This can be a big issue for new nurses and even non new nurses that are just new on the unit. After months of insubordination and terrible incidents I would just tell the tech, cna, aide that I would report such issues to the manager. The end. Examples: refusing to help while sitting at the desk online or on a cell phone ( we have a few like this and unless you are assertive or aggressive they won't help and will acutally refuse and laugh about it at the desk, going on 6-7 breaks and not getting vitals while you are drowning in your own work and not able to do their job too( aides have specific tasks they are too do on my unit). I think because I let it go for so long when I finally told the 1 offender I would just go to the manager this person was pretty shocked and shaped up quick. For things like aides that go beyond their scope or disregard doctors orders, I do some teaching( some of them really don't know any better or think they are helping ).