Major venting about some CNA's

[michelle95]

First, let me say that I am not venting against all CNA's or even most...I've been one myself. I know how hard they work. I applaude the good ones.

My problem is the majority of the ones at where I work. They talk back, they leave people in messes...it's really making me mad. Just this morning, I told a CNA that was going to get my blood sugars at 5:30, to wait until at least 6:00 because I didn't feel comfortable giving insulin at 7:00 on a 5:30 accucheck. I had originally told her 6:30, but, after she explained to me that she couldn't at that time, I told her I would compromise and make it 6:00. (Sometimes our patients don't get their breakfast trays until almost 8:00 and 11-7 is responsible for the insulin at 7:00) She flat out refused. She told me that the boss said it was ok. I told her, she's not here right now, is she? You're working on MY license, not her's.

She told me no and went and got them at quarter of 6 in defiance.

I told the 'boss' when she came in, but, this is the same boss that let another CNA get away with telling me to 'shut the hell up', as well as, telling a patient to shut up. (Which is why the CNA told me to shut up...I was getting on to her for doing that)

I am so SICK of not being backed up when I tell a CNA to do something. I know I am just a little 'ole LPN at this time, but, I still expect the CNA's to do what I tell them.

I try to be fair. Like I said, I was a CNA, I know how hard the work can be....but, I didn't talk to my nurses any old way I feel, much less, tell them no when they told me to do something.

If the big bosses won't do anything, what am I to do? Go over their heads?

This is my last night tonight. I've done decided that the next place I work, I am not going to be so nice. I've got an interview tomorrow and I am going to explain to the administrator that I DEMAND back up. If I tell someone to do it, and, they snap off, I EXPECT there to be repercussions.

I hate to be so down and dirty, but, I had an spiritual experience a couple of weeks ago that made me see that every patient I come in contact with, is someone's loved one. I don't expect to see them laying in pee or dried food for hours. That is soooo undignified. If I don't take up for them, who will?

Any advice? Should I go to the ombudsman if the bosses won't do anything about these CNA's with an attitude?

I hope any CNA's that read this don't take offense. If you do your job honorable, I am not talking about you.

[Sleepyeyes]

Sorry; this is OT, but i felt compelled to share

Originally posted by rebelwaclause

Yes Lantus is a high dose Insulin. I'm thinking of the sliding scales at my facility (different at every facility - I presume?). Our docs cut off at about 12 units (regular) and specify to notify them, usually leading to an amp of something (D5).

We do not use Lantus. Is anyone using Lantus in the hospital setting? Expensive, new and a little temperamental for an insulin.

At any rate, 40 units of any insulin deserves a quick "CYA" peek at the patients chart. Again, this poor 145 pound woman wouldn't have been subjected to a dropped BS if done so.

In LTC, I had to give 70/30 or NPH insulin to a couple of folks, their doses were about 30-40 units in the morning.

And yes, I quadruple-checked them because on top of that, they got regular coverage....

Never given that much Regular insulin though....

Our hospital orders usually read "If 400, call md" and then we have a protocol for

[Flo1216]

mattsmom-

Right on.

[gojack]

Not all CNAs work in hospitals. How about us licensed staff working in nursing homes? We have to "depened on" CNAs that have previous prison time and mental health issues taking care of the elderly. They are paid zit by the administration, and have no benefits. In addition, some are taking care of elderly white racists who use racial epithets.

My "backup"? A chief administrator fired right before Christmas, and a nursing home that hides who are the actual owners! These weasels are more likely to go to the state board, or fire a nurse for legal reasons (to help defray any additional amount in any judgement against the home), than to actually back up the licensed staff.

And I, cannot actually get mad at the CNAs for dumping on the patients in this madhouse (one aide said it was like the Jerry Springer Show). Any advice from all the experts out there, other than suggesting I just go out and find another job? Actually, I have heard that this is one of the better nursing homes in the area!

[flutterby]

I have been a CNA for four years now, and I've worked in a couple of facilities where the communication between nurses and CNA's was good and where communication between CNA's and nurses was bad. It also sounds like you may have a slight morale problem as well. Anywhere where people use such language with their coworkers or superiors as 'shut the hell up' raises a serious red flag to me that the problem is a little deeper than just the communication between the CNA's and the nurses. I'm glad to hear you have an interview with another facility, because it sounds like your best action is to just get out of there. If the bosses aren't doing anything about someone who tells their superior to 'shut the hell up', there's a real problem. I'm going to school to become an RN and have vowed not to treat the CNA's assisting me like crap because I've been there and know the phenomenal amount of work they have to do. They are there to assist me and not to be my slave. Good luck with your interview, and I hope you find a position where you are more comfortable.

[mattsmom81]

I recall a bruehaha between a good RN and a good CNA...the CNA did not wish to help this RN because she 'barked' at her. It was, I feel , a cultural thing...the RN was foreign trained and did not feel she should have to be polite to get the work done by the CNA. I understood both points of view but I finally had to write them BOTH up and let my unit director deal with it because neither would respond to my requests that they be mature and work their problems out!! Their arguments disrupted the unit and patient care suffered.

Bottom line: we all have to work together to get those patients safely cared for. If that is not occurring the RN has a duty to act. If the RN can't significantly improve the situation, then resigning may be the best option, because he/she is hindered in his/her duty to the patient...which our practice act demands.

Just how I see it, others may disagree of course.

I have left facilities where I was not able to impact safe patient care. It's our license and we do not have to remain in an impossible situation IMO. :)

If your facilities hire unsavory CNA types there are state regulatory agencies that would be interested in this info.

[MishlB]

I wish we had CNA's where we are working for clinicals. You don't realize how valuable they can be until you don't have them!!!

[michelle95]

Before I even read all of the replies, I need to clarify some points.

First, as I stated in the tile, I was VENTING. I am not the 'queen'...or think I am high and mighty. I do not boss anyone around. As I stated, I even compromised. I ASK nicely when I want something, I don't just come off with a 'tude and tell someone what to do. I am surprised that some of you would make generalizations on how I work based on a 'venting episode'.

The problem comes when you ask someone to do something that you are supervising and they tell you no.

The second thing I need to clarify is that I DO NOT EVER sit on my butt and watch the CNA's hump and not help. There have been times that I have put every single one of my patients to bed because the CNA could not be found. The guy with the food caked on him? His CNA had been sitting at the nurse's station for over 30 minutes while he laid like that.

So, now I am supposed to do my job's and someone's too? I have NO PROBLEM helping out. I have a problem with people thinking they can sit around and I can do their work for them, while my own suffers.

I'm sorry some of you are so hostile. Like I stated in my original post, I know cna's that are good...and, if you do your job, I ain't talking about you. It's the ones that like to sit on their rump and collect a check for doing less than the best care.

If I came off as rude, I apologize, as I stated in the first post, this was a vent. The CNA's at the place I just worked had some major attitude problems, and, I am far from the only nurse that has been told no by them.

And, what about being told to shut the hell up when I was reprimanding that one cna that had told the patient to shut up? I guess I deserved that for being bossy by fussing at her for doing that....

[michelle95]

I feel a little better after reading some other posts. The first few were just attacking and accusing.

For the record, I hated when I was a CNA and a nurse would ask me to put someone on the bedpan when they had just been in that room. I, too, swore, I wouldn't be like that. If I am in the room, I always try to put them on the bedpan or take them to the bathroom. I even answer call lights, and, usually the only time I ask a CNA to do something is if I simply do not have the time.

The problem with the facility that I worked at is that the bosses let people get away with talking rudely to others. According to state regulations, there should have been an investigation for that CNA telling the patient to shut up. As far as I know, there hasn't been.

Other nurses have left on account of not having an 'authority' and being talked to like dogs by the CNA's at this facility.

I talked to the DON at the place I interviewed at. I told him, I am not a hard ass out to try to be mean or get anyone in trouble, but, I demanded the respect that comes with my title. I don't expect to be told no if I ask nicely for something to be done, and, I sure don't expect to be told to 'shut the hell up'. I understand that respect is earned, but, there is always a certain amount of respect that should be there from the get go for your superiors. I would not tell and RN no if she told me to do something (unless, of course it jeopardizes patient safety).

You guys the patients need us to be their advocates. We can't just let anyone treat them any old way.

[Streamlined]

Just to add another way to look at this particular sharing of duties: (I'm not ignoring the attitude issue, but others have already made several good points). Why should your end of shift care be so fragmented? Why can't the licensed person check blood sugar AND give the insulin closer to 0700? Why should the nurse's duty to regulate glucose control be delegated to an unlicensed person when the latter could be doing last minute fluffing and buffing, mouth care, re-positioning for meal,etc. If the CNA just filled the fricking water pitchers I, for one, would be so grateful. I quit a hospital job where the care was fragmented this way. Some genius decided that taking vital signs was a duty to be delegated to CNA's. So there I was filling up water pitchers, clearing off bedside tables, re-arranging the furniture, doing poop patrol while the CNA's were attaching a Dyna-Map to all and sundry. If only I could have had a clear path to the patient, I would be happy to perform assessment along with vitals, knowing I had taken them accurately, interpreted them on the spot, forged a relationship with the patient that would have lasted the entire shift. But no, I'm "busy" waiting in line with the other RN's for a crack at the ice machine, so the patient will have water when I bring the 0900 meds at, say, 1130. I digress. The point I'm trying to make is: instead of agitating about a co-worker's attitude, perhaps what is needed is a collegial re-distribution of duties that would make more sense for the unit, thus the patients. It doesn't take much more time for the nurse to trundle in the glucometer, the insulin, the patient record/sliding scale/whathaveyou and get the whole process taken care of in a streamlined manner (please note my moniker). While the nurse is waiting for the machine to read the BS, she/he could inquire about pain control, could teach a little, could exchange a pleasantry, could help re-orient. I say divvy up duties in a way that makes sense, make sure all involved understand the rationale for how work is delegated, do what you can to keep from walking back and forth, and for crying out loud, get along.

[Stargazer]

Excellent points, and excellent post, Streamlined. Welcome to the board!

[RN auditor]

I think the nurse on the team has a responsibility to set an example. If you work as a member of the team, treat the residents with respect as well as the CNAs, they will respect you back. When you have free time do you ask the CNAs if you can assist them with anything? Do you give patients a bath or paint their nails just because you have nothing else to do. If you take the time to do this, the CNAs will respect you and want to work on the same team as you. Lead by example, not barking orders demanding compliance.

[Stargazer]

When you have free time

Do you give patients a bath or paint their nails just because you have nothing else to do.

The who in the what, now?

Seriously. Does any bedside nurse have this kind of time anymore?