Advice on handling/influencing problem CNAs and nurses?

[inaniel88]

Hi all, little info - 120 bed facility, usually 100-110 occupied, I'm NOC charge RN for 4 yrs, shift runs with 3 nurses, 6 CNAs (that's if we're lucky - usually 5, sometimes 4, a couple times I remember with 3!) with two 15-bed medicare/rehab halls, one of which is mine, plus my LTC halls... My assignment is always the fullest, usually 40+ residents. I actually enjoy my job, my residents, and being busy, and working as a team with my CNAs and other nurses.... so I'm not complaining about the LTC environment...I like the nursing part of being an LTC nurse.

But lately my facility is very short-staffed, my shift especially. It's become the norm for 4-5 of our CNAs to be staffed by an agency, or new hires, with major attitudes who hide/don't want to work.

I'm having some major issues the past few months that I've never encountered before and I really don't know how to deal with it lately. Generic example...agency aid or new hire, I give them their assignment/report. I tell them to pass waters/towels, check alarms are on, O2 tanks that need to be filled, do rounds, who they need to get up before they leave, who needs to be turned/offloaded, when they can go on break and to let me know when they go. I always give them their assignment/report/acclimate them to the facility and codes for med and stock room before getting my own report from 3 other nurses, or counting my own narc drawers (2) from PM shift that's waiting to go home, and by the time I do it's almost time for my midnight meds/txs/start checking my orders/do paperwork...

....And I'll see them on their butts. Or not see them at all, no carts outside the room they're supposedly in. This infuriates me, especially if they are blatantly lazy and just sitting out in the open or on their phones - I'll ask if they did rounds and they usually lie and say yeah, (I have my eyes on my halls and lights at all times so I CAN see if they are actually going room to room and doing their jobs and am very aware of my surroundings). Also get infuriated (is a strong word but true) when agency comes in and says "I have THIS many people?!, Oh no, that's too many, uh-uh"....or something to that effect ... No, that's the assignment, welcome to blahblah-facility, if you don't like it then at least do your job tonight and then don't come back! - is what I want to say... They are getting paid double what our employed CNAs are, they should be working twice as hard, if at least not AS hard.

If they ARE blatantly lazy then I have to spend my time micromanaging them and that's BS. We are all adults, we know what our job is...why should I have to micromanage someone who is 10-20+years older than me. I don't get paid extra for being "charge" (babysitter/receptionist/scheduler/moderator) nurse; that is the spot that was open when I was hired and it stuck.

In the past couple months I've had CNAs that have outright refused their assignment, have refused to go home when I got fed up and told them to go home (we've worked short before, it's nothing new, would rather work short then let our resident's sit in their waste and develop bedsores and most of our regular staff shares my sentiment), I've had CNA's claim I was being racist or being a bully or being a b*tch, I've had a CNA threaten to beat me up/have her bf beeat me up, I've had a CNA I had to write up every single day for consecutive days before she was terminated, I've had CNAs outright lie to my face and then try to lie their way out of lying when I point out that they're lying in the first place...And this really hasn't been a problem before the past few months. We used to have really amazing CNAs who have all left recently for one reason or another...

So problem #1 - how do you deal with this kind of person who doesn't want to do their job? (In the case of the agency CNA - they are getting paid well, if they're resolute in being lazy or insubordinate I report them to their agency and my DON/scheduler and ask that they not return. If it's a new CNA, and I really wish we COULD retain staff lately but it seems we're hitting the bottom of the barrel and just cycling through ab bunch of new faces who quit or are fired pretty quickly..., I try to be open/welcoming/understanding/establish a relationship. I try to be helpful and available, especially if they're brand new. I try to give explanations. I try to be they're partner when they need help with problem pts. I give them written AND verbal report so they can't say they didn't know something. I was a CNA not long ago so I know how hard it can be.

And problem #2, which is greatly contributing to problem #1, is another particular nurse. Been there a long time. Is very negative, dramatic, insecure, cliquey and talkative...talks excessively to the CNAs, tells them her whole life story. Want's them all to be her best friend. And gives them the impression that it's ok to sit on their butts and that work is the Oprah show for the next 4 hours. That they don't have to do rounds or chart. That they can chit-chat, they can go on break for their 45mins, then come back and chit-chat more and then get busy 2 hrs before shift ends so that everything is set for the morning shift. And her hall is always empty and she complains about how busy she is, complains about everything. And I work side by side with her, I see how busy she is NOT. Constantly complaing about how much she hates her job, dislikes the residents, talks down to the demented and sometimes annoying residents. But she makes problems patients worse by getting them worked up. I f she was a little more, idk, "therapeutic" in the way she talked to them, she wouldn't have to deal with so many behaviors. She should know better.

We'll have people new to the facility, whether they're new hires or new agency staff, and as soon as they have her as their nurse they get this impression that they can sit on their butts and talk all night and not work that hard. And I try to correct it when she's not there, it's like night and day. I've addressed this with her in the past in what I thought was a respectful way, but nothing changed and now she's suspicious of me and talks about me behind my back to the CNAs.

I don't know, I feel like this is an uphill battle, I don't really want to wait it out but I don't want to find a new job either. I've gone to my DON with my concerns, and she wants a meeting with our shift where she'll moderate us hashing it out but I really think that'll only add fuel to the fire.

Suggestions? Besides brushing up my resume?

[Neats, BSN]

You sound like a wonderful caring LTC Nurse who knows how to get the job completed. As a LNHA and BSN I can tell you I have had my fair share of employees not wanting to do their job...I have even had my car tires slashed (had to tie my two Akitas up to my car to keep those employees away.

Holding people accountable what I call follow through is very difficult, time consuming and sometimes I just want to give up but do not.

When I give difficult people assignments I break it down into chunks of time. So for the first 2 hours I want them to completed the following tasks A, B, C... I am organized so for the last 10 mins of their 2 hour duties I will actively search them out so they can show me their work. I then give them instructions for the next two hours (this even includes a break and I really watch them during that time. If they abuse it I ask them to come and tell me they are going on break and come tell me they are off break) Micro managing...YES!!. Most people do not like this type of leadership and I find that the good ones like it because all of us are held accountable including me. The ones who just want to slide do not come back after about a week (if that). They want to be reassigned, they quit, they complain to upper management. I have had employees call the 1800 I hate my Boss on me.

I follow the rules; the time and attendance policy is with me at all times. The written directives for what they do on 2 hour increments that include built in breaks is within policy/procedure and usually is welcomed.

Usually I find that it takes a couple of months to have a decent running shift and then I treat the employees to pizza, crock pot of stew and home made bread on a monthly basis...I save those daily assignment sheets so when we have our pot luck I can tell/show them how hard they are working (if they are still here).

If the management staff are not behind you in this endeavor then I would look for another place of employment as this type of environment is difficult to change and you must be supported by them. Invite management in early AM or late at night when you are following through with your tasks list this shows the employees you are supported and follow through and have management buy in. Have your DON include this as part of a QA improvement. This is a much better way then a shift meeting turns into a grip session with employees complaining of too much to do and the charge nurse riding them.