Difficult CNA's?

Nurses Relations

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Let me start by saying I have tons of respect for CNA's, I was one myself for many years and its a very difficult job! That being said, I also help them out as much as I can, I don't hunt them down to get someone a drink (I've seen nurses do this), I will toilet people anytime I have time and I've never walked out of a pts room without dumping a urinal that's just sitting there unless a pt is in serious crisis...

Unfortunately the CNA's were used to getting away with way too much before I was hired (April), I was forewarned this was an issue. I have worked with them and most if them are great now! The issues I did have were 99% authority issues, they are great with the residents. There's a CNA I can't seem to get through to and it's driving me crazy... She is one of the few that is not very attentive to the residents, I feel like I chase her just to toilet people and answer call bells! And we do not just answer "our own" call bells but I'm having a problem with her with that too... Today I had to send CNA's off the floor for trainings twice today, I send them based on how many it will leave on the floor, she knew all day about this yet planned a late lunch to run errands and never told me she was on break or leaving the facility!! It's policy to tell the charge nurse before you leave the floor but especially if leaving the facility... She told another CNA but she assumed it had been cleared with me and she was telling her so she could watch her pts. I've also had issues with her being rude, she had hallway duty at lunch and while I was running around delivering special things that had been ordered a pt rang, she was sitting talking to another pt, I asked her to answer the bell and she snapped at me and said she had been asked to check on the pt she was sitting with (she prob was, but she can feed herself & why be rude)? There are just numerous examples of rude behavior like this... I have talked to her repeatedly, this has been going on for awhile but she doesn't work for me a lot either (1-2 shifts a wk). Every time I talk to her it's like it was no big deal to her, she doesn't seem to understand the toxic environment she creates around her! If you're thinking this is a young kid, it's not so that is not even the excuse...

Sorry for the long post but I really feel like Iam creating a pretty good balance on the unit of getting respect from the CNA's and working with them but I can't get through to this one and its bugging me... Dont get me wrong, im not perfect im just trying and overall its working. It's not a personal conflict either because its gotten so bad between her and other nurses she had changed her schedule to avoid working when they are. I could write her up or go to my DON and trust me I'm getting close to doing both! I just don't want to if i can avoid it, I don't feel like either of those is a great option. Does anyone have any thoughts, advice, anything that has worked?

Thanks.

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Specializes in L&D.

Can't wait to see some answers. I work with some CNAs I'm just not sure about. There is one that sits around half the morning before doing any work while the rest of them are running their legs off. And gives orders to the docs about what the pts need! I'm also having a similar issue with one of the clerks...she works the afternoon/evening shift and comes in and chats until she's good and ready to work and I may have gotten admit labs and set them there for her to finish them and it doesn't get done. And then she will say "Oh I was going to do that." but she's left things there for over an hour which by then you might as well redraw all your blood.

Ok so now I had my own little vent, lol. But what about having a unit meeting about specific duties and who is in charge of the unit/chain of command?

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When I was just starting as a new grad nurse, I was SLAMMED on a med-surg floor. I asked a CNA who was sitting at a desk, READING HER EMAIL, to please ambulate an elderly patient while I was hanging blood for another. Looked me right in my face and said "NO". And let me say this was a lady that was in her 50s age wise. I was dumbfounded....I quickly learned that you dont put up with disrespect. I was all but nice to her and she was hateful.....when I was hired all of the CNAs on this unit laughed at me and made comments like "Well lets see how long she will last" right where I could hear. Then I dealt with the nurses who tried to eat you...

Lets just say I left that toxic environment and am so glad I did! You do what you think is right...dont let ANYONE get away with murder. :yes:

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Specializes in None.

Well, I am a CNA on a medical-surgical floor and I understand what you mean. There are some like myself that run their butts off and then there are some that hide and could care less about the patients. I've found if you want respect, you give respect. Therefore, I get along and work good with all of the nurses. They will help me with anything I need (because they know the CNAs will just complain if I ask for help). With that being said, obviously this isn't working for her. I would go to the supervisor or the one in charge and tell her about the situation because apparently it isn't going to get any better. We have had over 5 CNAs fired here lately because so many of us complained to the supervisor about his/her attitude and the lack of teamwork.

Oh, out of curiosity are you a nursing student or an actual RN? If you are a nursing student maybe she thinks she doesn't have to listen to you? I'm not sure. Like you said there are a lot of good CNAs out there, but it is unfortunate to not have good teamwork and a CNA that doesn't care for his/her patients.

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Next time something happens, you take her aside and have a conversation with her. Name the behavior that you think is inappropriate. Be specific. Use lots of "I language", like "I see this happening and it makes me feel _____". Again, take her aside. Do not have this conversation in front of residents or co-workers. Have a plan for how you would like her to behave differently. Instead of saying "Don't do ______", say "From now on, I need you to _______". Be specific. Also, be professional. Do NOT get emotionally charged during this discussion. If things go sideways, you can always withdraw from the interaction and then ask your DON for help.

Document this interaction including her response. In your documentation, do not be emotional. Be objective and use objective language. For example, if she raises her voice and says "You can't tell me what to do!" or something of that nature, you would document that she raised her voice and stated "You can't tell me what to do!" (use quotes), rather than saying she got angry and screamed in your face, as that is subjective language.

Forward your documentation to your DON. Do this every single time she behaves in a way that's inappropriate or unacceptable.

In the meantime, make an effort to catch her in the act of doing things right and give her recognition for those behaviors. Be sincere. Nobody likes fake praise.

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Specializes in Medsurg/ICU, Mental Health, Home Health.

I was a tech, and I've worked with amazing techs who I swear are gifts from God!

However, one of the things I love about being in ICU after 7 years on the floor is no techs. That way I don't have to deal with this stuff!

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Specializes in Pediatrics, Geriatrics.

This is the thing that I believe will cause me so many problems. For one, I'm 22, that alone will cause problems since a lot of cnas are older than me. I was a CNA for 3 years so I'm humbled to them and know exactly what they go through and most importantly, what kind of nurse I do/do not want to be.

I feel like they're not gonna listen to "that young nurse". I'm not confrontational but I know what to expect. I know all the ins and outs and cutting corners. So they won't be able to get over on me. I just never been in a supervisory position. (Other than for my children).

Finally a nurse...All for my three♡♡♡

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Havehope yes I'm an RN, not a student and while this job is fairly new for me it's not my first RN job either... I totally agree about the great CNA's, they all know I will help them anytime! I will help any of them but you want to help those running all day more, definitely!

Stargazer thanks for the specific advice! I do document all interactions with all staff, I have to as charge nurse, the specific language you suggest is helpful. I definitely never try talking to staff in front of others, I believe it just causes drama and chaos... I was actually hired for my calm demeanor to calm down the unit (and I think I have for the most part). But I think my quiet side has been taken as me being a pushover, a few found out the hard way I'm not and now all is good. I guess we will never get through to everyone but I'll keep trying...

Thanks everyone for the responses. Sometimes it's nice to know you're not alone...

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I am a lot like you, and have found that people take calmness as a weakness. If this particular CNA is a problem, document her behavior and turn it over to the manager. I've dealt with CNA's that for some reason think it is ok to be rude, intimidating, and lazy. It is not. It is not only unfair to you as the nurse, but also to the other hardworking caring CNAs who have to pick up her slack. It seems like you have tried to work things out nicely, but she still won't cooperate. She needs to shape up or go. Document, document, document, and give it to the manager. I worked with a CNA who was terrible, she would not follow instructions, horded equipment (refused to give me the only glucometer on the floor when I suspected my clammy diaphoretic patient was hypoglycemic, because she was GOING to eventually go do routine sugars. She told me I needed to be patient and wait my turn. This was after I calmly and politely explained the situation, I did not just walk up and demand the glucometer. I eventually got the glucometer only by physically taking it off her cart, but the whole ordeal wasted valuable time that should have been spent treating a patient. When I took the glucometer she had a stunned look on her face, she thought she had intimidated me into backing down because I refused to stoop to her level and get into a screaming match in the hallway. I'm pretty sure she considered chasing me down the hall but there were witnesses, instead she spent the rest of the shift pouting and refused to do any work.) and spent more time in the bathroom than a patient with cdiff. When I spoke to the manager she said that she was aware that this CNA was a problem but her hands were tied because even though people verbally complained, no one wrote the complaints down. I wrote my complaint down, the manager had a meeting with her, and the next week when I returned she was much much better. Not perfect, but I think the idea that she might lose her job gave her the much needed push to actually work at work. Unfortunately some people take kindness as weakness and respond only to authority. Don't waste your time, she is acting unprofessionally.

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Specializes in hospice.
The issues I did have were 99% authority issues

You admit there's been a culture of CNAs getting away with a lot, and you acknowlege the source of that culture as being a lack of authority.

I have talked to her repeatedly, this has been going on for awhile but she doesn't work for me a lot either (1-2 shifts a wk). Every time I talk to her it's like it was no big deal to her, she doesn't seem to understand the toxic environment she creates around her! If you're thinking this is a young kid, it's not so that is not even the excuse...

You've tried being professional and addressing the issues with her. Trust me, she understands exactly the toxic environment she creates around her, and she doesn't care. If it's benefiting her, she'll keep doing it. You don't have much experience with borderline personalities, do you?

I could write her up or go to my DON and trust me I'm getting close to doing both! I just don't want to if i can avoid it, I don't feel like either of those is a great option.

And then you refuse to exercise the authority you have and could use to ameliorate this situation. No wonder this aide has been a pain for so long. I am an aide, and trust me, when we see this crap in our ranks, screwing us over because we end up with her work tacked on to ours, we hate watching the supposed authority figures back down and refuse to discipline. Either shape her up or fire her and get us a good teammate! She knows exactly what she's doing. Punish her and see if she can learn, or get rid of her if she refuses to do so.

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Specializes in Psych, Skilled Nursing.

I have similar issues. I work evenings as an LPN at a Skilled/Rehab/LTC facility. I have been a nurse for two years but I am extremely young, younger than any other nurse I have met. I feel as though my age is a large factor is not receiving respect from my aides.

Well let me rephrase that... SOME aides, one in particular. I have a few CNAs that I work with who are worth their weight in gold and I love them to pieces!! We get along great as a team and everything goes smoothly I count my lucky stars for them every shift and I know my patients are well taken care of.

A little more background... I am never above helping or being a team player. I NEVER hunt down an aide for anything I can't do myself and I toilet residents if I'm not in the middle of a med pass/crisis. I keep my lines of communication open and I always take change of status comments from my aides very seriously. I will help with a difficult resident and I even put people to bed if we are short!

There is one aide in particular who I cannot get any respect from. She sits on her bum half the shift, is unfriendly with the residents when she does take the time to work, won't answer lights, and is always telling a&o x3 residents she will "get to them when she gets to them" when they ask for assistance or toileting. Everything has to be on her time and she cannot handle being asked to do anything. Even when I say, "I know you told Mr. Z you are busy and I know he can be hard to toilet but he really needs to go. I don't mind helping you if you get up now and we do it together...."

I'm at a total loss!!!! I could go on for days about it all. Any advice????

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