Unsafe CNA Help?

[fabiusgile]

I am a recent new grad I am fortunate enough to be employed at a LTC Mental health facility. Been there 3 months and have had resistance fromt he CNA's I have two older women who have been there for a long time. The one who is giving me the largest issues. Someone had told me was transferred from another unti to mine because of her competency.

The issues..

About a week ago I had her outright refuse to get a resident with cancer up to eat who requested it she hadn't eaten in 2 days. (hoyer/W/C) I work nights. I ended up having to call the supervisor and she had refused to her, But eventually caved. I was told she was going to be either verbally warned or written up. i've been getting non stop attitude and she's been giving me false information about the residents.. It got better until last night.

Last night she gave a resident a cola that was barely thickened who has emphysema who was choking and aspirated on it. I took the cola into the kitchen and checked the conistency had to add 2 spoon fulls of thick it to get the right consistency. I'm thinking she just tossed a lil cause usually 2-2.5 will do it.

I confronted her and asked if she had put thick it in it and then asked if she checked the conistency. I got an attitude and she said fine i'll put 3 scoops in it instead. "I don't mean to give you an attitude but l know how to use thick it"

Same resident. I'm working on my med order. CNA comes into the nurses station and says she needs a NEB and Cough medicine In a raised voice. Put my meds away and went to see what was going on. She was raising her voice at the resident telling her she her to go to bed. The resident was agitated. I could see the CNA was frustrated and stressed... I told her to go take a 15 minute break off the unit. She started to argue with me about it and I told her again in a Firm voice. I then got the resident to take her shoes and TEDS off. THE CNA apparently left them on because they are tough to get back on. After her shoes and teds came off no issues.

G-tube patient who l keep telling her needs to be at 45' and she keeps putting him at a 20-25' I've showed her with my hand what 45' looks like. When l did his gtube last night had 25-30 residual when I normally had none.

I asked her to come get me when she was changing a resident during roudns because l had a report her bottom was red. She said ya it was l put A&D and zinc on it. Zinc in my facility we need an order for. And she never came to get me during rounds..

A resident requested some Tyl+Maalox and l was never reported to and got yelled at by resident. She asks for it most nights.

I feel very frustrated and have been told by other nurses that the last 4 night nurses have left because of them. I am a new grad and want my residents to be safe and do a good job. I'm so frustrated. Should l be going through these hoops to either improve her or get her terminated even though i probably won't be there longer than a year or just swallow my pride and start applying. I have experience now. I am driving an hr to work because they were the only one who called me after applying over 100 apps. Ugg l don't mind my job just am sick of the CNAS.

Opinions and suggestions greatly appreciated.

[nursel56]

From my understanding she was a problem child on another floor and they moved her downstairs some time ago before l started... I think what frustrates me the most is when l do try to re-educate her l get attitude and then she goes on to continue what she wants... but your right l should be documenting the re-ed.. would just a note about the re-ed to my unit manager in a sealed envelope in her box be adequate?

Someone who is older and been at a facility for a long time will naturally be resistant to a confrontational approach no matter what the deficiencies are in your view. I'm not saying that anyone should accept unsafe behavior, but if you view an older, long-time CNA as a "problem child" she may be picking up on that and responding to that rather than the content related aspects of your re-educating goals.

I've read so many posts almost exactly like yours, and most of the time the outcome is that the "unsafe" CNA still has her job, and the RN has been shown the door. I can't say the reason for this phenomenon, perhaps there are fewer CNAs in an applicant pool than there are LPNs and RNs? I hope you are able to improve the overall quality and safety in your facility, though!

[fabiusgile]

If thats the case so be it. Atleast l will know that my gtube patient didn't drown for his hob being left low. She also gave my preceptor attitude. I need to do what I feel is right for my patients and if l'm shown the door. I will network and find something else.

[GeriRNfromNZ]

where I work we have unwanted event forms, (Im sure your facility has similar) which cover everything from pt falls, injuries, injuries to staff, unsafe practice etc - we fill these out describing the event, then what corrective action we took and the follow-up action we will do or want the manager to do.

eg: the corrective action is what you did at the time, and the follow up action could be a suggestion that the HCA needs further ed on ......

[GeriRNfromNZ]

HCA whoops I mean CNA lol we call them HCA's in new zealand

You could always volunteer to lead an inservice for the care staff, focussing on some of these major issues.

[Kooky Korky, BSN, RN]

If thats the case so be it. Atleast l will know that my gtube patient didn't drown for his hob being left low. She also gave my preceptor attitude. I need to do what I feel is right for my patients and if l'm shown the door. I will network and find something else.

Easy to say, hard to pay the bills with no job.

Hold on, deep breath here, now, here's what you do.

First, do start looking for work nearer to home.

Meantime, you get the proper form on which to do formal writeup's and you use them. Hand them directly to the person in charge of your ward or to the DON, not to the shift supervisor or whoever you've been giving them to, because you don't know for sure that that person is actually delivering them to the right authority. You must, must, absolutely must keep a copy of everything you write.

For example, if that HOB being too low results in pneumonia, you will have documented that you formally, on whatever date, instructed the aide in proper HOB positioning of a G Tube patient.

If you are going to counsel the aide, do it in the presence of another nurse, preferably the Manager or DOn, and do it in writing, that is, make your complaint formal and written. The aide needs to sign it. If she refuses, you have the other nurse sign that she observed the aide refuse to sign it. Again, keep a copy.

And so on, in this manner. Keep it up until you either break through to this stubborn wench, this miserable wretch of an aide, who does not deserve her job supposedly caring for helpless patients. She's probably not qualified to do anything else but too bad. She should not be inflicted on other helpless humans.

You should also probably report her, anonymously, to the federal disqualifying list people. Not quite sure how to find them but shouldn't be too hard. Actually, you might be able to skip all the write-up's and just do this but TELL NO ONE. I REPEAT, TELL NO ONE AT YOUR JOB. NO ONE.

For all they know, a family member could have been the one to report, or another staff member.

Your managers and supervisors are taking advantage of you, just using you and stringing you along, putting the patients and your license in jeopardy. This aide is stubborn, has ill will, hates her life and her job and you, probably knows the bosses don't really care about the patients and knows how to sweet talk them, as she has been doing for a long time. Some bosses think that doing stuff like moving lazy, no good employees like this to nights and to another floor is acceptable because the new grad won't make waves. Then they will blame you when the doo doo hits the fan - like the person whose bottom you wanted to see gets a bedsore and this witch refused to call you when she went to supposedly clean her.

One thought - you might try having a heart to heart talk with her. Say "Joan, I have a problem and I wonder if you can help me. As you know, we have had some differences of opinion on how to do certain things. I wonder if you can tell me what I can expect in the future if I ask you to come get me when you change someone or if I ask you to elevate the HOB a certain amount. I am in a very bad position, Joan. I have to either ignore the things you are doing or not doing or I have to report you. I don't really want to be the cause of you losing your job but I also can't continue to let you do ____ to the patients. I know you're older than I am, I know you've been here a long time, I expect you work to pay your bills just as I do. however, none of those things can matter. I must have your cooperation on everything I ask of you because I need for the patients to get proper care and I need to be able to trust that you are giving it." And see where that goes.

You could also speak directly to the person who will determine her future and just ask her advice on what to do. Ask what she is aware of re: this person, ask what she advises you to do about your concerns. And be specific. Of course, she might turn around and fire you or have you set up. Rock and a hard place.

I wish you well.

[EwwThat'sNasty]

It's a difficult position to be in, plain and simple and it doesn't need to be CNA to a RN, it can be MD to RN, staff secretary to RN, or RN to RN, but when this ugly monster rears its head it can get quite nasty.

The proper term is "lateral violence." Sometimes we hear it as "nurses eat their young."

The "giving me wrong information" is a classical symptom. I wonder if she makes it difficult on occasion for you to find items and supplies that you need?

To gain an understanding of the why's and some insight in how to cope with such behavior I highly suggest buying a copy of "Odd Girl Out."

This book will open your eyes regarding passive/aggressive behavior and why it occurs.

Do not underestimate the passive/aggressive person, oftentimes they are highly skilled at being the bully, having had decades of experience. Sometimes the actual best answer is to simply find another job--sad but true. These highly skilled people often can confuse your bosses, and usually do NOT work alone. So your single complaint can get trumped by the perp and an ally. It's all about power.

[nursel56]

QUOTE=Kooky Korky;4163984. . . . . .One thought - you might try having a heart to heart talk with her. Say "Joan, I have a problem and I wonder if you can help me. As you know, we have had some differences of opinion on how to do certain things. I wonder if you can tell me what I can expect in the future if I ask you to come get me when you change someone or if I ask you to elevate the HOB a certain amount. I am in a very bad position, Joan. I have to either ignore the things you are doing or not doing or I have to report you. I don't really want to be the cause of you losing your job but I also can't continue to let you do ____ to the patients. I know you're older than I am, I know you've been here a long time, I expect you work to pay your bills just as I do. however, none of those things can matter. I must have your cooperation on everything I ask of you because I need for the patients to get proper care and I need to be able to trust that you are giving it." And see where that goes.

This sounds like great advice. I believe the CNA in question had at one point said something along the lines of "I don't mean to have a bad attitude, but. . ." sounds like there is at least some awareness of her own part in the situation.