CNA/NTs singled out? - page 2

My facility just instituted a new one today. NOW we have to give every patient a card that grades the CNA (and of course NT) performance. Were they courteous, did you like their performance (rate... Read More

  1. by   SmilingBluEyes
    I find it grossly unfair and yes, singles out people. Rate em all the same way, or not at all, I would say. This From an R.N., not a CNA/NT.
  2. by   sjoe
    Chained writes: " Only thing that separates us from a waitress is about $15/hr more or less. "

    People who think that way ask and deserve to be treated as poorly as waitress are usually treated, IMHO.
  3. by   ChainedChaosRN
    I just don't feel people with college educations "deserve" special treatment. I didn't realize waitresses or anybody "deserved" to be treated differently.

    Still learning after all these years.
    Dawn
  4. by   opalmRN
    What was wrong with calling a patient a patient?

    Somewhere in the big reorg that healthcare is going through the name got changed to customer. OK, I DO understand the philosophy of being a public servant. BUT when you equate the sick, injured, terminally ill, mentally challenged, dying people in a hospital to a patron in a restaurant I think you are asking for something to be lost not only in the translation but the entire way care is meant to be given. (I don't mean at the patient/care giver level but at the upper level where decisions are made (but seldom road tested)). They make the decisions, we get to implement them and Walah, what a mess. Now to stoop so low as to have the care we provide be equated to that of a food service person is outrageous!

    If your facility feels there is some possible gain by polling the patients why don't they include this in the overall survey sent to the patient's home after discharge?
  5. by   Stargazer
    Originally posted by ChainedChaosRN
    IMHO we are in the service industry. Only thing that separates us from a waitress is about $15/hr more or less. A client will not come back to anywhere they had bad service, restaurant, hospital, or LTC facility. At least anyone in their right mind wouldn't.
    You're talking apples and oranges, in my opinion. What patients want or demand isn't always what they need or what's best for them.

    I had a patient once who demanded, the moment I walked in the room, that I bring him a phone, and went on to say that he was "paying for good service." I explained to him that what he was paying for was skilled professional nursing care, not a maid or a waitress, and I would be happy to bring him a phone AFTER I had fixed his Foley tubing, stretched so tight across the bed it was about to be ripped right out of him, and addressed the extremely malignant ventricular tachyarrythmias that were scrolling across his monitor.

    I think comparison between health care and "service" industries are inaccurate and harmful in that they lead to wildly unrealistic expectations on the part of patients and families.
  6. by   Sleepyeyes
    Originally posted by Stargazer


    I think comparison between health care and "service" industries are inaccurate and harmful in that they lead to wildly unrealistic expectations on the part of patients and families.
    Absolutely right on, Stargazer!

    posted by ChainedChaosHealth care in America is about making money. The best thrives and lasts. I think the nursing shortage has gone to our heads and we are thinking "they" are lucky to have us. Some of us better get our head out of the sand and take a look at the want ads....they have dwindled down over the last year. Nursing staff agencys are going bankrupt. (at least in my area) The economy has changed.

    I think it's a good thing that someone is asking the client about their service that day. I have to wonder if only one aspect of the care being singled out didn't develop that way from complaints.

    Remember these clients are paying us, not our supervisors. Granted our job has many aspects beyond what a client sees, but if we can't get the basics right of being courteous, prompt and professional, what's the chances the other aspects are being done correctly?
    And ChainedChaos, while I respect the fact that you're a DON, (according to your profile) and realize that you're making a lot more than $15/hour and probably haven't done direct patient care in a while, it's true, there really IS a nursing shortage.
    While the economy is changing, demographics are not. The population is aging and there are simply not enough caregivers to go around.

    Every client has the Patient Bill of Rights, and quite a few avenues to voice their opinion of their "service" during their stay. CNA's and other care workers are overworked and underpaid as it is, and these little questionnaires only falsely focus on the individual at the bottom of the food chain, diverting attention from the hypocritical management that lies to the public by talking out of both sides of their faces==insisting that it wants to give the best care while causing the understaffing and overworking conditions that generate complaints in the first place.

    I know that with a lighter patient load, I could give excellent care to all of my residents as a CNA, but when I had to care for 9-18 people on a 7-3 shift, or 13-20 people on a 3-11 shift, and 20-30 people on an 11-7 shift, there wasn't much time for more than, "Hi, my name is Sleepyeyes, and I'm here to wash your behind." If my patients only knew that I had exactly 10 minutes per patient for care, they'd have been shocked. But of course, we weren't allowed to tell them we were shortstaffed..... they just kinda figured it out for themselves.....
  7. by   Sleepyeyes
    I think it's a good thing that someone is asking the client about their service that day. I have to wonder if only one aspect of the care being singled out didn't develop that way from complaints.
    PS I'm not normally so snippy but this line particularly galled me on behalf of myself and all my hardworking CNA co-workers. As an RN, I don't believe that one bad apple spoils the bunch, and they should not all be treated like they've all done something wrong. There are far more excellent, hard-working CNAs out there than there are "bad apples."
  8. by   ChainedChaosRN
    First, I would never consider a CNA as "the bottom of the food chain". They are the backbone of any LTC facility. Without CNA's a LTC facility would crumble. Yes the majority of CNA's are over worked and underpaid.

    On another thread on this board nurses are almost proudly stating they sleep on their shifts. That it is an acceptable practice to many, and even more horrifying that many who don't sleep are aware of the practice and tolerate it.

    Yes there is a shortage of nurses, obviously patients/clients/residents are being shorted even by some staff on duty and not just CNA's, but "professional" "licensed" nurses.

    A report card or some similar evaluation can be useful and not necessarily for targeting certain CNA's or Nurses but as a means to point out to upper management (higher than myself as a DON) that more staff is needed. Sometimes a DON or Administrator can complain or explain that more staff is needed...but without the proof our words are lost in the wind.

    Dawn
  9. by   Sleepyeyes
    First, I would never consider a CNA as "the bottom of the food chain".

    Sometimes a DON or Administrator can complain or explain that more staff is needed...but without the proof our words are lost in the wind.
    OK, first off, "bottom of the food chain" is pretty much an understood colloquialism indicating that CNAs are the lowest-paid of us in the LTC facility, and the phrase means lack of authority as well as lack of respect from management.

    And in your first couple of posts, you didn 't indicate anything about facilities needing more staff, causing unsatisfactory care for residents; in fact, you nearly said the opposite==that you suspected that the staff was fully able to provide excellent care, but didn't have the motivation to do so without DAILY (remember the original post?) report cards.

    Then you wondered if such report cards weren't prompted by complaints.

    Frankly, there's an easier answer. Instead of having the CNAs pass out silly report cards for their elderly patients to fill out each day, how about the Administrators just answer a couple of lights or give a bedpan or two, and engaging their residents in conversation as they do.
    They'll get way better feedback if they're visible and approachable.

    Or is that too much to ask of someone who wants to run an excellent facility?

    As far as "proof" that more staff is needed, adn that DON's and Admin's are helpless without it--
    sorry, I just don't buy that. The numbers should speak for themselves. You have the numbers when you do the payroll. Is it really cheaper to use Agency? Is it really cheaper to burn the staff out and cause lawsuits by understaffing??
    Last edit by Sleepyeyes on Jan 23, '03
  10. by   Sleepyeyes
    On another thread on this board nurses are almost proudly stating they sleep on their shifts. That it is an acceptable practice to many, and even more horrifying that many who don't sleep are aware of the practice and tolerate it.

    No excuse for this; I'm with you 100%.
  11. by   Gromit
    ChainedChaos: You seem to talk on both sides of the subject.

    I freely admit that I've never been management, but I do understand morale. When one facet is targeted, that facet is not suddenly 'energized' to do the best they can. The exact opposite happens (I've never encountered an exception to this). They begin to look over their shoulders, or play blame games, which causes more disharmony in the work place, which viola! causes even lower morale. Heck of a circle, isn't it?

    I'm willing to admit that complaints probably prompted this change, I just disagree on their implementation.

    Besides, you get a patient who is just upset because :
    1 The doc hasn't come in YET, and its after lunch!
    2 WHEN are they going to do my test, so I can EAT??!?
    3 I wanted to leave today, and the doctor won't discharge me!
    4 The nurse will not give me my pain medicine (in reality, its too soon)
    5 the person in the other bed wont shut up (or snores, or complains, pees the bed or and the floor, whatever, and for that matter, won't quit fighting about what TV -1 per two patients) program we can watch)

    These complaints are all common to anyone who works on a floor.

    These patients are angy, annoyed or just plain upset, and it has NOTHING to do with the CNAs, or Nursing staff in general, yet do you REALLY believe they will make anything NEAR favorable on the only avenue they see that MAY gain immediate gratification?

    Mark MINE, X for Unsatisfactory!

    "What do >I< care if it reflects on some CNA? They are the one I see all day long.!" "I'm Unhappy!"

    Now, please tell me with a straight face that Management is going to go and dig deeply to find out WHY the CNA gets a bad 'report card' ?

    For the record, I know staff that I wouldn't let mess with my dog. But these are not far-fetched examples. They happen all the time. And we all know patients who wouldn't be happy no matter the circumstances.

    -heck, I even had security confiscate the smokes from one patient who lit-up inside his isolation room, because we wouldn't let him go outside to smoke! He had quite a few bugs in his system (thus the isolation room).

    Bet HE wouldn't have given me a good grade.
  12. by   ChainedChaosRN
    SleepyEyes, first you've apparently misread my first post. I said nothing about staff being motivated by report cards. On the post about one possible reason a "report card" could be used would be staffing. I can think of a dozen other reasons. I do wonder if it wasn't prompted by complaints from family, residents, or possibly even state. I have used similar audit tools that usually evaluate several aspects: food, cleanliness, care, attitute, call light response, etc. Sometimes we ask for anonymous responses if there is possibly a staff abuse issue (fear of reprisal) and if it's because of a frequent complaining family member a signature. To give you an example of something very recent at my facility: Neurotic daughter approached me saying she was calling the state that on 3-11 there was poor call light response, can't find staff, food is cold. I immediately made up the audit tool for the residents on this unit and family members to fill out anonymously turn it in on a daily basis if possible for a 2 week time period. There were no complaints but from the neurotic daughter - and on a daily basis. Now, if she calls the state, I've did my homework, I have proof other than my word telling a state surveyor I made rounds, visited with residents, they didn't complain to me. How far would my word go??
    Just for the record at my well run nursing home it is policy that no one passes a call light without answering it. We are a team. I make rounds several times daily as a decent DON should. I know everyone of my 160 residents and they know me and I know my staffing numbers every shift of every day. If we even get close to minimum staffing ratio's they are to call me and I put a backup system in place, which yes, it does include me going in. Everyday I thank God I have a fine staff and a fine home. We all work darn hard to stay there.

    Peace,
    Dawn
  13. by   Sleepyeyes
    The real crux of my problem is that there is only one facet being graded here. The CNAs performance. NOT the nurses, not janitors, food service or any other category.
    Although you've stated that you do audit various departments for certain reasons, this poster is alerting you to a few things:

    1) it demoralizes the staff to have their folks singled out-- Gromit clearly states that ONLY CNAs were being assessed, out of all the staff.

    2) If the staff being audited is aware that they are being audited, would that not change their behavior?

    The very act of giving out the cards every day could motivate different behaviors from the staff when giving pt. care, and in fact, that might of itself be enough to motivate the staff to do things better. That was my assumption, and that was how the "motivation" word got in there.

    3) While I have not been given such audit tools as you describe, I have, as a nurse, been asked to DOCUMENT in the chart all aspects of a pt's c/o poor service. For example, if a pt was c/o food, I might chart, "Pt ate 100% of meal and stated, 'This food is lousy; I'm ordering a pizza and Coke" and Pt was reminded that he is on a Low Na, Low Cholesterol, No Caffeine Cardiac Diet, but Pt stated, "Yes, I know all that, and I don't give a s***."

    Point being: I still don't get why the CNA's in Gromit's facility would have to hand out cards when you already have access to a legal document about the patient's care. Maybe I'm being naive, but like I said, the CNA's are overworked and overstressed as it is, and I have to ask why the CNAs are not only being singled out but have to do the work of giving the patient the audit tool as well.

    I was a night shift charge in a LTC facility, and I knew who the good aides/nurses were and who the slackers were. I worked as a CNA at times if we were short, and I talked to the residents as well.

    Lastly, I had the backup of my DON to initiate disciplinary procedures on anyone who wasn't doing a good job.

    So call me stupid, but I still don't see how these cards, which are not legal documents, are any different than simple conversations and decent recordkeeping.

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