Depending on CNA's in LTC setting

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I have been a nurse for 9 years. I have been away from direct patient care for the last 5 years. For the last 4 months I have been in the LTC setting - 12 hour shifts on weekends. I beleive that it is imperative that I manitain an open line of communicaiton with the CNA's about the patient's; b/c with my charge nurse responsibilities of 45 residents as well as night shift supervisor responsibilities, the CNA's are my eyes and ears.

About half of the CNA's are eager to complain about the nurses versus taking care of the patient's. Another 33 % of the CNA's will follow each other's lead in the staff -splitting process. Of course, that leaves only about 17% of the CNA staff that are participating in patient care in a manner that is healthy for the patient's and the team.

I am very frustrated by this reality.

Any thoughts on working as charge nurse and night nurse supervisor while overseeing CNA's that are more invested in complaining about the nurse (me); and quickly finishing their rounds so that they can sit at the desk- than meeting the resident's needs?

Thanks!!

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I'm sure you know that the buck stops with you!!! Therefore, i would have a meeting with them. Allow them to vent issues they may have. Let them know what you expect from them and enforce it, by any means necessary. Maybe the last nurse allowed them to get away with this. A cna is worth their weight in gold if they are doing there jobs. This is by no means a popularity or friend game. Do the job or get written up ,disciplined or terminated.

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Your problem with the CNA's will continue as long as it is tolerated. I have worked in many different facilities through agency assignments. I have observed everthing that you describe in some facilities. Other facilities do not tolerate this and it does not occur.

I often wonder if some CNAs would be able to hold any other kind of job. Some CNAs clearly should not be working in this field. Others are so unreliable or have such a poor work ethic that I believe they would be terminated from entry-level positions in any other industry. Staffing shortages and high turnover often allow these aides to be retained, sometimes even for years.

Are the aides who finish their rounds quickly really taking care of the residents? Or are they just doing very minimal care? Do you even know? If they are finished rounds, is there anything else that they can do?

What about the 17% who do provide good care? Do you recognize this? A few words of appreciation can go a long way. Do you ever see anything positive in the other 83%? If you do, take notice of it. Positive reinforcement can be a very effective motivational tool.

A meeting is a good idea, but also get to know your aides on a more informal basis. Try to occasionally take your break with some of your CNAs. Get to know them as individuals, not just generic CNAs. Ask for their opinions and suggestions.

You may have excellant nursing skills, but your role now also requires you to be a supervisor. What are you doing to develop or improve your supervisory skills? Many seminars and classes are available to help people become better supervisors, regardless of the industry they are employed in. This may be worth checking into.

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It maybe that the CNA's have been met with ill treatment from a previous nurse and have unjustly assumed you will be the same.

That does not excuse minimal care of residents. I am a CNA in a facility small like yours. I bust my behind from begining to end of the shift. We (the other CNA's) are short staffed on weekends and never get out on time. We could never sit behind the desk on a weekend shift.

I have only been a CNA for 6 months and I love it and especially the residents. However I have come up against one nurse that I am reluctant to report things to anymore.

I reported a resident was bleeding from her stitches throught the bandage and two shirts. This resident had just gotten out of the hospital from a blood clot. The nurse cocked her head at me and said "Is this an emergency? " I said I guess not I just wanted to let her know and she responded "Well I can't drop everything right now"

Another time I told her about a scabbed over sore on a residents leg that a ring of red was spreading around the sore. I had been asked by another nurse to keep an eye on it the week before and tell them if it got worse. This nurse looked at it and said the discoloration could just be the residents blotchy skin. I explained that I had been monitoring this red spreading for two weeks.

She turned to me with her hand on her hip and said "So what do you suggest?" I said I had no idea I was just telling her. Then she said "OH, well I thought you were going to tell me a cure." It affectively put me in my place, humiliated me and made me mad as you know what.

We are called nurses eyes and ears, but what we tell them and when we tell them(Sometimes things happen in the middle of med dispensing and that never goes over well) isn't always recieved like we helped. More like we added to the burden of the nurse's job.

This creates animosity and a distinction that hinders good communication.

If the CNA's are slacking off they should be taken to task, but a better working relationship can be formed with respect on both sides

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Vicki, keep up the good work! Don't let the one bad apple spoil your attitude. You are doing the right thing by reporting things in a timely manner. Sounds like that nurse is rather insecure. Just be matter of fact in your reports, don't diagnose, just describe what you see. You are right to look after your resident's welfare. :)

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Vicki,

You may work with me any time! One word from the wise...If you're allowed to do documentation, by all means document your findings, and just the facts and whom you reported this to. ALWAYS CYA. ;)

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I agree with the earlier post that you might have a meeting to help sort through some of the "issues". I would suggest (and this is from experience) that you make sure - if you have a meeting- that you be sure to separate the different levels of care-providers. By combining the CNAs (Is and IIs) and LPNs and RNs, the meetings inevitably end up trying to push the BS up to the next higher strata. I have found that starting at the "lowest" level - e.g. the CNA and moving up works - that way you are addressing the concerns of the people who really have the most contact with the patients first. Good Luck!

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Sounds like these CNA'S need some discipline and a reality check. Maybe if their hearts are in the right place for this job, they will realize why they are there-----for the care of the residents. By you setting a good example and cracking the whip, they will come to realize this through their respect for you. :p

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I agree. There are many aides who are unprofessional and undisciplined. Were they to work in any other industry, they would be fired for their conduct. For some reason, these aides are retained on the payroll in long term care, sometimes for years.

I have worked in long term care for 1 1/2 years. I have met several good aides, who really cared about their residents and who worked to improve the quality of life for their residents. Unfortunately, I have also met a great many who are lazy, loud, vulgar and just plain stupid. This should not be tolerated. Aides who behave in this manner should be disciplined and should be terminated if they cannot or will not perform in a satisfactory manner.

Many aides come from limited educational backgrounds and have had limited exposure to good role models. Perhaps some inservice topics could cover basic communication skills, conflict resolution or customer service skills in addition to nursing topics.

RN's and LPN's need to set the example and make their expections clear to their staff. Being a charge nurse is more than just having good nursing skills. You must also be an effective communicator, trainer, mentor, and supervisor. If you are not

skilled or lack interest in these areas, perhaps you would be more suited to a position which focuses more on your nursing skills.

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I work 11-7, the only RN in the building. We had 4 CNAs for 60 people. At the start of the shift, I asked the aides to please check and clean residents' fingernails.

One CNA--a real bulldozer type, been a CNA forever, challenges every request from every nurse about everything--actually stood up, pointed her finger and said, "I REFUSE to do that!"

I lost it. I wrote her up and planned on sending her home. She stood at the desk and demanded that I call the ADON.

Guess what the ADON said?

I couldn't send her home. This was "not a big thing." "We needed her for the 'body count'" (new regs on staffing ratios). "Yeah, I know she's like that; she used to do that to me when I was a floor nurse," and "Just write her up." When I asked if she could assure me that I would not have to work with this CNA again, she said, "No, I can't guarantee that," even though I work all over the whole 6-assignment building.

:chuckle :chuckle :chuckle (IN-credible!!)

PS. This happened last night. Letter to admin. made out, but should I....???

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:roll :roll

I already resigned; this is my last week.

:roll :roll

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It is part of a CNA's job to keep the residents nails clean. I have to wonder though, you requested this on the 11pm-7am shift? At our facility that is day CNAs job. Unless resident has obviously been digging and nails are disgusting why wake them up to clean nails?

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