Cna's gone wild!!

[mmdavids]

I have only been in a SNF for a few months. I have struggled with finding a balance when dealing witj the cna staff. Within my initial 90 days they had gathered together and writen notes to the DON stating I harrassed them to do their work. I have tried since then to change my approach and things calmed down for a few weeks. But I noticed they were testing me again by getting later and later with their intial rounds. We dont usually have a RN supervisor on my shift. So I brought another nurse in to witness my verbal warning to the cna's. But that has just created a huge mess. I have a 54 bed unit by myself and usualy around 2 or 3 cna's every shift. I am beging to think maybe I am not cut out for a nursing home. I just dont think I should have to tell people every night to do their job. Help me understand what I am doing wrong. aI try to keep an eye on what they do but most nights i can barely do my own work. I try to sit and joke and carry on with them but now that I confronted them they are throwing it in my face that I let them skip rounds. But really I was just trying not to ride them. Things are just getting out of control with skipping rounds, nodding off, laying heads down, dissapearing, and refusing to do assignments. Its like dealing with children. I like my job, benefits and shift and want to stay. I am just sick of dealinh with attitudes and people trying to see what they can get away with. Any suggestions are apriciated.

[mrslvj]

I am a long time SNF DON. Without knowing you or your staff or the politics of the building, I can't tell you exactly what to do. I can share some thoughts. It takes a minimum of 3 months to get adjusted this job. You are being tested.CNAs are wary of new "bosses". I knew a night shift charge nurse who was convinced by the CNAs that it was her job to mop the dining room every night. Fortunately, she figured it out.

They don't teach you how to be a leader in nursing school. Frankly, some truly wonderful nurses aren't supervisors by nature, but can be decent charge nurses with a little support.

Perhaps, it might work if you speak calmly and frankly with them and try for a fresh start. What do you expect of them and what do they expect of you? Treat them with respect. You can learn a great deal from CNAs. In general, you don't have time to micromanage them and do everything else you have to do. So don't even try. The staff sargeant approach doesn't work. Behave in a professional manner. Do your job well. You are not there to be liked but it's tough to get things done when you don't function as a team. Be approachable and try not to personalize what's going on. The worst thing you can do is be "snarky" or have a chip on your shoulder.

Reading between the lines, I suspect you are working night shift. That can be a lonely situation. Have you been able to get input from any other nurses in your building? Also, you should meeting with your DON. If things are this uncomfortable, it is her/his responsibility to give you and the CNAs the support you need to work things out. Bottom line is the residents you care for. I really think you are entitled to some advice and support from the management in your facility, even if it's to tell you what you are doing wrong.

[mmdavids]

This is very helpfull. Thanks.

[indiechic, LPN]

That's tough... I like to write job descriptions or required shift task sheets for them to sign and place in their employee file so I have documentation that they have been informed of their required duties and any further slip-ups will be grounds for written write-ups and eventually termination. I also think it's a good thing to check their work every now and then (check briefs, laundry, garbage, etc...) and document your findings.

[Nascar nurse, ASN, RN]

mrslvj - Hey you're new here! Welcome to AN. Great advice right out of the gate. Looking forward to having another experienced DON around to bounce ideas off of and share frustrations with. Make sure you visit us over in the DON forum as well.

Back to thread topic....

I would think most of your aides have already signed job descriptions as part of their hiring practice but I would definitely have an assignment sheet ready for the beginning of the shift, ie: who's responsible for rounds on which rooms, what times rounds are suppose to be done, who is taking out the trash at shift end, cleaning assignments, etc.

When things aren't done as assigned then you have a clearly defined written task sheet to refer back to when you speak to them about it (don't let them say "um well, ya know....I thought so and so was gonna do that").

I believe in treating all staff like adults. There is no need to be mean, rude, nasty, etc. These are not my children and I will not lose my cool with them. It is simply a matter of fact, such as "Hey you were assigned to do XYZ & I see it's not done. Can you tell me what happened"? If possible, help them solve what ever is keeping them from staying on task but don't accept the same old excuse day after day. You have to hold them accountable. You need to understand the disciplinary steps for your facility and plan to stick to it when needed. This is where it is best for you to get the help/support you need from the DON.

PS - don't let them skip rounds EVER. 1) This could result in very dangerous situations for the residents - pressure ulcers, unnoticed falls for hours, unnoticied deaths for hours and just really really bad care. Guess who is ultimately responsible if any of these issues occur...it won't be the aides!!!! 2) You absolutely have to have consistent expectations as a supervisor or they are going to eat you alive. Set the standards for good care, expect good care, & praise for good care given.

[lovingtheunloved, ASN, RN]

I never could figure out how to deal with the aides. And I was an aide before I was a nurse. I treated them with respect, but was direct with my expectations and addressed it quickly when those expectations were not met. The bottom line was, they didn't want to work. And management backed them up 100%. Getting out of the nursing home was the best thing that ever happened to me.

[Prairienurse1989]

I'm not a DON but I am in a Supervisory role on my floor. Through trial and error I have found that laying out my expectations in black and white at the beginning of a shift works well. This is especially important when working with new or unfamiliar staff. It goes something like, " hello everybody, this is the routine I follow on my shift: please do initial rounds and hourly rounds, do required CNA duties(so on,ect.), and don't be afraid to come to me with any questions. I'm not sure how the other nurses run their floor but this is how it is done on my shift". I always help my aides, and listen to their concerns, and addressing them in a timely manner is important to gaining trust. I am lenient with other things not related to patient care, such as break times, or taking quick smoke breaks, or stepping out to make phone calls, as long as I'm aware so I can help cover. My aides are really good to me, I'm very lucky to have such fantastic staff.

[fairyluv]

I have a really awesome Aide on my floor. She takes initiative and does it. She doesnt filly fart around and she has all our residents like little ducks in a row. She establishes a routine. and she goes by that routine. I never have to hunt her down or tell her what to do. And when shes working with someone who doesn't quite live up to her standards...she tells them about it. If she sees them texting on there phone she tells them they need to put there phone away and help her pass trays or do rounds. I was an aide for over 15 yrs before becoming a nurse, and this girl reminds me of me. When she is on my hall..my hall is like a well oiled machine, when she is off, my hall goes to hell. My advice to you...find you a good aide that you have a good working relationship with and kinda aske her to make sure the others are doing there job, but to be nonchalant about it. sometimes a little manipulation by another aide is all you need.

[SuzieVN]

It's not respect. It's treating them like they are not cattle. Big difference. Standing outside a door, while the call light is on, for example, waiting for the 'aide' to come. Giving them report. Appreciating them. Listening to what they have to say, and following up issues they present. Realize that most of them are from broken, inpoverished social backgrounds, also. They will make or break you- adjust your thinking, or you will never meet on common ground. And yes, they know their job descriptions- so instead of acting as if they are the enemy? Act as though they are 'da bomb'.....?