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Any nurse worth their weight in water knows, understand, values and appreciates the function and role every CNA plays in the delivery of our patient care. And yet, I still see RN’s treating their CNA team member horribly.
Here is the best piece of advice I can give to any RN out there when delegating to their CNA team members:
Never delegate out of sheer personal convenience
Too many times I have seen/heard/witnessed an RN/LPN delegate a task to a CNA simply because it was inconvenient for them. We all know the stories and the urban legends of CNAs always doing the dirty work (bed baths & bedpans to name a few), while the RN/LPN walks away. I have seen them answer a call bell, learn that they need to get their hands dirty. They walk back out of the room and call/delegate the task. There are actually individuals out there that believe that once they are licensed, they don’t need to get their hands dirty???
I’m here to publicly apologize to any CNA reading this. Contrary to popular belief, this is not the norm, nor is it acceptable to most of us currently practicing! I still strongly believe that the most important assessment skills can be learned from getting my hands dirty. I learned that from a CNA!
The professional rapport you have with your CNA can make or break your career. I make it a point to strengthen that relationship, because when the going gets tough and the you-know-what hits the fan, my fellow CNAs are often times the ones that keep me afloat.
What goes around comes around folks. If you cannot make the time to get your hands dirty, the CNA will not have the time to keep you from ‘drowning’ in your time of need. It really is that simply. It’s called teamwork.
A nurses’ aide (Certified Nurses Aid – CNA) is the unsung hero of the nursing world. When someone asks what you do, never simply say “I’m just the aide”. When we speak of bedside care and we refer to the ‘team effort’ this part of the team is probably the most under-appreciated, yet most needed team member. They are the silent majority. When they are doing what they do best, you sometimes (more often than we like to admit) forget they are there. But, when they are absent it turns your whole world upside down. Thank you for all that you do!
By the way, this post was inspired by a previous Scrubs post: Top 10 things you’ll need in your CNA survival kit. Be sure to take a look.
The best nurses I know started their healthcare careers as CNA’s. I was a “NA” before the “C” was required, I remember the treatment we got. My CNA’s are my most valuable tool!
Scrubs Blogger
Scrubs Blogger
@John, I was never an aide (CNA), but I agree with your concept absolutely.
Thank you so much for writing this. I am a CNA in nursing school and I am often insulted by the way im treated by most of the floor nurses. Ive been yelled at in front of patients for not being in two places at once while the nurse sat and gossipped at the station! I vow as a nurse I will treat my CNAs like gold..because they are a very important part of patient care!
Scrubs Blogger
Scrubs Blogger
@Teresa Hang in there! So glad you understand the value of the CNAs.
I had this LPN stick her head in a room as I had just come back from showering an obese patient and was drenched in sweat and water tell me to be sure to put powder under her fat rolls. She spent more time telling me what powder to use and where to put it then to actually take the 10 seconds to do it herself. She also wanted to change the sme person’s sacral bandage after a brief change but since I could not safely change the person’s brief myself I asked for her assistance. She pondered helping me but left and said she would just do it when I had found another cna (who was busy with her own hall mind you).
Scrubs Blogger
Scrubs Blogger
@anon Thanks for sharing your story. So sorry.
LVN
Licensed Vocational Nurse (California and Texas)
I worked as an LVN wound care nurse and I couldn’t have done my job without the assistance of the CNAs. I also learned to turn patients by myself because I never felt that finishing my job was more important than any CNA’s and having them stop what they were doing just so they could help me finish my job first. God bless the CNAs!
I am in complete agreement. I could not do what I do without them. A good CNA is worth their weight in gold. I also was an NA then an LVN before I became an RN.
Scrubs Blogger
Scrubs Blogger
@Evelyn Absolutely!
I was a CNA, LPN and now an RN and my nurses’s aids are my eyes and ears. They see and hear things before I do sometimes without them my job is twice as hard. Don’t ask an aid to do something you aren’t willing to do yourself. God bless all CNA’s.
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Scrubs Blogger
Scrubs Blogger
@Alana Well said!
I was a CNA, LPN and now and RN and my CNA’s are my eyes and ears. They see and hear things most times before I do and without them my job would be twice as hard. Don’t ever ask a CNA to do something you aren’t willing to do yourself. Just saying…
thank you for supporting us cna’s .almost all of us including myself pride ourself’s in the work we do.
Scrubs Blogger
Scrubs Blogger
@colleen you are welcome! Thank you.
I greatly appreciate and thank you for writing about CNA’s and the work we do! Too many times I have witnessed RNs who do not understand that we are here to “enable” you to do your jobs more efficiently, not to make it “easier”……..there’s a difference between the two. I hope more will read what you have written and incorporate it into their daily functions!
Scrubs Blogger
Scrubs Blogger
@Kim You are very welcome. “are here to “enable” you to do your jobs more efficiently, not to make it “easier” – well said!
I have seen many an RN treat LPN’s this way too!
As a matter of fact, it is the main reason I am working from LPN to RN now.
I am tired of Rn’s treating me like dirt and having to prove their “power”. I hope to set a good example when I get my RN & all my former
CNA’s said they would be glad to work for me.
Scrubs Blogger
Scrubs Blogger
@Suzi as a current RN I look forward to you starting your new role! Hang in there! And thank you.
@sean- thank you for your compassion. Sadly my experince as a cna at the ltc location aforementioned has convinced me that I will not be a floor nurse (I love the elderly). There was so much negativity amongst the staff, a SERIOUS lack of management, and frankly just a depressing environment because most of the residents got the bare minimum treatment. It’s a shame too because I really love the elderly and was really looking forward to improvong the resident’s quality of lives. Also in my clincal experiences I feel like floor nursing is chaotic, disorganized, fatally flawed, and… Hostile. After I have my RN I will probably just continue my education and eventually work in administration or policy.
RN
Registered Nurse
I can tell you that not all places are like that and there are some places who give quality and quantity of care to their patients. I have worked in negative environments and we turned it around as the staff. I heard a lecturer challenge a group of college freshman who were complaining about the government, their city, their state, etc. “They suck!” She turned it around on them and said “Maybe YOU suck!” All depends on your perspective.
CNA
Certified Nursing Assistant
They need your compassion. Please don’t let some negative nellies push you to administration if that’s not your true passion. The elderly get the short end of the stick so often.
Scrubs Blogger
Scrubs Blogger
@anon I’m sorry to hear about your negative experiences. I CAN tell you that we make our own experiences with each step in our career. I hope you find what you are looking for. Best of luck.
Student
Nursing Student (you can change this when you graduate!)
I wonder why cna s get paid so little for doing more work than anyone else? I was a cna in a ltc and got laid off at the beginning of the recession. I had been the last one hired. I had to move states so that I would be able to start my two years of certification over. I still have not found a job. The only one job that I was offered was for $7 an hour. That’s less than minimum wage and they were only offering me six hours a week. I am in school for my rn, just started, and I have tio take odd-jobs just to slip by. My certification is expiring in a month and then I’ll have nothing
RN
Registered Nurse
Great article Sean!
I, too, started out as a “Nurses’ Aide’ and worked my way through a 2-yr. RN program. The one thing I would add is: Never Ask Someone to do What You Are Not Willing to do Yourself!
Honestly, I have, on quite few occasions picked keeping my unit’s CNA OVER an RN who did not know the ‘territory’.
A good experienced CNA is invaluable to the rest of us!
Student
Nursing Student (you can change this when you graduate!)
Thank you so much for this post!
There are so many times that I dread going into work because I just know my busy day will only be worsened by a nurse who is too afraid of hard work.
I am very thankful to be an aide and when I finally graduate nursing school I will appreciate and respect every CNA I work with.
CNA
Certified Nursing Assistant
As a CNA, we can pretty much tell if our nurse has been an aide or not. I had one nurse tell me that “it was not in her job description to be nice to the aides or to make their jobs easier.” Needless to say everyone hates her, and she is always wondering why she cant find anyone to help her do her work.
RN
Registered Nurse
May I just say – bwahahahahahaha! Love it.
RN
Registered Nurse
Sean,
I could not agree with you more. I spent a great deal of my nursing career teaching nursing assistant courses. The folks who come to this job are not looking for a huge paycheck. They care for patients out of personal love and kindness, and choose this area of nursing because they honestly care about people. My advice to all nurses is to embrace these angels, and NEVER ask them to do anything that you (nurse) would not be willing to push up your sleeves and do yourself. They can be your most wonderful asset, or your biggest adversary. You choose!
RN
Registered Nurse
Absolutely. Never ask someone to do what you would not do.
RN
Registered Nurse
When I worked in the hospital, our CNA’s were the backbone of our team. I would have never survived some of my shifts without their help and dedication to our patients.
LVN
Licensed Vocational Nurse (California and Texas)
I have had the privilege of having the best CNAs, but they respond best when you treat them as human being. many are just lazy but still respond if you let them know what is expected of them during your shift.
RN
Registered Nurse
TRUE. It sounds like you also worked on the other side of the equation, as did I. I literally have heard people say “I’m an RN, that’s not my job.” to which I reply – “Yes it is! Did you not read your job description? ‘and ANY other duties as assigned.’”
RN
Registered Nurse
I think that while an RN should not be just avoiding helping people because it’s CNA work… CNAs should also not assume that a nurse who delegates something to them, is doing so for that reason, either. I have worked as a CNA, and now I am an RN, and on occasion, when I have been walking down the hallway on my way to attend to something, I will poke my head in where someone’s call light was on, to see what they needed, and then flag down an aid, if they needed to be toileted, etc; because while CNAs do a lot of work, and I can do parts of their job…. they cannot do mine. At the end of the day, I am responsible for a lot more dimensions of care than the CNAs under me are, and making sure that my patients get their meds and their treatments, and their new orders processed and their families notified of important changes, etc, is more important than me doing part of the CNA’s job, unless I have free time to help them, and am not otherwise occupied. I’ve been a CNA, and I know what it’s like- and that’s why I also know that it’s not impossible work. I’ll help if an aide asks directly, but often, I stay late charting in the first place, because i didn’t even have time to sit to chart during my shift- so no, I don’t have time to do what I delegated to you.
Thank you for taking the time out to write this! I was an NA in the late 80′s, a CNA in the early 90′s. I took an 18 year break from nursing for many reasons of which one was the way I was treated. Now I am an LVN and start school again in the Fall for my RN.
Just out of personal observations, some of the best nurses started as NA/CNA’s.
I think LVN/RN’s can all agree that we would be lost without the strength and compassionate care provided to our patients by of our CNA’s.
Hugs to all CNA’s xxxxx
RN
Registered Nurse
WOW, Sean! You hit a Grand Slam with this one! Congrats!
Scrubs Blogger
Scrubs Blogger
Thanks Rene!
I have CNA,Rn’s & LPN’s working in my home and had an LPN look at the CNA and snap her fingers said clean up on isle 5. I was horrified she had said that to the person that has more hands on with me and spends 6hrs./ day with me to her 45 min / day. I made it very clear that she was no better than my CNA!!! You all are very valueable to me and my care. THANK YOU!!!
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Student
Nursing Student (you can change this when you graduate!)
I appreciate this article being posted. I am not a CNA- I am an EMT Intermediate. I essentially have all the qualifications of a Paramedic except there are several cardiac medications I cannot give.. however, I am enrolled in Nursing school and working in a local Trauma/ER as a Patient Care Tech. The majority of the nurses treat the tech like they are ignorant. I have many times brought to the attention of the primary nurse a significant vital sign change or change in mentation of a patient, only to be looked at like I am inappropriately overstepping a boundary by advocating in the patients best interest. I have witnessed a nurse chart a respiratory rate of “18″ for an adult patient who I witnessed breathing close to “38″ times a minute- when I asked her about it she went on to give me education on how DKA patients often breath fast… This is something I already knew and the unwanted advice did nothing to clear up the question of why she was falsely documenting a vital sign on a patient who was – as she said – in DKA and hyperventilating. The majority of the other ER techs are phlebotomist or CNAs that are cross trained to start IVs, draw blood, perform EKGs etc and I see them getting treated worse than me. I have seen even the strongest nurses trick these other techs into doing things that clinically should not be delegated- because the nurse didn’t want to get up and quit texting on her phone. I agree with other CNAs who have posted- this gives me an exact indication of the type of RN I never want to be. It is sadly a large majority of the nursing staff, not just one or two and not just one one shift. It is unacceptable and I wish more nurses were aware and recognized this as an issue. Some of us have clinical background- I am licensed on an ambulance to assess, treat, medicate, diagnose, intubate and trasnport any patient of any age – trauma or medical. I have worked more codes in the past 8 years than some veteran RNS have in their entire career. It has been a very eye opening experience to see how I am treated and I appreciate the rare oppourtunity I have to see it from this position so that I can have even more respect for the CNAs when I become an RN. Because, like many nurses mentioned on here- when the going gets tough- the CNA is who keeps you afloat and typically knows what you need before you know you need it!!! Thank you for posting this issue!
As an RN, I loved my CNA’s and ER techs. They were team players and I could not have been a strong PCU nurse without them. I often bought them lattes from our coffee stand, and whenever appropriate I would openly acknowledge their contributions. Give credit where credit is due, CNA’s are worth their weight in gold. Our strongest CNA’s often got my “Go to nursing school!” lecture!
I worked as a CNA in a hospital, but quit my job because I was treated like crap by 3 of the nurses I worked under. Have my own business taking care of people in their homes and going to school to get my nursing degree. I wil never treat my CNA’s the way I was treated.
As a three yr CAN in my pre-core, I appreciate the chatizement of not “just the aide”. I. Have had the priveledge of working with 30< vetran nurses who wouldn't tolerate me calling myself "just the aide"
I also have worked with rookie nurses who had the education, but the fear of being hands on. There is a huge difference between the nurse who says they know what to do, and the nurse who walks away having done it.
I appreciate all aides whether NA’s or CNA’s. I was NA for 3 years prior to becoming an RN and being appreciated went a long way! Thank you’d go even further! So for all the aides out there. THANK YOU!
My daughter is a CNA on a bone marrow transplant floor. She works hard and loves her patients and her nurses and they love her. However, it is hard to make a living being a cna. She has been with this hospital since March 2011 and got her first raise in August 2012 and it was 13 cents an hour even though her review was excellent. She was crushed because she loves what she does and loves the one on one patient care. It is sad that the jobs that are so important pay so little. I told her she needs to go to nursing school but she said the nurses do lots of paperwork and do not get to spend as much time with the patients. They are on the phone with the doctors and such. She was crushed. Thank you cnas for all you do! Where would hospitals be without you!
RN
Registered Nurse
After working in a nursing home on a division where I could have up to 28 patients, I really understood how important my CNAs were! Often times my division would be short an aide and I would be left with 2 CNAs and myself, along with the Med Tech who was busy passing meds on 2 divisions…not once did I ever just sit around and delegate simple tasks that I could do myself to my aides! Every aide I worked with thanked me for helping them with stuff, and always told me how none of the other nurses would even dare to help with some of the simplest things! I was just appalled! I have only been a nurse for about a year now, but never will I just leave my CNAs hanging, I couldn’t do my job without them!
APN
Advanced Practice Nurse CRNAs, CNMs, CNSs and NPs
I started my career as a CNA, then went on to be a SN in both the floor and ICU environment. I remember thinking that when I graduated I never wanted to be treated the way I was treated or be thought of as lazy. I got my RN in 2009 and have worked as at 2 different locations at an ICU. One was a step down/ ICU unit in one with an acute side and a subside. Out of the 7 CNAs in that hospital unit only 2 helped out. One actually would verbally abuse both nurses and patients but due to the union they were a part of nothing could be done I was told. While one of my patients arrested and I was at this bedside on the subside that night, my other patient called several times only to have the calls hung up. As a result this patient called 911 and managed to fall attempting to get the bedpan. All the while, the CNA was reading for school at the nurses’ station and I was pushing meds in another room slowly coding my other patient. I filed a complaint and soon after left the job. I felt it was unsafe to have no help. In my current job, I experience the same situation. I bathe my own patients, QC my glucometers, stock my supplies and linen, call for environmental services when needed, and get my own EKGs and lab draws. There is only one CNA on our unit that will actually help. Most of the time the charge nurse will help with turns or we ask each other out of fear that we will a) get verbally abused b) it will not get done. I guess my point is that it happens in both spectrums depending on where you work. My experience the last 4 years with CNAs has been negative to say the least.
I have read most of the comments posted and agree, Just like the RN is the eyes and ears of the MD, CNA’s are the eyes and ears of us RN”s and are at the foundation of good patient care. I am a pretty new RN and have been working in a LTC facility for the past 10 months. Taking care of 20 to 23 patients sometimes makes you feel like only a pill pusher, allowing you not as much time to do the vital assessments as you would like. I do try and help out my CNA’s when I have the time. (and sometimes when I dont because the resident is in immideate danger – which makes for those “crazy shifts” that all nurses just LOVE…) On VERY rare occasions am I able to take the two 15 minute breaks and sometimes do not get my 30 minute dinner break because I would rather see my family rather than stay 1 hour or an hour and a half after my shift ends ( especially when my shifts supposed to end at 10 pm at night and my stop time is at 1130pm at night, with a daughter that gets up at 0630). This is part of the RN world that many do not think about. Sometimes it feels like the paperwork never ends and those 8 to 12 patients you have to write a narritive on ( usually a paragragh and a half to two paragraphs, if you REALLY want to CYOB from legal liability) are never going to get done. Or the 3 lab draws, 10 head to toe assessments/10 Vital Signs, and the 5 skin assessments you have to get done before you med pass for 20 to 23 residents( Including the 6 residents with Accu Checks and coverage) starts 2 hours into your shift. Then starts the 2 hour med pass , which this WILL take you 2 hours if you are very dilligent about your pass, with those 6 resident you give insulin to. This is half of my 8 hour shift. Then you MAY get an hour of calmness to start charting on your residents, which take approximately 8 minutes a piece if you go into the specificity you are supposed to on why they need our care, what assessment, intervention and evaluations you did to help that resident( Indispensible for getting reimbursed for care from private pay/medicaid for resident care). Easily an hour and 1/2 work of paperwork. Then another med pass starts and if you work 2-10 that means another 23 people to pass pills on, which may take an hour and a half if your lucky with another round of 6 accu checks and coverage.By the time your done with this workload, you have an hour and a half to fit in your 30 dinner and to finish charting on 4 – 6 more residents. Leaving you approximately 15 to 20 minutes in the shift as “down time”….of course, you havent cleaned off your med cart, restocked it or replaced meds and write down on a pharmacy reorder sheet which meds you need….damn, there goes another 15 minutes….This countdown doesnt even include when you have an admit, someone falls, or someone needs immideate intervention which can happen at any moment on ANY shift. Helping aides is important,but I hope they remember in turn an RN”s usual schedule and what all he/she HAS to complete during thier shift for the team that only they can do as an RN and come in under the dreaded OVERTIME for the company. Sometimes RN’s feel undervalued and scathed upon because we HAVE to delegate those things that a CNA can help us with….myself and the other 2 to 4 nurses on the floor are the only ones who can complete our assessment or provide the interventions needed by the patient….and they have their own patients as well. In my point of view its not really about how much nurses help out their CNA’s, but how much the TEAM is willing to lean on eachother to get the things done that need to be done. Just remember the RN has ALOT on her plate as well and is under ALOT of pressure.
RN
Registered Nurse
I appreciate our CNA’s greatly, they are awesome, efficient and keep our unit rocking!
LPN
Licensed Practical Nurse
I was a CNA and I am now a LPN I value my CNA’s and they know it….they are totally under appreciated and a much valued part of the team…thank you for all you do
RN
Registered Nurse
I am an RN but I don’t treat my CNA/LNA that way. They are an important part of the patient care team and I do appreciate them.
I work in nursing homes and I love CNAs. I just wanted to voice my appreciation for them. I also worked at a hospital and appreciated my Patient Care Technicians!
I’m really glad to see so many nurses really appreciate their CNA’s. I’m working as a CNA while going to VN school and plan to continue on to RN. I’ve heard many nursing students say they want to be a nurse so they don’t have to do the dirty work. I have been quick to remind them they don’t want to become the nurse we CNA’s hate to work with. Ultimately the patients are the ones that suffer when the nursing staff doesn’t work as a team.