CNA's not completing assignment. Vent.

[Forever Sunshine]

I just worked an overnight shift and it was my first night being the only LPN on the unit. When it comes to CNA's I trust them to complete their assignment without any nagging. Well they kinda changed that.

They left at 7am and the day CNA's came to us during report and said that only a few residents were totally dressed. They are assigned a couple residents for each assignment to get up in the morning. In my definition- get up means out of bed to chair, changed, cleaned, dressed, ready for the day and brought in for breakfast. 4 residents per CNA.

I felt like a total idiot because they didn't do their job. I wrote their names and assignment down for the day supervisor. I am ******. I have a lot of work to do during the night. If I don't do it. I get written up. I really hope I don't get written up for what they didn't do. I know I am responsible for them to make sure they did their assignment but their assignments are their responsibility.

Did I do the right thing in reporting this to the supervisor? Should I have made my expectations of them clear when I made the assignments of the night?

[Boog'sCRRN246, RN]

Is it possible that maybe the residents refused to be gotten out of bed and completely ready for the day before 7am? I'm not sure what type of unit you work on so I'm just wondering...

[kcochrane]

The NM usually sets the tone. That is why you make have one unit where people work well and others where they get away with anything. If a CNA can't get their assignment done, they need to let the nurse know. Just like a nurse has to let her charge nurse/or replacement know.

CNAs at my old job had to sign their assignment after they were done. It stated they understood their assignment and did it. We are all adults, we shouldn't have to be watched.

[Ddestiny, BSN, RN]

Sorry you had to deal with this. Though, as a Med Aide that works in LTC, I have to wonder if either A) the residents didn't want to get up or B) there was genuinely no time to finish everything before the end of the shift. When I worked 2nd shift I know the night shift would be mad with us if we didn't get everyone in bed but if a resident didn't want to, then it's there right to stay up. The few that did occasionally want to stay up usually required either limited help or had dementia and would be violent if an aide encouraged them to lie down. Again, it's their home and their right. Sometimes people forget that, especially if it means they have to do a little more work.

And of course there will be those occasional nights that you just can't get everything done. I know every facility (and every hall/house in those facilities) are different in their dynamics and timing but I've always worked on very busy, rush-rush-rush halls. If your aides were sitting around a lot then that's one thing but a lot of places won't let you stay after your shift to "complete your work". Technically, it's everyone's work. The residents shouldn't feel pressured to insure that they are taken care of before the end of X shift.

Reporting it was probably a good thing. If they were busy or the residents refused then the aides can defend themselves if they are asked and maybe something could be said to the next shift about *why* those things were not done. If they were being lazy then it lets them know that someone noticed.

[Forever Sunshine, ASN, RN]

Is it possible that maybe the residents refused to be gotten out of bed and completely ready for the day before 7am? I'm not sure what type of unit you work on so I'm just wondering...

They got everyone up. But not all of the residents were dressed.

I am not saying that CNAs can have bad nights. Nurses have bad nights too but we stay late and make sure everything is done so we don't get written up.

[Debilpn23]

They got everyone up. But not all of the residents were dressed.

I am not saying that CNAs can have bad nights. Nurses have bad nights too but we stay late and make sure everything is done so we don't get written up.

Not sure about where you work, But where I work the LNAS aren't allowed to stay pass their shift, they have to punch out no later then 7 minutes pass 7AM, or they will be written up.

[Forever Sunshine, ASN, RN]

Not sure about where you work, But where I work the LNAS aren't allowed to stay pass their shift, they have to punch out no later then 7 minutes pass 7AM, or they will be written up.

And what if their assignment isn't completed? We don't get written up but we don't get paid overtime. I cannot stand going home thinking one little thing was not done. It drove me nuts.

But I don't care if they turn against me or hate me if they end up getting written up. They were the ones that didn't complete their assignment. We are there to provide excellent and compassionate care for the residents in the facility. I trusted them to do that because on my usual shift I know the CNA's do that and do it well.

[Forever Sunshine, ASN, RN]

Sorry you had to deal with this. Though, as a Med Aide that works in LTC, I have to wonder if either A) the residents didn't want to get up or B) there was genuinely no time to finish everything before the end of the shift. When I worked 2nd shift I know the night shift would be mad with us if we didn't get everyone in bed but if a resident didn't want to, then it's there right to stay up. The few that did occasionally want to stay up usually required either limited help or had dementia and would be violent if an aide encouraged them to lie down. Again, it's their home and their right. Sometimes people forget that, especially if it means they have to do a little more work.

And of course there will be those occasional nights that you just can't get everything done. I know every facility (and every hall/house in those facilities) are different in their dynamics and timing but I've always worked on very busy, rush-rush-rush halls. If your aides were sitting around a lot then that's one thing but a lot of places won't let you stay after your shift to "complete your work". Technically, it's everyone's work. The residents shouldn't feel pressured to insure that they are taken care of before the end of X shift.

Reporting it was probably a good thing. If they were busy or the residents refused then the aides can defend themselves if they are asked and maybe something could be said to the next shift about *why* those things were not done. If they were being lazy then it lets them know that someone noticed.

They were up, changed(I hope), and ready for breakfast. But only 1 resident per assignment was dressed. 1 aide dressed 2 residents but that doesn't give her the prize. The rest weren't dressed. Which aggrivates me .. if you are getting them up.. you can't take the extra few minutes to get them dressed?

I know some of the residents are combative and difficult but thats when they needed to inform me about that so it could be taken care of properly.

[Crux1024]

And what if their assignment isn't completed?

Then it goes to the next shift. Nursing is a 24 hr job. Not saying you or anyone should have to pick up slack all the time, but sometimes you have no choice BUT to hand off things that still need to be done. Its part of the job.

[neutrophil]

Well, I am so glad that you brought this up. I was a CNA, I was proud of it and knew that my job title meant that I was an aide to the nurse. Not the other way around. I am now an LVN. Most CNA's try to do a good job. But my goodness. Turning in vitals the last hour. I asked one. "why do you do vitals." She said it was so I could chart. No, it is so we can see the condition of that patient on alert throughout the shift and the vitals help us know where they are at the beginning of the shift. There is one CNA that has been written up several times, she in turn sued a male nurse for sexual harassment, so all male nurses, just say yes ma'am. I don't have any idea how to fix that problem but it is huge, especially in LTC. Not so much in hospitals. I am not sure why.

[Forever Sunshine, ASN, RN]

I made sure this was clarified tonight.

I was correct that they are to dress their residents. They did with no problem. So that was a relief and a huge weight taken off me. I know its not my job but I am charge nurse and I feel as if I didn't keep them in line if they don't complete their assignment.

[anonymurse]

This is just an aside. It casts no judgment on anyone in this thread. It's just something that's been on my mind.

Last week, a nurse complained to me that she had no help at all from the aides, that they hid from her. I realized I had all kinds of help. The aides are always in my pts' rooms. They're an extra pair of eyes and they always let me know when there's potential trouble. And they're indispensable in the crunches an hour before and after shift change and at HS med pass.

But then I realized that when someone asks for help, if at all possible, I drop everything, and I don't care who's asking. So I treat everyone as an equal, as a fellow professional, doctors, nurses, lab, xray, transportation, environmental, nutritional, and yes, definitely aides.

Plus I teach. My favorite docs are the ones who teach me as they go, they don't just write orders. So when I ask for something, I provide rationale. If I ask for a BP, I explain why I need it. This makes aides partners in problem solving. It lets them use their imagination as to the kind of information I need. This works.

After I take report, I give report to aides. It's important for them to know a pt was admitted, for example, for a fall, don't you think? So I keep aides in the loop on everything, all changes, all concerns.

New aides need to know the HS snack is part of diabetic management. How long does it take to tell a new aide "You might want to take the snacks with you when you do the finger sticks so you can make sure you give them out right after the finger stick. Very important treatment. You're making sure their sugar doesn't crash in the night." I mean, what does that cost? Don't they need to know they're delivering a medically important treatment, rather than acting as a waitress?

It's said you should never give anyone a problem without a solution. For example, to an aide by themselves, every total is a problem. If I have one aide and a total, I won't just ask the aide to do continence checks Q2H, I'll say "Would you check her diaper every time you pass her door? If she needs changing, give me a yell, I'll be right there to help."

The main difference, I guess, is that I treat aides as equals. Maybe she doesn't have as much training, but maybe she has 20 years more experience than I do. And even if she has the same amount of experience in years, she's probably had 4 to 5 times more patients than I have. She's seen more pts go bad. She knows how they act and what they look like just before they go bad, right?

Of course, there is a special kind of aide that's pure gold to me, the nursing student aide. What can I say about these guys that would be adequate to what they contribute? Anyway, aides are my lifeline, and I let them know it.

Sorry about rambling on like that. It's just something that's been on my mind lately.

[PhoenixTech, LPN]

should i have made my expectations of them clear when i made the assignments of the night?

yes.

no. we go through training to become aids as well as an orientation to the unit/floor upon being hired. we know how to read an assignment and shouldn't need to be watched over. running out of time is one thing, in that case we endorse to the oncoming shift and inform the nurse. leaving without completing the assignments are just that, leaving without completing the assignment. anything else, such as combative pts or such, we inform the nurse as to why it wasn't done. sounds like they were being sneaky by leaving w/o informing anyone as to why it wasn't done.

this is just an aside. it casts no judgment on anyone in this thread. it's just something that's been on my mind.

last week, a nurse complained to me that she had no help at all from the aides, that they hid from her. i realized i had all kinds of help. the aides are always in my pts' rooms. they're an extra pair of eyes and they always let me know when there's potential trouble. and they're indispensable in the crunches an hour before and after shift change and at hs med pass.

but then i realized that when someone asks for help, if at all possible, i drop everything, and i don't care who's asking. so i treat everyone as an equal, as a fellow professional, doctors, nurses, lab, xray, transportation, environmental, nutritional, and yes, definitely aides.

plus i teach. my favorite docs are the ones who teach me as they go, they don't just write orders. so when i ask for something, i provide rationale. if i ask for a bp, i explain why i need it. this makes aides partners in problem solving. it lets them use their imagination as to the kind of information i need. this works.

after i take report, i give report to aides. it's important for them to know a pt was admitted, for example, for a fall, don't you think? so i keep aides in the loop on everything, all changes, all concerns.

new aides need to know the hs snack is part of diabetic management. how long does it take to tell a new aide "you might want to take the snacks with you when you do the finger sticks so you can make sure you give them out right after the finger stick. very important treatment. you're making sure their sugar doesn't crash in the night." i mean, what does that cost? don't they need to know they're delivering a medically important treatment, rather than acting as a waitress?

it's said you should never give anyone a problem without a solution. for example, to an aide by themselves, every total is a problem. if i have one aide and a total, i won't just ask the aide to do continence checks q2h, i'll say "would you check her diaper every time you pass her door? if she needs changing, give me a yell, i'll be right there to help."

the main difference, i guess, is that i treat aides as equals. maybe she doesn't have as much training, but maybe she has 20 years more experience than i do. and even if she has the same amount of experience in years, she's probably had 4 to 5 times more patients than i have. she's seen more pts go bad. she knows how they act and what they look like just before they go bad, right?

of course, there is a special kind of aide that's pure gold to me, the nursing student aide. what can i say about these guys that would be adequate to what they contribute? anyway, aides are my lifeline, and i let them know it.

sorry about rambling on like that. it's just something that's been on my mind lately.

thank you. i was reflecting on this very same point last night as i thumbed through an old med-surg book's assessment chapter. i realize that it's not the nurses' job to 'report to the cna/tech' and it's technically the other way around. it is our responsibility to report to the nurse, however knowing why we are doing something does make us feel especially included. it's one thing to say that the 'cna is the most vital part of nursing because we are the eyes and ears', but when you show it by explaining why you need a certain task done, we really feel those words as opposed to just mechanically memorizing them to make us feel better.

i'm not saying that you as nurses' should explain yourselves to us as cnas, after all, the reason why we go on to nursing school is to learn to care for the whole patient as opposed to parts of the pt, i'm just saying that sometimes instead of just telling us what to do, telling us why goes a long way.

as i read more material, especially on death and dying, i realized that some of the confused patients truly are confused and not just acting the part for family members' sympathy. i also realized why a pt may not be able to lay all the way back to get washed, the importance of the vital signs as it relates to med distribution and more. it really made me look at what i do differently than as just a job to be done on an assignment.