Charge Nurse did CNA work. Learned A LOT.

[arelle68]

I did the work of a graveyard CNA last night on my Alzheimer's unit. There was no CNA to cover, so I volunteered to stay another 8 hours. I found out everything that my CNAs should have done, and didn't do. I also found out how hard they work. I know that they work the whole time they are there, and don't always get a break, and the facility quibbles with them over getting out as scheduled. The work that they do is emotionally, and physically exhausting. I have been screamed at, hit, cussed, invited to bed, and barely avoided having my fingers smashed by an angry resident. I feared for my safety during those moments. I moved lots of heavy people, and changed lots and lots of Attends, sometimes with the Rsdt. fighting me. My body hurts all over.

I saw things that made me upset. Bruises that had not been reported. Teeth that had been left in, and not cleaned, with one resident's mouth bleeding. Heels not floated. Heel boots left off. Things that I just trusted that the CNAs would do. Things that I sign on the MAR as done. I don't have time to check on all of these things. I barely have time to initial the little box so that I can hurry and initial the next little box...You people know how it is.

My CNAs need to take care of these things, and I need to make them. Not because my job is on the line, but because it is the right thing to do. The question is, "How?" How do you fo the work without time to do it, and staff to do it? How?

I could tell them, "Ok, these are your residents, these things are what you have to do for them. Do a round with me before you leave, and prove to me that you have done these things before you clock out." That would be the thing to do, right? I know it is in my heart. But then, things will take longer for me, and longer for them, and administration will be all over us about the time.

I am a fairly new nurse, and I want to be the best I can be. I want my unit to shine as an example of excellent care. Please give me ideas, fellow nurses. CNAs, I'd like to hear from you too. What do you think I should do?

[Nikki69]

I was a CNA for about 4 years before I was asked to take the job as Staffing Coordinator. I make the nurse's and CNA's schedules, and assign where they work every day(among loads of other things). When I have nurse's constantly complaining to me about certain CNA's that don't do their best, or leave their work uncomlete or sloppy, I have to keep reminding them that they are the supervisor and one small role of their job is to make sure their CNA's know what they expect from them. I know that this may be difficult for some people but it's necessary. That's not to say you should get out the write ups at first but I think the CNA's should realize that what they do and don't do reflects on you and the image of the whole facility. Last week I had to attend a veeeery long meeting on "better management". The biggest message the speaker wanted to get across to us all is that if the employees under us are not succeeding, it is our job to do everything in our power to make it so they can. If they fail, we fail. We can make sure most of them succeed not by writing them up every chance we get, but to encourage and nurture them. This can be done with a passing smile, a "good job", or a "don't forget to___________ before you go". It doesn't take up any time at all, and it might make the CNA's feel recognized because that's one thing that they probably don't feel very often.

One thing I think might help (even in my facility) is to take a personal moment when you're at home or whatever and write down the most important things that you expect to be done by your CNA's-no matter if it's as simple as brushing and soaking the dentures or floating the heels and discuss them with the CNA's at the beginning of your shifts during report. If you don't give report to your CNA's, start. Call them all up there and do it even if they other nurses don't. They will respect you more if they know a little bit of what you know. If you're uncomfortable "telling them what to do", you could always say something like "we've had some complaints about_________, or the DON is going to be checking _________, so can you please make sure you pay special attention to that". That way it will take the focus off you and on to the management or hopefully, their own work ethics.

Good Luck!!

[nkara, CNA]

becoming a nurse doesn't mean neglecting the "cna" work. I understand being busy but assuming that the aides are doing the job falls under your license if it doesn't get done. Protect your risidents and your license and follow up on the cna's.

[StarNurse2006]

Every morning I have a quick meeting with the CNAs assigned to my residents. I give them any report pertinent to their assignments, confirm what showers they have assigned, let them know if a (combative, agitated, etc) resident has or will be medicated, tell them my expectations (vital signs in by 10 AM, let me know when you are leaving the floor, etc) and ask them if they have any issues they need assistance with. It takes less than 3 minutes, and it makes for a fantastic day. I believe it makes them feel that we are a team and they can come to me with issues, and it also makes them aware that I DO watch to make sure things are done correctly and that I appreciate them.

If a CNA does not meet my expectations I set out, I counsel them, in person or with a written warning. That is usually sufficient to prevent a second occurance.

We call these the morning "Come to Jesus meetings." LOL

:rotfl:

[coffee4metech]

Arelle-

Your managemant skills are flawed if you are doing your job the CNAS would be doing there job and obviously they are not doing the job appropiately. And by the way you don't own the CNAS they work for the patients not you ,your not writing the checks every month .So please view them as people not slaves who have to complete the impossible during the shift like most floor nurses do also . Be humble and take this as a lesson and manage your staff with a more structured form of management.

[Nikki69]

StarNurse:

You are communicating with Your Assistants. Good Job!

[LEN-RN]

This is a classic example of not enough staffing. You saw it and lived it. Maybe you should bring it up to your DON, when basic care is being missed - there is a problem. .

I liked branbran's approach....I should have quoted it:).

Ok,

The OP is CONCERNED about the CNAs and their workload and many of the responses are about how calling them "my CNAs" is disrespectful?? Its apparent she cares and it sounds more like an affectionate term. But even so, not sure how it sounds like she owns them and no idea where slave came from. I interpreted that she walked in their shoes and had a whole new respect for their job. AND wants to make changes for the better and was asking for suggestions. And not that it matters, but she didn't say she called them "my CNAs" to their face. Oh should nurses be offended when someone asks the CNA who "their nurse" is??

The fact that this nurse stayed and worked 8 hours after her own shift, SO THE CNAs wouldn't be even more overloaded, shows her character. If she had no respect for them, she wouldn't have done it and certainly not come on here asking for advice in how to do things better.

[t1nkerbell]

To: Starnurse2006

YOU ARE NOT JESUS!! HAHAHA! LOL:down: If I worked with you and had to hear you blaspheme the Lord one time, I would file a complaint against you. How is that remotely funny? And how can you be in charge when you don't even care about someones beliefs even if their not yours???

[Dixiecup]

You asked for advice, so here's my opinion. Don't refer to them as " your "CNA's. It's just disrespectful to them. They are the patient's cna's, and even if they are working under your supervision and direction, they are not "yours". If they hear you talking like this, It would be highly likely that they will resent you. Ask them to round w/ you and "prove" they are doing the required tasks? Umm, no. You will create even more resentment, and no one will want to work with or take direction from you. I think you need to examine your own attitude and learn how to delegate effectively.

This is just my opinion and advice. I hope you don't take this as an attack. I am trying to help you as a new nurse.

I disagree here. Nurses absolutely should do rounds to make sure the CNA's are doing their job. Maybe not "with" them but they do need to check that the job is being done. At my facility, the nurses are required to do rounds on the CNA's about the middle of the shift, they have a paper to check off what is not done and give it to the CNA. The CNA completes the tasks that aren't done and hands the paper back to the nurse to sign off on.

On the other hand, if a CNA has a perfect hall, they get a smiley face on their paper and we keep track of how many "smiley faces" everyone has. They can trade in their smiley faces for rewards in a little store we have with prizes of sorts in it. You would not believe what a motivater this is for the CNA to have a perfect hall. They love shopping in that store!

[t1nkerbell]

You made an excellent point and it sounds favorable, but dixiecups statement was completely different than what you addressed. It's awesome to hear what you really meant, but I believe it is still good to hear what dixiecup is saying. You were making two complete different statements and you ignored what she said as if it didn't exist. Her response was according to what you said, but apparently that is not what you meant. So, kudos to both of you.

[fuzzywuzzy, CNA]

On the other hand, if a CNA has a perfect hall, they get a smiley face on their paper and we keep track of how many "smiley faces" everyone has. They can trade in their smiley faces for rewards in a little store we have with prizes of sorts in it. You would not believe what a motivater this is for the CNA to have a perfect hall. They love shopping in that store!

What? That's incredibly juvenile...

[t1nkerbell]

True. That is very juvenile, although I can see how that kind of system would work. It's their approach with it, that is wrong. It felt belittling to read, but then on the other hand I think a reward system is great. It takes a professional, mature, caring individual to be a CNA and their words and attitude do not support that.

[Dixiecup]

What? That's incredibly juvenile...

Well, it works for us and at least we are doing SOMETHING to show appreciation. Our CNA's think it's great and get quite upset if they think we havn't tallied thier smiley faces correctly. No on has a problem with it. If they see me coming down the hall they will sometimes ask me to come back in a few minutes so they can get that smiley face!