Difficulty with a CNA

mamason · Dec 23, 2006

I've worked with CNA's like that. And usually, they were so overwhelmed with their job, it was just as hard for them to keep up as well as the nurses. I found that if I explained to the CNA how important a certain task was, and why we were doing it, they usually complied and did their best to get it accomplished. Sometimes, they don't quite understand ( not all CNA's) why certain things need to be done. Like, Accurate I/O's on a CHF pt. If I explained that this is a tool to measure wether the pt is retaining too much fluid etc. they would say, "OH...I see." This is in no way a put down to CNA's. I used to be one myself and I value their contribution to our pts very much. Couldn't do my job without the help of a CNA. I just think most of the time it's lack of understanding or they are so....bogged up with what's going on with a difficult team that day.

Katnip, RN · Dec 23, 2006

I notice you are 24? Well, I am 23 an a new RN..I have the same problem but only with a few of the aides. I think they feel threatened and jealous that the "new and young nurses" are telling them what to do...well most of the time it is just ridiculous to try to ask some of them to do something.
I took the issue to my nurse manager and she has done nothing about it...so what I do is if I need a BP, foley emptied, someone repositioned, whatever..I just do it myself. It might take you an hour to find them and then talk them into doing what it is you want..just do it yourself..atleast that is what I do. It usually is a task that will only take 2-3 minutes anyways.
mostly...there is no teamwork haha. I get a lot more done with the RN/LPN helping me than what meI could ever get from an aide. I guess in the end we are the liscenced personnel anyways.

Unfortunately, this is why some CNAs continue to refuse to do their jobs. Because you, the nurses allow it.

If you ask a CNA to do their job and they refuse, start with talking to them first. Tell them that's what they are paid to do. If they continue to refuse, start writing them up.

It won't make you popular, but you aren't there to be popular. You're there to give good patient care and the CNAs are there to help you do that.

htrn · Dec 23, 2006

I work with one CNA that is 65+ and can work circles around me and many other nurses. As a new grad, she helped me learn so much about being a good care provider. Now, several years later, she remains cheerful, helpful, competent and is wonderful enough to make sure I don't miss something. I really do feel like I work with her and she makes my shift run sooooo smoothly.

On the other hand, I work with another CNA that can be wonderful, but I just don't feel like I can trust her. There are times when she really can be nice, helpful and even funny. The worst thing is, I don't know if she is going to be crabby or helpful when I walk in the door. She has lied to me about completing tasks that I know were not done; deliberately done things I specifically asked her NOT to do; argued with me in front of patients, families and colleagues...and those are just the overt things that leave me feeling hung out to dry. I haven't even talked about sitting around and watching me run my *&^ off doing things that she is capable of doing, but she has already done 'her job' and now it's time to work on crosswords, etc... I am not the only nurse that has issues with her, but when I say something it seems to be chalked up to a personality conflict between us.

I have written her up, talked to the NM, asked for help from other colleagues, etc... and have simply been ignored or told that's just how she is and you have to deal with it. We finally had a meeting with several nurses, the aid, and the NM - and it was decided that it was my fault because I treat her badly. Specifically, I speak down to her, check her work and don't trust her. My view is that after all that she had done to/for me, I need to ensure she understands exactly what I am asking of her and I need to ensure that she has done what needs to be done. Oh, and during it all, she has an attitude that makes me crazy.

At this point, my only forseeable relief is her retirement in the next couple of years. Sometimes you have to choose to put up and shut up or move on.

Simplepleasures · Dec 23, 2006

I've worked with CNA's like that. And usually, they were so overwhelmed with their job, it was just as hard for them to keep up as well as the nurses. I found that if I explained to the CNA how important a certain task was, and why we were doing it, they usually complied and did their best to get it accomplished. Sometimes, they don't quite understand ( not all CNA's) why certain things need to be done. Like, Accurate I/O's on a CHF pt. If I explained that this is a tool to measure wether the pt is retaining too much fluid etc. they would say, "OH...I see." This is in no way a put down to CNA's. I used to be one myself and I value their contribution to our pts very much. Couldn't do my job without the help of a CNA. I just think most of the time it's lack of understanding or they are so....bogged up with what's going on with a difficult team that day.

I agree, if you are working as a team it is imperative to let the CNA know WHY some things HAVE to be done, seems like some CNA's dont understand the complexity of the patient's diagnosis and feel as if they are just being given extra work by the nurse. I would not want to do their job on a daily basis, darn hard physical work.I do agree however that some CNA's are not suited for this line of work, as some nurses aren't either.Nursing, not for everyone.

allantiques4me · Dec 23, 2006

I say set very clear specific guidelines and time frames.In report with all your aids,state ,for example All b/ps are due by9am.They certainly cannot go on break until its done.I hate the way things are now.I was a nurses aid in the 80s.We were not certified,our LPn was 19 years old,most of us aids were teenagers also.I wouldnt dream of talking smart to our team leader and we always did what needed to be done in a timely fashion.Times have really changed for the worse.I worked as an LPN at a long term care facility I would change patients ,give baths,feed pts ect without breaks or lunch for that matter,half the times I couldnt find the aids,or they were sitting on thier behinds.I didnt have to give baths ect I was tryng to be nice when I had some down time.I ended up in a different area of nursing,which I love.Anyway your aid is being insubordinate,you might warn them,then write them up if it continues.It sounds like youre a fair easygoing nurse,like me,but sometimes ya need ta put your foot down.Godd luck

20RN06 · Dec 23, 2006

I was a CNA before becoming an RN. There is a lot of team work and cooperation needed for certain in this field of work. I try to help my CNA's when I can do it myself, i.e. checking VS. But if I'm unable to do so, I delegate. I usually do a followup on the task before it is due, b/c sometimes CNAs get caught up and may forget. At the end, it is our (RNs') responsibility to get the work done, so if the CNA is known to neglect their duties in assisting the nurse as their title says, then there's no other option but to notify the supervisor/management, after of course we confront the actual problem ourselves first. In addition, I think most of the issues stem from a conflict in personality and attitude. But regardless, we all need to take care of the same patient/s come start of shift.

GardenDove · Dec 23, 2006

I love working with a CNA with a great attitude, who works independently, and acts like an adult. Otherwise, they are a PITA and it's not worth it. I hate checking up on people. I hate babysitting adults!

moongirl · Dec 23, 2006

side note to this.. I am still just a student but I have seen 2 times now, different hospitals, CNA's with this same attitude and PLEASE, I beg of you , if you do get a someone like this DO YOUR OWN VITALS. One I know of got fired- she finally got caught- she wasnt doing the vitals at all, she simply looked at the charting from the previous shift and "tweaked " the numbers a bit (her words). she got caught because she told someone how "funny" it was.

The other girl- same thing, I ALWAYS do my own BP before administering any cardiac med, and her numbers were way different than mine, WAY different. So I did it twice and then got my primary to follow it thru as well. When confronted this CNA shrugged and said " Oh well, thats what I got" and walked off.

I know the majority of aides are awesome, but even with my limited experience, if I see someone acting like this, I am very careful

nurse_lsm · Dec 23, 2006

hey everyone:

i agree with all of you. that's the reason i left my last job because of the aides and ward clerks who fussed everytime you asked for help. so, i just did the work myself. it's easier than listening to them fuss.

i'm also taking pre-reqs. for upward mobility nursing.

am i crazy or what? i've been an lvn for almost 8 years now.:monkeydance:

Daytonite, BSN, RN · Dec 23, 2006

nursewi_jennjenn. . .when a subordinate worker is continually not doing tasks that you are delegating to him/her you need to first assess that the task is something that they are trained to do and is appropriate to be delegated to them (i don't think that's at issue here). you also need to make sure that when you delegate tasks that the directions are clear and, this is very important, that you put a deadline on them. "i need you to take a set of vital signs on mr. smith at exactly 8pm and bring them to me as soon as you have done them." you could also add, "if i don't hear from you by quarter after 8, i'm going to come looking for you." you should also have the person repeat back your instructions. "now, tell me what i just asked you to do." that way, the instructions for the task and the time you want them completed are clearly defined. and, unfortunately, follow-up is part of delegation. if you don't follow-up on a consistent basis, then lazy subordinates tend to slack off, take short cuts, or just not do the work. this is just one of the headaches of supervision. once you are delegating and giving instructions properly and these subordinates are still not doing what they've been instructed to do, they have now passed into the territory of insubordination and have broken a rule of their employment. you need to begin disciplinary action. so, read what that involves at your facility or discuss it with your manager. usually, it involves a verbal warning. "i asked you to xxxx, had you repeat back those instructions to make sure you had them right, and you still failed to do what i asked. i have no choice but to tell the manager what you're doing. if you do that again i'll have no choice but to write you up." these confrontations don't have to be long and drawn out and they don't require you to provide rationales or listen to excuses if you don't have time. i simply tell people "it's in your job description". i know this is kind of an arrogant attitude to take, but these kinds of workers are not ever destined to be in supervision or management positions. they are acting like spoiled, manipulative children and need to be treated accordingly.

the problem with doing something yourself when a subordinate fails to do it is that it takes away from your other important priorities. not only that, but it undermines your authority with the subordinate worker. you might as well hang a sign around your neck that says, "even though i ask you to do something, you don't have to do it". i guarantee that if you had the opportunity to sit and talk this problem over with the ceo of your facility you would most likely be told that he/she expects you to take the bull by the horns and act like a supervisor of this caregiver because that's in your job description. the facility is paying this cna to perform tasks so that you can focus on some rn things that need to be done. you owe that obligation to the facility. what do you think someone like donald trump would do with an insubordinate and lazy cna like this?

when a subordinate tries to change the focus of a confrontation and bring up things you do, you need to re-direct the conversation. "don't try to change the conversation. we're talking about you and what you are doing wrong. my work is not an issue here."

i don't know what you're reading to help you with this, but there are only two sheets of paper that you need. a paper that has a list of the rules of delegation and another that has the basic rules of assertiveness. you practice what you are going to say to this person in your car on the way to work. tackle one task at a time. when i was first learning to confront i used to actually write the words i was going to say on the back of my "brains" so i wouldn't forget them. you'll get sweaty and your heart will be beating a mile a minute, but that goes away after you've done this a few times. my biggest problem was always to keep my voice calm and not look like i was angry (which i was, but not to let my nonverbal behavior show it so much).

http://www.ehow.com/how_3816_delegate-responsibility.html - how to delegate responsibility

http://changingminds.org/techniques/assertiveness/assertiveness.htm - assertiveness

http://www.dlsweb.rmit.edu.au/toolbox/fmi/content/tutorial/assert/assert00.htm - this is a really nice online assertiveness tutorial from australia. click on the links to proceed through the tutorial. includes sound clips of examples.

as for the others who have posted that they don't want to take the time to track cnas down to confront them about doing things they are supposed to do, all i can say is this. . .i took the time to do this when i worked in a nursing home and people disappeared. when they realize you're going to come looking for them and you begin to find out where their hiding places are, they shape up or they eventually leave after you've written them up enough. if you don't take the time to find out where they are hiding so you can include it in your documentation on their write-ups, the people with the authority to discipline and fire can't do anything to help you out. it takes continually documenting over time to get rid of problem employees--especially if they've been allowed to get away with that kind of behavior for awhile. some places may want to have documentation from more than one charge nurse to be fair to the employee that is in trouble. so, if no one wants to take the time to document--oh,well. but what i found was that usually when one nurse gets bolder and starts confronting and writing up employees other nurses will follow suit, especially when they see results of these efforts. newly hired crappy employees are easier to deal with and get rid of.

allantiques4me · Dec 24, 2006

hey everyone:
i agree with all of you. that's the reason i left my last job because of the aides and ward clerks who fussed everytime you asked for help. so, i just did the work myself. it's easier than listening to them fuss.
i'm also taking pre-reqs. for upward mobility nursing.
am i crazy or what? i've been an lvn for almost 8 years now.:monkeydance:

what is upward mobility nursing?

chenoaspirit, ASN, RN · Dec 24, 2006

There are 2 CNA's on my floor who are the same way. A patient (3 month old) was running a temp of almost 102 at vitals. I gave Tylenol. Next vital check, she skipped the baby, knowing it NEEDED to be done. Whenever I use the call light to call out for help turning an obese patient, she wont come. I leave the room to find her, she is sitting at the nurses desk chatting! One night I had a combative patient who needed an IV re-started, all I needed was the CNA to hold his arm so I could start it, she threw things down and yelled at me. We proceeded to the room, I was trying to ignore her, but she then got beside the patients bed and started yelling at me again. I had been trying to get someone to help me start this IV for 4 hours! I was FURIOUS! There are other CNA's who work with me as a team, and I appreciate them. But I HATE working with the lazy ones. I used to just do it myself, but if I am going to to their job and mine both, then they dont need to be there. So you will get to the point that you will get sick of it and deal with it. It is hard to deal with people like that, there will be a huge confrontation, but in the end it has to be done. The patients need it to be done. I hate it that you are going through this, it makes your job ALOT harder and longer.