Hello,

By way of explanation to the largely UK members of the group,
"CNA" in the USA is not a professional level nurse and is not licensed or
registered. Nor, in any way comparable to (pardon the older term) SEN of
several decades ago. "CNA" is a "Certified Nursing Assistant" with
basically a school term length of training (weeks, months) and is typically
employed in low-level, low-wage home care of elders at home, and sometimes
in nursing homes or hospitals as care attendants, bedmakers, or "sitters"
who continuously observe patients at risk, then to notify the professional
nurse. Confused elders often refer generically to "my nurse" without a
clear understanding of the distinctions, between the occasional clean,
dress, get out of bed care of the CNA and the health assessments of a
Visiting Nurse. There is no autonomy in making decisions for which they are
not trained.

It appears that here what was sought was a familiarization only
with the superficial aspects of reconnecting the patient's Oxygen
Concentrator, etc., as might happen if the patient was disconnected at
intervals or accidentally. This is the sort of task about which the lay
family members should have been oriented when the machine was installed. I
can see that due to the extreme reliability of the machines, the family
might in the interval have become vague about the details and turned to the
care attendant for advice. This orientation would ordinarily have been
provided by the oxygen vendor's technician at time of installation, and
some written literature and phone number left for them. It is reasonable
for a CNA to have a need to know how to help the family in the same manner
in which they had been trained with the machine, without exceeding the
remit of their own training.

It is commendable that this person sought information, although
the request should more properly have been transmitted through the
employing agency, supervising nurse, the vendor's representatives or
literature with the machine. (The vendor has an ongoing obligation to
help.) I would imagine that this person happened across this list by
happenstance, and asked for help. It is unfortunate that the reply, while
correct in principle, was not given with an understanding of the
particular circumstances of the jobholder. While not negating the
principles expressed, I, personally, was taken aback by the reply which
seemed quite harsh, and off-putting to someone who clearly wanted to be
appropriately helpful but might have received a fairer reply from local
sources. With the Internet, people are not always aware that they may be
opening discussion with someone an ocean away who does not understand the
local situation. A more-to-the-point reply, noting the Texas (postcode)
origin, might have simply redirected them, as suggested above, without
taking responsibility for online instruction.

The UK NHS has led the way and provided many excellent models for
domiciliary care, health visitors, district nursing, etc., from which the
USA has been able to borrow. I hope that this "translation" will be of use.

Sincerely,

Tom Trimble, RN CEN


At 08:21 AM 7/21/2006 -0400, you wrote:


>Thanks Euan, what I find hilarious is that there is always one nurse in the
>arena who believes there are short cuts -I am really glad I am live in the
>UK.
>A nurse unable to do a certain task such as hook up 02 would not be allowed
>to do it and would be encouraged and supported to learn
>
>If I was an assessor/ on a registration panel I would actually remove nurses
>who take short cuts from the register for one year and send them back to
>school
>
>There is absolutely no way this is acceptable and if nurses don't like it
>then tough.
>
>The patient comes first and if as a practitioner you are greedy and work day
>and nights without care for your patients well being then you should try
>another profession.
>
>Some nurses do work overtime and moonlight and are very competent. But to
>ask how to hook up as you couldn't be bothered to take a day to learn that
>freaks me actually.
>
>Fenella
>
>
>
>In a message dated 21/07/2006 13:15:13 GMT Daylight Time,
><mailto:euan%40euanandirene.worldonline.co.uk>euan@....\
uk
>writes:
>
>Why are you getting at Fenella? You made a request to the group for
>information to help you look after a patient using equipment and
>techniques you were unfamiliar with. When Fenella made the absolutely
>correct comment that you should make the effort to learn the skills
>required to do your job without endangering your patient or
>registration (licence in USA?) you have become huffy. You have now
>decided that it was not that hard to learn, but the whole point is
>you should not have put yourself or allowed yourself to be put in,
>the position where you are trying to learn a practical skill on-line,
>look for further information yes, but not "how do I do this"?
>
>Euan
>Emergency Nurse Practitioner
>
>--- In _emergency-nurse@emergency-nueme_
>(mailto:emergency-nurse@yahoogroups.com) , "mizbap007" <mizbap007@.mi>
>wrote:
> >
> > First off, this was no joke... Second, I learned it a work and was
> > not that hard.
> >
> > have a good day.
> >
> >
> >
> > --- In _emergency-nurse@emergency-nueme_
>(mailto:emergency-nurse@yahoogroups.com) , "Fenella"
> > <organiclemon1000@> wrote:
> > >
> > > You cannot surely expect to skill up like this online???. This is
> > not
> > > a joke-you should have formal training in this and its both you
>and
> > > your employers joint responsibility to ensure that you are
> > competent
> > > for the work you are about to do. You have a duty of care to your
> > > patients first and foremost and should not attempt to handle
> > > equipment you are not trained up to use.
> > >
> > > Sorry I think its highly selfish and irresponsible going to work
>on
> > > your own in an area that is high risk and the skills are
>doubtful.
> > If
> > > you missed a day, then tough don't be greedy , take another day
>off
> > > and go and learn. Think about your patients -there are no short
> > cuts
> > > in nursing-those who try end up playig a dangerous game that
>often
> > > can cost a patient their life and your registration. Never mind
>the
> > > litigation risks.
> > >
> > > Fenella
> > > List Moderator
> > >
> > >
> > >
> > > --- In _emergency-nurse@emergency-nueme_
>(mailto:emergency-nurse@yahoogroups.com) , "mizbap007" <mizbap007@>
> > > wrote:
> > > >
> > > > Hi All
> > > > I work at night and take care of a female pt with a trach
>and
> > > she
> > > > is hooked to humidifier machine and hooked to a separate oxygen
> > > > concentrator( it also has a humidifier, but the only use the
> > > oxygen)
> > > > machine.
> > > > She has O2 tank. A few nights ago, the oxygen
>concentrator
> > > went
> > > > out and pt didn't have o2 til am. It was the filter, but the
> > > provider
> > > > didn't have knowledge on how to hook up the 02 tank. She was
> > shown
> > > how
> > > > too hook it up. there was a meeting this week for the rest of
> > the
> > > > workers to learn , but I have a day job and was not able to
> > > attend. I
> > > > feel a little nervous now, because I go in tonight and none of
> > the
> > > > family knows how to hook it up if anything goes wrong.
> > > >
> > > > I have seen it done once, when she went to the ER and that
> > > night
> > > > the transferred her to the room and they hook her up to a o2
>tank.
> > > >
> > > > So, could someone help me out with some basic info on how
>to
> > > hook
> > > > up an o2 tank to a patient with trach before I go in tonight.
> > > > Hopefully the person with the knowlege willShe has a white
> > > vetillator
> > > > hose that hooks on the the humidifier and then a long green
>tube
> > > that
> > > > hooks up to the electric concentor machine and she is on 2
>liter
> > of
> > > 02.
> > > >
> > > > Thanks in advance.
> > > >
> > > > Sheree, cna, tx
> > > >
> > >


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