Eleven Residents, a Nurse in a Code, and a Family in the Hallway
Renee is a CNA on a 6:00 AM to 2:00 PM shift with 11 residents; her usual assignment is 8. The second aide called in sick, and at 6:35 the charge nurse is in a room with a resident who fell and is waiting for the provider to call back. At 6:50 a daughter stops Renee in the hall: "Mom's blood sugar was 210 last night and they're talking about her insulin. What do you think - should they increase it? And while you're in there, can you look at the blister on her heel and put something on it?" Renee also has not charted a single intake or turn since 6:00, and breakfast trays arrive at 7:30.
1. How do you answer the daughter about the blood sugar, the insulin, and the blister?
Read the worked answer
Be warm, be clear, and hand it to the nurse - all three.
Blood sugar and insulin: "A blood sugar of 210 is something the nurse needs to see. I can't tell you whether her insulin should change - that's between her, the nurse, and the provider - but I'll make sure it's passed on right now." Do not interpret the number. Do not say "that's high" or "that's fine," and do not discuss the dose.
The blister: "I'll look at her heel as part of her care and tell the nurse what I see." You may observe skin and report it. You may not open or lance it, and you may not apply ointment or a dressing on your own. You never cut anything on a foot - foot care for a resident with diabetes is a nurse or podiatry task, not a CNA task.
Why the wording matters: "I'm not allowed" sounds like you do not care, and it invites the family to push. "I'll get the nurse" gives the same answer and keeps the relationship.
2. Eleven residents, the nurse tied up with a fall, and nothing charted since 6:00. What do you do first?
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Sort by risk of harm, not by how loud the request is.
First 10 minutes:
- Quick safety sweep - everyone who is up, in bed, or on a toilet gets checked: call light within reach, no one on the floor, no one sitting in a wet brief. A fall in an unattended room is the event that ends the shift.
- Tell the nurse the one-line version that cannot wait: "Mrs. T's daughter is asking about insulin, and there's a blister on her heel." She can triage that in five seconds between tasks.
- Ask for help and ask for a priority list: "I have 11 and nothing charted - what do you want first?" A CNA cannot delegate nursing tasks, but she can and should ask the nurse to set priorities and bring in another aide.
Charting: chart as you go, in the moment, for what actually happened. You do not catch up by writing what should have happened. An honest gap is defensible; a made-up entry is a safety problem and a license problem.
3. At 8:00 the nurse asks, "Are the 7:30 intakes done?" Two residents have not been fed yet. What do you say, and what do you write?
Read the worked answer
Say the true thing in one sentence and offer the fix: "No - Mrs. A and Mr. L haven't been fed yet. I got pulled into the safety sweep and the daughter. Can someone take one of them, or can I feed them now and chart them late?"
When you do feed them, chart:
- The time you actually fed them.
- What they actually ate - a percentage you watched, not a percentage that looks normal.
- "Late entry" with the actual time of documentation, if your facility's system allows it.
- Any refusal, with the exact words used.
What never happens:
- Charting 75% before the tray is opened because "she usually eats that."
- Charting a turn, a brief change, or a weight that was not done.
- Back-dating an entry so it looks like it was on time.
Why: the record is the only thing the next shift, the nurse, and the surveyor know about the resident's day. A pre-charted 100% intake hides a resident who is not eating - often the earliest sign of a real problem - and it makes every other entry you write suspect.