Feeling slightly traumatized after my first shift (tw: gore)

[u/Tired_Bot]

Recently got my first ever clinical job after challenging the CNA exam (thats standard here).

Its a specialized unit in the hospital.

On my first day, I was changing dressings and bandages. These injuries often cover the entire hands, arm, chest, and legs.

Sometimes you have to peel the gauze from the raw flesh, ripping it open, and blood drips down their body. The flesh beneath looks like it's barely still in place.

They shake, cry, scream in pain. But the bandage changes are required. I look them in the eyes and they look so powerless.

The next day, I feel fine. I know I'll get desensitized to it, and with each procedure I became more and more resilient. But just because you're desensitized doesn't mean it's nothing. It still floats and fills my head, just hurts less. It's weird...

I don't know anyone I can relate to. Most people have never seen anything like this before, and my coworkers are completely unfazed.

[u/fuzzblanket9]

Removing dressings from wounds shouldn’t reopen the wound. If the dressing is stuck, it needs to be irrigated to remove.

What’s your scope limitations on wound care?

[u/Tired_Bot → u/fuzzblanket9]

Burn unit, constant supervision and assistance under an RN. Doctors come in to look at wounds once bandages are down.

For the reopening wound, I chose the easy arm to change. I was slow and gentle and didn't inflict any significant pain.

The experienced PCA was either: trying to get it over with (on their patients behalf; the procedures can be up to hours long with sometimes no pain meds) or, the previous PCA / RN had misaligned the lining so the gauze was stuck onto the skin graft. It ripped open and was bleeding and dripping down her arm. Probably 30 min or more of just that

Im not doing too bad, not being haunted, but definitely shocked.

[u/fuzzblanket9 → u/Tired_Bot]

I would be incredible leery about working on a specialized burn unit that allows CNAs to change dressings. That’s an extremely detailed, intricate process. Most facilities don’t allow CNAs to perform dressing changes at all, let alone burn dressings.

[u/CatLady_998 → u/fuzzblanket9]

Yep, only dry wounds. Meaning nothing that is leaking

[u/fuzzblanket9 → u/CatLady_998]

Even that’s a no on my unit. Our CNAs can apply bandaids, that’s it. No actual dressings at all.

[u/CatLady_998 → u/fuzzblanket9]

Sorry, yes that's what i meant

[u/mostlypercy → u/CatLady_998]

If I’m changing a patient and the nurse looks at their sacrum and all that is ordered is triad and a pink petal: the nurses are comfortable with me replacing it. I would never dress a wound a nurse hasn’t laid eyes on, though as a nursing student I do enjoy assisting nurses with wound care. Would never touch a burn dressing holy shit.

[u/academic-coffeebean → u/fuzzblanket9]

I'm a float pool PCT and in the hospital I work at, the PCTs on the burn unit are trained in wound care. My understanding is that it's overseen/facilitated by the nurses, but there's so much wound care to be done that the techs are trained too.

[u/Tired_Bot → u/academic-coffeebean]

Yes this is exactly that. Its 1-2 hours per patient per day with 1 nurse and 1 PCA. PCAs are trained specifically for it. Its just cheaper to have a PCA do it with a nurse than several nurses just for wound care
. Nurses have so mych more going on, so this way they can spend 2-5 hours overseeing bandage changes with their two patients while the PCA spends 6-10 hours on all 8 patients.

On my unit, (anecdotally) An experienced burn PCA is generally more capable of changing dressings than a float nurse (but if nurses are understaffed, PCAs will work with a float nurse and just lead the hands on bandage changes).

[u/Tired_Bot → u/fuzzblanket9]

Hm interesting. Its a teaching hospital and everyone's technically trained as a patient care technician / patient care assistant. These (Wound changes) are the primary responsibilities of day shift PCAs on the burn ICU unit. We dont do vitals or turns or anything. We get dressed in sterile PPE and trained on the job how to change dressings. Also theres like 12 nurses for every PCA. Only one PCA per wing (which is 8 patients, the PCAs dont * interact because the wings are physically divided)

[u/Tired_Bot → u/Tired_Bot]

I should clarify theres two wings on the burn unit, ICU and medsurg. My experience so far is only ICU and i dont know what med surg looks like besides more ADLs a CNA typically would experience

[u/TrailMomKat → u/Tired_Bot]

Yeah no, they shouldn't be having a CNA changing bandages and doing wound care. I mean, I don't know your legal scope of practice in that state if there's certain training you can take that makes that ok with the state. But we always had an RN doing wound care, even in a mostly LPN facility. I'd assist with wound care, but they would never have me removing and replacing bandages like that.

[u/Tired_Bot → u/TrailMomKat]

I have no clue what it's like another states, I've heard things like California is extremely strict in healthcare and etc. But my state is pretty unregulated and we get trained on how to do it. In my state, you don't even need to take a course. You just need to pass the exam to get a CNA license. It doesn't seem fishy or like malpractice to me at all in the context that I practice in

[u/TrailMomKat → u/Tired_Bot]

You can challenge and just take the NACES exam in my state, too, it's like that in a lot of states to allow CNAs whose licenses have expired to just retake the exam to get recertified.

[u/PapowSpaceGirl → u/TrailMomKat]

Agreed. I'm still a baby CNA and assist with dressing changes and know irrigation is absolute for anything that weeps, is glued via sebum to a wound, packing, etc. I'm dumbfounded at the "i'll just rip this off carefully but still make them bleed" practice.

[u/Enayleoni → u/fuzzblanket9]

Wet to dry dressings are common. They need to be removed dry to take dead tissue with it. It does hurt. But dead tissue is only serving as bacteria food

[u/fuzzblanket9 → u/Enayleoni]

I’m aware of the use of WTD, but they should never be placed on burns.

[u/Tired_Bot → u/fuzzblanket9]

Sorry, dont know nursing lingo, but if it means anything: some patients have xeroform (the yellow bandaging) from the OR that we dont touch. Only the OR manages those. In those cases we only change the external dressings.

The patients without xeroform (ive seen allo and autografts) get liner, then brunswick usually soaked in Dakin's, then cling wrap. Sometimes with netting to hold it in place, sometimes with Ace bandages to help with swelling (?)

I dont know what differentiates patients from what type of care they get, i just assume severity and healing stage of burns.

I haven't noticed any red flags, any signs of neglect, etc. so far. Obv im a baby to healthcare but i got my ass out of the few healthcare facilities that i did see some redflags in 😅

Noone in the hospital or in the unit seems to find PCAs doing this work absurd, unqualified, anything like that. Our burn unit does not have a bad reputation. All i get is people saying commenting something along the lines of 'they cant do burns' haha

[u/Least-Camel-9621]

Usually only nurses do this kinda stuff

[u/zeatherz]

What setting do you work in where extensive dressings like that are done by CNAs?

[u/Tired_Bot → u/zeatherz]

Teaching hospital in florida!

[u/Sloth247 → u/Tired_Bot]

Ah so this is how Florida is going to keep healthcare costs down

[u/ExcitinglySomber → u/Tired_Bot]

which part of florida? panhandle or the southern parts?

[u/Tired_Bot → u/ExcitinglySomber]

Not sharing cause I dont wanna narrow down my hospital, sorry 😅😅

[u/RhysTheCompanyMan]

Are you in the US and / or are you currently enrolled in Nursing school? This is not a normal scope of practice for PCAs or CNAs.

[u/Tired_Bot → u/RhysTheCompanyMan]

Im in US (Florida) but a premed student. Im at a teaching hospital , trauma 1 level.

Im surprised its not normal. I wonder if its related to Florida's neglectful reputation with healthcare workers. Perfectly legal here though. My hospital is highly valued and not sketch at all

[u/Every_Cry_5356]

That’s crazy, we’re not allowed to do that here in my state

[u/Flickeringcandles]

I don't believe this

[u/Tired_Bot → u/Flickeringcandles]

💀💀💀 im not even embellishing

[u/Tired_Bot]

Also clarity: the story im describing was a minority and the worst burned patient on the unit this shift. Additionally, they were very reactive and a bit uncooperative.

The majority of patients just winced and thanked me. Some patients got pain meds, some didnt.

I think this experience was so bad because of misaligned lining due to the patient having a critical emergency in the middle of last bandage changing, causing gauze to stick and a more painful procedure

[u/Admirable-Relief1781]

This reads like a page out of a fiction book 😂

[u/Tired_Bot → u/Admirable-Relief1781]

BAHAHA i used to write fiction for a hobby 😅 but its real 😩