A post to CNAs

I want to start out by saying I am very thankful for all the hard work CNAs do, and I am lucky to have worked with some really great aides. But there are a few things all CNAs need to understand:

Some nurses don’t appreciate the work you do, talk down to you, delegate any and all tasks they can. I get that BUT it’s not the majority of nurses so stop acting like it!

Every single healthcare provider feels overworked, underpaid, and under-appreciated – and we are.

You work under my license. I am responsible for you and what you do. The responsibility of care is on me. Yes, you can be fined and have your licensed revoked by State but usually a nurse will go down with you.

Education – CNAs coursework is 75 hours, the minimum to be an RN is an associate degree (2 years) these are requirements for the state of Iowa, your state may be different.

Even if you are in nursing school you aren’t a nurse. Yes, I want you to come to me and tell me if you have any concerns about any patient. I don’t even mind if you want to offer an opinion. But you are not the nurse you don’t get to call the shots and do not stand there and try to explain things to me. And by me not wanting you to explain things to me, I don’t mean the person’s condition I mean I don’t want to hear your last lecture from class. Been there, done that, graduated. You have no idea what it’s like to be a nurse until you are one. You will realized how much more you need to learn from being on the job and how irrelevant some of the stuff you learned is. Reading it out of a book vs. doing it in real life can be totally different. I have years of nursing experience on you, let me do my job.

Nurses don’t just ‘sit around’. I hear this one a lot from CNAs, how nurse’s just sit around, how our job is so easy, that CNAs work so much harder than nurses. And I just laugh, every time. To be honest, if you’re not a nurse you have no idea what we do. Many times I have had CNAs that have became nurses or even med aides say they didn’t realize how hard nurses worked until they were there.

Our jobs are not the same; I can do mine and yours, you can’t do mine. I am capable and qualified to answer call lights, give baths, change beds, help people with ADLs, etc. But if I spend all my time doing that, whose going to do my job? Who will pass the pills, do treatments, document, call the doctors/lab/family/etc, transcribe and implement new orders, do assessments, etc? Not the CNA that’s not within your scope of practice.

There is a lot of responsibility as a nurse, so it may seem like we are being ‘bossy’ at times but it’s to ensure the best care for the patient.

We are a team we need to work together, not two teams playing against each other.

Nurses are truly thankful for what you do. Without you it would make for some really long days.

Now, I think it’s important to let you know what type of nurse I am. I have great relationships with most of the CNAs I work with. I don’t act like I’m better than the aides and I listen to what they have to say. I don’t jump all over them 2 minutes after a call light comes on. I don’t constantly tell you what to do or stand over your shoulder. You have a job to do and know how to do it, as do I.

work together

How to Really Work with Doctors.

As I was reading though blogs today I can across an article titled Working with Docs written by a fairly new nurse. It was written like there was a strict protocol needed in order for a nurse to call a doctor, how doctors are on a different level – untouchable, and made it sound like unless your patient is coding don’t bother calling. This is NOT what new nurses need to hear. No doubt she did make some very good points about what you need to do before calling the doctor such as having the patient’s chart, recent vitals, labs, and med list available before you call and knowing if anyone else needs to talk to the doctor before hanging up. She also touches on how in the beginning it is so nerve-wracking to call the doctor- which is totally true. In reality a good portion of what was written was relevant and pertinent information. But one paragraph was not. It was almost written in a degrading meaner towards nurses. Here it is:
“Doctors are very, very busy.  Do you think you’re busy as a nurse?  So are docs, but in a different way.  They work on less sleep with much more responsibility.  We get to clock out and completely forget about the patient’s we just took care of.  They are on call overnight and still expected to come in the next morning, even if they were in surgery for hours or had to come in for a consult overnight, then come in the next day to round on all of their patients. Don’t immediately page them with every single question.  Don’t you hate 10 calls/questions when you’re trying to assess, document, and medicate your patient?  It’s the same thing with doctors.”

I would just like to point out some things. Nurses are very, very busy. Yes, I am a nurse, and I am busy when I am working. Yes, doctor are busy as well, but I don’t see how it’s so different. And they work on less sleep? Why would a doctor automatically work on less sleep? Especially when they aren’t working shifts. Plus it’s not like the same doctor is on call night after night. And seriously, how often are they called in? Obviously this will very by geographical area & type of hospital. And I would say level of responsibility is pretty even. Since nurses do almost EVERYTHING for the patient they are responsible for doing it and making sure it’s correct. Just because a doctor ordered something doesn’t mean it’s correct. Even though the doctor order something YOU as the nurse are just as responsible if something was incorrect and still given/completed. Because that’s part of the job, you’re supposed to catch it. But the line that really bugged me the most out of this whole post was “We get to clock out and completely forget about the patient’s we just took care of”. What what WHAT!? I don’t think most nurses are sitting there watching the clock to run out the door & we don’t just forget our patients. We bring our work and feelings home with us. Doctors see/deal with way more patients than nurses do, so let’s be real they aren’t sitting at home thinking about some patient. And they aren’t patiently sitting at home in case they are called in, they’re off do their own thing. Nurses are on call as well, don’t forget that. Especially surgery nurses, as doctors and surgery was pointed out in the original post. AND TO ALL THE NEW NURSES READING THIS: IF YOU ARE QUESTIONING SOMETHING OR HAVE A GUT FEELING – CALL THE DOCTOR. Don’t let people with this same opinion that doctors are untouchable scare you. It’s the difference between life & death. Yes, don’t call the doctor for something stupid that can wait, but if you’re worried about something do it. Doctors are just people and they are no better than nurses. Once you realize this you will be set. And yes, getting 10 phones call while you are busy with patients is annoying. But for real, we as nurse put on out big girl/boy panties and deal with it. Plus, you’re not generally calling the doctor 10 times in a short period of time anyways. Doctors will call or talk to nurses for their opinion, because they are the ones dealing with the patient on a daily basis. And you are aloud to question medications and order, but do so with caution. Don’t question an order because you want to play doctor, but do question an order if say the patient is in renal failure and the med shouldn’t be given to anyone with kidney problems. We have all helped each other out. Doctors have said that nurses saved their ass nursing residency and into their first years of practice. Remember your first days on the job and how unprepared you really were? Well doctors are the same.

I guess my main problem with this was that it makes it sound like you should never call a doctor. That’s not the case, and new nurses need to know that it’s OK to do so. Doctors and nurses are on the SAME team, we all work together. Before calling the doctor I always consult with my coworkers to make sure we have brainstormed everything, but then I call if necessary – no big deal. But you do need to have your information ready and know what you need to say/ask. Most doctors will sound like you are bugging them when you call, but whatever don’t let it bother you. Just be respectful and get to the point. Being on call and receiving phone calls IS part of a doctor’s job and they knew that going into med school. Plus, whatever they’ll get over it.

Pass NCLEX the First Time.

So you’ve done it. You’ve finished all the classes, completed all the clinicals, and passed the final exams. You sent off your transcripts and like $600 bucks. You anxiously waited for that letter from the Board of Nursing. You’ve selected a date and time. Now, what? Take a deep breath.

Now I know everyone learns differently and certain things work from some people and not others. I personally think paying for a study course is not worth it. Trust yourself. YOU completed all the classes and course work. YOU made it. YOU can do it. I’ll be completely honest with you; I didn’t study for my LPN boards or RN boards. And you know what? I passed. Both times. Easily. I’m not trying to brag and I’m not saying you’re not cut out to be a nurse if you don’t pass the first time. But think about it: NCLEX is over ANY subject nursing-related and can be a variety of different types of questions (multiple choice, select all that apply, put in correct order, diagrams, etc). Oh how I hate ‘select all that apply’ questions. How do you study for that? Really? Seriously, somebody tell me. Just re-read all your textbooks? Or pick some subjects and pray to God that’s what happens to be on your test? Plus, since NCLEX is a test from Hell if you start doing bad in a category or even on a type of question it will give you more of that type of question to make sure you know you’re stuff.

My advice to you is to trust yourself. And your gut. I don’t know though, can your gut be trusted? Anywho, use your common sense. That’s what it’s all about. Sure you have to be book smart. Uh-hmm memorizing all those abbreviations and lab values. But what it all boils down to is common sense.

So you’ve arrived at the testing facility, where they will treat you like a giant cheater. Even after the photo, fingerprint, palm vein scan, and strip search, ok so maybe they don’t strip search you but they might as well. Geesh. Ok, they’re pretty nice, but seriously they have to assume everyone is a cheater.

The NCLEX-PN has a minimum of 85 questions and a time limit of 5 hrs. The NCLEX-RN has a minimum of 75 questions and a time limit of 6 hrs. Yes, because you’re wondering NCLEX-RN is harder than NCLEX-PN. For my NCLEX-PN I had the minimum of 85 questions and it only took like 30-40 minutes. For my NCLEX-RN I had a little over 75 question and took 40-50 minutes. You continue to get questions until NCLEX is able to be 95% certain you’ve achieved the passing standard. So if it shuts off right away then more than likely you passed unless you did TERRIBLE and I mean like terrible terrible. They’ll tell you in school that you can just randomly get all 235 questions but I have since read that in fact that is a myth and that the only way you get all the questions is if it has taken you that long to achieve the passing standard. So I don’t know for sure which is true.

Also at some point you are offered to take a break. I don’t really know much about this because I finished my tests before the break screen popped up. Unless you really need a drink or have to poop or vomit, I recommend skipping the break to stay in the zone.

Ok, so you’re probably wondering where that info about passing the NCLEX the first time is. Well here we go. Start off with a deep breath. Then take each question one at a time, once you’ve answered one you’ve answered it, don’t continue thinking about it. And please, for the love of God, don’t sit there and stare at the same question for 10 minutes. If you didn’t know it in the first minute, I highly doubt you’ll have an epiphany and remember 7 minutes later.

1. Common Sense. I believe you can answer every question using this method! Especially use this for the ones that can’t be answered using the ABC’s of Nursing or Maslow’s Hierarchy of Needs.

2. ABC’s of Nursing.
ABCs You will have many questions about triage. Which patient will you see first. Most of these questions can be answered by the ABCs. You see the patients with airway problems first, then breathing, then circulation. But some of the questions won’t have patients with a diagnosis that pertains to ABC but use the same concept. Would you see a patient with a broken leg with a pain rating of 6 or a patient who is jaundice with a fever of 100.9?

3. Maslow’s Hierarchy of Needs.
needs needs with picThese are both of Maslow’s Hierarchy of Needs. One lists each category and what type of stuff is included in each category, the other has small pictures to depict what goes in each category. I’ve included both because some people remember better by seeing pictures and being able to related back to it. Basically you take each question and figure out which category it would fall under. Obviously, the most important is ‘physiological’ and moves to the top towards the less important categories needed to sustain life.

So you’ve completed the test. WOO-HOO! Go on take a big sigh of relief. But here comes the most antagonizing 3 days of your life. And for real THREE days exactly. Like 72 hours. You took your test at 2:30pm? Don’t bother looking online (or calling in) at 12am, 6am, 8am, 10am, 1pm, sit back and relax til good ol’ 2:30pm my friend. You will more than likely have a lot of anxiety during this time. And you will probably feel like you failed. I’m pretty sure this is natural. Remember patience is a virtue.

In case you don’t have any patience. Like most people. You can try the NCLEX trick. But I can’t ensure it’s accuracy. I didn’t do the trick for my LPN boards but I did for my RN boards. It did indicate that I passed my RN boards, which I did.

Good luck all you future nurses!