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?

[wyogypsy, RN]

I don't know if we should have to work as a CNA without a CNA being scheduled, wouldn't want to do that to the poor patients! I used to be able to do it but am not so young anymore. But I definitely think a nurse should be scheduled to work a full shift with a CNA, how else do they have a clue what the CNA does and how busy they are, especially if they haven't worked as a CNA before?

[Alnitak7]

In some nursing programs they become C.N.A.s after the first half of the year that they're in it.

I have seen a lot of L.P.N.s and R.N.s who are willing to work as C.N.A.s when one calls in sick.

Getting back to the subject of C.N.A.s with an attitude, I do know that if you take care of ten patients then you get used to having a list of responsibilities and each time someone asks you to do something it can be like a final straw on your back.

Charge nurses have the same problem.

[LVN2RNMom, ASN, BSN, LVN]

I've had some ruthless CNA's and I've had some excellent one's. No matter what you do or where you work, you will find good & bad. I've never been a CNA but I was an MA thus I'm not new to this. I have never been bothered or felt it was below me to change a patient or help them. I am after all a nurse & the patient is my focus. I could careless about whose job is to do what BUT if I have to do YOUR work much of the time cause you assume I will do it, then we will have a problem.

[ricksy]

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.

Nice post, but hopefully not 15 minutes very often in one shift...LOL! SUNK!

[rkumiwcc]

I'm glad I'm not alone in this aspect. & I am so thankful for all the advice on how to deal with some of the CNA's here. it's just that much I understand I'm brand new so I would love to be part of the team and help out the CNA's. which I do quite often sometimes when the CNA's are sitting down sleeping on the night shift if a resident rings the call bell, I'll answer it I'll take the resident to the restroom, it doesn't bother me.

sometimes I won't even take my break I'll go into the day room with them and help with feeding, but these things go on unnoticed all they seem to see is that I am too slow or not fast enough for them to get their work done quickly

[jigzawnurse28]

I havent worked with CNA's but will be soon (next week) so I am looking forward to observing this issue. I bet they are ****** for new nurses like us telling them what to do. Well im not fairly new I used to work at an ambulatory clinic and worked with Med assistants and yes some got attitude because they know more stuff than me but mostly are nice and respectful. But CNA's that I have to see. But we have to hang in there you know how difficult to even get a job interview nowadays! I waited 6 months from getting my license before finding a job so im going to have to humble down because I have no other options!!

[BrandonLPN, LPN]

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.

The rub, of course, is how can nursing homes that already run on razor thin profit margins afford to substantially increase the pay of their direct caregivers?

I totally agree that CNA training ought to be longer and more substantial. But if you substantially increase the educational requirements you must also increase the pay just as substantially. Nobody in their right mind is going to go through the incresed education/training propsed here only to come out of it making the 10 bucks an hour CNAs currently average. I would imagine such a highly trained caregiver would expect at least $15 an hour. How is this doable for the average LTC facility?

I guess one pluasible scenario is that, with a higher educated and more motivated CNA staff, nursing homes would make up the extra expense in other ways. CNAs who made $15 an hour would certainly have a much lower turnover. And the residents would benefit from caregivers more educated in subjects like skin break down, nutrition and proper vital sign monitoring. This would save the facility money in the long run. It would be an investment.

But I really, really dislike this idea so many nursing leaders (ANA Im looking at you) have that it's okay to increase the educational requirements for entry to practice, without also increasing the scope of practice, pay and overall role. To suddenly expect people to increase their education in order to do the exact same job for the exact same pay is absurd. You can't have one without the other.

[calivianya, BSN, RN]

But I really, really dislike this idea so many nursing leaders (ANA Im looking at you) have that it's okay to increase the educational requirements for entry to practice, without also increasing the scope of practice, pay and overall role. To suddenly expect people to increase their education in order to do the exact same job for the exact same pay is absurd. You can't have one without the other.

PREACH IT!

Sorry, couldn't help myself. Unfortunately, in this economy you absolutely can require more eduction and keep the pay the same. Everyone is so desperate for a job that if it required a master's degree to be a CNA I bet some people would do it. A lot of the time, it's even harder to get a job in a different field than in nursing. I know people with master's who are waiting tables for $2.14/hour who would be very glad to make $10. It's pathetic.

Honestly, I don't think there's any way any reform can be done to the pay structure of nurses or CNAs until the economy picks up. Once there is more need than availability, nurses and CNAs will be able to advocate for themselves. However, as long as there's more of us that spots, we have no power. It sucks.

[BrandonLPN, LPN]

PREACH IT!

Sorry, couldn't help myself. Unfortunately, in this economy you absolutely can require more eduction and keep the pay the same. Everyone is so desperate for a job that if it required a master's degree to be a CNA I bet some people would do it. A lot of the time, it's even harder to get a job in a different field than in nursing. I know people with master's who are waiting tables for $2.14/hour who would be very glad to make $10. It's pathetic.

Honestly, I don't think there's any way any reform can be done to the pay structure of nurses or CNAs until the economy picks up. Once there is more need than availability, nurses and CNAs will be able to advocate for themselves. However, as long as there's more of us that spots, we have no power. It sucks.

Well, we would have some leverage if we organized some sort of nation wide nursing union. Of course states like mine have passed "right to be poor", oops, I mean "right to work" legislation that prevents entire industries from becoming unionized.

The BSN RNs at my (union) facility fare much better than their private sector couterparts. They actually get compensated for their advanced education. A new grad BSN starts out several paygrades above a new grad ADN. And BSNs are put into unit manager roles, while ADNs are put into shift supervisor roles.

Magnent hospitals talk a big talk about all they do for nursing. But all it is is a way to make peolple do more for the same (or less) amount of money.

[trinitymbaker00]

I was 20 when I became a nurse... I got the same reaction from some/mosy CNAs I worked with.. it was really hard. All I can say is develop a trusting work relationship with them and let them know you are here for them not here to boss them around!

[Alnitak7]

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!

I have seen C.N.A.s who are very controlling and authoritative so they say things that are not true and end off the conversation like no one has anything important to say. They do not have the skills and insights needed to be in a place of power and control and yet they get away with this sometimes.

I have seen what happens when they help with the care plan with their blatant lack of concern for others.

I saw them take a man who was sexually inappropriate and make him a single-person transfer.

They demanded that everyone on the staff move him alone just because a few of them were not bothered by him.

It was my opinion that everyone should not be forced to do the "hug" transfer on this abusive man if they did not want to. They would leave the floor for a smoke while whoever they targeted for their "singles" list was left alone on the floor.

Most times they would order someone to work alone without help and not bother to offer their assistance and this involves coercion.

[Nurse Medicine Woman, ASN, RN]

I worked as a CNA for a while before i worked as a LPN. And yes, the work is hard BUT what I found having worked as both a CNA and LPN is that the CNA work is hard, but the running around is what is done all shift. What I found working as a LPN is that the nurse works hard too but at the same time the nurse is having to use her brain more causing mental and physical tiredness. The nurse is responsible for EVERYTHING on that shift not just what the CNA's do on their shift. And I have seen CNA take 3-4 smoke breaks in one shift when the nurse has been running from start of shift to end with no break - forget about lunch MOST days in LTC. I found when i worked as a CNA I was physically tired but did nto use my brain to really think.But when I worked as a LPN - well you nurses know what I mean. I would like to see a CNA do a horrendous 8AM med pass, then treatments including wound care of A LOT of pts, then blood glucose, then insulin, then giving out pain narcotics and documenting in med book, then more meds, then calling Dr for high blood glucose, then checking labs and calling Dr. Waiting for new orders THEN carrying out that new orders, then dealing with pt. family, then more meds and more Dr orders etc etc. And assessing pt. pain PRN tehn more narcotics.Or the kitchen sent up the wrong diet for a pt hat has diet restrictions, so the nurse must handle that too. CNA's shift is is NO WHERE near a nurses responsibility!! There is a reason CNA take their scheduled breaks ON TIME, EVERY TIME and the nurse barely gets to use the bathroom some days!! Then there is charting too! And all this nursing responsibility MUST be doen in a timely fashion!