A problem with CNAs

[olli975]

Hi,

I am a new RN at the teaching hospital. I used to work at the same hospital on a different unit as an RN extern for a year prior to this. As an RN extern, I usually took 4 patients and did am care, assessment, education, charting, etc. Things I did not do were meds/some procedures like G tube care/trach care that only RNs could do... Besides, at 8am and 12pm I did VS and Accuchecks for ALL of the patients on the floor... When they were very busy, I was just utilized as a CNA and did am care/bed change for everyone, Vitals, Accuchecks and I&Os... I got recommended for an RN position by Associate Director of Nursing based on recommendations or RNs I worked with

Now at my current floor we have some really great CNAs but there are a few who constantly do a half @** job... I am lucky if I at least get VS and Accuchecks from them for my pts, not even mentioning bed or bath... and I do all I&Os myself. There were a few times that some of my VS were missing for one reason or another. Most common answers usually were: "pt off the floor"(although pt left at 11am and came before 12pm), "MD was in the room at the time", "pt stated you checked her VS" (although I rechecked it at 10amto see if BP went down after I gave BP medications), "pt is going home"(although her pick up is not until 2 pm) or simply "I did not do it because I was busy"... They lie, take constant break, forget their phones, look for an opportunity to skip smth. I tried speaking to a few but it did not help. I also spoke to charge RNs when I had a problem. Other RNs have the same problem with those few CNAs. This morning I emailed my manager with things to mention at the next CNA meeting for everyone (basically remind them on what their job description and responsibilities are) and told her about everything.

Do you think I handled this situation right? How do you handle it at your job?

[rngolfer53]

I so feel your pain...I am truly amazed at the amount of healthcare workers that really don't care...Last night...I had one leave for one of her many breaks...She closed the door to a resident's room leaving me to wonder if she was caring for them...Nope, one was left on the toilet alone (90 years old) and needs a lift to get to bed. The other had her 02 off and dirty linen and briefs on the floor...She was gone for 20 minutes...leaving the door closed with the residents in danger...

I wrote a letter to the administrators. I think that is a great idea. The sad reality is, many don't need more training. You can't train someone to care...

In general I agree fully. But with someone still young, it may be they've never actually had to work hard. Once they understand the expectations of the job some will rise to the level needed.

The rest are a waste of time and resources, and should just be fired. Too bad that often takes way too much management time.

[GaMBA]

"One thing I did notice when I was a floor CNA is that there is a different mentality for CNAs who are in nursing school versus those who are not. If a CNA is in nursing school, he or she will be more than willing to work hard for you because they are thinking of their future career."

I disagree.

"However, if the CNA is not in nursing school, they are only thinking of themselves and their JOB, not career."

Speak for yourself. At the hospital where I work, many of the CNAs are not students nor do they plan to be, and they are excellent. They are not lazy at all and work just as hard as the students do, if not harder and BETTER. Many of them have been in this field far longer than us students (some even longer than I've been alive!) and they are extremely good at what they do. They have worked in different facilities, different units and know everything there is to know about this job/career. So many of them have stepped in to help me (a student and a newbie) countless times. I love the CNAs I work with, students or not, careerist CNAs or not!

Believe it or not, some CNAs are perfectly content being CNAs and take a lot of pride in what they do. They are excellent care providers and need to be appreciated as such, whether they plan to "further" their career into nursing or not. I don't look down on anyone because they have chosen a profession that happens to not pay a lot or require a lot of education. Who cares???? If someone loves what they do and it's enough to pay THEIR bills and fulfill THEIR life goals, then be happy for them.

[mamason]

I think letting your manager know that VS and blood sugars was right on the money. THos things are crucial on my floor and determine if I give a med or not, or if I have to call the doc about low sugar or low bp. That is very unsafe practice on their part. I understand that if the pt is off the floor, etc. But, upon return, vs need to be taken. I must be very lucky where I work. Our CNA's are very good about taking sugars and VS in a timely matter. They also, immediatley, alert you of a critical value. They have extensive inhouse training in order to work on our unit.

[Magsulfate, BSN, RN]

That's exactly what I do: I write their assignments, and I highlight it too... and I tell them: if for any reason you did not or could not do this, tell me ASAP... Doesn't help

Also when they are utilized as sitters, they literally sit on the chair, watching TV, hiding food in pockets and attempting to use pt's phone to make personal phone calls...

It sounds like they are beyond talking to. You need to document EVERYTHING, and then turn it in as insubordination along with not doing their job. Keep at them. Do not stop writing it up until they start doing their job. Sometimes just writing them up once work wonders.

It sounds like they are the type of CNA that will push the limits and do just barely enough to keep their jobs. But that is not enough, and it is time for action on your part. You've talked to them, now it's time.

[Magsulfate, BSN, RN]

"One thing I did notice when I was a floor CNA is that there is a different mentality for CNAs who are in nursing school versus those who are not. If a CNA is in nursing school, he or she will be more than willing to work hard for you because they are thinking of their future career."

I disagree.

"However, if the CNA is not in nursing school, they are only thinking of themselves and their JOB, not career."

Speak for yourself. At the hospital where I work, many of the CNAs are not students nor do they plan to be, and they are excellent. They are not lazy at all and work just as hard as the students do, if not harder and BETTER. Many of them have been in this field far longer than us students (some even longer than I've been alive!) and they are extremely good at what they do. They have worked in different facilities, different units and know everything there is to know about this job/career. So many of them have stepped in to help me (a student and a newbie) countless times. I love the CNAs I work with, students or not, careerist CNAs or not!

Believe it or not, some CNAs are perfectly content being CNAs and take a lot of pride in what they do. They are excellent care providers and need to be appreciated as such, whether they plan to "further" their career into nursing or not. I don't look down on anyone because they have chosen a profession that happens to not pay a lot or require a lot of education. Who cares???? If someone loves what they do and it's enough to pay THEIR bills and fulfill THEIR life goals, then be happy for them.

Once you have been around the block a few times you will realize there is more truth and reality in those statements than you have learned so far. It sounds like you are lucky to be at a facility where the CNAs are doing a very good job all around. However, this is not the reality in most hospitals.

In most hospitals, you will find ATLEAST once CNA who will only do what she MUST to keep her job. She hates her job and thinks that the RN should do it because she gets paid 3x's as much as her.

With those kind of CNA's you must put them in their place. YOu must tell them that their job is THEIR JOB and they MUST DO IT to keep the paycheck coming. Most of the time they will straighten up and start doing their job, or they will quit or get fired for not doing the tasks assigned to them.

[HARLEYBEAR]

I understand that CNA's can be frustrating to you as a RN...however, do you look at their workload compared to yours? In my hospital the CNA/pt ratio is at least 10 to 1. What is yours? 4-5:1? CNA's are greatly underpaid and unrespected. If the aid goes through at 11 to start vitals and the pt isn't in the room...then the pt isn't in the room. By the time she/he is done it is probaly time to pass lunch trays or a pt needs help to the restroom, or labs needs to be ran down......A suggestion is if the CNA is busy...pay attention they usually are....take the vitals your self!!!! It is utlimatley YOUR RESPONISIBLITY anyway!!!! I am a CNA/nursing student and it infuriates me when the nurses ***** and complain that the aids are lazy while they are drinking thier coffee!!!

[nlovell]

I've always found the best way to work with ANY staff is to be up-front about what you expect. Clearly state your expectations and limits. If you want VS and accuchecks taken before 8am, then say it. I worked in an ECF for a short while and I handled my team the same way then as I do now. There's always time for a quick, 2-minute "homeroom meeting." Again, clearly state your expectations and let them know that if they need help, you are available...but that you don't read minds. If someone comes to you and says "I won't be able get these 2 accuchecks done because Mr. Smith had an accident and I need to spend extra time in his room," then I know what's going on and how to help. But you need to also be clear about what will happen if you "discover" missing vitals or slipshod work, instead of being told up-front...and then follow through with it. Make sure you are available as much as you can to assist, make it seem like fun and don't forget to thank everyone at the end of the shift for their hard work.

[Junebugfairy]

cna's are paid according to their education, which is not anywhere near what an rn has.

i am a cna in nursing school, and i have been a cna for 9 years :)

cna's are just that nurse aides, they "aide" or "assist" the nurse in the smaller tasks so that she may perform the more pertinent tasks.

i would never dream of telling a nurse that "it is your job"... no, it is my job, it is in my job description.

[Virgo_RN, BSN, RN]

I understand that CNA's can be frustrating to you as a RN...however, do you look at their workload compared to yours? In my hospital the CNA/pt ratio is at least 10 to 1. What is yours? 4-5:1? CNA's are greatly underpaid and unrespected. If the aid goes through at 11 to start vitals and the pt isn't in the room...then the pt isn't in the room. By the time she/he is done it is probaly time to pass lunch trays or a pt needs help to the restroom, or labs needs to be ran down......A suggestion is if the CNA is busy...pay attention they usually are....take the vitals your self!!!! It is utlimatley YOUR RESPONISIBLITY anyway!!!! I am a CNA/nursing student and it infuriates me when the nurses ***** and complain that the aids are lazy while they are drinking thier coffee!!!

Keep in mind that many, many of us nurses have been CNAs and have walked in those shoes, while no CNA has walked in the nurse's shoes. I always cringe when I hear the "I have X patients and the nurse only has ___, so s/he can just do it themselves", because this shows a clear lack of comprehension of just how much the nurse is required to juggle. There is just no way the jobs of CNA and nurse are equivalent in this way. It is a completely irrelevant comparison.

At any rate, this is not a nurse vs. CNA thread, it is about CNAs who are problematic in their work habits, or lack thereof, and how to deal with them. I have no problem, if my CNA communicates with me how busy they are, getting my own vitals. I often do my own turns (I work with some inexperienced CNAs that do not realize that many patients can be turned with a one person assist, and wait for the nurse to be available to help instead of being proactive), toilet my own patients, and do my own linen changes since I am right there. Changing a patient gives me the opportunity to assess their peri area and their skin integrity. What I have a problem with are the CNAs that disappear at the beginning of the shift, do not communicate, and instead of cleaning up patients or offering oral care or filling water pitchers, are sitting in front of the computer checking their email or doing their homework. There is a difference.

[Virgo_RN, BSN, RN]

I just want to add that I've worked with these types of employees in other areas as well. This is not an issue unique to healthcare. I was in a middle management type of position in my previous career, and the amount of hand holding and babysitting required to get grown adults to do the job for which they were hired and getting paid astounded me. I just can't wrap my mind around the kind of work ethic that says it's okay to just do the bare minimum to get by. I think the most effective approach I have seen is a healthy mix of team building, morale boosting cheerleading and holding people accountable. When people receive acknowledgement for what they're doing right and not just what they're doing wrong, this can help them to take pride in their work and want to do better. But there has to be accountability as well. Someone has to be willing to be the bad guy and point out when these people aren't pulling their weight and to implement appropriate consequences. I've noticed that with nursing, at least on my unit, individual nurses can't hold the aides accountable unless the aides know that the nurse manager will back the nurses. If the nurse manager is not invested, then the aides can easily tell the nurses where to stuff it.

[Magsulfate, BSN, RN]

I understand that CNA's can be frustrating to you as a RN...however, do you look at their workload compared to yours? In my hospital the CNA/pt ratio is at least 10 to 1. What is yours? 4-5:1? CNA's are greatly underpaid and unrespected. If the aid goes through at 11 to start vitals and the pt isn't in the room...then the pt isn't in the room. By the time she/he is done it is probaly time to pass lunch trays or a pt needs help to the restroom, or labs needs to be ran down......A suggestion is if the CNA is busy...pay attention they usually are....take the vitals your self!!!! It is utlimatley YOUR RESPONISIBLITY anyway!!!! I am a CNA/nursing student and it infuriates me when the nurses ***** and complain that the aids are lazy while they are drinking thier coffee!!!

This is exactly the kind of attitude that I can't stand. Sure CNA's are frustrated and have a huge work load, and so do nurses. There are things that a nurse cannot pass off to the CNA and that MUST be done, and done now. Actually, my day consists of these things, over and over, left and right. When I am working with a CNA that despises the fact that I get paid more than her and she has to do all the "dirty work" it makes everyone's day even harder. Like most nurses I know, I will clean poop and change sheets, brush dentures and do little things that the CNA can do. But there are countless things that the CNA cannot do that I am responsible for.

Keep in mind that many, many of us nurses have been CNAs and have walked in those shoes, while no CNA has walked in the nurse's shoes. I always cringe when I hear the "I have X patients and the nurse only has ___, so s/he can just do it themselves", because this shows a clear lack of comprehension of just how much the nurse is required to juggle. There is just no way the jobs of CNA and nurse are equivalent in this way. It is a completely irrelevant comparison.

At any rate, this is not a nurse vs. CNA thread, it is about CNAs who are problematic in their work habits, or lack thereof, and how to deal with them. I have no problem, if my CNA communicates with me how busy they are, getting my own vitals. I often do my own turns (I work with some inexperienced CNAs that do not realize that many patients can be turned with a one person assist, and wait for the nurse to be available to help instead of being proactive), toilet my own patients, and do my own linen changes since I am right there. Changing a patient gives me the opportunity to assess their peri area and their skin integrity. What I have a problem with are the CNAs that disappear at the beginning of the shift, do not communicate, and instead of cleaning up patients or offering oral care or filling water pitchers, are sitting in front of the computer checking their email or doing their homework. There is a difference.

Right, and I do want to point out the pay issue. The pay is more for an RN because we are educated more, we have a license to protect, patients to protect and everyone to be accountable to. The CNA... well, she's accountable to herself, and if she has good work ethic, it will go a long way in helping her to be the best CNA she can be. There's really no monetary reason to be a CNA, so it must be the love of the patients.

[lookingbeyond, BSN, RN]

:twocents:I too was a CNA and understand your frustration...Today, I am an LPN and can't believe I thought nurses had it much easier. I just had my first panic attack and was sent to the hospital via ambulance. I had never experienced one, and thought I was having a heart attack, and this was on my day off....There are great, good, mediocre, and horrible nurses as are CNA's...

I hope you have the opportunity to become a nurse...you will then be able to judge from the other end.

I was a HHA and CNA for 5 years...challenging beyond belief...GREAT nurses...are hard to find, because they don't last long at times...Same for GREAT CNA's...there are so many Great people that just can't keep up due to the demand and hearts that truly care....:paw: