Tell the CNA to clock out and go home

Specialties Geriatric

Published

Things are changing now at my "Anything goes" LTC. We are now being told that we are not to put up with any CNA insubordination anymore. We were told that if a CNA refuses to do what we tell them to do, that we are to tell them to clock out and go home. How do you think this plan will work out on the 3-11 and 11-7 shifts when we are already short of CNA staff to begin with?

Hey, this just happened to me a couple of weeks ago! I had an amazingly insubordinate CNA , and by 2 am I knew I was writing her up, by 6 am I found her sleeping on the job and that was it. I told her to clock out and leave, by that time we had extra staff on the floor thank goodness. Her reaction was right on target for what I had experienced thru the night, she refused to leave initially and then did clock out and refused to leave the floor for another half hour. If I had security I would have called, but as it was all I could do was repeatedly ask her to leave the floor. On a hall with 30+ residents I have 2 CNA and many are 2 person assists, so if I had to ask a CNA to leave during the night, it would leave dayshift with a lot of catching up to do. Better than finding an aide sleeping on someones bed while another resident is getting sick 2 doors down, someone else is screaming bloody murder and pharmacy is staring at me from down the hall, all at the same time, LOL.

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Some of the CNA's at my LTC treat the patients like hell. If a patient asks for help they get a rude nasty hateful CNA who is "mad" because the patient bothered the CNA by putting on their call bell. After all, the CNA was busy playing on the computer or her cell phone at that time. How dare that patient disturb the CNA by putting on her call bell? Of all the nerve!!!

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Some of the CNA's at my LTC treat the patients like hell. If a patient asks for help they get a rude nasty hateful CNA who is "mad" because the patient bothered the CNA by putting on their call bell. After all the CNA was busy playing on the computer or her cell phone at that time. How dare that patient disturb the CNA by putting on her call bell? Of all the nerve!!![/quote']

This! Or like today one of my CNAs had the nerve to get mad because I asked her to go ahead & give a resident that normally doesn't get showers on Mondays a bed bath the residents family member was ****** about her walkin in and finding her mom laying in a wet diaper like she was livid and I know LTC is about customer service so I just wanted to defuse the situation & the only thing that was gonna calm this chick down was for her mom to get a bath...don't get me wrong between the "calling state" threats and all the bs she was saying I was a but annoyed but I didn't let it show the CNA was down right rude...she was purposely NOT goin to the particular resident just to prove a point the point was that "I can't drop everything and go to her" idk why CNAs feel that way yes that's true to a extent as a nurse I had to stop what I was doin ( literally in the middle of punching pills concentrating on the MAR so I don't screw up someone's meds) and go and deal with this VERY upset family member which resulted in me getting behind not getting a lunch and blah blah blah but I never complained about it not once because its my job (well I'm venting about it now) but she ****** me off

They get BOTH of their 15min breaks & their 30 I'm soooo jealous I'm lucky if I get to pee lol ugh then they have the nerve to huff and puff about how tired they are & don't get me wrong I love my CNAs like I'd be screwed without them I truly do appreciate them....I try to help them if I can in anyway

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All the care staff working when I'm on the floor are working under my license; I'm accountable for the quality of care they provide. Why would anyone jeopardize their license by not holding the support staff accountable?

I've only had to send one person home since I began at my current position; but I also make it a point to randomly go behind my care staff and double check their care.

Sending someone home increases the work for the rest, but if the alternative is people being overlooked, or corners being cut, most of my staff would rather have the extra work.

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Your language is inflammatory: You compared CNAs to "slaves." You believe that CNAs rebel. (Most don't.)

You believe that the nursing staff is "holier than thou." According to you, there are nurses "on power trips."

You are "so far only the second (known) advocate for CNAs", but have you recognized other posts and threads on AN where CNAs also lament their lazy, uncooperative colleagues? These wonderful CNAs pick up the slack because they genuinely care about the residents and, because of the lazy ones, they have to work harder.

I believe she was sticking up for the CNAs.

If people are so upset with their lazy CNAs why do places insist on a year's experience? I know a lot of people who went to CNA classes and can't find jobs because of this. Fire the ones that don't want to work and hire those who do even if they are new.

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Management has told us nurses that they cannot fire the lazy nasty hateful CNA's because they are protected by "the union."

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Specializes in Gerontology, Med surg, Home Health.
Management has told us nurses that they cannot fire the lazy nasty hateful CNA's because they are protected by "the union."

I've been the DNS in two union buildings. You certainly can fire people. It isn't done on a whim and all the documentation must be in place. Of course they can go to the union and you'll have to go to an arbitration hearing, but the aggrevation that brings is far less than dealing with the consequences of a bad employee.

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To me it sounds like they are putting the nurses in an untenable position. Why is management making you do their job? It seems like a set-up that will create an adversarial environment between nurses and CNAs, when they should be problem-solving and finding ways to make the units go smoothly.

You guys are all front line staff and the management should be doing whatever they can to promote a healthy team environment. If that can't happen it is on them to look at their staffing and hiring practices, and additionally address discipline problems and find ways to create a positive working culture. Making the nurses do their dirty work is just wrong.

Not to mention the fact that if you send a CNA home, now your unit is working short. No one wins with that. Except management -- one less paycheck to worry about; they've got a unit that is drowning and understaffed, but now they can just blame the nurse for sending the CNA home.

I wouldn't want to be in your shoes.

I appreciate the support if I have to send someone home. The aids are working under my license; we need to be able to enforce that relationship. Sending someone home, provided they are already aware of that possibility, is the logical decision for dealing with someone who is not meeting the standard of care their job entails.

I'd rather be one person short than have my residents subjected to a neglectful/abusive work ethic.

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Specializes in LTC.

What works for me in relations with my CNA's is first off, I ask them how they're doing when they arrive for work and check in with them a couple times throughout the shift just to make sure they're OK. If they're not, I try to help them with whatever their issue is, even if it's just to listen to them vent. When I make assignments, I know who likes what hall and assign them accordingly. I ask them when they'd prefer to take their lunch breaks. If we're short, I call them all up and let them divide up the assignments. I am there to iron out any issues if they can't come to an agreement, but they're all adults and can usually work it out among themselves. In other words, I treat them like adults and allow them to make choices for themselves where I can. From what I have seen, that goes a long way in making them feel valued as employees and as humans and not just a tool used to complete said assignment. They know I'm busy as I know they're busy. If I can handle something quickly instead of having them grab a towel or whatever, I'll do it. They also know if they need help transferring someone or simply pulling someone up in bed they can come get me and I'll help. I show them respect and they afford me the same in return. They will do what I ask of them because of that. I've used that method in every building I've worked in and it works every time. It takes longer in some buildings to achieve that because so many CNA's have been treated badly by nurses that a lot of them don't trust us and do think we're all a bunch of "lazy orifices" as I've been told by many, many CNA's. I am also aware that there are some CNA's that have a chip on their shoulder and simply do not want to work, or will do the bare minimum to get by to the detriment of the residents. Those CNA's should be written up and terminated accordingly. I find that those type are the exception rather than the rule. However, one bad apple in the basket can poison the rest, so they should be dealt with quickly. I am not saying that my way is the right way, but it has worked well for me so far.

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Something that you may try before coming down as the heavy is to let them rant while you stand there calmly and quietly and while looking them dead in the eyes ask "Are you refusing to give patient care?". Initially (when working is such an environment as you wrote about) it is often followed by loud protests etc. Do not react. Do not try to cut them off. Wait till they finish keeping your earlier stance and again keeping non-confrontational eye contact repeat the question. This will often leave them stammering.

Now, if the person in question is just lazy and used to doing nothing the confrontation may continue, at this point with their refusal to comply, I would send them home. And I would tell them why, using no emotion. Just flatliy state the facts and let them know that you will be following this up with a write up and that the DON or HR will contact them in the morning for follow-up. Just make sure that you alert the DON.

Sometimes, this is done because of caregiver fatigue, fear of the task or because of prior abuses by superiors and I have found that the second time I ask this question, it will end up in tears and the real reason for the outburst will be spoken. Once the reason for the outburst is finally out in the open, we address the issue together and move on. No need for a write up and most of the time, no hard feelings and the relationship between us (and the unit as a whole) is stronger than ever. They then find out that if they don't know how to do something or are simply overwhelmed with the assignment or workload, they can just come to you, knowing that you will at least try to help THEM find a solution.

At one point this had occurred. What I found out at that facility is that the aids made up the group assignments. And what this group would do is to cherry pick the easiest patients for themselves and give all the lifts and toughest ones (often giving them twice as many patients to top off having the toughest patients). After a short shouting match, I looked over the assignment sheet and found the reason for the outburst. Needless to say, the assignments were more evenly distributed. I was able to keep the ones that really wanted to be there...as for the others, most made the choice to find other jobs that would tolerate this type of behavior and get paid not to work.

Best of luck!

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I sent a CNA home with a fellow nurse documenting to back me up, CNA was sleeping on the job. Upper management fired the CNA based on my and the other nurse's documentation (went to get her on another unit to witness the CNA asleep so it wasn't just my word against the CNA's) and I didn't feel bad about it. I was tired at 4 AM too but I was working!

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Specializes in LTC, Education, Management, QAPI.

My *incredibly awesome* ADON has started being our unofficial mediator when an issue of attitude arises. I am a DON that would most likely have failed long ago without her. We are completely different people, and we balance each other so well. When our CNA's, LPN's, RN's, or anyone for that matter gets belligerent or disruptive or rude, they take an immediate time out and go to the "mediator". It's so simple, but it works! I live and work in a *very* diverse area, so it's been difficult to say the least. It helps to remember that a lot of times the attitudes are coming from overwhelmed, overworked, underpaid staff. We should be tuned to that as managers. There is, of course, that CNA or LPN or RN that just thinks they own it all and those, well, they get canned.

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