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 Transitional Nursing.
I placed dirty linens on the floor because I had changed the entire bed actual two of my four pts' beds that shift. I didn't have time to run back and forth. There wasn't any linen bag in the room. Like I said most of the time our floor is busy. In that same time my other pts needed me. I feel their medical needs supersede this. So I tried doing the best I could cleaning them up given them new clean fresh linens then move on taking care of other pts. I told myself I would come back for those dirty linens, but other things kept me running and I forgot altogether. This CNA found it on the floor said do I (me) really leave a dirty linens on a floor, really?!

Everything else aside, while you were overwhelmed with the patients calling for meds while you were helping the patients with ADLs have you concidered that the cna was overwhelmed with the same only with more patients needing bathroom etc etc? Cnas shouldn't ignore calls or be slacking off but I can tell you from experience that there have been so many days that I am toilet in in patient getti g another off the toilet in the process of helping someone get washed up and then going back to the first patient who now wants off the toilet while the third patient is sitting half naked because they can't reach the rest of their body and the second patient has to pee again! All while the nurse ( who mind you Is super busy too) is calling telling me mr jones needs to be changed and breakfast just came. All the trays need to be passed and most of the patients need to be set up ahhhhh this was my day today actually. Lol I'm just sayin maybe these cnas really are super busy. Most of my nurses just call and say so and so needs this and I do it when I can. Rarely would they interrupt a med pass to do my job.

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Specializes in Transitional Nursing.

I'm sorry but it doesn't matter that you changed 2 of your 4 pts beds and had other things to do. It is never acceptable to leave dirty soiled linen on the floor. If yuo can not see why then I suggest you review universal precautions and your facilities infection control protocol. As a CNA of 8 years and a nursing student in my second year, I understand that there are lazy disrespectful CNA's. I also understand that as a nurse it is a lot to do the meds, charting, and assessments on 4 patients but try doing vitals, bed changes, toileting needs, the nurse's grunt work, plus running to get drinks and snacks and all the personal little things patients needs for 12-15 patients. I can not stand when a nurse thinks she is above and beyond what I do. If I am not busy tending to someone else that is one thing and if that is the case that person does need to be approached but don't leave a room that you are doing something in to come and get the CNA because you feel that is there job or leave dirty linens on the floor for the CNA to pick up because you are busy. guess what we are busy too!

YES My sentiments exactly. Here is a snapshot of my morning. Put mrs jones on toilet run and put mr smith on toilet. Start washing up mr doe hear mrs jones ringing to get off toilet get called to go help me grumpy he's puking. Mr doe is yelling he's cold go and help him finish his bath now go get.....oh crap which ones on the toilet..... Look for blinking light now coworker needs help transferring. Mr jones needs ice water and the RN. Just let me know I need to do q2 vitals on new admit 1......and it's only 8 am. You need me to what? Lol

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Specializes in Transitional Nursing.

Just thought Id point something out...I get that RNs make more than CNAs, but they in NO WAY make great pay lol! Simply wanted to make that clear. A lot of CNAs seem to think that about nurses, and it is absolutely not the case. Where I was working, as a new RN, they were paying just a little more than 20$/hour. That is after 3 years of school. And it would be the same whether I have an ADN or BSN. BUS drivers were making more money, had more benefits, and could actually go on strike if they wanted more, which RNs cant do. So, yeah....jus' sayin'

Just saying.... Double what I make right now 75% more on weekends sounds damn good to me. I can not wait to be in your shoes. It may not be great money but its not poverty. It burns me that cnas (yea yea I know., no education) make such crap. I do what I do because I freaking love it but it would be nice to clear enough to pay the rent. Yeah can't wait.

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Specializes in Long term care.
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.
I wanna work where you work
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Specializes in Med-Surg.
Just saying.... Double what I make right now 75% more on weekends sounds damn good to me. I can not wait to be in your shoes. It may not be great money but its not poverty. It burns me that cnas (yea yea I know., no education) make such crap. I do what I do because I freaking love it but it would be nice to clear enough to pay the rent. Yeah can't wait.

And again, I get THAT too. But its not even about NO education. Lets compare 6 months schooling to 3 years. Its normal to make more money. Just like Im not resentful of the MDs who make like 10 times what I do, because they had to go to school much longer than I did, and amass much greater student loans.

Off topic a bit, Ive repeatedly told my high school dropout brother that he should be grateful to be making the almost 15$/hr he makes and quit complaining! In this economy, in this day and age, it seems to me that if you dont have a high school diploma or GED, you are lucky to not be flipping burgers at minimum wage! And I dont say that because I am implying that dropouts are dumb or dont deserve it or anything like that. I just mean that with the unemployment rates as they are, there are millions of people with degrees who cant find work. So, if an employer has to choose, I would think most would go for the degree...

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Specializes in Med-Surg.

Oh, and please dont get offended, I was in no way telling you that you should be grateful for what you make...I really think CNAs, or at least the competent ones, are grossly underpaid and underappreciated. I love all my awesome CNAs and tell them often!

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Specializes in Med-Surg.

Now Im sure I will be getting some backlash for that. People tend to misinterpret what I say, take it the wrong way and all. Sorry to those that might offend, it was not meant to.

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Specializes in Transitional Nursing.
Oh, and please dont get offended, I was in no way telling you that you should be grateful for what you make...I really think CNAs, or at least the competent ones, are grossly underpaid and underappreciated. I love all my awesome CNAs and tell them often!

I get what your saying and I certainly think nurses are underpaid too ( in my area anyway) especially given the money that school costs. I just think that cnas should be paid more. When I leave work I literally limp around my house. I love love makin a difference in my patients lives and honestly I would be a cna forever if it would pay the bills and I my body would hold up. I just can't get over being paid 10 bucks an hour and not clearing 100 bucks a day ( 12 hour shifts) Im in the process of getting my RN and actually I'm kind of dreading the part where I don't get to do as much patent care. *sigh* but that's how it works. Go to school get a degree and spend the whole shift cya with documentation. Lol. But I totally get what your saying and I know you get what I'm saying :)

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I am having the same issues with CNA's - I obviously haven't read thru this entire thread - but

writing them up does nothing at my facility - I am not the only nurse/supervisor who has stated

this - and I am the "newbie" having been at the facility only 3 months.

One of the CNA's who goes out on break without telling me, gets irritated when I come find them

because lights are ringing and I cant do all of them, is on the floor maybe half of the shift if that -

is good friends with the DON. Writing them up does nothing - in fact, its a joke. The other CNA's, not all but

alot of them, are in this circle with the DON's good friend and they cannot be touched.

I have talked to this person several times, tried showing them thru my actions that I am not above helpiing them

because I am not - but nothing has helped. So writing them up and being assertive is doing nothing for me in this

scenario because of their connection to the DON. What do I do with a situation like that?

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I have never NOT had enough time to simply walk to a laundry bin and put the laundry in it. That is quite the excuse.

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Regardless of how busy you are you cannot just leave dirty linen on the floor. It's gross for one and also is a huge safety risk. Imagine how much you'll get behind when a pt fall and cracks their head or staff sprains their ankle and has to go home. Also it's shows the pt. there family and everyone else that you are lazy! Even if that is not true

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Specializes in Trauma/Tele/Surgery/SICU.

I haven't read all the responses. I stopped on page 4 because all the posts chastising the OP over the dirty linens made me angry. As an RN if I had a dirty patient and changed his bed only to find no linen bag in the room and another patient called me for a medical need, I too would have shoved that dirty linen in a corner on the floor or thrown it in the trash to go tend to my other patient. We have to prioritize our care and in my opinion you prioritized properly. If you read the post the OP clearly stated they intended to go back and put the linen away AFTER tending to the patient!!!! In the meantime the aide walks in the room, finds the linen, and hunts you down to yell at you???? Ugh!

The risk of infection posed by the linen is certainly real but so is the risk that while you were hunting down a linen bag, putting it on the container and tossing the linen that your other patient who CALLED for help could have suffered some ill effect. Tossing it in a corner minimizes any fall risk to pt./staff. And I disagree with those that say pain is not a priority. It most certainly is to the person who is in pain!!! Have you ever seen a chest tube or abdominal surgery patient throw themselves into respiratory distress due to pain? I have. Patient's trust you when they know you will treat their pain as a priority. If that aide would have yelled at me I would have said if there was a linen bag in the room I would have put it there! The aide can toss the dirty linen, they cannot go administer meds to the patient.

Listen, I have worked with "those" aides/techs. The brutal truth is that you will need to learn to function without an aide. You can educate them all you want to. It does not matter. You can treat them with the utmost respect. It does not matter. You can praise them, thank them, build alters in their image and it does not matter. You can be in your managers office all day and night but it does not matter!

The fact is that being an aide is a backbreaking brutal job, just like nursing! They do not have the accountability that you do and so there is no incentive to change. If I had a dollar for every time I have heard an aide say to me "You only have 7 patients, I have 14" I would not be working today, but lounging on a beach in the bahamas! I have had aides chart fictional vital signs, not tell me when there is an acute change in a patient, refuse to assist me in toileting a person who I stupidly tried to take myself because no one would help and halfway there we almost fell on the floor. I have had aides refuse to let me use their pulse ox when I discovered my patient in respiratory distress. "I am using this one, find your own!"

Here is my real world advice to you and to any other nurse in this situation to make your life a little easier. Do the aides carry phones? If they do make sure to put their number on the patient's board. Tell your patient you can call the aide first if you need water, another blanket, help to the bathroom, etc. Use my number for medications, any medical issues etc. or if your aide does not respond to your request. Make sure you carry a marker with you at all times and check your boards when you go into a room because they will wipe off their phone numbers. (this only works if the aide keeps the phone on them or bothers to answer it.)

Med pass times? Go get a fresh water with the patient's medications EVERY TIME. Even if you end up with 5 waters in a patients room, it will save you from running back and forth and you can toss them on your final med pass of the shift. Get a linen cart prior to assessment/med pass. Make sure it is stocked with washcloths, towels, sheets, blankets, pillow cases, socks, gowns, soap, skin cream, bed pans, scd sleeves and a glucometer (make sure the glucometer isn't due for Q/C). Hide a working dyna-map and pulse ox behind that cart! Place it in a place that is near your assigned rooms when you go in. That way if you find a dirty patient you will have what you need nearby and it will save you time. If a patient is very difficult to toilet by yourself, order them a bedside commode if you can without a docs order. Just make sure to make time later in your shift to ambulate that patient. On your final med pass of the shift empty all canisters and write down totals. (Foleys, NG's, Wound Vac's, etc.) Pull your dirty linen and garbage bags and toss them in the hall in front of the room and pick all of them up when done.

I agree with explaining to an aide why you need their help at that time, but again this only works if the aide actually cares. For example: I need your help to turn the patient in room 2. Aides response "family is in the room, they can help you." My response: "they are on c-spine precautions and it is not appropriate for family to assist." etc. etc. Bring to your managers attention any blatant refusals of appropriate requests, fictional vital sign charting, non-notification of vital sign changes.

Do not be "that" nurse. The one who calls the aide from the patient's room to request they bring water or help the patient on the bed pan. If you call the aide for a bed change and they do show up do not walk out of the room. If you couldn't do it by yourself.....neither can they! If the aide calls you for assistance...please go and assist them even if it is not your patient! We are all busy. Only pull the I am sorry but I just do not have the time right now, find another aide card when you absolutely have to! Always remember that just as you sometimes have to refuse to help because you are too busy so do they!!!

Do not talk down to or disregard the aides input. This is a mistake that I see nurses making often. If the aide tells you something is up with your patient GET IN THAT ROOM AND CHECK!!! They are not stupid. Just like nurses some are smarter, more astute than others, but they have patient care experience that guides their intuition and you would be foolhardy to disregard it! If it ends up being nothing....great for you and the patient! Don't get angry with them. I have heard nurses say terrible things to aides. The worst being "I could train a monkey to do your job." If you do not believe an aide is integral to patient care.....go and ask your patients. They spend the most time with them, provide the most hands on care for them, and most of the time the patient will tell their aide something before they tell the nurse.

It sucks to have to do all this for yourself and much more so when you have patients with issues (and there are always issues!). Trying to stay on top of orders, consult results, test results, lab trends, vital sign trends, assessments and meds as well as these other tasks is daunting and at times seems impossible! Often times this is what aides/techs do not understand. They assume that all we have to do is: asses/pass meds/chart. They do not understand that we have to have a complete picture of the patients hospitalization, even a routine patient. And so when they see us at the computer or chart "sitting around" they do not realize that we are checking orders, reading consults, looking up x-rays etc. Especially if that nurse has refused to help them because they are too busy. All they see is that nurse "sitting." This is why I always included the aides in the plan of care for our patients. Always. Some of them appreciated that, others of them could have cared less, but making that effort let them know I respected their role. Including them in the plan of care helps them to see how important their jobs are to the patient and why I may be asking them to do things out of the ordinary such as more frequent vitals, etc. Even the most hardened aide will be more likely to assist you if they know you are truly a team player.

Finally when you do find yourself working with a good aide, resist with all that is in you the urge to load up on them, because I can assure you all the "I didn't go to school to put people on bed pans" nurses already are! If you have to pull for a sitter do not always only pull the bad techs! The good ones end up burnt out/quitting and you are back to square one. DO NOT PUNISH the good ones!!!!!! Make sure they know how much you enjoy working with them! BRING IT TO YOUR MANAGERS ATTENTION IN WRITING!! A good aide/tech is worth triple their weight in platinum!! They can make or break your shift.

Those are my survival tips you can use until you find a better managed unit. And make no mistake this type of issue with aides is most often a sign of a very poorly managed unit/hospital, and the direct result of the "do more with less" dogma in healthcare. We have too much to do and not enough time in the day. Nurses and aides alike become hardened when in a every man for himself environment. Even towards the patients and their needs. It is a defense mechanism. Be aware that even if you implement all of the above advice you will still encounter those aides (and nurses, docs, housekeeping etc. too!)that make as little effort as possible.

Sorry for the book, it is just that I have been there, done that, and know how much more difficult it makes your job.

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