CNA's in control

[FlorentineBird]

I am in a nightmarish situation where the CNA's are in control. The worst night was when a patient had to go to the bathroom. The CNA demanded that I handle it because she was on the phone to the police to break up a drunken party (mostly because of her BROTHER!) at her house. She also got at least two other CNA's to gang up on me because I was asking her not to use her cell phone, especially not in patient's rooms. She began screaming at me, shaking her finger in my face, shaking a clipboard in my face, and screaming "Get out of my business!!!" She also leaves early with a couple of other CNA's to go to her second job. She is using the term "harassment" to describe my simple wish for her to do her job, and she lies, a LOT.

What can I do?

[abusedtravelnurse]

Very good Larry... He has the right idea here. There are many times when it is worth you putting in time explaining and conversing with a coworker to dissapate a problem. This sounds like you have to take the bull by the horns and act like a charge nurse. The next time you tell her to do something and she either ignores you or becomes belligerent with you, Do please ask her if she understands the meaning of the work insubordination. If she does not, have it ready to hand to her explaining that if she does not comply with your directives that she will be forced to leave the shift and return only after speaking with DON. I would also speak to the DON or nursing supervisr ahead of time explaining this problem and working out an across the board plan of action with them. Until you take charge of the situation, you will have nothing but disrespect from them and it will eventually push you away from that job. This can all be done with swiftness and straightforwardness, no emotion involved Do not let her know that she can shake your cage. Best to you.

i HAVE EXPERIENCED siyuations like this and as a travel nurse or occassional per diem nurse I have asked managers and ful time staff why they tolerate things like this and I am usually told something along the lines of " Welll, there is always going to be a few bad apples in the barrel ". When I write them up for things like sleeping in vcant patient beds, leaving the facility without even telling me, refusing to answer call lights of patients because " he peed all over the floor" I end up being the problem because I am too harsh or " noone wants to work with you." I pretty much had it. I either do my work and theirs, move on or resort to hot lines. I am most sorry for the patients who are on the recieving end of this type of care and sometimes I tell the cna I hope that if they ever have to go to a facility that they end up in the care of someone just like them. I know this is not very charitible so I usaully end up praying fot the staff and the patients. I have even had the director on the line and told the cna to ssspeak to her and still they refuse to do what they should and they still have jobs.

[ColdFusion]

She began screaming at me, shaking her finger in my face, shaking a clipboard in my face, and screaming "Get out of my business!!!"

I'd wager this isn't an isolated incident.

I'd ALSO wager that, if the RN writes her up or otherwise attempts to discipline her in any way that the Unit Manager will take the nurse aide's "side."

[1Tulip]

I have to agree with AbusedTravelNurse and ColdFusion, that this is NOT the most rare event in nursing. A lot of the posts here assume that nsg. admin. in the LTC facility will deal effectively with the problem. I suspect the problem wouldn't exist if administration hadn't allowed it to develope.

I'm worried about the clip board/finger waving, yelling incident. This CNA is not exercizing any self-restraint. She isn't in control of herself.

I know this may sound extreme. But when someone gets in your face and waves any hard object in front of your eyes, while yelling at you... friends, that is assault. (Not battery. For that she actually has to touch your person.) Call it ward-rage.

Maybe I'm making the assumption (can't remember if it was specified on the OP) that this is happening on the night shift when admin is not around. If this was happening to me, (and folks, I'm as serious as a heart-attack here) I would call the police and have the CNA removed in handcuffs.

I would do it in a New York minute. But it would be helpful if I'd documented her negligence to patients and aggresion toward me to the administration in writing. You should certainly tell them that this CNA is a danger (through neglect or simple venality) to patients and that you personally do not feel safe around her...

(In our state CNA's have to be certificated by the State Board. I would try to get her license lifted.)

But even if I had done none of that, and someone got in my face screaming at me waving their clipboard at me... I wouldn't hesitate, it would be a quick call to dispatch. Period. End of story.

PS: I believe such an outcome could have a very salutory effect on the attitudes of other CNA's with the mistaken impression that they control the ward.

[fergus51]

As far as I know, cops don't arrest people for yelling and not touching someone. Best to deal with the management. If they won't do something about it, find another place to work.

[gr8rnpjt, RN]

Here is the problem. CNA's are needed for the manual labor that is required to keep a LTC functioning. Administration cannot hire enough nurses to do the job, so they rely on the cheap, manual labor of the CNA's. And since they (CNA's) know their value to administration, they are not going to answer to any RN who is making the good money and not doing the "labor". They are a pi$$ed off bunch, who have the Administration eating out of their hand, because they know they are needed there. Administration are over a barrel they cannot run the business without both sides, but why get involved? it is a lose/lose situation, so why rock the boat? Let the nurses and CNA's duke it out like the wild west because the DON and nursing administrators make themselves scarce in the face of controversy.

I feel sorry for the patients. What happens when the CNA in question can't control her rage? What if she has one too many code browns on her shift and she decides to flip out on a patient?

:stone

[skrnypa]

When I did some training in family therapy a few years back, I remember this description of kids whose behavior was out of control in a family. Our trainer said that one of 2 things was happening-

one- no one in authority (the parent) is putting a lid on them (like a simmering pot on the stove that bubbles over) and keeping them in control- this was the control them from the outside component.

two- there's some force underneath the behavior, fanning the fire, blowing the kid up, making him/her bigger than he/she should be. This was the undermining, sabotaging dynamic where the kid needed to act that way to give the parents something to point the finger at.

I'd lean toward the "no one is keeping a lid on her" theory here- the CNAs can't be in control, they don't have the authority, responsibility or accountability. It sounds like a supervision issue, one for disciplinary procedures if necessary. Document the behavior and use the established policies and channels for addressing it, if discussing it directly is not possible or effective.

Good luck- it's not the most pleasant part of our job, is it?

[Cute_CNA, CNA]

I agree w/the other posters. When you come to work, you are to do your job and do your best to leave your personal life at home. I wouldn't even talk to another CNA that way. And nurses have enough responsibilities w/o having to constantly make sure the CNAs are doing their job.

They should be written up and need a talking to with the DON.

[RosesrReder, BSN, MSN, RN]

wow, I am so sorry to read this. Can only imagine how frustrating it must be. Good luck

[Daytonite, BSN, RN]

let me guess. . . you work in a nursing home, right? why do i know this?

you have two choices here. either meet the challenge of being a supervisor and confronting these problems head on (and it's going to be a big, big challenge) or get out of dodge--now!

if you want to go the supervision route, the first thing you need to do is talk to the powers in charge, tell them the situation, and find out if they are willing to support you, and how they want you to go about it. there are rules of the facility and state regs that have to be followed in order to not step on anybody's rights. if you can't get the support of the don and the facility to clear out this deadwood to begin with, just saddle up and ride off, kiddo. it's possible that they are aware of this problem, but haven't been able to find a charge nurse who is strong enough to stand up to these clowns. and, that is what it takes to run these clowns off--a strong charge nurse.

next, you need to read over the section in the company policy manual on discipline and the rules of conduct. it's easy enough to figure out what rules these clowns are breaking. the sticky part is starting the disciplinary process on each of them. you really have to follow it to the letter as it is listed in the policy manual. in some facilities the don takes on the role of writing the actual disciplinary warnings, and she just needs the charge nurses to write up the incidents they catch these cnas involved in. i've worked in some, however, where we supervisors and charge nurses were allowed to actually fill out the official disciplinary report of the facility. the facility needs to have the progressive disciplinary documentation in order to take any kind of action against these cnas (suspension or firing them). because you nurses are the immediate supervisors of the cnas and because you are the ones seeing and witnessing what these clowns are doing, you have to be the ones to start writing up this bad behavior. without the documentation, the don has difficulty firing cnas like this because they go straight to the unemployment office and file for unemployment. and, they will get it, too, if they were fired without the proper documentation of their wrongdoing and discipline. and, in most cases, the facility or the facility's insurance company ends up paying the state for every penny the state ends up paying out to one of these jerks for unemployment--that is why it seems like it is so hard and takes so doggone long to get rid of these people. better to get them to quit on their own, if you can, by making their work life as miserable as possible without violating their rights.

my experience with this, and, believe me, i've written up a lot of cnas when i worked in nursing homes, is that after you do a couple of really good, thorough write ups on people and the don follows up on them, mostly they will straighten up their acts--at least, as long as they know you are around and watching them. i don't worry about what other charge nurses have to deal with. i had enough trouble just getting through my own shifts with these kinds of cnas. as these cnas quit or get fired, their little clik starts to break up, you get a reputation for being a no-nonsense charge nurse and things eventually turn out ok. it can take quite a few weeks to get to that point, however, and that is assuming that your don is supporting your efforts. i often found that after finally getting rid of clowns like you're experiencing, the other cnas in the facility start thanking me for whatever i did to expedite their exit because they were harassing the good cnas as well. everyone benefits.

the other thing you need to prepare for, if you decide to face this situation head on, is to deal with the smart mouthing and insubordination. that was the greatest challenge for me at the beginning of my career. it is a skill. it requires some knowledge of assertive techniques. it requires a little bravery. but once you start getting the hang of the right responses to make to their insubordination, it gets easier to actually say what you have to say to them. you have to be brave though. remember, you are the one with the actual legitimate authority, not them. you have a lot more power over them than you realize. you can't let them buffalo you by accusing you of harassing them. i would dare them to go to the don. let them stand in front of him/her and detail the situation and look stupid. if you're worried about lying, start carrying a small tape recorder with you in your pocket that you can discretely turn on when one of these people is having one of their rants. won't they look stupid when you play it in front of the don to prove their lies and your side of the story? (this is only going to work one time, however. after that they'll be expecting you will be taping them, or you might be specifically told to not do that again.)

whatever you decide to do--good luck. if you decide to face this bunch of clowns, ask for advice. i have plenty of tips i can pass on to you.

[FlorentineBird]

I really appreciate everyone's advice. I am trying to get the administration to see what is going on, but the focus is on why I put in overtime. Usually my patient load is well over 30 in a long term care facility.

[Bipley]

please no fights.

(respectful posting, please)...after i move it.

awww, com'on wolfie.... give us a little more credit than that!

[Bipley]

You are the RN, you have to take control of the situation. I would report all the CNA's to my supervisor.

I disagree. Sometimes when ANY person is in the heat of the moment a situation that seems trivial to everyone else is really a huge issue to the person in question.

Again... social skills. The RN should have the ability to take the person aside when things have calmed down and have a heart to heart. If that doesn't work, by all means... move up the food chain.

Have you EVER EVER EVER acted in a manner you wouldn't have had if the situation hadn't been quite personal for you?

If we are going to claim to BE professionals we need to BEHAVE as professionals. That does not always mean going to the floor mommy. It's a judgment call. Sometimes it is necessary the first time, sometimes it isn't. That is the true test for a professional RN vs. a competant RN. When to move along the food chain.

As for the OP, I wasn't there. I don't know all the details. If you believe you can handle this one on your own, do it. If you can't or if the situation is soooooo far out of hand that you need to get upper mgmt involved, do that.