Unsafe CNA Help?

Nurses Safety

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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.

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Document, document, write up, write up, bye-bye before too long.

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Specializes in Gerontology, palliative care.

Well......... As I read it, your manager has taken your past concerns seriously and should be easy to approach with these recent ones. In my experience with difficult/unsafe co-workers (also as a recent grad), you first need to make sure that you are not being unfairly tough on this CNA because of your past altercations with them.

Then if you are sure that you are holding all your co-workers to the same standard, I would suggest you start making formal complaints to your manager ASWELL as attempting to re-educate this CNA on why these situations are unacceptable - so at least you can say you have tried to help them provide appropriate care. Try not to go overboard with the complaints, I mean forgetting to let you know that a resident needs pain meds - when they have them regularly and you know this (I would go check myself), isn't as big a deal as the Gtube guy or aspirating a resident

I had a similar situation when I started my first job in LTC as a new grad RN, needless to say the 2 CNA's were let go - and I'm still there!

Good luck with it!

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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?

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Also when l started the unit was a mess. I got oriented from a nurse who works another unit who spent half her time fixing the unit so l wouldn't be to overwhelmed when l went on my own. I'm still fixing things and everyone on the other shifts expects me to do there job. I think l'm a little frustrated. Apparently the last 4 night nurses have quit from what l've been told and the day nurses/cnas were telling me how they felt bad I was put on nights. It sounds like the cna's burn through the nurses.

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If you want to keep your job, you will have to resign yourself to the fact that writing this person up is part of your job. Whether or not anything is ever done about her, and it is obvious that nothing has happened in the past, she is still there, you have to protect your professional reputation with the employer and your license. Should she cause harm to a patient in the future, you will need copies of all your write ups, to prove that you did your job. Meanwhile, it would not hurt to resume your job hunt. You need something closer to home anyway. Good luck.

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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?

No, this is not enough. The notes might get tossed. Do full write ups. You may find it necessary some day.

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What do u mean by full write ups... Sorry about not knowing... I've been notes of the incidents on paper and passing em to the night supervisor who then passes them to the unit manager. I was told that she was going to pass this one to the unit manager and DON

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Most places of employment have forms for disciplinary actions. Get one from your supervisor. Make lots of blank copies, seems like you will need them.

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I will have to ask... Idk if thats something the supervisor has to do or what.. I am the default Charge because i'm the only night nurse on my floor 25 bed unit in a MH facility.

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I was told by supervisors never to address a CNA without another nurse/supervisor. because they will gang up and lie.

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I was told by supervisors never to address a CNA without another nurse/supervisor. because they will gang up and lie.

Sounds like you are getting some good advice. Work with your supervisors on this.

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