How would deal with these type of CNAs?

Art_Vandelay · Aug 8, 2012

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.

Sorry, I don't have much advice, just empathy as I struggled with this too. IMHO, there are three types of CNAs. The first type, you never have to ask to do anything. They always jump to help, have vitals and everything done without any prompting, and always remember to report abnormal results. The second type gets the job done more or less, but needs a little prompting and sometimes "forgets" to tell you important abnormals. The third type is the hardest to work with. Getting this type to help is like "pulling teeth." They roll their eyes when asked to do something within their job description while sitting at a desk on their iPhone.

My best advice(after I said I didn't have any) is to remain professional and set out specific directives. Ask, don't be bossy(I had to work on that). If the specific directives aren't met after repeated one-on-one attempts to correct the employee's error, then a write up may be in order or you may need to address it with management. IMHO, management is a last resort though. Unfortunately, it also depends on the culture of the unit.

p.s. As far as the dirty linen on the floor, I personally wouldn't have left it on the floor if I started the task.

Art_Vandelay · Aug 8, 2012

CNA's will test you . Many want to do as little work as possibly. Read their job description. It is not necessary to go through a period as a newbie , while letting the slackers run over you.
Enforce your direction , each and every time. Write them up for insubordination, They will learn to respect you STAT!

Ha!! I wish I had learned this sooner! I had one CNA that I will never forget who walked all over me for a while until I finally stood my ground. I thought being nice would work; Ha!! I finally broke down and wrote her up for her behaviors. It was nice to leave that facility finally having her respect(though not her liking me). Unfortunately, if other CNAs see you as a push over, they will lose respect for you too.

Jess_Missouri_RN · Aug 8, 2012

It's hard for new grads. I've been out of school and at my hospital for two years. They are testing you, to see how you work, your abilities, and your attitude. I had this happen to me as well and once they saw that I would get knee deep in it with them they accepted me. They know I will help at anytime for any task. If they see me changing a patient they will come in and assist or take over so I can get back to charting or whatever. I answer call lights, change patients, assist to bathroom, etc. They know if I ask them to change so and so it's because I am busy not because it's "not my job". So I have an awesome team, not one CNA to complain about but I do watch them with new nurses and I see they are feeling the person out.

kcmylorn · Aug 8, 2012

All the reasons I left bedside nursing and hope to never go back!

Write their names down with name date and time with a brief description of what happend.( called cover your butt)

Write down time and date you spoke to them about the behavior and their response.( called cover your butt)

Write down when you went to the Nurse manager about it- name date and time( called cover your butt)

Don't be shocked if nothing comes of it, If an insident occurs( patient harm or you get reported by patient or family), you have documentation to take to court- give the court the CNA's name, the insident, date and time. No way take the blame for an insubordinate CNA's/PCT's. Once you have spoke to them about it, you have done your due diligence. Going to your manager- you have done your due diligence also. let themplay with the judge!

Your documentation shouldn't be common knowledge- keep it for your own records. let a court and a judge correct these CNA's/PCT's if need be may be they would rather hear it from a judge than a "new nurse"

As far as leaving dirty linen on the floor- take your linen hamper in the room with you- don't leave it on the floor if a fall occurs and the breach in infection control practices is on you.

AshleyO77 · Aug 8, 2012

I used to be a nursing assistant on a fairly busy unit. Now I'm an RN. If I have a problem with a CNA, I talk to them directly first because I know if it was me, that is what I would have wanted. If the behavior does not change, THEN go to your manager and report the behavior. I would not recommand going into "I'm the RN, so I'm the boss!" mode. I PROMISE those CNAs will make your life harder. But at least try to talk to them. Some CNAs are just SUPER lazy, and nothing short of reporting them will change their behavior.( Also, just a sidenote, some CNAs do not understand how hard the nurses actually work. They think all nurses do is sit at computers all day and push meds. I always tell people "Being a CNA was physically demanding, but being a nurse is physically and emotionally demanding". Some of them are so lazy and rude because they just assume that nurses are just high paid drug dealers).

joanna73, BSN, RN · Aug 8, 2012

I've worked as a charge nurse in LTC for 2 years. Working with NA's can be challenging, because although they work for you, you still need to encourage teamwork and work WITH them. Otherwise, many NA's will find ways to rebel.First, ensure they know exactly what is expected. Refer to written job descriptions, and explain the unit expectations. Sometimes people need reminders. If this is not effective, speak with your manager and the NA's about write ups. Some people will need to be written up if they won't conform to unit expectations.

luvtranscendsall · Aug 8, 2012

I used to be a nursing assistant on a fairly busy unit. Now I'm an RN. If I have a problem with a CNA, I talk to them directly first because I know if it was me, that is what I would have wanted. If the behavior does not change, THEN go to your manager and report the behavior. I would not recommand going into "I'm the RN, so I'm the boss!" mode. I PROMISE those CNAs will make your life harder. But at least try to talk to them. Some CNAs are just SUPER lazy, and nothing short of reporting them will change their behavior.( Also, just a sidenote, some CNAs do not understand how hard the nurses actually work. They think all nurses do is sit at computers all day and push meds. I always tell people "Being a CNA was physically demanding, but being a nurse is physically and emotionally demanding". Some of them are so lazy and rude because they just assume that nurses are just high paid drug dealers).

I'm sorry but a CNA's job is not only physically demanding but it is also emotionally and mentally demanding. CNA's are allowed to be abused, spit on, slapped, scratched etc. Yes that can happen to a nurse to but CNA's are providing more ADL, hands on care for a patient so they are more likely to endure this type of abuse. To say that a CNA's job is not emotionally demanding is really diminishing what we do. There have been times where I have been totally spent and burnt out. At least nurses have the incentive of great pay. CNA's are overworked and underpaid. There are lazy CNA's and then there are CNA's who are just burnt out. Just like there are lazy nurses and nurses that are just burnt out. Truth is everyone has to work together. Nothing in my job description is beneath an RN. In fact, I had no problems in fundamentals of nursing class in my first semester of RN school because it was all CNA type stuff. Just like a nurse has to set boundaries with CNA's and delegate tasks, CNA's need to set boundaries with nurses that think toileting someone or changing bed linens are beneath them.

AshleyO77 · Aug 8, 2012

I'm sorry but a CNA's job is not only physically demanding but it is also emotionally and mentally demanding. CNA's are allowed to be abused, spit on, slapped, scratched etc. Yes that can happen to a nurse to but CNA's are providing more ADL, hands on care for a patient so they are more likely to endure this type of abuse. To say that a CNA's job is not emotionally demanding is really diminishing what we do. There have been times where I have been totally spent and burnt out. At least nurses have the incentive of great pay. CNA's are overworked and underpaid. There are lazy CNA's and then there are CNA's who are just burnt out. Just like there are lazy nurses and nurses that are just burnt out. Truth is everyone has to work together. Nothing in my job description is beneath an RN. In fact, I had no problems in fundamentals of nursing class in my first semester of RN school because it was all CNA type stuff. Just like a nurse has to set boundaries with CNA's and delegate tasks, CNA's need to set boundaries with nurses that think toileting someone or changing bed linens are beneath them.

Hey I've been there. I've been beaten, kicked, slapped and verbally abused with the best of them. I was not trying to say that CNAs have less stress. What I should have said is that CNA work is more task oriented, and nursing work is critical thinking oriented. That's not my opinion, it's a fact. And you are right, teamwork is the key to success! And I remember very well working with nurses who would go into a room, stay for 5 minutes, then come out and start looking for me (while I'm knee deep in poop) so I could go empty a urinal because that "wasn't her job". Those were days when I wanted to quit. And you know what? Because you have seen that type of awful nursing, it will make you an even better nurse! Good luck with your studies!

whoa-now · Aug 8, 2012

I had a crew of CNA's who made my life a living hell as 3-11 RN shift supervisor. When I would pull them aside and go over P&P with them I would get comments such as "I don't know you, you haven't worked herelong enough. So I won't listen to anything you say to me because I don't trust you. You might just tell me to do something that would make me lose my job"..(although my last job was also RN shift supervisor) Can I just say "WTH?"! I had two of them like that. These same two would tell me in the middle of their shift they were leaving becuase their kids were sick. So I would ask them OK do you have someone to cover your patients for the rest of your shift? Their reply your the RN it's your job to replace staff. OMG. I worked with the MOST immature, disrespectful CNA's I had ever run across. So of course when they would start their "I ain't doing that, I don't have to listen to you and I am leaving" I would call my DON and she would ask to speak to them. I told her sorry they split as fast as they could. Don't you know I was the one who got yelled at and in trouble for not being able to "manage my employees. The next afternoon before 3P shift started, they would get there before me and go to the DON's office andstart telling a bunch of lies about the whole situation. Was always the same 2-3 girls. They would also dissapear for long periods of time. LOL after 5 months I got canned for not being able to get my admissions, Dr.'s orders, assessments and etc done. All I can say is WOW:madface: Best thing that ever happened to me was ro lose that job!! P.S. I was able to collect unemployment, no problem until my next job came along. They didn't even try fighting me on it and they hired back the girl that worked there before me that let the CNA's run the place and treat her badly. I feel bad for the resident's there. Thanks for letting me vent!! So HousTx you are NOT alone!

whoa-now · Aug 8, 2012

I appreciate my aides more than I probably sounded like I did in my last post. I am all about team work "You scratch my back and I will scratch yours" sort of thing. I just happened to take the position right after a very lazy, who cares attitude type nurse. When I started the patient and family complaints were through the roof. Both because of the nurse and the aides. I came in just trying to make it better for everyone but it was an impossible task at that particular facility. Working with your CNA's and appreciating them can either make or break your day, week, month etc etc. To all you aewsome CNA's out there:cheers: I could never do what you guys do, day in and day out. But am not afraid to pitch in if needed. Just felt I needed to clear that up.

CrunchyMama, ASN, RN · Aug 8, 2012

I unfortunately understand your frustration. I work nights, so there's only 1 aid on our floor (which sucks only having 1). She's not the best aid. She does a basic job and that's it. When she makes rounds to do the vitals, she doesn't check those who are incontinent. I know this because when I go in there shortly afterwards, the patient is either soaked or full of poopsie. She doesn't turn and reposition patients either. It's frustrating working with someone who doesn't do their job. And that's crap about the aids and/or nurses "breaking you in". It's not high school....they have a job and that's that, no need for games. These are patients we're talking about here!

P.S.....Luckily they just hired a new aid, so we'll now have 2. Praying she's a good one. :)

annlewis · Aug 8, 2012

Quit complaining and just do it, earn their respect by helping them, we LPN's do that and pass meds, it's hard but you have to do it, everyone must do it. If you have emergencies with patients and can't do it then they will pitch in, their job is hard too not just yours.