DNS undermined my authority with CNA

[achot chavi]

HELP, I am an ADON in a 200 bed SNF, 2 1/2 years into it- I think I've got the handle of the place and my DON is appreciative of all the improvements I have brought to the table. One of our biggest problems was that the CNA's were running the joint if you know what I mean, and we worked hard to wrestle back control from the CNA's and Soc Workers. Now that its done, I was asked to manage a unit for one day a week while the Head Nurse took a leave of absence to get her RN degree and the replacement doesn't want to work more than 3 shifts a week. No Prob, I took the unit in hand and am busy bringing it to par- hard work as the previous head nurse was lax. This morning a spanish speaking patient was trying to tell me something I didn;t understand and I asked a spanish speaking CNA to translate. She refused and started yelling and threatening. She then refused every other request I had of her that day (bring me the EKG machine, distribute toothpaste to those who don't have etc.) I got someone else to help me and wrote up the incident to our DON The DON spoke to the CNA and began ignoring me- she went over my head to the SW to transfer one of my patients to another unit- a move I didnt feel was necessary. instead of consulting with me (acting Head Nurse) she physically went and moved the patient and afterwards tell me she was just trying to help and felt it was enough to hear from the CNA (who is lazy and didnt want to feed the patient and change her diaper while she was getting over a virus). Besides when I transfer a patient I like to do it nurse to nurse with the chart and not just bring the patient and dump her with no background. I told my boss that it's her call but its not the way I run a floor, and she tells me that I am irrational. then she goes yelling down the staircase "I'm sorry" in a sarcastic way. Forget about the way the CNA now smirks at me (I ignor that ) I prefer a professional attitude at work . ANY ADVICE ( sorry this is so long...)

[achot chavi]

End of story- turns out the transfer was not done properly as the patient had an expensive hearing aid which no one looked after and now its lost. The bottom line responsibility fell on my DON who did the transfer. I feel terrible about the lost hearing aid but the whole situation was taken out of my hands. The CNA on the other hand has been out of work with a bad back (not related to work believe it or not), and probably cant return to work. Life goes on.

[bluegeegoo2, LPN]

What is it with some CNA's? I have some good ones, but the lazy ones with attitudes are the ones that cause all of the stress for me. The other day, we had 6, count them, 6, aides on a 60 bed unit. Silly me, I thought, "Gee, we ought to have a pretty good day today." HA! I spent most of my day toileting people as I couldn't find the aides anywhere. I can't tell you how much time I spent trying to hunt them down to do their job. The residents were soaked, needed toileting, etc. And when I did find one, I'd put them to task, and get attitude for telling them to do their job. I am new to this unit, and the other nurses as well as the UC are as lax as anything I have ever seen. Excuse me, but I give a crap about my residents and don't want them sitting around in their own excrement. Going to the UC is useless. I have offered suggestions on how to account for the aides, as they take break or lunch at will and don't bother letting us nurses know when they've gone. I suggested a "sign-out" sheet, the the nurses initial with the time when one goes/returns from break. They like to take long breaks/lunches. Also, when one is on break, it's like pulling teeth to get someone else to cover their hall because, "That's not My hall". ????? You're on the payroll aren't you??? AAAHHHHH!!!!!!! I understand well the frustration. If you don't have the support of those on high, you're never going to get anywhere, even with the best intentions. That's just plain sad. Sorry for the rant!

[achot chavi]

Good for you and I hope if I ever need a nurse- you'll be around. My story ended well as our DON realized her mistake. I'm sure in time the staff will appreciate you. They will come to realize that you are improving someones quality of life and not just trying to bust balls. I can only suggest- if you are their manager- to do more teaching and performance reviews- Point out and praise positive behaviors- when you catch them at it. There are movies that depict good nursing care in long term settings. I use them as motivation- and pep speeches. Over the three years that I am at this facility- and it took me a while to adjust as I am originally from New York and I was new to Israel, so I needed to learn what was the norm here. Slowly I managed to improve things- my only successes came from positive reinforcement and lots of charm, when I criticize- I am closing doors. Keep it up I am proud of you for caring-

[Upstate NY DON]

I am a DON and is constantly being undermined by people above me. my VP of HR is "in bed" with the union that leave me with no authority to discipline the disgustingly lazy staff especially the CNA's. This makes me want to give up on nursing all together:bluecry1:

[bluegeegoo2, LPN]

I am a DON and is constantly being undermined by people above me. my VP of HR is "in bed" with the union that leave me with no authority to discipline the disgustingly lazy staff especially the CNA's. This makes me want to give up on nursing all together:bluecry1:

I am a floor nurse, but I know what you mean. We don't have a union, but the pickin's must be pretty slim around here judging by who my facility will hire. The worst blow to morale is that they will fire someone, but hire them back on average 3 weeks later. So, the message is: Do what you want, and we'll give you a 3 week vacation and hire you back, no problem! It's bad enough I don't even bother writing anyone up anymore becuase nothing ever happens. The only reason people get fired is d/t absenteeism. ??? Our aides know this, and pop off at the mouth on a real regular basis, going as far as to flatly refusing to do their job. Our UC doesn't bother firing anyone because they know they'll be right back. I am disgusted with nursing, too. I love what I do, and the people I care for, but the politics in health care cause a serious disservice to the people we are charged to care for. It's depressing.

[catlynLPN]

I have worked 2 jobs in the past. I work at a local NH occasionally for extra money, then my regular job for the state I live in. On the NH job, I experience the same thing with the CNAs there, refusing to do their jobs, insubordination, back talk, failure to turn people on nightshift, etc. I absolutely detest working there, but sometimes I need the extra money.

Then my other job, with the state, I don't have to supervise the aides. They have their own department and their own supervisors. The nurses are nowhere near responsible if the aides don't do their jobs.

We have the authority to give instructions on things needed to be done, write up what we want done in the form of a treatment sheet, and give it to the aides. After that their supervisors are responsible for seeing those things are done. All bathing, turning, feeding, is their responsibility, the nurses have nothing to do with it, unless a problem is brought to our attention or we discover a problem, then we go from there in treatment and care.

My point is, though, there is the world of difference in these two jobs.

Even with the problems we do have on my state job, they are nothing compared to having to supervise insubordinate CNAs who

seem to get the DON on their side and nothing is ever done about their behavior. I would never go to work in that NH fulltime, for any amount of money, as badly as I need it. I can only take that kind of stress for so long.

[achot chavi]

Yes we all see these problems- I have a technique that works well to keep my CNA's motivated- I can't "punish" bad behavior (like hiding from work, neglecting responsibilities etc.) I write up (briefly) the undesirable behavior as specifically and objectively as possible, I write what I would expect, I approach the CNA and review it with him or her. Then I tell them that if there is no marked improvement I will have to move them to only day shifts in order to be under supervision. I make sure to end by saying "I need this work done- if you cant for whatever reason- let us part as friends, if I think you need more hands on direction from me I will be happy to schedule" The kicker is that they want the weekend and night shifts for its differential.(salary wise) and will suffer if transferred to day sifts!!