires a different level of care and you are so worried about the patient being comfortable and getting relief from the illness that we tend to forget the little things like LISTENING, HOLDING HANDS etc. That's where we rely on you to help complete the care. Just because you may not get immediate recognition know that while we are in report (where you may not be ) alot of us are saying ' I don't know what I would have done without the aide today' From your tone and emotion I can tell that you are compassionate about your work and I apologize if I offended you or anyone alse that is an aide that was not my intent. Let me end this by saying " THANK YOU FOR YOUR HARD WORK EVERYDAY!" If you don't get an ' I appreciate you or a Thank you' know that on this forum we Thank you and whomever else is out there giving their all without being appreciated.

Merry Christmas.

This is such a great site! It's nice to get perspective from so many different people. Isn't it powerful to think that by sexynurse263 sharing her experience further lives may be saved? I have learned so much from the discussions on this site.

Now, might I suggest the Christmas Cuervo Cookies that cdnurse posted in "Break Time; Anyone can make these cookies". Cherry Mistmas!

I'v been a CNA for almost 9 years. I have worked with alot of good nurses over the years. I have help alot of them with D/c foley cathethers, changing colostomy bags etc. Sometimes, the nurses will delegate a duty, that they know, that is not in your scope. I had that happened to me, and got scalded , when I didn't do it, lets be honest everyone, some nurses use nurses aids the wrong way, don't get me wrong, I have helped alot of nurses that were in pickels, everyone has to know their bounderies in their scope of practice, and like I said early in one of my comments STOP FRONTING!!!

I am an aide right now and I am going school for nursing. First of all, I would never do anything to jeopardize the patient. If I am not sure of how to do something, I ask!!!!! We are not perfect but at the end of the day when I go home, I sleep very well knowing I did my best with the patients. No Aide should be doing any kind of procedures they are not qualified for and they should realize, the nurse is not going to get fired because it will make the company look bad and they would be liable for a lawsuit so the aide will most definitely lose her job.

No one should be doing anything that they were not formally trained to do, PERIOD. I think that it is unreasonable for samsrn to say that "JACHO hold us responsible to know the qualification of every person that is in contact with the patient we are assigned, including the docs" We are responsible for the 5 rights. Did you forget that? We can't possibly know EVERYONE'S qualification. It is the hospitals responsibility when they hire someone for a specific job description that the person is able to do it. Hence, this is why we have credentials. As far as samsrn " I get to grade her work " let me remind you that the tech is there to assist you and if you feel that she is incapable then you probably should be doing your work yourself. All the tech should be doing is bathing, T&R, possibly blood sugars, emptying the foley, and taking vitals. YOU ARE RESPONSIBLE FOR ANYTHING AFTER THAT!!!!!! So standing with them to see their work ethics actually should have been honed in on in the interview process, which, you were not a part of. JCAHO holds the HOSPITALS responsible for knowing who they have hired in their hospitals, making sure that they have the correct credentials and have completed the proper training. I wonder how the techs feel that you are "judging" them. I also think that you are taking your position out of context. Albeit true that we are accountable for what happens to our patients, I agree. If the doctor writes an incorrect script, if we give it without checking we are at fault. But the tech is also responsible for the duties she was taught and by you grading them is degrading. You didn't specify whether the tech is an agency person or not and you seem to be biased about agency workers. On the light side, agency workers get paid better and they don't have to deal with in house cat and mousing as they would have to if they were a constant employee. On the dark side, they do tend to be on an " let me just go in, get it done and leave " mode, but the majority are caring people. Just b/c they chose to accept a higher wage and more flexibility they should not be frowned upon. You have the same option as anyone else. Most of the agency people I have worked with chose to do so b/c they don't have to deal with the backstabbing that goes on or constantly be concerned that a "nurse has it out for them". There are many ways to skin the cat, but lets not attack without having all of the info involved.

cdnurse said:

ddxp: Sounds like she did not learn. Otherwise the patient would not have died.

I am an aide working as I attend nursing school. Yes, there are nurses that will allow aides to perform functions outside their scope of skill and job description. I will not do such a thing. I have seen other aides disconnect equipment they know they shouldn't do, and most times, do not know how the equipment functions. I've seen them just pull and turn off things, and then go... uh oh, how does go back together? Most of the nurses I work with would be clearly and understandably upset if something like that were done. It doesn't matter if we know how to set up, disconnect, etc. we are not to do it, plain and simple.

Understanding your scope of practice is critical to safe patient care, protecting your license (or certification), and keeping both your job and your house.

LoveNurisng: there IS a substantial difference between the LPN scope of practice, and the RN scope of practice. RNs learn much more about pathophysiology, learn more advanced skills including in depth assessment, use of nursing diagnosis, and planning of care. LPNs are in a dependant role to RNs. It is not that RNs are "better" than LPNs. It is that their scope of practice is different, and for an LPN to stray from that scope is to invite disaster. The same applies to an RN, a CNA, an NP, or any health care provider. We must all function within our scope.

On a personal level, I do not agree with training CNAs to pass meds. They do not have the structured education in pharmacology or pathophysiology that makes them qualified to pass meds. There is much more to medication administration than the 5 rights and here's your cup of pills. Most med aides wouldn't know how to recognize a potentially serious drug interaction, or know when NOT to give someone their medications. It is unfair to train CNAs to perform this critical skill without the foundation to do it safely. Facilities simply need to wake up and hire more RNs or LPNs to do that job.

Now, don't get the idea I'm putting down CNAs. They are the eyes and ears of nurses, and often recognize something is "not right" with a patient even if they can't specify the problem. When a CNA tells me something is "not right," I listen, because I know that more often than not there is a real problem developing that I need to deal with.

As a nurse, I work hand in hand with my CNAs in the backbreaking work such as ambulating patients, turning, hygeine, feeding, etc. These tasks that CNAs perform are still NURSING tasks. They are simply nursing tasks that can be delegated by the nurse because they are in the CNA scope of practice. That does not mean the nurse should shuffle off to "more important things." There are no unimportant tasks in patient care (though all tasks must be prioritized, of course). I hate a nurse that hides at the nurses station all day and never goes into a patient room except to check the IV or pass meds.

The CNA originally mentioned in this post clearly exceeded her scope of practice. She deserved to be fired, and lose her certification as well. The nurse, however, has minimal liability because the nurse is not responsible for acts performed by those she supervises that she did not delegate. If a nurse had TOLD the CNA to do what she did, then she would be just as responsible because she delegated a task to a CNA that was out of her scope and for which she was not properly trained.