CNA issue

[Schmoo1022]

This isn't a rant about CNA's....just one in particular. We have CNA who work all three shifts per diem. She is in nursing school, but I am not sure how far along in the program she is. Well the issue is, she is a complete LOUD MOUTH, KNOW IT ALL! She has told me several times "if the nurse doesn't call the MD, I will notify the director. If so and so nurse doesn't call the director, I will. " and so on and so on. Who is the one in charge here? She undermines the charge nurses authority. Unfortunately, everyone seems to just brush it under the rug because she always picks up shifts.

She will ask me things like why wasn't a xray ordered? How come this patient isn't on ABX? If I explain that the Dr. was notified and there were no new orders...she can't let it go. She is overstepping her bounds. If she was asking to learn what the rational behind the nursing orders were, I would be more than happy. But she is completely accusational.

[Asystole RN]

I would maybe attempt to use humor to diffuse the next situation and remind her of her SOP and the NPA. If need be, print it out for her and highlight the pertinent areas and ask her, " Do I need to call the director?"

[mediatix8]

OK I know what to say. Next time she asks stuff that is beyond her business for the scope of practice as a CNA kindly inform her that it would be a HIPAA violation for you to disclose personal health information that she does not need to know to perform her duties as a CNA. This is the "minimum necessary" rule under HIPAA law.

"The minimum necessary standard in HIPAA's privacy rule requires covered entities to make reasonable efforts to limit protected health information (PHI) to the minimum necessary to accomplish the intended purpose of the use, disclosure, or request."

Tell you you will report her to the director for HIPAA violation. Does she also flip through the patient's charts too?

Has she ever actually called the director? I say have her do it and see what happens. I hope that you aren't intimidated by her. I wouldn't let her think that she has power over me because she's going to call the director.

[dudette10, MSN, RN]

She definitely needs to learn how to ask questions that inevitably come up when she's mentally comparing her "book learnin'" to her real world observations. It's a skill that all nursing students need to learn, which is much easier when the student keeps the ego in check.

Maybe someone needs to let her go to the director. Any director worth his/her salt will get her ego in check for her, toot de suite.

[Orange Tree]

I would give her a really stupid answer to every question she asked.

"No x-ray was ordered because I have x-ray vision."

I would also encourage her to call the "Supreme Ruler of the Whole World" instead of just the director.

[tyvin, BSN, RN]

She has appointed you as her working preceptor type buddy. Oh this can get annoying but don't be too hard on her; she probably doesn't realize what a pain she is being. I mean do you think she gets up each morning and tells herself that today she gets to irritate you? No of course not but you need to talk with her and clear the air, set some ground rules.

Next time she challenges you about calling a doc/going to management tell her be my guest. As long as you got your T's crossed and the I's dotted why would it matter? May be just the off campus lesson she needs to compliment her nursing courses.

[KarmaWiseRaven]

People like that you need to grab them by their scrubs and tell them I'M THE FREAKING NURSE MIND IF I'M IN CHARGE FOR A WHILE. And kindly explain to her the next time she steps out of her scope of practice she will be written up. because to look at it she's doing just that.

And speak with the DON about her behavior. Extra shifts or not i don't care. She's lucky she's wasn't on my floor pulling that crap. I would say hows your residents should i go check them or i would take her by the hand and take her to the DON myself and say we have this problem please help.

As you can tell tact is not my strong point. And i feel if I'm the nurse i shouldn't have to use tact with my aids they should know I'm in charge and to keep out of my way unless something really really needs my attention. Don't get me wrong I'm always polite i tell dumb jokes and i have a great sense of humor but i don't have time for KNOW IT ALL PEOPLE like that. These are my thoughts use them as you wish...

[MntnGirl]

I kindly and assertively let the CNA know that patient health information is discussed with others on a 'need to know' basis, information will be discussed with her that is pertinent to her performing her job duties. If I discuss info. with her that really has no weight on how she'll perform her CNA role I'll be violating patient privacy and HIPAA rules. I work with a CNA that sounds similar to the one you described, it gets old having to deal with all of her questions; I'm already having to answer the questions of the doctors, case managers, social workers, therapists (PT/OT), family members, unit manager, and the countless other health care staff that work with our patients, the last thing I want to do is give irrelevant updates to the CNA. If she's 'threatening' to call the director regarding diagnostic tests and medications just let her do what she thinks she needs to do, as long as you're doing what you know is best for the patient you have nothing to worry about.

[AprilRNurse]

Benefit of the doubt.... maybe she doesn't know how she's comming across? Next time- I'd calmly explain the rationale... and then nicely let her know how she's comming across to the nurses.

[Schmoo1022]

She is in nursing school, but is working in a CNA capacity at my facility, not a student nurse. I am not sure if she is even done with her prereq's. She has done this to every shift she works on so it's not like a buddy thing. It comes across has, "Why aren't you doing this or that".

I enjoy teaching and orienting and would have no problem explaining, but when she says stuff like if you don't call I will....It makes me grind my teeth

[jessica.lanelle]

I think I would tell her to stay in her own lane, and ignore anything else she has to say.

[itsmejuli]

Next time she wants to call the director call her bluff and give her the phone.