A Dressing Change and a Blank Repositioning Box: Scope of Practice and Honest Charting
Your unit is short-staffed. At 10:40 the charge nurse hands you a dressing-change tray and says, 'Mr. Petit's surgical wound needs a fresh dressing - just peel the old one off and put this on, I'll sign for it.' Fifteen minutes later she adds, 'And sign off that you repositioned Mrs. Doyle at 10:00. I know you didn't get to it, but we'll both get written up if the box is blank.' You did not reposition Mrs. Doyle at 10:00; you last turned her at 8:00 for her two-hour turning schedule. Mr. Petit's dressing is dry and intact, and the wound edges look the same as at the last change.
1. What do you do about the dressing change?
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Decline the dressing change and say what you can do instead. In Connecticut, wound care involving a surgical incision is a licensed-nurse task; a CNA's scope is assisting, not performing it.
- 'I'm not able to do the dressing itself - that's outside what I'm certified for. I'll position him, hold the supplies, and tell you anything I see.'
- Then actually do the assisting part well: position, expose only the wound, keep the old dressing in view until the nurse sees it, and report your observation that the dressing is dry and the edges look unchanged.
- If she insists, do not do it. Tell the unit manager or director of nursing the same day.
Why: the risk here is not that you would botch a simple dressing - it is that accepting a task outside your scope sets a precedent, removes the nurse's assessment from the wound, and puts your certification and the resident's healing on the line. 'I'll help, but not that part' keeps the shift moving without crossing the line.
2. What do you do about the request to sign off for repositioning you did not do?
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Do not sign it. Ever. This is the clearest line in the scenario.
- Go turn Mrs. Doyle now and chart the actual time you turned her.
- Charting a 10:00 turn that did not happen is falsification. On a two-hour turning schedule it also hides a real skin-breakdown risk - the next aide reads 'turned at 10:00' and waits until noon, so a resident who was already at higher risk goes four hours without a turn.
- If the blank box is a problem, the accurate entry plus a note that staffing delayed the round tells the truth and flags the real cause.
- Keep your response flat: 'I can't chart care I didn't give, but I've just turned her and I'll write the real time.'
Why: a falsified record is what turns a staffing problem into a neglect finding against you personally. The box being blank is the nurse's problem to solve; the box being false is yours.
3. How do you raise both of these with the nurse without blowing up the shift - and what if she does not back down?
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Handle it privately, quickly, and factually, then escalate if needed.
- Pick a moment away from residents and family: 'I want to flag two things before they become problems.'
- Use facts, offer alternatives, avoid accusation: 'I can't do the dressing, but here's what I can do to help you get it done. And I've turned Mrs. Doyle - I'll chart the real time, and if we're behind we should tell the supervisor now rather than after.'
- Keep a record of the date, time, and what was asked, in case it repeats.
If she pushes back or retaliates:
- Go up the chain the same shift - unit manager, then director of nursing, then administrator.
- Falsification and out-of-scope practice are reportable; protecting a coworker's comfort is not a reason to stay quiet.
The judgment: you can be firm about scope and honesty and still be a good teammate. The two requests are the same request - 'pretend' - and both get a no.