Advice for charge nurse ...Help

Nurses LPN/LVN

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I'm the charge nurse of a 60 bed unit. I have 3 CNAs and a med aide. My problem is conflict with the aides. Most the time we all get along and they do their jobs without problems but sometimes when I tell them to do something it either doesn't get done or gets done at their convenience or they argue with me and sass back. Example: last night I had 2 admits at the time I am usually doing my evening treatments so it threw me behind. I was trying to get blood sugars checked before it got too late and also had to stop and take care of a resident who is on peg tube dependent feeding, O2 and trach care. I was in the room doing his breathing tx and medications while an aide was changing his sheets. I heard the aide asked him is he wanted a sheet or just a blanket and then walked out of the room. I thought to go get a sheet since he didn't have a top one but she never came back so I had to take the time to go get a sheet then go back and cover the resident. Most times I don't mind helping, I put residents on and off bed pans, empty urinals and so on but when I am behind and still have 30 residents to do plus paperwork it gets frustrating having to do the aides job too. When I told her I had to cover the patient she said "I wasn't the last one in the room" I said no but you are the aid. She then told me I need to learn how to speak to people and then when I told her she also needed to put another resident to bed because it was 10pm and the resident was falling asleep and leaning out of her wc the aide told me she wasn't sure I had given the resident her medication and since I forget things she wasn't putting her to bed until I had done it because the resident sometimes tries to get back out of bed when she hasn't had her medication. I told her then next time ask and the aide got another attitude. I know I can send them home but I hate to put the extra work on the other 2 aides or cost someone their job. Sorry this is so long but any advice would be greatly appreciated.

Specializes in LTC, Memory loss, PDN.
I'm really concerned about you right now

you're not acting appropriately, are you alright, do you need a five minute

break away from the floor?"

Try that and see what it will do.

I said the same exact thing , the CNA got even more belligerant and told me it was none of my @#$% business how she was feeling.

I have, on several occasions

the outcome is 50/50

some calmed down and even said thank you, while others

reacted as described in the quote

and i sent all but one of them home

the one was so out of control, i called admin and she

was dismissed on the spot

i never had to send a CNA home a second time

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Thank you all for your comments. Let me add that I had trouble with the same aide on several occasions as had the other nurses she worked with. She would hide out in the laundry talking on her cell phone instead of doing her job or I'd tell her to do something and later check and she hadn't done it or told the other aide I said for them to do it. She was recently fired for sneaking out of the facility to go to get something to eat or go out in the parking lot to see her bf when she was supposedly in the laundry room. The other aides would cover for her. I don't mind helping the aides when we are swamped as long as I know they are doing their jobs to the best of their ability but when I know that the aide is just goofing off it gets frustrating. I now work with 3 aides that not only do their job they work together with me as a team.

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This is one of those super tricky yet super common nurse to nurses aid "issues." I completely understand what you meant when you told her "but you're the aide," but that is always going to offend an aide no matter what. I never worked as a CNA, I went straight to nursing school and I give all props to anyone who makes a living working as hard as they do. But, someone made a great point in a previous post that went something like "the nurse can help the CNA with their work, but the CNA cannot help us with ours." and that is the truth and it is how it is. CNA's and nurses both are swamped and at the end of the day, you being the nurse, are ultimately responsible for the care that you give as well as the care your aids give. I also get highly frustrated when a CNA questions a nurse's practice like when she said "you hadn't administered the patient's medication to her yet." She shouldn't be taking notes and observing what you are doing because if she was doing her work which we all know is never ending, she wouldn't have time to know whether that patient had received their medication yet or not and frankly, that is nothing she is to be concerned with. When it comes down to it, you have to pick and choose your battles with your CNA's very carefully because I know how many times that I have done scatter brained things like that, too. And I am in no way trying to offend any of the CNA's out there because God, we couldn't function without you but from my nursing experience, they do resent nurses in general but it is because of the way the majority of nurses treat them. I know nurses that will leave a patients room and go find an aid to hand them their water pitcher because they need a drink. That is unacceptable!! You really have to work hard to earn respect from your aids just as you have to prove to them that you've got their backs and are there to help them. I'm not saying that you do this but i see nurses everyday acting like they are better than their aids and treating them like servants and I don't understand it. I've also seen RN's treat LPN's like they're stupid as well. That is always going to exist in this field but like I said before, you have to choose your battles wisely. Everybody needs to cut eachother a tiny bit of slack in the healthcare field because there isnt one member of the healthcare team that isn't physically and emotionally exhausted. Another good tip is to never talk down to or condescend anyone that you are in charge of. Also, never confront them or have any kind of conversation about their job performance in front of any other employee. Always take the person somewhere where you can be alone to discuss whatever the issue maybe. It is unprofessional and it is embarassing someone infront of their "friends." I'm not saying you did that either but its just something good to keep in mind. If I were you, next time you work together I would give her one compliment about something you saw her do. Don't go overboard and appear to be kissing her butt, but that will let her know that you have some faith in her and she will come around. I hope that helped some.

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The solution involves playing hardball: you've gotta send insubordinate CNAs home.

CNAs are not exactly the highest-paid workers in healthcare. Most depend on a full paycheck to pay their bills, so a short paycheck often means the difference between staying above water or having the electric bill disconnected.

The strategy is to hit the disobedient people where it really hurts (read: in their wallet). After taking repeated hits to the pocketbook, you'll increase the chances of the CNA's compliance to work rules and obedience of your directives.

Can I just say that cna's are not slaves or militants. I am actually offended by the terms "insubordinate" and "obedience" etc. I was a cna in various settings. The way a nurse would speak to me would be the difference between me making their job easier or more difficult. I am a very respectful person. And everyone knows you get more with honey than you do with vinegar. Nobody needs to kiss butt but just be respectful. And why would you want to hit someone where it hurts, as in their wallet? You used the example of them maybe not being to pay an electricity bill but let's take it a step further. It could mean their child not having lunch for school, or their pet not being able to go to the vet, or them not being able to afford their prescriptions.

Overall, your response was just wicked offensive and just plain wrong!

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Can I just say that cna's are not slaves or militants. I am actually offended by the terms "insubordinate" and "obedience" etc.
All of us who punch time clocks that do not belong to us for a living must "obey" our employer's work rules and be "subordinate," or else we will not be employed for long. If these are concepts to which you take offense, then the solution is to be your own boss and start a business so that no one else has authority over you.

And why would you want to hit someone where it hurts, as in their wallet? You used the example of them maybe not being to pay an electricity bill but let's take it a step further. It could mean their child not having lunch for school, or their pet not being able to go to the vet, or them not being able to afford their prescriptions.
Someone who is purposely playing games and not doing his/her job does not exactly deserve to continue receiving pay for not fulfilling work duties. It's called the real world. Those of us who want to be paid for the services we render will put in the work necessary to receive our paychecks.

On the other hand, someone who wants to disappear, evade responsibilities and not do the work is basically saying to the world, "I do not care about my job." Someone who actually cared about feeding the kids or affording important prescriptions would not purposely goof off at work.

Overall, your response was just wicked offensive and just plain wrong!
Sometimes the truth hurts. Life is not about what happens to us; rather, it is about the manner in which we react to what happens to us. Best wishes!
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What I have learned being the charge nurse is simply that confidence goes a long way and gets you very far. If you are confident in yourself you will be able to deal with whatever comes your way. It is ok to doubt yourself at times but use yr head and judgment and do not let it show on the floor. Be calm and level headed. Do not gossip. Be respectful of your fellow nurses and especially your CNAs. Thank people for doing their work and praise when necessary. Sometimes the stressors of the job or of the day inhibits simple things from being said like "thank you"..but trust me if you respect those around you you will be respected too.

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Sorry but I don't believe that if you respect people, people will respect you back.

some people just have no respect, whether you are nice to them or not. This is the real world folks!

In the real world, cna's can act childish and not do their job properly and who do you think gets in trouble?

charge nurse!

i really agree with sending these people home as punishment and most of the time it works.

nursing is a team effort and if one person is not doing his/her job properly then the whole team does not need to suffer.

i admire those folks who thinks they can just talk nicely and diffuse the situation but in my experience, wounds make better lessons than books or words. And I meant that figuratively.

A cna who was sent home will never make the same mistake again unless the person doesn't want a job.

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Oh I agree some people have no respect! I have a couple of aides who despite write ups still come in late, call out, give poor care and still have jobs. When I say respectful it means to treat everyone fairly. Once you make an assessment on peoples work ethic or behavior do I think you can form other opinions.

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Specializes in Med/Surg, Peds, Geriatrics, Home Health.

NO WAY on this one. It doesn't matter if she came off "a little condescending" or not..... there was no time for this CNA to get her feelings all in an uproar over silly crap when patients needed to be taken care of. This is a perfect example of this nurse getting taken advantage of. OKIKATT said "but you are the aid".... that was not something negative..... that was a statement, that was the truth, and that was assertive; exactly what she should have said. Business first. When the shift is over, that CNA can speak to the nurse and tell her if her feelings are hurt over something she said and they can discuss it. If this was me, after this shift was over, I would have a meeting with these CNAs, let them know what is expected of them, let them know what their job description is, let them know what will not be tolerated, let them know what has been happening that has been upsetting me, and let them know what will happen the behaviors continue. I would also express, like you did above, how well you DO usually work together as a team and that you don't want to lose that team. Remember, try to sandwich a negative statement between 2 positive statements, it helps to cushion the blow. Good luck.

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I work as a charge LPN too. Most of the time, the CNAs that work with me are pretty good in doing their jobs and duties. I keep a friendly demeanor with everyone. I always refer to everyone elder than me as Mr/Ms. Respect can go a long way. Whenever I can, I try to help then whichever way I can. They too, will help me if they can. Also, use friendly reminders. I always say, "When you get a chance, __". So it doesn't sound like you are mandating they perform that task right away. They are busy too, and have a lot of work as well. I guess being friendly really is the trick. Atleast with me. I haven't been a nurse for too long, but so far I haven't had any issues like that.

Idk, I hope I helped out somewhat.

Good luck! :)

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This seems to be a common theme in a lot of different settings. I have never worked as a CNA/aide, I went straight to LPN school. However, the first 6 months of our schooling, as it may be for everyone else's, was a basic CNA course. I came into a LTC facility as a new grad LPN charge nurse, and have encountered similar problems. What I do is exactly what Commuter said, I took the insubordination for about 2 weeks as I was new and still trying to get my own system down. I've sent 3 aides home in 5 months for various issues such as, not providing care, leaving the floor whenever they please, and just flat out not performing job duties. I believe sending them home is really the best way to handle it.

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I deal with same thing as a new nurse lately, my aides are wonderful for the most part, and then there's the few who come whining and ******** to me about the other one, and neither are doing their job. I was confronted by my director tonight and some of the aides have said I've hurt their feelings. I know this is not an accurate statement by the one or two who said this, however I cowgirled up and handled it appropriately. My QUESTION is how do I handle that kind of situation? Should I just not delegate, or ask the aides to do things or remind them to do things? I don't tolerate laziness, and I felt like the wind was knocked out of me tonight simply because I'm trying to do my job. I am aware I can b demanding during certain situations, but in emergency, your flight or fight takes control. Any suggestions??? I'm stressed over this now. I would never intentionally hurt anyone.

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