Advice for charge nurse ...Help

Published

I'm the charge nurse of a 60 bed unit. I have 3 CNAs and a med aide. My problem is conflict with the aides. Most the time we all get along and they do their jobs without problems but sometimes when I tell them to do something it either doesn't get done or gets done at their convenience or they argue with me and sass back. Example: last night I had 2 admits at the time I am usually doing my evening treatments so it threw me behind. I was trying to get blood sugars checked before it got too late and also had to stop and take care of a resident who is on peg tube dependent feeding, O2 and trach care. I was in the room doing his breathing tx and medications while an aide was changing his sheets. I heard the aide asked him is he wanted a sheet or just a blanket and then walked out of the room. I thought to go get a sheet since he didn't have a top one but she never came back so I had to take the time to go get a sheet then go back and cover the resident. Most times I don't mind helping, I put residents on and off bed pans, empty urinals and so on but when I am behind and still have 30 residents to do plus paperwork it gets frustrating having to do the aides job too. When I told her I had to cover the patient she said "I wasn't the last one in the room" I said no but you are the aid. She then told me I need to learn how to speak to people and then when I told her she also needed to put another resident to bed because it was 10pm and the resident was falling asleep and leaning out of her wc the aide told me she wasn't sure I had given the resident her medication and since I forget things she wasn't putting her to bed until I had done it because the resident sometimes tries to get back out of bed when she hasn't had her medication. I told her then next time ask and the aide got another attitude. I know I can send them home but I hate to put the extra work on the other 2 aides or cost someone their job. Sorry this is so long but any advice would be greatly appreciated.

Up Vote Up Vote ×
I'm the charge nurse of a 60 bed unit. I have 3 CNAs and a med aide. My problem is conflict with the aides. Most the time we all get along and they do their jobs without problems but sometimes when I tell them to do something it either doesn't get done or gets done at their convenience or they argue with me and sass back. Example: last night I had 2 admits at the time I am usually doing my evening treatments so it threw me behind. I was trying to get blood sugars checked before it got too late and also had to stop and take care of a resident who is on peg tube dependent feeding, O2 and trach care. I was in the room doing his breathing tx and medications while an aide was changing his sheets. I heard the aide asked him is he wanted a sheet or just a blanket and then walked out of the room. I thought to go get a sheet since he didn't have a top one but she never came back so I had to take the time to go get a sheet then go back and cover the resident. Most times I don't mind helping, I put residents on and off bed pans, empty urinals and so on but when I am behind and still have 30 residents to do plus paperwork it gets frustrating having to do the aides job too. When I told her I had to cover the patient she said "I wasn't the last one in the room" I said no but you are the aid. She then told me I need to learn how to speak to people and then when I told her she also needed to put another resident to bed because it was 10pm and the resident was falling asleep and leaning out of her wc the aide told me she wasn't sure I had given the resident her medication and since I forget things she wasn't putting her to bed until I had done it because the resident sometimes tries to get back out of bed when she hasn't had her medication. I told her then next time ask and the aide got another attitude. I know I can send them home but I hate to put the extra work on the other 2 aides or cost someone their job. Sorry this is so long but any advice would be greatly appreciated.

Did the CNA forget the sheet?? OR purposely not bring it to the patient?? Regardless, the issue is she asked the patient which they wanted and then left to supposedly get the item, in the meantime, the patient is lying there uncovered because she did not return with it. I would have discussed that issue with the CNA, but I don't think I would have said "But you are the aid" .....it comes off a little condescending, and also it is ALL of our duties to care for patients. Bottom line is we all need to work together, discussing things with CNA's is fine but we need to show them the respect they do deserve also. Just my opinion, I think that using "but you are the aid" set off your CNA, that she may have felt that was condescending.

Up Vote Up Vote ×

"it gets frustrating having to do the aides job too."

Yes, the assistants will surely let you do their job.

YOU are in charge. Get control of the situation. Each and every task the assistants perform are legally under YOUR direction... and YOUR professional licensure.

They are playing you.. and you are allowing it.

Up Vote Up Vote ×
Specializes in LTC, Memory loss, PDN.

CNAs get behind and overwhelmed just as we do or

even more

i don't know how the CNA was approached either, but

here is how i handle this stuff

I'd say something like, "I'm really concerned about you right now

you're not acting appropriately, are you alright, do you need a five minute

break away from the floor?"

you never know what bad situation a person maybe going

through and five minutes isn't going to ruin the schedule any

more than it already is, but it maybe all a person needs to

collect themselves, then they need to know what is expected

of them so I'll say something like,

"We are all really busy tonight and i need to know that i can

depend on you to do your job as part of a team, can you?"

if the staff member is or continuous to be inappropriate

i will send them home, because i do not feel i can trust them

with residents, but i certainly wouldn't send someone home,

because i had to get a sheet

CNAs get interrupted all the time by nurses over something

the nurse spent more time on hunting down the CNA than the

time needed to do the task

Up Vote Up Vote ×
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

The solution involves playing hardball: you've gotta send insubordinate CNAs home.

CNAs are not exactly the highest-paid workers in healthcare. Most depend on a full paycheck to pay their bills, so a short paycheck often means the difference between staying above water or having the electric bill disconnected.

The strategy is to hit the disobedient people where it really hurts (read: in their wallet). After taking repeated hits to the pocketbook, you'll increase the chances of the CNA's compliance to work rules and obedience of your directives.

Up Vote Up Vote ×
Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.

I was sooo looking forward to your reply, Commuter!! Your advice was on point!!

Up Vote Up Vote ×

I'm really concerned about you right now

you're not acting appropriately, are you alright, do you need a five minute

break away from the floor?"

Try that and see what it will do.

I said the same exact thing , the CNA got even more belligerant and told me it was none of my @#$% business how she was feeling.

Up Vote Up Vote ×

that was a bit harsh! Commuter? and a bit judgmental towards CNA's not ALL cna's are single mothers who depend on that little paycheck some do it really just because they enjoy the work!

Up Vote Up Vote ×
Specializes in critical care, ER,ICU, CVSURG, CCU.
that was a bit harsh! Commuter? and a bit judgmental towards CNA's not ALL cna's are single mothers who depend on that little paycheck some do it really just because they enjoy the work!

no Jsylynn, with my humble 41years experience, The Commuter, knocked it out of the park

Up Vote Up Vote ×
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
that was a bit harsh! Commuter? and a bit judgmental towards CNA's not ALL cna's are single mothers who depend on that little paycheck some do it really just because they enjoy the work!
Not once did I ever say that "all CNAs are single mothers." You are conveniently adding your own thoughts and inserting them into my original post. I've worked with male CNAs and childless female CNAs, so I thoroughly know that not all CNAs are single mothers. Putting words into one's mouth is an exercise in futility.

As harsh as it seems, I still stand by my idea to send insubordinate CNAs home. It is a tried and true method that works wonders in getting mouthy employees to obey.

Up Vote Up Vote ×
Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.

As a single parent and former CNA I don't feel Commuters comments were offensive in the least.

We all know that some LVN/LPNs don't do their job appropriately either. (I assume that's where the OPs comments are coming from)

BUT....

Let's not turn this into a CNA vs LVN/LPN debate.

As a new LVN, I know I will need effective ways to supervise those whose my job description requires me to do so, even when they are being insubordinate.

Thanks Commuter!

Up Vote Up Vote ×
Specializes in critical care, ER,ICU, CVSURG, CCU.

and as the Commuter, has suggested, I have found when I would send one insubordinate cna home, i seldom had to do it again for quite some while..... and as DON, the charge nurses also knew I had their back, for similar behaviors

Up Vote Up Vote ×
+ Join the Discussion