warning or write up????

  1. I just started a PRN position at a LTC facility, and my 2nd night on the job, I had an STNA who really started off on the wrong foot with me. First she left for her dinner break at 6:45pm and did not return until 7:50, with the exscuse that she went to McDonald's and it was raining so she stayed in her car a little longer so she wouldn't get wet! Giving me this smirky face as she is talking too me. The policy for lunch is 30min, and if you leave you have to clock out and back in upon return which she didn't do according to payroll. The next thing she did was sometime after my 9pm med pass she cleaned two patients that happened to be tube feeders, and instead of asking me to hold the tube feed so she could reposition them, she took it upon herself TO TURN THE PUMPS OFF!:angryfire Both patients were lying flat!!!! When I asked her about this, with the same stupid smirk, she says yeah I turned them off so I could clean Mrs. So-n-so. I forgot to turn them back on. I told her you are not to touch the pumps you need to tell me when you need the pumps on hold not turned off. I will do this, not you. I don't know how long they were like this but she then says to me we do that all the time, you don't need to come do that for me, I know how to do it. ***!! Call me the bad guy, but I wrote her up. I get the impression from her that since she is older than me (15 years or so), and because she's been an STNA for 13 years she feels that she doesn't need to do the things I request. Is this a common?? I also work at a major hospital here in Cleveland,OH and the CTA/PCA as we call them I have no prob with regardless of age,race,gender. But other friends of mine that are nurses in LTC facilities have tons of problems. Sorry so long..
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  2. 22 Comments

  3. by   TazziRN
    Yes, it's common in facilities that allow it to happen. This is definitely write-up-able, but if she's been allowed to get away with it for this long, don't be surprised if nothing is done. Make sure you document everything, including what admin does or doesn't do, because if something does happen to a pt because of her actions or inactions, you want it to be documented that you did everything you are supposed to do to rectify the situation.
  4. by   RN BSN 2009
    yes... document... document... document!!
  5. by   MsKieshaRN
    Administration was Johnny on the spot with it b/c the STNAs here are union, and admin have 48 hours to present it. That is also how we found out she didn't clock out to go get dinner. They had my back completely on this. The Staff developer actually took this as a sign that there is a need to rebrief STNAs on the scope of their role. The union steward was the one who suggested that I give a warning before giving a write up. The unit manager then told her that the write up was a warning for any Aide that works there that they are not to touch any of the pumps.
  6. by   jill48
    Very common, but still cannot be tolerated. I was weekend supervisor at one LTC and due to many call in's, I had to switch two CNA's to other floors. Well, they just threw a fit and threatened to walk out. I told them I won't be threatened, then told them to get out and don't come back. The following Monday, I was the one that was fired and they were back on the job. Do what you have to do. There is no room for danger and insubordination in healthcare.
  7. by   CTstudent
    You wrote somebody up on your second night on the job?? I don't think you should have written her up for doing something she was used to doing. You could have told her that from now on you want things to be done a certain way and then if she still kept on doing it you would write her up. You were only there for 2 days. Whoever was in charge before probably made them get away with whatever, so you need to talk to them first and let them know what you expect of them. I think it's very important to have a good respectful relationship with your coworkers/subordinates and you started out on the wrong foot.
  8. by   dcnballmom
    in my LTC - GNAs are few and far between so we are warned by admin not to "come down on them too hard" - this is ridiculous - i have a few that complained about me and my work, so i just started not helping them with theirs and made their lives miserable for a few days - now i get a little more respect, but there are times that i sure would like to whip out one of those disciplanary action forms and toss it right in their face - my assts are my lifeblood in my facility but i dont need attitude
  9. by   vonxojn
    It's important to have a good respectful relationship BUT the priority here is patient care AND safety. If that patient developed Pneumonia and eventually died..whose house do YOU think the lawyers will try to take. It's the NURSE full responsibility to provide safe and adequate care for her patients. If It is not in the CNAs job description to touch those pumps then she should have kept her hands off of them. I don't care if I was on the first day into my first hour..if I see someone jeopardizing my patients safety and MY license...YES I would write them up too. If the other nurses are letting the CNAs go outside their scope of practice then they should be written up as well. If your willing to lose YOUR license and probably kill a patient in the progress just to let a CNA do what everyone has been letting her do..even though it may not be in her/his scope of practice then go right ahead. In the end you'll lose your license and the CNA will probably still have her/his job. Good luck with that.

    Quote from CTstudent
    You wrote somebody up on your second night on the job?? I don't think you should have written her up for doing something she was used to doing. You could have told her that from now on you want things to be done a certain way and then if she still kept on doing it you would write her up. You were only there for 2 days. Whoever was in charge before probably made them get away with whatever, so you need to talk to them first and let them know what you expect of them. I think it's very important to have a good respectful relationship with your coworkers/subordinates and you started out on the wrong foot.
  10. by   Daytonite
    mskiesharn. . .hello, fellow clevelander! yes, this is very common to see this kind of behavior and attitude in stnas. stick to your guns and keep writing her up. you are in charge and responsible for those patients. she has to understand that. if you don't think that the other stnas aren't aware of her 1 hour lunch breaks, think again. there is more of a silent majority who is watching to see what you are going to do and what is going to happen to this stna that wants to blatantly defy the rules. your credibility and respect as a charge nurse have to be earned and this stna has just drawn the line with you. time for you to demonstrate your authority and power.

    i've worked in ltc off and on over the years in addition to acute hospital work and i will tell you that i really learned more about dealing with attitude and discipline in ltcs with the cnas. many acted like brats and children. not good for them because i was a brat and snotty teenager myself, so i know a lot of the tricks. some children act better than the cnas in ltc. after you go through the aggravation of having to seriously deal with a few like this one you've described, the rest of the stnas will respect you and do what they are supposed to do. the problem will be that you will probably have to really run after and follow this idiot closely (the proper term is "closely supervise" her) until she finally comes around, quits or gets fired after you've written her up enough. write her up for everything she does outside the scope of her job and for every facility rule she breaks including not clocking out or reporting when she is taking a break. i would, in particular, remind her at the beginning of every shift that she is to notify you when she takes her breaks and that she is to clock out. that nails her when she goes ahead and doesn't do it and makes your write up of her even stronger as to her insubordination. she might try staying out a long time and "forgetting" to clock back in. refuse to initial her time card if she pulls that one on you because you can't verify the actual time she returned. let the don deal with that--never hurts to pass the buck and let the boss take care of some problems. chances are, however, that she won't be fired if she's worked there a long time. still, take the time to document and write her up. you never know that a brave new don might come into the place and decide after reviewing all the write ups that she's just not worth all the trouble anymore. also, if she makes a big boo-boo with another charge nurse of a similar nature to messing around with the enteral pumps who also writes her up, it may be enough to get her otd (out the door). one of the biggest problems ltcs have with not being able to fire people is that they all know who the bad workers are, but no one takes the time to document their bad doing. then, when a really bad incident occurs, there is nothing else documented to back up the one bad incident and the administration's hands are tied and they cannot terminate the person. there are also state unemployment laws that administration has to deal with that most charge nurses are not aware of. there are a good many cnas who will go right to the state unemployment office and file for benefits if they are fired and a facility will have to pay the state for any unemployment benefits paid out to a person that is fired without following their own written disciplinary policies! with any luck she's more likely to request to be moved to another unit where she won't have to work with you any more. to me, that's a win for my team. with some more luck another charge nurse with some balls will also write her up and this stna will be intimidated enough to realize she needs to leave and move on to become some other facility's problem. ha! ha!

    don't let your bosses try to feed you any bs about how badly they need this stna, if that happens. your license is the one on the line. i've had personal experience with how the state ombudsmen personnel for the ohio department of aging work. they are on the side of the patients, believe me. i'd run this stna ragged until she hated the sight of me. of course, i'd always be fair minded and nice to her, but firm and assertive. every time she turned around i'd be behind her. make sure you know the facility rules and disciplinary policy and follow it to the letter with her. you have the authority and power to do this. i might even sit down with the don and tell her how bad i felt this stna was and that she could expect to see documentation from me for every thing i caught her doing that was wrong. notice i'm not telling the don i want the stna gone. that would be presumptuous on my part. i would just tell the don that i think she's a rotten stna and that i will be carrying out the authority i have to discipline her at my level. this is just being assertive and making a statement of my intention. you have to act a little hard nosed until people realize you are serious. after these kinds of stna problems are solved, then you can relax a little and be more lenient with the stnas that are still around and perfectly willingly to follow the rules as they as are supposed to. got it?

    in one facility that i worked the cnas took long breaks or disappeared all the time. i often found them in a visitor's lounge that had one of those large screen tvs, watching the tv. i started checking the lounge when lights were going off and no one seemed to be around. i would march into the lounge and find 6 or 7 cnas sitting on the couches watching the tv. i'd pull the plug out of the wall and tell them to get back to work. i did this not once or twice, but probably 5 or 6 times. they were like kids and just wouldn't give up! i took phones off the walls of hallways in one facility that had them (as a convenience for the charge nurses!) when i would find the cnas making personal calls and hanging on them instead of doing their work. had a couple of cnas that would hang out at the nurses station on either the facility phone or their cell phones while everyone else was busy feeding patients in the dining rooms and us charge nurses were out in the hallways passing medications! there were other favorite hangouts. when other worker cnas found out that i wasn't afraid to confront the slackers they started telling me where these hiding places were. i got suspicious of any patient doors that seemed to stay closed too long. it was even worse when i first started working a night shift in one facility because cnas started disappearing because they were going off and sleeping. i found one cna--get this--it took me awhile to find her. . .she turned a very nice high-backed upholstered chair in one patient's room just enough so the back of it was to the door. then, she had settled into the chair and kind of crunched herself into a corner of it so she couldn't be seen by someone just looking into the patient's room from the doorway. she also pulled the privacy curtain just a few inches from the wall to cover about half of the chair. from the doorway, it looked absolutely innocent, almost normal. i had looked and looked all over for this aide for maybe a half hour. i had to walk into the room quite a way and look around the chair before i actually found her in a fetal-like position sleeping in this chair! wrote her up. can't remember if she got fired by the don, but i don't remember her being a problem after that because i don't think she was working there much longer. found another cna who had put a bath blanket down on the floor between the far wall and a patient's bed and was lying down sleeping on it! it was also hard to see him from the doorway of the patient's room! the thing is this, when these "children" realize that you have caught on to some of their little tricks and games it becomes too much of a bother for them to pull them off. most will do us all the favor of quitting and moving on. always keep your temper because you never know if one of them is nuts and wants to retaliate. you don't want to give them a reason to retaliate. you are always just doing your job.

    good luck! keep up the good work!
  11. by   MsKieshaRN
    Quote from CTstudent
    You wrote somebody up on your second night on the job?? I don't think you should have written her up for doing something she was used to doing. You could have told her that from now on you want things to be done a certain way and then if she still kept on doing it you would write her up. You were only there for 2 days. Whoever was in charge before probably made them get away with whatever, so you need to talk to them first and let them know what you expect of them. I think it's very important to have a good respectful relationship with your coworkers/subordinates and you started out on the wrong foot.
    I see that you are still a student, and what I did may seem a little harsh to you. You, in fact are still working under someone elses license yourself (your clinical instructor). Think about what happens to you or your fellow classmates who do not follow instructions.... They are either put on probation or fail the course depending on your schools policy. Once you go thru the program and the NCLEX to get your license, you will look at things a lot different, or maybe you will give warning after warning and we will see you in Momentum Magazine (or what ever publication CT's board issues out) with FAILURE TO PRACTICE SAFE NURSING next to YOUR name. But it will never be me in the publication like that!!!
  12. by   moongirl
    Quote from CTstudent
    You wrote somebody up on your second night on the job?? I don't think you should have written her up for doing something she was used to doing. You could have told her that from now on you want things to be done a certain way and then if she still kept on doing it you would write her up. You were only there for 2 days. Whoever was in charge before probably made them get away with whatever, so you need to talk to them first and let them know what you expect of them. I think it's very important to have a good respectful relationship with your coworkers/subordinates and you started out on the wrong foot.
    are you kidding? no way. she did the right thing. SHE is the nurse, not the aides. anything went wrong, she would have had to taken the blame. Just because someone is used to getting away with something doesnt make it right.
  13. by   nurseinlimbo
    I think when you are a prn new hire the staff will test you to see where your boundaries are. Some worse than others. They will also test your knowledge, and some will even set you up to see if you are paying attention. Personally, I wouldn't let things like this go, but at the same time I would deal with it directly the first time, and if it happened again I would take it further (in writing). It is likely that this has been allowed to go on by others in the past and the DON knows about it.

    I personally don't have alot of problems with the staff I work with, they care about their residents, and most are conscientious about their work. If anything I feel for them because they are not treated very well, always work short or short shift, too many days in a row etc. They are hassled if they call in sick, hassled if they come in sick. My manager doesn't send in paperwork on legitimate workmen's comp claims, and causes them grief if they tell their doctor that they got hurt at work.

    Anyway, assert yourself but don't make enemies, because your aides will work for you so much better if they like and respect you, and it goes both ways, don't talk down to them, treat them with respect, help them when you have time. I was one once, and I know I didn't like being treated like a peon.
  14. by   gitterbug
    I think you were being tested by the CNA's to see how far you would let them slide on duties they know exactly how to do or not do. You did the right thing, but I agree that you need to establish a working relationship with the other staff. Maybe a few minutes of touching base before the actual crew hits the floor, just go over a few points you feel are important and let them know you will be there for them too. LTC is difficult to work at the best of times, so any thing you can do to promote good working relationships will only benefit everyone . Have a good day.

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