CNA is driving me crazy...help!

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Dear Nurse Beth,

I have been a nurse for around 26 years. I currently work in LTC which has become extremely stressful due to post-Covid nursing shortages. One of the things that is causing me extreme stress is a CNA who thinks she knows better than nurses. She is a very diligent CNA, but she goes overboard with it.

She will hound and harass me to no end about small things...like the size of someone's clothing or a minor medical issue that she feels should be treated as an emergency. I work nights so calling the on-call doctor is reserved for true emergencies. I have been to management about her but nothing changes.

I have tried talking to her and even referring her to other staff that can help with things like asking families to buy residents clothes that fit but she refuses to follow up on her own and expects me to fix these issues. She will tell me over and over again about her perceived "emergency situations" and puts me behind every night.

She gets very offended if I remind her I am a nurse and I have been trained to assess what is an emergency and what is not. She is 70 years old and really needs to retire but says she tried that but couldn't stand it because "I need someone to take care of" she has shared some of her personal life with me...more than I really wanted or needed to know...and she is probably one of the worst cases of a co-dependant person I have ever met.

She buys into patients behavioral issues and automatically assumes all their problems are some sort of medical emergency that she of course expects me to fix. Help! She is driving me Crazy! What can I do?

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2 Answers

Specializes in Tele, ICU, Staff Development.

Dear Making Me Crazy,

It sounds like you're facing a challenging situation with this CNA who is overstepping her bounds. It's really frustrating because she's in control with her repeated demands for your attention.

Unfortunately, your efforts to address the issue with management haven't led to any changes.

As it stands, if the CNA refuses to change her behavior and management is not taking action, your best option is to modify your responses.

Here are some steps you can consider to take back control.

Set clear boundaries. It's essential to establish boundaries with the CNA. Let her know that while you value her diligence, you must focus on your tasks.

Politely but firmly remind her that you are the nurse in charge and will assess and prioritize your patient's needs based on your training and experience.

"Thank you for that information. I will take care of it/see to it when I can."

Communicate assertively. If she continues to push with non-urgent matters, acknowledge her concerns but reiterate that you need to focus on your nursing tasks. Calmly remind her that you will address the issues as time permits, but your priority is patient care and immediate needs.

"Thank you, and we can talk about that later, but not now."

Redirect her.

  • Delegate a task, such as refilling water pitchers or re-stocking.
  • "Can you please make sure there are gloves in every room? Thank you."
  • Ask her to list her concerns in writing and give them to the charge nurse.

When setting boundaries or redirecting, expect deflections and arguments; she will attempt to draw you into arguing but do not engage. Do not justify your actions. Repeat your message calmly and clearly.

Document incidents. Record any instances where the CNA's behavior disrupts or interferes with your work. Note the time, date, and nature of the incidents. This documentation may be helpful if you need to escalate the issue further with management or HR.

Involve the charge nurse or supervisor. If the CNA's behavior persists despite your efforts to address it, involve the charge nurse or supervisor when you encounter difficulties. They may be able to intervene or provide additional guidance on how to handle the situation.

"I am experiencing interruptions to patient care due to the CNA. Can you suggest a solution for this issue?" or "How would you like this handled?"

Promote teamwork. Encourage the CNA to work collaboratively with other team members, such as the charge nurse, CNAs, or social workers, when addressing non-urgent matters. Reinforce the importance of working together as a team to ensure patient needs are met appropriately.

Seek support from coworkers. Talk to your fellow nurses and colleagues about the situation. They may have experienced similar challenges or have helpful insights on handling difficult situations with CNAs or other staff. 

The CNA is manipulating you for her own needs and distracting you from patient care. If all the nurses stand up for themselves and set boundaries in a firm but respectful manner, it may discourage this behavior from continuing.

Lead by example. Continue to demonstrate professionalism and focus on patient care in your interactions with the CNA. Your leadership and dedication to nursing responsibilities can set a positive example for others.

Consider counseling or mediation. If the situation becomes overwhelming, you may want to suggest counseling or mediation to address the communication and interpersonal issues between you and the CNA. This approach can provide a neutral space to discuss concerns and work toward a resolution.

Remember that dealing with difficult coworkers can be emotionally taxing, but it's crucial to prioritize your well-being and focus on providing the best possible care to your patients.

I wish you the best in navigating this situation. I hope some of these suggestions help you as soon as your next shift.

Very best,

 Nurse Beth

"Thanks for letting me know." Period. Don't look eager to know more. [Don't give further space for continued commentary].

"I need to concentrate on my medication pass right now, please do not interrupt me unless a patient is having an emergency."

"I am working on [ ____] right now. Please [do x, y, z] so that [your concern] can be followed up tomorrow."

"This concern does not merit an interruption right now"

"The patient is stable and this doesn't warrant any action right now." >>>

"I have heard your concern, explained that no action is warranted, and now continuing this discussion is inappropriate and is interrupting patient care. Please stop."

Sometimes these situations become monstrous because they are over-entertained in the first place. It feels rude for some of us to have to be the one to shut it down, but we need to. Being kind and professional but direct is not rude.

Some people have poor situational awareness and poor boundaries and don't even understand that their actions are inappropriate. Sometimes we have to be more direct than what initially feels comfortable.

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