The $20 Bill and the Blood Pressure Question
You are a CNA on the 3–11 shift with nine residents. At 6:40 p.m., the daughter of Mrs. R (82, admitted after a hip fracture) stops you in the hall. She presses a $20 bill into your hand and says, "I know you're busy - just look in on Mom extra tonight." Then she asks, "And while you're at it, is her new blood pressure pill working? The nurse never tells us anything." Mrs. R's care plan reads "encourage fluids, offer every 2 hours." When you enter the room, both her lunch and dinner trays are barely touched and her water pitcher is still full. She says she is "not thirsty" and "doesn't want to be a bother." The charge nurse is in a wound-care treatment and cannot be interrupted for several minutes.
1. How should you respond to the daughter's tip and her question about the blood pressure medication?
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The tip: Return it politely and immediately - do not "hold it for now." Accepting cash violates facility policy and can look like soliciting, even if your care would be the same either way. Say something like, "I can't accept this, but I'll check on your mom as part of my rounds anyway." Do not imply extra attention depends on the gift.
The medication question: You may not interpret, evaluate, or explain the effects of a medication - that is the nurse's role and outside your scope. Don't guess or say "it seems to be working." Redirect: "I'm not able to discuss her medications, but I'll let the nurse know you have questions so she can call you."
The reasoning: Both parts of this are role-boundary issues, not knowledge issues. The correct move in each case is to stay inside your scope and route the request to the person licensed to handle it. Then actually follow through - tell the charge nurse that the daughter has unanswered medication questions and offered a gift, so the nurse can document and follow up.
2. Mrs. R has hardly touched her trays and refuses fluids. What should you do during the shift, and what should you not do?
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Do:
- Offer small amounts frequently (e.g., 60–120 mL every 1–2 hours) rather than a full glass, which is overwhelming.
- Offer preferred fluids within any restriction, and try ice chips or a straw if she accepts them.
- Keep the pitcher and cup within reach and remind her each time you pass the room.
- Address the real barrier - she said she "doesn't want to be a bother," so reassure her that helping is your job and set up a toileting schedule so she isn't worried about incontinence.
- Measure and record actual intake in mL; "poor" is not a measurement.
Don't: force fluids, shame her, or chart a judgment like "noncompliant." If she continues to refuse, that is a change to report to the nurse, not something to argue about for the whole shift. The reasoning: hydration support is within your role, but overriding a resident's refusal is not.
3. At end of shift, what do you report, to whom, and how do you word the documentation?
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Report to the charge nurse, verbally, before you leave:
- Estimated intake at both meals and fluids taken since.
- The pattern of refusal and her stated reason.
- The daughter's request for medication information and the gift offered.
- Any change in her condition you observed.
Documentation: objective and measurable - "Ate approximately 25% of lunch and 10% of dinner; accepted 180 mL water over shift; states 'not thirsty.' Daughter at bedside 1840, requested medication information, referred to nurse."
Do not chart opinions about the family ("daughter is demanding") or labels about the resident ("noncompliant," "difficult"). The reasoning: the next shift and the nurse act on facts, and judgmental language follows the resident in the record and can bias future care.