How would deal with these type of CNAs?

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I am one among the newest RNs on a busy floor. Every shift I am struggling to help pt's ADLs with minimal CNA assistance. A few CNAs are plain horrible. They won't answer my pager or when they do they would tell me they are with another pt. I told them when they finished with the pt then come help me. Most of the time they don't so I ended up doing it all myself. At other times when they didn't come and help me they complaint that I left dirty linen on the floor. I told them I helped this pt and changed all her linens after she pooped or puke on herself and yes in between I also passing meds while another pt paging for pain medication as well. When they hear that they don't like it.

Specializes in Psych, LTC/SNF, Rehab, Corrections.

Well, I've already discussed being a self-hating aide. LOL No, I'm just kidding. It's just that...you can never have an aide staff where everyone's on point. There's always two or three who are bound to be ate the hell up. No one wants to fire them, either. It's honestly the part of the job that I dread. I've managed. I've supervised. I've trained. I was NCOIC of the rad dept for a time. I've done lots in the ways of leaderships.

...but I've always hated leading. I've always disliked managing people. Always hated supervising.

I really didn't know, until nursing school, that this was a part of the job. I'll do it and I look at it as...an opportunity to be a better leader, I guess. I just really don't want to have to run behind people to ensure that they do their jobs. I don't like dealing with employees and their issues. I see some of the aides (well, those who quit after being told 'there's the door') and they did nothing but bother the nurses with their interpersonal issues...and I'm like, "Why can't you solve these issues on your own...?" Now that they're gone? No problems. We're short, but all but 1 were dead-weight anyway.

More importantly, I know how hard I work as an aide. It will annoy me when I deal with people who slack off. That's when the paperwork begins. Do you job or go the hell home.

*********************

On the other hand?

I think it's easy for someone to throw blame off on those in their charge. Did you manage before being a nurse? Doesn't sound like it.

It also seems like you just annoy the hell out of the aides for one reason or another. I mean, you said CNA (plural). You want everyone to drop what they're doing to help you with ADL's?

Why are you rushing the aides along? That's what it seems like. Can the residents not dress themselves and if they need to be dressed? Can they not wait until the aides finish with the other residents, first? Of course, the CNA students will jump and answer you pages.

They need a job. LOL I do a fair amt of hoop jumping myself to secure my position. My charge nurse and the others do haze me a bit. Plus, they probably take pity on you. You can spot a new grad from a mile off.

So, yeah...I jump hoops. My nurses never needed help with anything besides tube-feeding combative residents, though.

What are you doing to the pt's that you require so much assistance? If one had a pattern of constantly needing help because she was jumping the gun, moving in on my work...doing it half-assed...then calling for me to stop what I'm doing and finish up her mess because she's late with her assigned tasks and blah, blah, blah?

I'd be annoyed with her, too.

Are you giving the aides time to complete their tasks? We have nurse assistants for a reason.

If you have nurse-y duties to complete, why aren't you? If no one's dying, why are you stripping beds when the med pass takes priority?

Notify the pt's aide that the pt is dirty and pukey and that there's pooh everywhere...and tell them to get to her as soon as they can, 'please'.

Continue passing meds.

If the pt isn't clean within the hour. Find the aide, pull them to the side and figure out what's going on. If this behavior is a pattern and continues? Start throwing down paperwork.

Period.

If you say that you're in 'busy' area that makes me draw from own experiences as an aide. Perhaps they don't have time to help you. If this is an LTC? It makes a bit more sense. Are you as respectful of the job that they have to do?

I absolutely hate it when I'm running around trying to keep pt's dry and beds from being stripped when this or that person calls me out of the room to handle mundane tasks.

Mundane = 'can you change her?"

Let me tell you what I mean (a long scenario that reminds me of your situation):

At my facility, it's not the nurses who do this. They 'get' it.... Sure, they might 'bomb' half the residents and laugh about it. I swear, it's for poops and giggles. But, they get it. They help out when they can. You don't expect it, but it's nice when they do.

They're good leaders.

So, it's not THEM. It's one of the girls who works laundry.

So, I'm in the middle of a transfer and she's hollaring down the hall for a CNA. "I NEED A CNA!!! CNA!!!"

sigh

I know that it's her...I know that she's interrupting my work to deal with a non-emergency... and I'm in the middle of trying to get people up for their meal.

So, I complete the transfer. I get my little resident settled and head on out the door with her in the geri-chair.

Meanwhile, Laundry Girl is still hollaring down the hall like a nut.

I stroll over...and I meet another aide who is also strolling over. In ways, I think she feels the same as I do. We both had that look of annoyance.

Me: 'What's going on...?"

Laundry Girl: "She needs to be changed...!"

We look in the room.

Coworker sighs: "She's fine..." and walks briskly away.

I went and got my resident.

She was pushing her laundry cart and popped off about the residents not being changed.

FIGHTING WORDS!!!!

LOL

I said while pushing my little lady to the dining hall, "I'm in the middle of a transfer. I'm not going to drop everyone and possibly drop Ms _____ running out to change Ms ____. Next time you scream down the hall like that, I'd better find a resident on the floor twitching and foaming at the mouth and surrounded by clumps of doo-doo..."

I change that woman every hour, are you kidding me?

Hell, if Ms _______ would stop guzzling diet Cokes like an addict, she wouldn't be so ***** all the time, in the first place. That woman has a 12 soda a day habit!

Yet and still - this woman can take herself to the bathroom. She just...won't. She knows when she has to urinate. She just pees in the brief. She doesn't even go to the toilet, anymore. I think she's regressing because she can't make it to the toilet. I don't think it possible to wean her off. It's her right to drink her soda. What are you gonna do?

But I know when my residents need to be changed. Ms ____ will tell you. That day, she told me and I told her that I'd 'be with her in a second'. But, see...Ms. _____ is impatient.

She's in the midst of a Burger King delusion and either doesn't undertand or doesn't care that I'm servicing 10-20+ rooms (at times) of people besides her.

So, she yells 'I'm wet' and 'change me' to any able-bodied person who happens to walk past the door. LOL

This is where Laundry Girl came in. I've thrown a sheet over a naked resident and practically fell over the trashcan (that I was throwing the dirty diaper and wipes in...forgot it was there) running to get to her screaming, 'I NEED A CNA!!!!' in the past. I get to the room and discover that it was all for not.

"She needs to be changed!"

Jesus -- take the Wheel!

My under-eye was twitching. That was the closet that I ever came to a TIA...I think. Well, thus far. My nursing career has just begun. LOL Something tells me that I'm only on the cusp of seeing 'the crazy'...

I just stared at her a beat. Told the resident in even tones, "I have to step out. I'll be with you to change you in a second, ok mama? Alright."

Turned around and stalked out of the room.

So, if Laundry Girl wants to do rounds like she's part of the nursing staff? She can slap on a pair of gloves and change the residents herself. She doesn't want to do that. So, she needs to stay the f out of the resident's rooms and stop bothering everyone with her non-emergencies.

She needs to concentrate on not losing undergarments instead of worrying about what CNA's do.

Every freakin' day the nurses have to deal with crazy family members interrupting important business to run around on wild goose-chase looking for Grandma's socks or Tia's draws. Ugh... Hell, the aides sort the laundry for them! Laundry does arrange the laundry by floor when they dry it.

How hard is it to put the crap in the right closet?

**********************

So, the big question is: Why did we respond like this to her?

Firstly...she's annoying. Obviously. I swear, I nearly pop a blood vessel when she comes around.

Secondly...we knew that she didn't want anything. Thirdly... CNAs have to maximize their time and prioritize like everyone else. She does not try to understand how we - I - go about my tasks.

When she demands and screams, it is done without respect and understanding to our job and duties.

I was changing and assisting other people. We both were, the other aide and I. Ms ____, the resident in question, was standing up out of her wheelchair waiting for someone to wipe and change her. Yes - she can wait.

The priority is getting to the people who CAN'T ambulate or stand or take themselves to the bathroom. Those who require self-care.

************************

Dirty linen on the floor? Depending on who you are, that would tick me off. LOL

If you're one of my nurses that I know and love and notified? I'd say, "Hey, thanks.... No, I'll go get it off the floor...."

If you're one of the aides and told me, I'd say, "No, I got it. Thanks for helping. You need help with anyone?"

If you're Laundry Girl? "***** If this b is going to do everything half-assed. Don't do it at all!"

If an annoying nurse did it and didn't say anything? I'd think...similarly. LOL.

"Why is the nurse leaving dirty linen on the floor...? Hello, infection control."

...because you're a nurse. More importantly, what if I wasn't able to get to the room...and didn't know that dirty linen was left on the floor?

The Charge or management would walk by the room, see this...and chew us all out.

It'd be a real and vague generalized comment, too.

An announcement would be made that so and so 'saw dirty linen in one of the rooms and disposed of it properly'.

CNAs would be looking at each other: "What dirty sheets on the floor...?"

Regardless...let the haranguing and finger-wagging begin.

PERSON IN CHARGE: "The point is.... there's dirty linen on the floor. Everyone needs to check their rooms and cut the lights off, too. Mr ____ walked by the room and saw 3 lights on this morning. This is a no-go! Why if state came through and saw --""

Can you tell that this has happened to me before?

LOL

If you start a task, complete a task and notify when you can't.

Don't leave dirty linen on the floor, ma'am.

I don't care what else you were doing. Rooms usually have trash cans. You couldn't set it atop the trash can?

Do not leave dirty linen on the floor, ma'am.

Changing a bed, cleaning up a pt and changing their brief would take you (someone with no aide experience...it's obvious) a heck of a lot longer than it would for you to take the dirty linen and dump it in it's receptacle.

You wasted 20-40 minutes practically doing a bed bath with a bed change on a pt. You can't take 3 more minutes to gather that pukey, poopy linen and dump it correctly?

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Specializes in ICU / PCU / Telemetry / Oncology.

I'm lucky to work where I work, where EVERY single CNA on my unit (day, eve, and night) is plain AWESOME! Not one of them is lazy, and they work well with us nurses. And there are a good mix of men and women CNA's on my floor. We treat them with respect and they don't huff and puff when we ask them to help out. Everyone knows their scope, and no one thinks they are above the other. When I did clinical there as as student, they even treated me awesomely. Now as an employed nurse, I embrace their value. Without them, my job would be much more intense.

So, not so unfortunately, I have never met a bad CNA.

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First I can understand a little about how you feel. But with that said, there are other RN's they are helping and also just like you can only be spread so thin without breaking. Let's face it, there is never enough staff and we all can only do what we can. Some days are okay and some there are no never enough time or hands to get it all done. You attitude sounds a little elitist to me. I can promise you that will not get you very far with them. If you are a new RN you can earn some respect by showing them respect. Just because you say please doesnt mean you are being respectful. Most of the CNA's I work with have way more experience than the new nurses right out of school and could educate us all. My last comment is about the fact that you left dirty laundry on the floor. That is gross and disgusting and even if you are going to do another task it doesnt take a minute to do the right thing and empty the linen into the linen bag, room, bin or whatever you have there at your facility. We were taught never to drop them on the floor anyway. I have been an RN for 30 years. Dont do the job half way. Have you ever worked as a CNA while you were in school???? that probably would have helped you to understand their point of view a little. Good luck but remember change often starts from within.

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OP - I am a CNA and I would love to work with an RN like you that if I would have told you I was busy with a patient, you performed the patient care task while I finished the other task I was performing! That is very rare! At the facility I work at, it is rare that we (CNAs) receive that type of help from nurses. I will say, often times, the CNAs tend to be a bit jealous of the nurses, especially if they have been CNAs for a long time and are taking orders from a newer, younger nurse. So you will encounter that type of insubordination. I have seen it occur before. Personally, I am not that type of worker, because I do not see myself as working for anyone but my residents...I work with my nurses and other CNAs but ultimately it is the pt that I am serving and I do not like to see them suffer regardless of my personal feelings. Also, I do not harbor any resentment toward anyone and I make it a point to show respect to everyone I encounter. I believe another reason CNAs tend to be a little testy towards some nurses is because there is a lack of respect. You can be assertive while also remaining polite as well. We do have to work as a team to reach our main goal which is help the pt reach a maximum level of health. That can't be done if there are barriers because team members can't properly conduct themselves.

I am a nursing student as well so I understand the strife at both ends of the spectrum. There are character flaws that people in both positions tend to have but I think everyone has the potential to be a good worker if people learned to work together and not against each other.

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Specializes in MedSurg, OR, Cardiac step down.
New RNs have to earn respect from experienced workers on the floor regardless of position. You may be above them on the ladder, but you are the new kid on the block who needs to earn their trust.

Perhaps you accidentally talked to them as people who work FOR you, rather then WITH you as teammates. Perhaps they are "breaking you in" testing your mental strength seeing if you will crack under pressure.

You need to pull them aside individually and talk to them professionally expressing your concerns. Setting boundaries and expectations. Add that if they continue to ignore their pages that you will have to bring it up with your charge or Unit manager.

Be the bigger person here and rise above their highschool behavior.

Have to earn respect, funny. maybe this is what's wrong here. Shouldn't respect be given to all from all be a standard?? How should one earn respect? By being bullied, abused and left to run amock on their own, at the risk of the pt. The idea that one needs to earn as if it's some sort of initiation to a sorority is ridiculus.

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Oh and as far as the linen on the floor - Nurse, CNA, Dietary, Housekeeping...etc...any position...We all know that is a huge NO NO! Infection control!!! :redlight::)

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If I am busy, I am. I am the one who has to prioritize. I work very hard and always help everyone at work. RNs, LPNs and aides, even if " it's not my patient." ETC.I will get vitals, blood sugars etc, for other nurses, instead of sitting at the desk doing nothing like many of my coworkers do. i have never asked anyone to help my pt to the bathroom, change a bed, while I went to the linen room with mcdreamy or mcsteamy, sat at the desk doing nothing, etc. At my job I will get my pt's vitals ( the aides are supposed to where I work) if I can or am in the room. If I ask for help then I NEED IT. 1 pt needs pain meds RIGHT NOW, one has stat orders, another needs help to the br. Why should any wait, so an aide can sit at the desk on facebook( have seen it time and time again). I can't believe how much I let this go in the beginning. I am smart enough to usually know who is not busy and can help me. If I ask I excpect it or just politely say you are busy. Why do I have to justify myself/rationale every time. Some are lazy , very lazy. There are a few like this at my job and will either outright refuse to help everyime, or sit at the desk and do nothing, not even his/her assignments whether you are a lazy nurse or not. Some shifts I dread because of who is scheduled. Other shifts, i see who is scheduled and know that at least I can count on a good team.

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Specializes in LTC/Skilled Care/Rehab.

I am fair and get along with most of the CNA/PCTs but I will speak up if they aren't being fair with me (or the patients). The other day I was in a patient's room giving him medications. A bed alarm goes off on a patient who is a very high fall risk. I look out the door and the PCT is standing at the nurse's station talking to a co-worker. I got mad and said "So is anyone going to check on that bed alarm" and then run down the hall to go check on that patient. Luckily he was sitting up in the bed and hadn't go up yet. I had to leave the computer and all the meds in the other patient's room (which we all know is a no-no). These are the situations when I get mad. Or if a PCT goes to lunch without saying anything or takes more than a 30 min lunch. I tell all my co-workers that we are all adults and should act as such. I don't feel like I should be looking all over the hospital for someone. After giving several warnings about the same thing, I will go to the manager. I used to feel bad about doing stuff like that but there is only so much I can take.

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Being fairly new I must admit there are lots of things I have to learn and I am trying my best graphing it. I don't have problems with all CNA's except with a few. Those few others are wonderful and I am grateful to work with them. There is not any doubt CNA's play a major role in pt's care. Without them we can never get our work done correctly. Another thing I just now learned leaving dirty linens on the floor is a no no. I could go on defend myself why I did what I did, but why I did it I guess isn't really matter in this case.

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I am fair and get along with most of the CNA/PCTs but I will speak up if they aren't being fair with me (or the patients). The other day I was in a patient's room giving him medications. A bed alarm goes off on a patient who is a very high fall risk. I look out the door and the PCT is standing at the nurse's station talking to a co-worker. I got mad and said "So is anyone going to check on that bed alarm" and then run down the hall to go check on that patient. Luckily he was sitting up in the bed and hadn't go up yet. I had to leave the computer and all the meds in the other patient's room (which we all know is a no-no). These are the situations when I get mad. Or if a PCT goes to lunch without saying anything or takes more than a 30 min lunch. I tell all my co-workers that we are all adults and should act as such. I don't feel like I should be looking all over the hospital for someone. After giving several warnings about the same thing, I will go to the manager. I used to feel bad about doing stuff like that but there is only so much I can take.

That was almost exact same situation I had. I had meds with me narco and in our policy we suppose to give within 10 mins after withdrawal from Pyxis. I can't be just walking around looking for CNA when this person refused to answer their pager. I know linens thing is a killer and majority says I'm in the wrong (which I agree) and that day one of my pts almost coded on me *sigh* that is the beauty of being a nurse. FYI- I'm new so like I mentioned there many things I need to learn and I'm willing to learn.

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Specializes in Med/surg, Quality & Risk.

I have encountered techs that basically have the attitude that "I've been here way longer than you, I'll still be here when you're gone so I'm just going to put you at the bottom of the priority line when people ask me to do things." I had one that straight up, no matter what was going on, when I would call her or ask her to do something, she would just say she couldn't do it. Fortunately she got fired for other reasons, but I pretty much just tolerated it because our manager did not stand up for anyone.

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Specializes in ER, ICU, Family Practice.

I have come to learn that many CNA's/PCT's are not exactly sure what your role as the registered nurse is. I have had my fair share of unlicensed personnel give me the "why can't you do it" speech. I have learned to be firm and forward during situations like this. A CNA is a certified nursing ASSISTANT. They are there to perform basic level tasks that allow the registered or licensed practical nurse to practice skills and procedures that are above the unlicensed personnel's practice. If you have a patient who is in pain or requires medication or assessment for an acute problem, and you find that the ancillary staff is resistant to assist with ADL's, don't hesitate to remind them that as a registered nurse, you can do their job but they can certainly not do yours.

On the same token, when you have the time to do so, never hesitate to get your behind out onto the floor and assist the CNA's. This will establish you as a leader that actually leads by example.

I work most of my hours in a busy ICU in which the RN's perform total care for their assigned patients so I of course love floating to other units where I am blamed for being "too good" to perform certain tasks.

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