Problem CNAs on night shift

javanurse2000, BSN, RN · Jan 7, 2005

I would meet with the other nurse and organize a shift meeting....you just might have the report tape left on and behind a pile of washcloths or something to help defend yourselves when the bold-face lies against you start. I would clearly let your staff know what the expectations are in the form of a hand-out...I'd give them a few minutes to read it and ask if there are any questions. Be specific on the hand-out ie. include times you want the ice passed...yes, ice! AND when you want the v.s. Let them know you are there to help if they need it...but that you have to follow charge nursing guidelines. The best way to help with the pericare is include them in the care...know who looks like they are starting to breakdown and talk WITH the CNA about it "I was thinking of using a new cream on so and so...what do you think?" I point out to my staff that if they find things in bad shape on their first rounds...(11 am doesn't count) to show me and I'll f/u with the previous nurse. I have one some loyalty this way but there is still a major culture difference. When I worked 3rd shift and I saw someone sleeping :nono: I would sneak up and yell "get up, you're going to miss the bus -I'm not driving you to school again!!!!" I try to have fun with the CNAs once we know where we stand. I would also find a blessing for caregivers (you can find on the net) and include that with the handout expectations.

lovingtheunloved, ASN, RN · Jan 7, 2005

A friend of mine used to work 11-7. She even had an aide call her a b***h to her face. Her solution? You didn't want to work, she sent your butt home. It's not like you'd be losing valuable manpower.

live4today, RN · Jan 7, 2005

....................b. take charge and really make them work and they will be miserable and go report us to the head people.?
:uhoh21:

i choose (b)!

you are the nurse...take charge and see to it that your residents care takes presidence over staff attitudes. afterall, it's not about them...it's about the residents. so what if they go report you. if they report you for doing what is best for your patients, what do you have to fear? you each have job descriptions. pull one out and read it to your cnas. in every job description i've had to sign regarding a nurse's duties, one of those duties is delegating necessary tasks to other staff under your license. :nurse:

angelkay · Jan 11, 2005

I am currently working in LTC on the 11-7 shift with a friend of mine. There are 2 nurses 5 aides and 1 CMA. The CNA's are consistently hateful to me and the other nurse and they refuse to do there work. Most of the time the CNA's just sit down on the hall and sleep or read magazines. And we have also been fighting to get the CNA's to perform pericare after the residents urinate or have a BM. You would think that they would know to clean someone after they have urinated or had a BM. Then on New Years Eve our administrator came in with wine and sandwiches( half of our cna's are 18-20) and told them in front of me and the other nurse that since this pericare crap has started that there needs to be a male/female team go in to change the residents. It just seems like this whole situation is hopeless. Do you a. let the cna's do as they wish and everyone except the residents are happy. or b. take charge and really make them work and they will be miserable and go report us to the head people.?
:uhoh21:

I know where you are coming from. I go through it at work too. The cna's on my shift are all older than me, I could be one of their kids, So they feel like they dont have to listen to any thing i am saying. If these Cna's are close to your age then they probally see you like someone they hang out with. When I had this problem I told my supvervisor, and she saw where I was coming from, but in the end you are the first person they look at when and if something goes wrong, just make sure you document your findings with the resident then they will know that you took action and they will look at the cna to see what she did about the problem. Some CNA's feel that you would get in trouble if they dodnt do their work (this is my opinion) but as l;ong as you CYA. (i Learned that in school) you will be fine.

Mandylpn · Jan 12, 2005

I would send their butts home for refusal of patient care! Write 'em up. :nono:

SophieMae · Feb 10, 2005

I personally would leave that job in a heartbeat. If you have an administrator bringing in wine for a staff that is legally/solely responsible for the well-being of people's lives it sounds like trouble to me. And I might add if you have CNA's that are not doing their jobs........the reflection will be, you are not doing yours. Take you gifts, talents, and abilities somewhere else, you deserve better than work in an un-caring and most likely un-safe environment.

UM Review RN, ASN, RN · Feb 10, 2005

Most of the time the CNA's just sit down on the hall and sleep or read magazines. And we have also been fighting to get the CNA's to perform pericare after the residents urinate or have a BM.

I agree, you won't change this bunch. If you were to enforce some actual rules, you already know the administrator won't back you up, don't you? That was proven by her statement on NYE. So whatever you did on nights, the aides would just run to the administrator and get it reversed or challenged.

What a headache. I doubt you're getting paid enough.

Decubs are one of the favorite reasons for litigation against a LTC facility and the CNAs not doing pericare is a huge contributor to decubs, as you know. I'm shocked that the administrator doesn't realize the extent of his/her liability in this.

Before you quit, you might want to do CNA rounds with the other nurse and note any skin problems to the residents. If you find a lot of decubs, you would certainly want to report this to your Elder Abuse Hotline, because you've apparently stumbled onto some pretty blatant neglect issues here.

If you don't find a lot of decubs, the CNAs might be messing with you and cleaning the residents on the sly.

Whatever you find, get outta there very quickly.

happthearts · Feb 10, 2005

Having been a CNA for 20 plus years and now I am managing care-givers and CNA's . Also have been a Patient in a hospital Not being able to do my own peri care. Seeing all sides of the coin here .

I would suggest to the administrator that we have a meeting with him /her present .Like come in at 10 or so for a half of an hour and with the CNA's .Dissus the issues

I would show pictures of what happens when you don't do peri-care .Do in-services till they get sick of it explain it .That it starts with a tiny red spot That its like putting acid on your skin and letting it sit. That it first itches then burns . Then really burns Then starts eating at the skin.Show the whole process. You could use strong lemon aide and put a drop on there fore skin of the arm To show how bad it itches and stings after while.

Also Why in the heck isn't 3-11 CNA'S toleting these people any way .You need to get them involved as well. If you toilet these Pt's you don't have half the problems or work with BM's and such on 11-7 If the CNA would toilet at bed time .Most of the Pt's would stay clean until the 4.00 AM round .Then all you have to do is turn them and check them and offer the PT's that are with it, the bed pan. or toilet Then go back in about 5 min's take them off the bed pan and do a little peri care much less work .This gives the Pt respect so they want to stay dry.I would always offer the bedpan if the Pt was a wake.If your aides would do this they could spend a lot less time and could still sit on there backside and enjoy the shift.

Also are you willing to help when you can .IE. when they need to move a really big Patient Do you hold them on the side so they the CNA can access the Patient to do the peri care at times .Do rounds with each one and show them what you want and expect.

I personally Even though CNA's are dead weight ,If You can not replace them right then .Would not send them home God forbid if anything happened on your shift and they state it was your fault that you didn't have proper staff ratio .Because you sent Them home. The hospital needs it to look good on paper they really don't seem to care if the work gets done just so it looks good on paper.Sad to say.The families will be complaining soon.

I would also be keeping a personal notebook of time and days ,When The aides didn't do what i said for awhile.Like sleeping on the job and such and not doing there job Decub's The time place where they were. This will keep your back covered so when the aides complain .You can show them time date and when these incidents were happening. You can also have this to show to the state and elder abuse. If you should lose your job. For reporting this.

In My agency I called and RN to see if My CNA was working out OK. One night one my CNA was not ,so I came and personally replaced her.at 1.00AM. in the morning. Funny later that shift the RN and half the aides were down for a nap saw them all laying on the couches .

If you complain about the aides make sure you are doing everything proper as well, that those aides can't turn you in on You Like med request and how long you took to get them, and If you sleep on the shift. Just make sure you watch your back side and keep safe

Good luck Your going to need it

Kitkat23 · Feb 13, 2005

I am currently working in LTC on the 11-7 shift with a friend of mine. There are 2 nurses 5 aides and 1 CMA. The CNA's are consistently hateful to me and the other nurse and they refuse to do there work. Most of the time the CNA's just sit down on the hall and sleep or read magazines. And we have also been fighting to get the CNA's to perform pericare after the residents urinate or have a BM. You would think that they would know to clean someone after they have urinated or had a BM. Then on New Years Eve our administrator came in with wine and sandwiches( half of our cna's are 18-20) and told them in front of me and the other nurse that since this pericare crap has started that there needs to be a male/female team go in to change the residents. It just seems like this whole situation is hopeless. Do you a. let the cna's do as they wish and everyone except the residents are happy. or b. take charge and really make them work and they will be miserable and go report us to the head people.?
:uhoh21:

:angryfire I would bring this issue up to the supervisor. Last year, I finally got hired at a nursing home. I got lousy training on third shift. The aide who trained me was so awful and thought she knew everything. She was the queen of shortcuts. She complained that I took too long on my rounds, because I changed patients who were incontinent again. She admitted that she leaves them for the next round if they wet or soil the linens the second time! After 3 days, I did my rounds in 20-40 minutes. I did a round in 40 minutes once, because I had a patient who had a bout of diarrhea 4 times. I did two total beds on her.

My trainer complained that it took me 15 minutes on one patient and I told her that Miss Mary had the runs 4 times on me. She said that she would have left her for the next round. Plus she never helped me with the call bells or my patients. I helped her with her patients and got all the bells. She mostly sat around the nursing station being bossy and reading magazines and gossiping with her buddy on the phone in another wing. I got fired a week later because I wasn't fast enough. Obviously, my trainer went to the DON to ***** about me. I wished I brought this to the supervisors attention. I told her that I was keeping up and getting with the system and was doing the right thing. (how my instructor taught me.) She said that rounds take 10 minutes on grave shift and I was fired and that was final. My mom told me to let it go and that I'll find another facility where I'll be appreciated more. I volunteer at a hospital now, and hope to get hired as an aide. I'm appreciated a lot more now. I hate it when aides sit around and do nothing. They love testing the new aides as well. :angryfire

UM Review RN, ASN, RN · Feb 13, 2005

I got fired a week later because I wasn't fast enough.

Holy crap! I'm stunned! We'd JUMP FOR JOY to have an aide like you!!

Gennaver, MSN · Feb 13, 2005

:angryfire I would bring this issue up to the supervisor. Last year, I finally got hired at a nursing home. I got lousy training on third shift......
Obviously, my trainer went to the DON to ***** about me. I wished I brought this to the supervisors attention. I told her that I was keeping up and getting with the system and was doing the right thing. (how my instructor taught me.) She said that rounds take 10 minutes on grave shift and I was fired and that was final. My mom told me to let it go and that I'll find another facility where I'll be appreciated more. I volunteer at a hospital now, and hope to get hired as an aide. I'm appreciated a lot more now. I hate it when aides sit around and do nothing. They love testing the new aides as well. :angryfire

Hi Kitkat23,

I feel for you this is so frustrating and not easily dealt with, some people, (like your trainer) are indeed manipulators and social loafers with a mean streak.

I have encountered a couple in my work history too, they seem to get incredibly jealous when you come on and actually start 'doing' your job and giving good patient care.

Its so tricky too because they will try to trump you out, (like your trainer did) before you trump them, (which you wouldn't do but, they think the world is as greedy, lazy,tricky and manipulative as they are).

I finally decided to take it up with the nurse manager once and she said somethign basically like, "well so and so has been complaining about your poor work performance for about six months!!" What? Yeah. So I told the manager how the things really were and decided to report this regularly. Before I realized it the manager got tired of it, (I did not do it tattle tale just matter of factly, this happened today or last week) the manager told me that she is not my mother and that I should handle this on my own.

Really? Handle my coworkers incredibly poor patient care on my own? Also, there were patients that complained also.

It is a shame and unfortunately we are going to run into these super poor care-givers who will let us run ourselves ragged while doing the work. We cannot do all their work, they need to be and should be held accountable yet, when they are so good at manipulating that you got fired, that is really a shame. Good luck in the future and watch you back.

Gennaver