Management question

  1. The supervisors at my long-term care facility are getting rather frustrated with the lack of respect given their authority by the Certified Nurses Aides. A supervisor will tell an aide she needs to float to another unit to help out, and the aide will flat out refuse to go. She'll say, "I'm not going, and you can't make me go." This leads to long discussions, time which could be better used for resident care. Sometimes an aide will refuse to clock in until she's told on which unit she's assigned. She'll threaten to go home if she doesn't like her assignment. Supervisors cannot be as strict as they would like to be in enforcing the rules because they don't want to compromise resident care by lowering the staff:resident ratio.

    My question is this: Since the aides are certified, is there any board to which they must answer in disciplinary matters? Can they lose their certification for insubordination and compromising resident care?

    It seems to me that if they were afraid of not only losing their job, but their livelihood (their certification, and, therefore, their chance of working anywhere else as an aide), they wouldn't be so quick to defy authority and jeopardize the health of the residents.

    Any answers?
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  2. 24 Comments

  3. by   Vailgang
    I think that it is lack of discipline on the supervisor's part. If they can get away with it then they (the CNA's) will continue to do it. Yes, I can understand the reason behind not following through due to comprimising resident care but they need to have respect and show ALL employees who is boss. I guess you could say that I am probably known as a tough supervisor. I would rather do the job myself then work with someone who tells me how they are going to do the job. I had staff that said they were not going to do laundry because they no longer got their .25 cent an hour shift differential. I reached in my purse and gave them both 2.00 and said here, now let's do laundry. There needs to be a staff meeting to discuss this action or better yet there needs to be one on one counseling. Sorry to be so harsh but I have been in this situation as a charge nurse and it drives me crazy. Good luck and keep us posted.
  4. by   BBFRN
    Originally posted by Vailgang
    I had staff that said they were not going to do laundry because they no longer got their .25 cent an hour shift differential. I reached in my purse and gave them both 2.00 and said here, now let's do laundry. There needs to be a staff meeting to discuss this action or better yet there needs to be one on one counseling. Sorry to be so harsh but I have been in this situation as a charge nurse and it drives me crazy. Good luck and keep us posted.
    I don't understand- if the $2.00 is not that big a deal to you, why don't you just give them back their shift differential?
  5. by   BBFRN
    Originally posted by blondie


    It seems to me that if they were afraid of not only losing their job, but their livelihood (their certification, and, therefore, their chance of working anywhere else as an aide), they wouldn't be so quick to defy authority and jeopardize the health of the residents.

    Any answers?
    Sorry, but their "livelihood" consists of very low pay for doing very hard work. Ever feel unappreciated as a nurse? Try being in their shoes. I did it for 5 years, and never did I feel scared to lose one crappy job with crappy pay for another crappy job with crappy pay. The stakes aren't that high IMO.
  6. by   traumaRUs
    You get respect by being respectful. If they don't want to work, fire them and hire someone else. If they get fired and it affects pt care, you call in the administrator, DON, ADON and MDS coordinator. You'd be surprised how fast you get CNAs that are good when you do this. I'm the wicked witch of the west and oh oh look out...the house is gonna fall on me!
  7. by   Buddha
    I was an CNA for seven years prior to getting my LPN. Without the CNA's I would never get my work done. I respect them not just because i was one, but because having a poor or fantastic
    CNA make all the diffrence in the world. I have walked many a poor aide to the door that I witnessed abusing a resident and I have walked a few Nurses to the door also. The sorry thing was that the Nurse usually gets fired first. When I asked the management the reply I got was that "WE EXPECT MORE FROM OUR NURSES. WE EXPECT THIS STUFF FROM OUR AIDES." Everyone needs to be more professional including the management IMHO. Untill the corporation you work for gets tuff but fair the write-ups you pass out are just a waste of time and paper.
    Last edit by Buddha on Mar 20, '03
  8. by   Disablednurse
    As long as the CNAs know that they can run the facility they will do it. They want to get the admin, DON, ADON, MDS coordin, etc on the floor to do their job. That is why I could not stay caught up when I was working as MDS coordin, because the staff on the floor thought that I did not do anything except sit at a desk, so they thought that by calling in and refusing to do their job, I could do it. Admin and DON were so dumb that they could not catch on. I could not let the residents suffer, so I would do the work, Then I would get in trouble because I did not have my work done also. When was I supposed to do my work?
  9. by   ChainedChaosRN
    Respect goes both ways. First, if someone is hired to do a job CENA or Nurse, either do it or leave. This facility sounds exactly like the facility I am currently at when I first started.

    The first month was hell. But, if you refuse to take an assignment or whatever, you leave and you don't come back. End of story, it's insubordination. If they want to discuss it later on break time, or after work, fine..we can discuss it. But patient care will not be compromised by making demands, grandstanding and threats. It took a couple of weeks of me standing at the door with the staffing book to quietly and firmly relay the message. It's not been a problem for a long long time now. I ended up firing about 5 CENA's and one nurse that ended up taking the leaving option. Which did hold up in the union arbitration. Simple reasoning: If you were hired to do a job, you refused, you lost your job.

    Somebody needs to decide who is going to manage, the management or the employees. You can't have both.
  10. by   Darlene K.
    ChainedChaosRN - I completely agree with you. An RN that I worked with years ago (we did team nursing) once said to a CNA that was complaining about the job - "If you don't like what you are doing then either get another job or go back to school." As harsh as it sounded, it made sense. He wasn't going to tolerate her being rough or short with the patients. It's not the patients fault that we are short staffed or that someone feels they are under paid. If you agree to do a job, do it.
  11. by   BBFRN
    Originally posted by ChainedChaosRN


    The first month was hell. But, if you refuse to take an assignment or whatever, you leave and you don't come back. End of story, it's insubordination. If they want to discuss it later on break time, or after work, fine..we can discuss it. But patient care will not be compromised by making demands, grandstanding and threats.
    While I agree that if someone doesn't want to do a particular job, they are free to leave, I have one small point to make in defense of CNAs: Why is it that when we nurses voice our unrest, we are "standing up" and "crying out for better working conditions," but when the CNAs do it, it's "insubordination?" Maybe I'm one of the lucky few to have an extraordinary group of Techs working beside me, but I think we tend to forget that their working conditions are not all that great right now, either. Yes, we all need to work together to ensure positive patient outcomes, but the onus of responsibility is on us as nurses. Not to sound sanctimonious, but I treat the Techs I work with with respect, because I respect what they do, and I am lucky not to have to deal with the power struggle BS mentioned above. Treat people as unappreciated children, and they will act like unappreciated children.
  12. by   sjoe
    trauma writes: "You get respect by being respectful."

    WRONG! You get respect by demanding and earning it.

    disabled writes: "As long as the CNAs know that they can run the facility they will do it. "

    Exactly, and so will anyone else.

    All of the proposed "solutions" in the original post are about "How can we find a way to use fear to control these employees?"

    Two problems: Your managers are NOT managing, and your supervisors are NOT supervising (though they are collecting and cashing the paychecks for doing so).

    Training (for management and supervisors) is obviously needed here, or THEY need to be replaced by people who are able to do these jobs. Poorly trained and/or incompetent management (along with widespread absence of leadership) is one of the top two problems in nursing today, IMHO.


    Remember:
    Last edit by sjoe on Mar 26, '03
  13. by   lee1
    "It's not been a problem for a long long time now. I ended up firing about 5 CENA's and one nurse that ended up taking the leaving option. Which did hold up in the union arbitration. Simple reasoning: If you were hired to do a job, you refused, you lost your job. "

    Nurses work UNDER a license even though they might be working and paid by your facility. If you are compromising that license by allowing unsafe patient care then a "nurse" has the right to NOT accept such an assignment. If you fire her then I am sure she can also bring bring you up in arbitration as forcing the situation on her.
  14. by   VickyRN
    As long as the CNAs know that they can run the facility they will do it...
    I have worked in one or two facilities in which the CNAs actually DID run the facility. It was an upside-down world. You dared not complain about it or make waves. The CNAs would disappear, goof off, or, actually try to boss the nurses, while the nurses were running their bottoms off all shift long. Management always sided with the CNAs.

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