What is the Problem?

[rkumiwcc]

I worked hard to get my license, and even harder to find a job. I actually found one really close to my house! Who would've thought right? Some of the staff were really calm and patient with me, especially since I'm a brand new nurse.

However...the hostility and disrespect doesn't come from any of the nurses...its from the CNA's! Even when listening to a conversation between some of the CNA's and the LPN's or RN's, they are very disrespectful. When asked to complete a task, there is constant eye rolling, sucking teeth, and sarcastic responses. If you pass a CNA in the hall and ask a question, they'll keep walking and act as if they didn't hear you. I didn't realize I'd be working with so many unprofessional people. I'm very kind to all of the CNA's because as far as I'm concerned, they work hard. To have to clean 10-15 people, feed them, toileting them, and documenting on time? Their jobs aren't easy. But come on...quit being so rude.

However since I've been here I've heard many mumblings about how some CNA's are upset because the new LPN's are young and inexperienced, and they don't appreciate someone younger than them telling them how or when to do things. I think with some, its a cultural thing which is understandable but there isn't any excuse for the disrespect. At the end of the day, its the patient that suffers as a result of the poor work ethic existing in my facility. The supervisors have been aware of the disrespect for some time, but are slow moving to handle it because its such a touchy topic. Anyone else out there, new and experienced, know what I'm going through? Any advice on how to deal?

[LadyFree28, BSN, LPN, RN]

I think the root of the problem lies in the lack of education given to CNAs. I've long pondered this - why are people who have the most frequent and intimate contact with patients given the least amount of training? In my home state CNA training was 3 weeks. 3 weeks of daytime class 9-5, a few days of clinical, a written exam and a skills test. Boom. Here's your state certificate, go take care of patients.

I happened to have a very thorough and compassionate, old-school CNA instructor back in those days (15 years ago!) who pummeled into our heads an element of customer service and stewardship toward our patients. We didn't just learn to wipe butts & make beds; she was adamant in lecturing us about respecting the humanity of people, normalizing their experience, treating them with courtesy and old fashioned manners.

I could tell even then, this teacher was fighting an uphill battle. The majority of students were a) totally disinterested in learning about the meaningful elements of this work and just wanted to get their certificates, scram and get a job - many were on court ordered programs, welfare to work etc. b) from foreign countries where the cultural practices are so different than ours, especially in a western medical setting, with a language barrier, that many could not grasp the theory. (I asked.) The test was mostly about skills.

So we are left with a workforce of CNAs who are largely undereducated, uninterested, and from vastly different cultures who struggle to adapt & communicate effectively.

Before anyone gets their panties in a twist, I'm not generalizing. I've been very careful not to use blanket terminology. There are some AMAZING CNAs out there who are dedicated, hardworking, respectful and skilled. Most of them are on their way to nursing school.

It's so typically American to wait for a crisis, then try and treat the symptoms/problems rather than analyzing the root of the problem and changing systems to prevent the crisis. Nursing homes have been and will continue to be places of low quality care and workplace conflict until we figure out how to modify and improve CNA education & raise the pay. Patients, technology, pharmacology, and health care laws are getting more and more complicated. 3 weeks of training doesn't cut it any more. We need to stop churning out such poorly prepared direct care workers and stop tolerating low quality employees. CNAs are the backbone of any facility and as long as they remain undereducated and underpaid, this is how it will continue to be.

^Well said.

[wyogypsy, RN]

I have not read the other replies, but do know that they see so many nurses come and go. Unfortunately the nurses who are too good to empty a bedpan, or walk someone to the bathroom, or get someone a glass of water, or help to wash a patient or change a bed have made it more difficult for the rest of us. Ask the CNA questions about your patients, involve them in the patient care as they know them better than you will, do not talk down to them, and offer to help them. Taking 15 minutes to help them clean a patient and change the bed goes a long, long way. We may be short of time as well, but still have to show that we can do teamwork, not just spout off about it. Make sure you thank them and tell them you appreciate them, don't just talk to them when they have not done something you think they should do. I know I could never do their job - did it when I was younger but boy howdy I am not young anymore, and their workload has increased exponentially just as the nurses' workload has.

[wooh, BSN, RN]

I have not read the other replies, but do know that they see so many nurses come and go. Unfortunately the nurses who are too good to empty a bedpan, or walk someone to the bathroom, or get someone a glass of water, or help to wash a patient or change a bed have made it more difficult for the rest of us.

Amen. I'll never have a problem with one of our techs, then I got stuck with a bunch of lazy nurses and the techs get so overrun running around doing the stuff those nurses refuse to do, even if it would be easier for them to do it than to call for a tech to do it. When it comes time for me to ask for the only thing I've asked for the entire day, then *I* get attitude because they're frustrated.

It's not as easy as the techs are lazy and disrespectful. It's a culture of lazy in every discipline. How many times have we nurses had to pick up the slack for a lazy MD or pharmacist or RT or housekeeping? Then the only ones we have to dump on are the techs/CNAs. And plenty of nurses take advantage of that.

The problem would be solved if EVERYONE would just come to work and shut up and do their job and try to be helpful to everyone when they can.

[Alnitak7]

Doing the med pass and treatments is already stressful enough without people being rude.

[prmenrs, RN]

What worked for me in situations like that was "stroking". Hi, [name] how's it going? I'm glad to see you! Thank you for helping me today. Did you just clean up so and so? Awesome! If you hear a good joke, share it. Bring in food. Participate in unit stuff. Ask for their opinion: Did you see that lesion on Mrs X? What do you think? Have you seen it before? If you're passing in the hall, stop, reach out (but don't touch) to ask your question. Lower your voice. Ask (and MEAN it) if you can help them.

This has to be sincere or it won't work. Make no mistake about it: you need them! (and vice-versa, but don't expect them to admit it)

I'm just suggesting things. I hope the situation improves.

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

The CNAs' attitudes might be the result of them not wanting to at work there in the first place. A huge number of the CNAs in my city (and many other cities across the US) are part of a "forced workforce" due to welfare-to-workfare regulations.

Many of these mostly single mothers would much rather stay at home and raise their children, but they are being forced into accepting certain jobs in order to keep certain public assistance benefits such as food stamps, section 8 housing and welfare payments. The welfare-to-work programs tend to track women into jobs that entail quick training and little formal education such as nursing assistants (CNAs), dietary aides, childcare workers, etc.

When we've got a literally forced workforce of caregivers in America's nursing homes, bad attitudes happen because many of these single moms simply do not want to do backbreaking CNA work.

Just plain ****** lazy!!!!! I'm an RN and I don't want to work either. But I do and I do not cause a hostile environment in doing it! I had this same issue just last night. And my thoughts were, "that's why I'm the nurse and you're the tech!" I am NEVER, EVER judgemental but this time, I was pushed. Everytime we are short a tech, some of their duties are added to the nurse. Everytime we are short a nurse, we just have to suck it up and do the **** work! None of our duties are EVER assigned to anyone else! EVER! Age doesn't play a factor in it then. I am an older nurse...but not that old. However I do have 27 years of nursing experience under my belt and I know how hard SOME of these girls work and I do whatever I can to help THOSE girls out. But the more you do to help some of them, the less they do because, "oh, the nurse got it", so they don't even check the next time an issue rolls around.....they just wait on the nurse to do it since the nurse did it the last time.

So what if the nurse is younger than the tech. They have no problem with that when that younger nurse has to take on some of their duties because they are short a worker. Some of these people have no pride nor self-respect....only looking for a handout. I was a single mother, too. But I set an example for my kids because I did NOT want them to be a "victim of the environment" that was created by adults. Our lives are what we ACCEPT and CHOOSE to make of it. Being a minority myself, I can relate to how hard it can be in this world. But damn! When does the b****** stop and the changing start? It is a free country and if you want something out of life, turn off the soap operas and get your you-know-what in gear.

Now, I know there are some nurses who will provoke God if given the chance. And I hate working with or even just giving or receiving report from those types of nurses myself. But those nurses are like any given family in that everybody's got ONE. But I'm not that type of nurse and for the tech or a nurse to have an attitude with EVERYBODY? Surely the hiring manager had to have picked up on this during the interview because these individuals are making no secret of the fact that they DO NOT want to work in this field. I think it is pretty darn pathetic that these people are hired anyway simply because we need the help. Nurses have enough to do other than babysit co-workers with hellified attitudes.

This one CNA says that she was going to go to nursing school and I just finally told her that she wasn't ready because if she gripes about doing her job, how on earth is she going to handle it when she's forced to do the job of a nurse AND that of the tech when the tech refuses just as she does now? Sadly, that tech and I are the exact same age!!!!! But the mentality is as different as night and day. You have to GIVE respect in order to receive it. NOTHING is free. Even our own deaths is gonna cost somebody something!

If pushing a bedpan and WATCHING a dynamap check a blood pressure is too hard, go to Family Dollar or Dollar General or Piggly Wiggly or Walmart or ANYWHERE that there is no actual concern for a person's well-being other than making sure there is no slippery floor.

Sorry all....this is just a very touchy subject for me because I will never understand why someone would use the workplace to humiliate themselves and others without giving it a second thought. I hate my job with a passion because I never wanted to be a nurse. And I probably would hate ANY job because it takes up too much of my personal life. But my employer NOR my patients EVER see how I really feel about it because I am a professional.

Last night, one of my patients said that I smile all the time and was wondering why I was so happy. She had no idea just how hard I tried to get out of coming in just a few hours prior. And a couple of weeks ago, I cared for a patient and discharged this patient. In our conversation, it was discovered that he was the Mayor of one of the towns that I pass through on my way to work. He and his wife were so grateful of the care and attention I gave to them that he asked his wife to give me one of his cards and said that if I am ever pulled over when passing through the town, show the card to the officer. There were no words to express how I felt at that very moment. This particular night could have gone in any number of ways because, for starters, I was floated to this area of the hospital that I didn't even know existed. So needless to say, I had no experience in the area at all. But I went there with no attitude even though I was internally p***** for being floated to an unfamiliar place with no orientation to the unit yet again! But the attitude that was visible provided a relaxed atmosphere for my patient and his wife and yielded me a get-out-of-jail-free card......(even though I'm not a speeder). My thing is, why make the 12 hours seem like 24 by having a nasty attitude and dodging work? It takes more effort to throw your work off on someone else than to just do it and not have to worry later about explaining why you repeatedly fail to do your job.

Ok....my breakdown over. I've been holding on to this one for a while now. Places like this is where I vent; not at the patient's bedside or nurses station.

[lemur00, BSN, RN]

I had issues with the aides at my one job when I WAS an aide. One time I complained to my LPN co-worker that anyone who is afraid to deal with poo should NOT be an aide (this group frequently tried to avoid poop duty whenever they could) and he said "look what other job are they ever going to make 20 dollars an hour with benefits with virtually NO education or motivation??" (many of them had been grandfathered in so had no education) That put it in perspective. I worked at my job because I loved it, but a lot of people doing the work really do not want to be there.

And I found that certain facilities end up with an overabundance of those people because the management don't treat anyone with much respect--the people who take pride in their job move on to places that will appreciate them. Those left often can't get work elsewhere. They also are often burnt out from being over extended and over worked. Those who are smart get out of those types of places while they still are capable of caring (I know I did).

I do concur that some newer nurses tend to have an attitude about aide work. It's not that they're intentionally disrespectful or anything, they just say things like "wow I would kill myself if I had a dead-end job like that" and "I can't imagine just being an aide and doing bowel care". Because giving meds and doing treatments magically makes your profession noble or something--forgetting that aides do the most basic of nursing work. None of my classmates could believe that being an aide would ever be in any way rewarding. People pick up on that kind of condescension pretty quick, even when offence isn't intended.

[Marshall1]

CNA's behaving badly is nothing new..nor is some nurses being disrespectful toward CNA's. Set your own limits w/anyone who you work with in regards to respect and if needed go up the chain - otherwise, just assume, as with any job, there are going to be some nice people and some not so nice people so boundaries are a must - liking someone is not.

[ricksy]

I disagree that more pay would make them less disrespectful. Respect goes by a pay scale? Someone mentioned that CNA help in plan of care.............hmmmmm, wonder if that would be an NCLEX question..............................NOT!

[ToyaB]

I am curretly going to school for to be an RN. My mom is a CNA and has been for a long time. She warned me to always be willing to help with direct patient care because apparently A LOT of the RNs --new and otherwise-- do not like to help and that creates this animosity. I think this has been going on for such a long time that that bitterness is just there. What will it take to fix it?? More nurses that are willing to be nurses and handle their business right alongside our CNA counterparts.

Now if it's a matter of CNAs not liking their job or feeling diminished in their role, then do something about it and move it onward and upward. A lot of it is also perspective. Some people are just unhappy people who feel jaded at any infraction--actual or perceived.. whether that's due to conditioning or whether that's just who they are... Hang in there OP. I think maybe voicing it maybe even to the people who you feel have disrespected you or who you feel have some issue with you.. not in a confrontational way, if that's possible. If you think not, leave it alone.. no need to go losing that license you worked so hard to get behind some foolishness!

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

I am curretly going to school for to be an RN. My mom is a CNA and has been for a long time. She warned me to always be willing to help with direct patient care because apparently A LOT of the RNs --new and otherwise-- do not like to help and that creates this animosity. I think this has been going on for such a long time that that bitterness is just there. What will it take to fix it?? More nurses that are willing to be nurses and handle their business right alongside our CNA counterparts.

Now if it's a matter of CNAs not liking their job or feeling diminished in their role, then do something about it and move it onward and upward. A lot of it is also perspective. Some people are just unhappy people who feel jaded at any infraction--actual or perceived.. whether that's due to conditioning or whether that's just who they are... Hang in there OP. I think maybe voicing it maybe even to the people who you feel have disrespected you or who you feel have some issue with you.. not in a confrontational way, if that's possible. If you think not, leave it alone.. no need to go losing that license you worked so hard to get behind some foolishness!

Thing is, I really believe with all my heart that the CNAs with those attitudes do NOT read sites such as this one in order to gain perspective on what nurses have to do. Nor do they follow sites like this to gain some insight into their own behaviors and attitudes. Those individuals are very complacent with living negativity. The wonderful CNAs are either aging (they came into the field when behaviors like that were somewhat unheard of), or they are in the processing of self-improvement as a nursing student, so they are aware of the attitude that is required to care for the ill. These others don't care about themselves, let alone the ones who rely on them for assistance. They don't want to be there and another poster said, where are they gonna go? Nobody else will hire such people.

Once you get your license, it may take a minute, but you will see just how much 'CNA work' that you (as a nurse) will do and how that correlates with the time that you get off the clock because while you are helping them, your duties still wait for you. I'm all for helping but they need to be understanding that as we help them, they cannot do what we do and the majority of what we do as licensed nurses, has a time limit on it that only WE will be held accountable for. Not one time will you hear a tech say to a nurse, "what can I do to help you" because the answer is just do YOUR job and that will help me out a lot. Again, this is only directed at those with that attitude. I feel, again, if a CNA is on this site, they are concerned about people and how they can better serve them. After all, when all is said and done, we are all servants.

Someone mentioned a nurse calling for ice for a patient while that nurse was in the room. Well, I'm here to say that I have been guilty of that because of those patients that keep you in the room like there is no other patient there and when you are about to leave after being in there for 30 minutes, they ask for something that will bring you right back in for another 30 minutes. So, I call for the ice and when the CNA arrives, I leave. That is the only way that I can get to my other patients. But if the CNAs would pass ice and keep check on things like that regularly instead of ducking and dodging their duties, nobody would have to call. That's the purpose of hourly rounding. Just because ice passes are twice a shift doesn't mean that it can't be passed more frequently. If you know there is a needy patient in the midst, go ahead and give them EVERYTHING that they could possibly call for as a way of preventing the call.

I think I'm gonna have to leave the house because this is my day off and I try not to do, say, or think anything nurse-wise when I'm not on the clock. Something told me not to check back on the post.

[Alnitak7]

When I worked as a C.N.A. I never thought charge nurses deserved to wash the patients over and above what they were already doing.

I was always grateful if one of them washed up any of patients.

I think it would help if all the R.N.s and L.P.N.s would

have a few days where they all work as C.N.A.s without the C.N.A.s being scheduled so they can gain insight into what

they're going through.

I also think there should be an in-service created so they all know what their charge nurses are going through.

When I passed meds this was one of the times when I was not abused by C.N.A.s