Nursing Assistants

Your facility may call them CNA’s (certified nursing assistants) or PCTs (patient care technicians or “techs”), or something else.  For the ease of writing, we’ll just refer to them as CNA’s collectively for the moment.  Most nurses are very familiar with this position so we aren’t going to dive into what they are, but more so how you can work with them, maximize your time, and minimize hiccups. 

In many units, CNAs are responsible for obtaining routine vital signs, blood sugars, assisting with meals and ambulation, turns, skin care, etc. They are assistive personnel, so it is ultimately the nurse’s job to ensure tasks necessary for their patient are completed. The best way to do this is to stay in good, respectful communication with your CNA’s. 

What this looks like

If you’ve got a patient with specific blood pressure parameters and need to know ASAP if it’s out of range, make sure you tell them that. While we would assume that a patient with a new BP of 189/92 would necessitate a nurse notification, not all are aware of the danger of that reading.  (Yes, they should be, but that’s not always the case.)  And if it takes them a little over an hour to round on all 15 of their patients and get vitals, it may be that long before you realize the pressure. 

If you have a patient who is notorious for not letting people know when he or she has ordered lunch and blood sugar checks are missed frequently, give them a heads up.  

If your level of urgency changes, meaning everything was fine/routine a minute ago and now you need them to help you quickly, communicate that. In the cardiology world, this can happen in the drop of a hat or beat of a heart (literally). You may need to be assertive, which can come off bossy. If you think you were a bit rude or intense in a situation, especially to a CNA or new nurse, circle back after just to clarify that you weren’t trying to be - things just got real! 

We’re not all great at communicating respectfully in high stress situations, especially when we’re learning simply how to be in them and keep our cool. Cardiac ICU and the cardiac floor, as well as the ED, are environments in which stressful situations happen very quickly. You’ll get used to codes, ACLS protocol, and all that jazz. But it will take time; we just don't want collegial relationships to suffer in the meantime.

Nurses have great poker faces, and couple that with this assumption that everyone can pick up on your stress level/need for support, and unmet needs lost in translation can result. Please let people know if a patient isn’t doing well and you need people to drop what they’re doing and come help. Or, if you are drowning and need assistance, ask. Please don’t wait for someone to notice how far behind you are, how fast you’re moving, or the overwhelmed look on your face. Everyone is so caught up in what they need to do that we frequently miss these subtle signs. Successful well-functioning teams over communicate with one another. This means checking in when you’re caught up, helping out, seeing how you can consolidate tasks to become more efficient and help out others. At the beginning, you’ll be pretty consumed with learning how to function, but as you become more efficient you are then able to manage your time in a manner that enables you to help out your coworkers. 

If you’re not sure if they’ve completed a task, just follow up in a matter of fact/business like tone. 

“Hey, did you get that blood sugar on Mr. Smith in 17?”

“Mr. Smith’s food should be here any time, can you grab that blood sugar on him?”

“Mr. Smith is ready for his bath whenever you’ve got time this morning.”

Please don't feel like you're bugging them or adding more work to their load. We all have responsibilities related to patient care, and this is how it is facilitated.

Gratitude

Don’t forget to say thank you. While we realize that people will respond to extending gratitude for someone simply doing their job as unnecessary, when you work in such a dynamic, unpredictable, and stressful environment, gratitude and recognition goes a long, long way. 

A nursing unit is like a basketball team, and when your teammate makes a great play, or is clearly working hard and diligently, or saves your butt, say thank you.  Again, we all have great poker faces and sometimes you have no idea how terrible a day someone is having and if they’re barely hanging on by a thread. A simple thank you or recognition can make the biggest difference to someone. 

As the new nurse on the unit, you won’t be a leader right away or running the show, but extending simple gratitude to people is an easy way you can positively contribute to the team dynamic.