Disclipline

[CapeCodMermaid, RN]

We are having a huge problem in my facility with insubordination and just plain rude behavior. The DNS has been there for 4 months and has been out for the last 5 weeks on medical leave so I'm the acting DNS. It seems to be a case of the inmates running the assylum or too many chiefs and not enough braves (as my father used to say in the pre-PC days). We've had meetings with the nurses, the CNA's, everyone and it hasn't gotten better. There is one CNA who continues to be insubordinate. The first time he refused to pick up any extra residents because there was a call out. The nurse, instead of dealing with him, called me. I explained to him about insubordination and told him if he acted this was again, I'd write him up. I explained to all the nurses on the units that THEY are in charge of the aides. So a few weeks go by and I get a call at home from one of the nurses telling me that the same CNA is paging overhead for people to come to his floor to help. I spoke to the charge nurse and told her to either get him to do his work or send him home. I found out on Monday that SHE did 5 patients.

Then again there were several callouts so I asked one of the nurses to send a CNA to the floor who had 3 aides...each unit has 40 residents and each is supposed to have 5 aides. She wanted to know why because that would mean HER aides had extra residents and she didn't think it was fair. I asked her if she thought it was fair that the CNAs downstairs would have many more residents each because they only had 3 aides.I told her I knew it was rotten, but I had to look at the whole building and asked her again to make sure a CNA went to the other unit......long story short, an hour and a half later no one had gone. She told me the staff wanted to speak to me. So up I went into the dining room ...the aides marched in and stared at me. I asked them why they hadn't floated someone and got the same litany of responses about unfair this and unfair that and "you don't know what it's like"...hello people I WAS an aide once and know what it's like and I know that if I don't do what my boss tells me, I'll get written up. They continued to argue so finally I said "Enough...someone goes and that's the end of it for today."

They later called the regional executive director for a meeting which he had with them when the DNS came in for a hour. I asked her what they said...they told her I yelled at them and was 'mean'....I DON'T yell at work. I always speak in a low voice when I'm trying to get someone to listen. She told me that she told them that she wouldn't discuss that particular day. But instead of telling them that they have to do what they are told, she told them to cut me some slack because I was trying to do my job, her job and the ED's job that week. She might as well have told them to pat me on the head because I had PMS or something.

It seems I am the only person in the building who cares about this. We had a dept. head meeting about it and the administrator actually asked if being in charge of CNAs was in the job description we handed out!! Yes, I said, but more importantly, it's in the nurse practice act.

I like to have fun at work, but the residents have to come first.

Wow this is long! So...do all y'all have discipline problems? Do the charge/floor nurses write people up or do the managers have to do it all?

[suebird3]

Yep, at my Facility, Floor nurses can write people up. Insubordination, not doing job.....oh, there are a few different things. Enough of them, and you "hit the door".

Suebird :)

[PBAJS]

"it seems to be a case of the inmates running the asylum or too many chiefs and not enough braves (as my father used to say in the pre-pc days). "

in my ltc, it depends on who the charge nurse is. some nurses are 'chiefs' and other nurses seem to let the 'braves' (cnas) be the 'chiefs'.

"there is one cna who continues to be insubordinate. the first time he refused to pick up any extra residents because there was a call out. the nurse, instead of dealing with him, called me. i explained to him about insubordination and told him if he acted this was again, i'd write him up. i explained to all the nurses on the units that they are in charge of the aides. so a few weeks go by and i get a call at home from one of the nurses telling me that the same cna is paging overhead for people to come to his floor to help. i spoke to the charge nurse and told her to either get him to do his work or send him home. i found out on monday that she did 5 patients. "

most nurses in my ltc would have kept him there. the choices would be ... better to keep him there and to do some residents herself ...or ... send him home and have more residents for each cna and to hear complaints and comments from the remaining cnas. "because you sent him home, we have more work to do!"

we do not have any cnas that refuse to pick up any extra residents, they may grip and grumble, but they don't refuse. we do have some cnas that will only do her own assignment (they have the same assignment every day they work) they will not toilet other cnas residents, help other cnas with transferring and repositioning residents, float to other units, ...

"then again there were several callouts so i asked one of the nurses to send a cna to the floor who had 3 aides...each unit has 40 residents and each is supposed to have 5 aides. she wanted to know why because that would mean her aides had extra residents and she didn't think it was fair. i asked her if she thought it was fair that the cnas downstairs would have many more residents each because they only had 3 aides. i told her i knew it was rotten, but i had to look at the whole building and asked her again to make sure a cna went to the other unit......long story short, an hour and a half later no one had gone. "

when we have call outs, most charge nurses will assign an aide to the heavier unit with more total assist residents. a couple of charge nurses will not assign an aide to another unit because that would mean her aides would have extra residents (who often need limited care).

it seems i am the only person in the building who cares about this.

we do have a few nurses who do care. most nurses don't care anymore as the same things have been happening for years. they just arrive at work and 'do their best'. a few have mentioned that: in the event of a call out, the heavier unit should be adequately staffed; cnas will not have the same assignment every day they work, cnas will help other cnas, will float to other units, ...

do the charge/floor nurses write people up or do the managers have to do it all?

the charge/floor nurse writes people up (what one nurse may write someone up for, another will not). the write up is sent to the don who, at a future time, will discuss it with the person.

i have only known of two people that 'hit the door', one was for excessive absences, one for under the influence (? alcohol or drugs).

[SilentfadesRPA]

Is it within your power not only to send someone home but to terminate as well ie for gross misconduct ? (ie getting on the PA system as a CNA and asking for help )

Marc

[mlnrs1]

All these problems start at the top. I worked in LTC facilities in Florida and they are all about the corporate squeeze like everything else. I've seen many places with nursing stations that sit empty - that means the facility was designed to have xx amount of nurses, but now they run it on half that... everybody is overworked, underpaid, and it all falls on the shoulders of some poor schlep who was "promoted" to DON, ADON, or DNS, or whatever.

Nurses need to unionize, nationwide.

[Charity, RN, APRN]

How 'bout this... create a CNA float pool. No CNA is assigned to a certain floor or certain group of patients. Every day, assignments are made according to need after callouts (funny, we call them call-ins) and such. May do away with some of the possessiveness and such. It shouldn't take long to show the CNAs that helping out another floor or another group on occasion is a small trade-off for continuity in the workplace/duties other days. And if you lose some? You didn't need them in the first place.

[suebird3]

nurses need to unionize, nationwide.

i don't want this thread to go down hill, so fair warning!

unionization is good for some things; our facility has a union for lpn's and cna's. however, it did take us a very long time to get rid of 3 aides wh did squat! we ended up having one come back.....do not ask why. the paperwork we do is kept, so.....keep a goooood trail.

suebird3

[soliant12]

What poor managers and spineless nurses you have working at your facility. Run Forest run!!!

[htrn]

If you are the acting DON does that come with the authority to suspend or fire an employee. If you are given the responsiblity without the tools then you have been set up for failure.

Would love to know what others think of sending home all the CNAs that are refusing to work and bringing in agency CNAs for a shift or a day - or giving CNAs the option for signing up for call at time and a half - then when someone pulls this kind of crap, send them home and call in someone willing to work.

I really sounds like you have been set up for failure - if you can't discipline employees with the backing of the administration, that's a recipe for disaster. Good Luck!!

[cannoli]

I'm not in LTC but acute care hospital.

I recently spoke with a nurse manager (new unit) who asked me how I would deal with negative people, she admitted she had an aide with an attitude.

My opinion, which I did not voice to her, is that if she has an aide with an attitude that is HER problem, not the staff nurses problem.

The staff nurse can't hire and can't fire and can't discipline so why expect the staff nurse to deal with this problem, yes the staff nurse can write the person up, but the unit manager (or DNS in LTC) is the only one that really has the power to discipline or fire the problem person, and in my opinion they need to deal with it, not expect the staff nurse to do it.

[AuntieRN]

When I was a CNA at a LTC (back in the day) we always had the same assignments, however, we had our assignments according to how many aids there were working that day. We had them all written on note cards put together with a ring. If there were 4 aids you had xxxx...if there were 3 aids you had xxxxyyy....etc. We also knew there was the chance we may have to float to another floor if they were short handed because it was heavier...I can not fathom ever telling my boss or charge nurse that I was not going to do something whether it was to go to another floor to help out or help out another aid or even take on extra patients. I also learned very early on, as a matter of fact it was when JCHAO had come for a visit and I was asked why a certain pt did not have his lap blanket on..i responded with I don't know he was not my pt....well....I learned that day they are all everyones pts. What I actually meant was I did not know why he did not have it on as I had not done his care that day.

Guess I am just from the old school where you did not do that. I am so glad I do not do LTC anymore. I love the hospital.

[achot chavi]

Long story and I can sympathize. Re the nurse who did 5 patients (CNA's job) I dont sympathize- she chose to do his job rather than deal with his insubordination.

As an ADON, I know how important it is to have full staffing each day and I have had to deal with what youre going through. Always preface requests to do extra work with "I'm really sorry, and I know it is unfair but what can we do, Mrs Z is a person too and we can't punish her just because John called out today. We all have harder and easier days, today is just going to be a more challenging day, if we work together, I'm sure we can get everything done!"

An empathetic approach helps. If not I try to find out why- Is his back hurting? Is he having other problems? Is he burned out and needs a few days vacation?

Last point is a Positive Reinforcement incentive:

In our facility we have twice a year "Employee of the Year" bonus allowing the winners to go out to an expensive restaurant and dine with their spouse or a friend

We also give a bonus of $100 to employees that dont call out in 4 to 6 months

and lastly employees that refuse to come in and help fill a call out (without a good reason) are put on a list for the ADM

I once had a situation where a CNA was insubordinate and I immediately called him into the ADM"s office and boy was he embarassed. He has since been a doll to me and even agreed to come into an evening shift (to fill a callout) despite a friends wedding. I arranged for the night CNA to come in early releaving him to go to the wedding a little late (which he appreciated)

It sounds to me like you need more support than you're getting!