do you feel like the CNA's run the floor?

ljds · Mar 8, 2006

I have no real advice for the OP, since if your admin isn't going to back you up,it looks like either their way or the highway...

but I think certain environments facilitate better teamwork. At our hospital, either a nurse works by his/herself (on a TPC=total pt care) or a nurse and aide work together on a team. The aide knows she is responsible for specific pts. There isn't any gray area, and she is directly responsible to only one nurse. One nurse can't dominate the aides, and it is not as easy for a lazy aide to slack (or a lazy nurse, either). It is overwhelming to think that you are potentially responsible for 40 pts, and you know you can't get it all done. likewise, the nurses are all hoping that the aide at least gets their pts' vitals done.

I think that just assigning rooms or halls to aides, independent of the nurses' assignments, leaves too much up in the air as to who is responsible for what. Having a team with specific assignments can have it's disadvantages, sure, but for the most part, that is what I have seen work best in an acute care environment (and I've seen it from both the aide and the nurse's POV).

Marie_LPN, RN, LPN, RN · Mar 8, 2006

I have no real advice for the OP, since if your admin isn't going to back you up,it looks like either their way or the highway...

I agree with this.

RN34TX · Mar 8, 2006

I am working as a CNA while I wait to get accepted into nursing school, and I work with a few wonderful aides who love their jobs, love taking care of people, are sensible, have great work ethics and personalities, and are a joy to work with. They do run the floor in their own sense, as they get along very well with the nurses and are able to help (legally!) because they've been in the field for so long that they've picked up a few things. Such CNAs are worth their weight in gold, and I would trust these people with my own mother. Unfortunately, they are a minority. I work with too many who prioritize their own petty issues over their assigned jobs, and don't care that people's lives are in their hands. I'm not bashing on the CNA field, it's that I'm working in a nonprofit nursing home that's so desperate that they're willing to overlook the fact that they're employing potential perpetrators of negligent manslaughter.
CNA is a job which does not weed out enough people. Although you can't be stupid and pass a CNA exam, it doesn't teach you valuable life lessons. In high school and college, I learned many valuable lessons such as modesty, obedience, patience, having to grit my teeth and move on, good work ethics, diligence, prioritizing skills, taking responsibility teamwork, having a good attitude, empathy, and workplace psychology. I'm not saying that school is necessary for a good attitude. Some people never outgrow a middle school mentality and grow up thinking that the only way to survive is to attack others before they attack you, which turns into a very bad, very defensive attitude. These said people smirk at you when you ask nicely to help you transfer a patient, as to show that they're not "slaves" to anyone, yet loudly sigh, roll their eyes, and tap their feet to show that they're PATIENTLY waiting for you to make a bed for them. They never learn the value of "please" and "thank you," but expect those words to be used on them lavishly. They consider themselves victims to an unfair society, and deny all responsibility for their offensive actions. They bounce from nursing home to nursing home, either quitting out of bratty tantrums of get fired when they push the limits, and continue to abuse the fact that they cannot be easily fired.
CNA is a job that is taken out of necessity rather than choice. Many low-paying, low-skilled jobs are taken because they need the money and the jobs are available. Many of my coworkers are doing it because it pays better than McDonald's, and don't care that people's lives are depending on them. If a resident requests to have their briefs changed or to please help pull them on in bed, they treat them the same way as most people would treat a call button-mashing patient who demands filet mignon. I have nothing but respect for the people who love their job and excel at it. All too many act as if they're doing a HUGE favor for you by being there, even if they aren't doing anything and are all too happy to make your job miserable. It's a stressful job that underpays and understaffs, which guarantees bringing out the worst in people.
CNAs have a tough job, and we're caught in a Catch-22 that the majority of the nursing field is caught in. A quick CNA is more highly valued than a thorough CNA. I would never neglect to wipe feces and urine from someone nor leave them in a highly uncomfortable position, yet the ADON called me in and accused me of slacking, bad prioritization, and dependence on others (this has NOTHING to do with the fact that there are 50 residents and often only 4 CNAs). I've noticed that management tends to give up on difficult employees, as nothing can be done, so they nitpick on those that they can lay blame on. I care about the residents and take my job seriously, and while I'm flattered that they expect more from a future nurse, this is ridiculous. After a particularly bad shift, I called up my father and told him that I'd rather shoot him than put him in a nursing home. We proceeded to have one of the best heart-to-heart talks of my life, which was simultaneously morbid because we discussed our death plans.
I don't think that CNAs run the floor, but I do think that too many CNAs hate their jobs, make no efforts to conceal their feelings, and abuse the fact that management can't afford to fire them like they deserve. This gives them delusions of grandeur and invincibility like spoiled children get, and assume that they can do as they please, fail to show up on time or at all, give attitude, and slack off without repercussions. This is dangerous, as people's lives are in their hands.
Sorry for the rant. I'm working with someone who has repeatedly barked at me that she refuses to help me because I supposedly don't do my work, never mind the fact that I had to ask 3 times for her to pass out trays while she was flipping through the latest Mary Kay catalog and talking on her cell phone about "This little bi*** who thinks she's the boss who I'm going to give a piece of my mind to." I informed her to her face that I am always willing to assist her, and that if she could not prioritize her job over her petty animosities, I would have report such behavior to the DON.
I'm not saying that all CNAs are like that, nor that CNA is an undignified job. There are difficult people in every field and any educational degree. I know that nurses are busy, but just as I wouldn't mind rolling a patient on his side while s/he administers an enema, I love nurses who can take 5 seconds to help transfer a heavy resident, or simply a "thank you." I once worked with a nurse who flagged me down from the hall to help another CNA transfer a resident. The nurse stood by and barked orders. The resident is a former nurse, and commented that the nurse COULD be helping out, but the nasty nurse simply retorted that it wasn't her job.

Excellent post!:yeahthat:

Especially the part about CNA programs not weeding enough people out.

I think that CNA programs should definitely be upgraded (along with pay as well) but that probably won't ever happen.

Good job at putting in the "I'm not saying that all CNAs are like that" before the "don't generalize" speeches start flying at you.

"Not all CNA's are bad. My floor has great ones or I worked as one for X number of years and I never once.......blah blah blah."

It's the bad ones that are the problem and the focus of the discussion, not the good ones. Nonetheless, I now always include a line acknowledging that there are great CNA's out there before the speeches start, because they will.

I worked as one for two years, and I'd like to think that I was at least a good one if not great. My partner is one now and I feel sorry for him many days because it's such a brutal job for low pay. I couldn't believe the kind of people they allow to do such an important job, but they do.

But until wages improve, too often you're going to get what you pay for.

And sadly, CNA's "run floors" only because nurses and management allow it to happen. There is no other reason for that to happen.

I've left jobs that ran that way. I've had CNA's literally walk up and give me a list of the people that they will be bathing today and then instructed by the CNA that I will be doing the others. The others of course would be the heavy, combative patients or those with the most difficult families to deal with, of which they had no intention of assisting me with.

I have all the respect in the world for CNA's who helped make my difficult med/surg jobs even a little better, but I did not go to nursing school to be delegated to by any CNA, and many did delegate to me and had a manager who backed them up so I had to go.

Writing them up does no good when you're the manager/supervisor's pet.

Working with bad CNA's is second only to bad family members as the reason I left Med/Surg nursing altogether and will never do it again.

Yes, it's sad that there are CNA's out there who simply do it because it pays better than McDonalds.

That runs in the RN and LPN circles as well. Some are nurses simply because it pays better than another job that requires the same amount of education/degree and have no business doing it.

Marie_LPN, RN, LPN, RN · Mar 8, 2006

CNA is a job that is taken out of necessity rather than choice. Many low-paying, low-skilled jobs are taken because they need the money and the jobs are available. Many of my coworkers are doing it because it pays better than McDonald's, and don’t care that people’s lives are depending on them.

Almost choked on my coffee when i read this.

The region of WVa where i first started working as a CNA, CNAs got paid no more than someone on the fry line. Yet there were plenty of retail and fast food jobs around.

In my certification class, the instructor had us go around the room and say why we wanted to do this. Almost everyone's first sentence was they wanted to become a nurse, but there were SEVERAL reponses from those people of "i want to work at a job where i make a difference to people and get a little more respect than i got working at XYZ burger joint."

In other words, there were easier ways to make money in that area, considering all the tramp-bars that are located in there (i don't miss driving past the billboards advertising those pathetic eyesores anymore), but the vast majority in that class were looking for a care-related job, that they were proud of, made a difference to people, looked forward to going to everyday, and were treated like valuable workers if they really were valuable.

And here it is, 2006, and the only time the CNA pay has gone up in that area is when minimum wage is increased. Althought they now get a quarter more on the hour than minimum wage. To factor in the cost of living, a CNA cannot live on their own there and make it on their wages.

Am i excusing piss-poor work and laziness, no. Nor am i advocating for the CNAs to be in control. But i honestly can say that i have a different perspective on CNAs because i was one myself (still am, i keep my cert up) than i would have if i hadn't been one first. Pawn in a chess game is sometimes how it felt, oh, you're just a warm body we can put wherever and whenever. And i will also say that CNA is one job where you'll always hear what you're doing wrong, and never what you're doing right the majority of the time.

nursemike, ASN, RN · Mar 8, 2006

Back when I was a UAP (an orderly, basically) I was clocking in one evening with one of my favorite co-workers and three of my favorite aides, and we were all pretty pleased to be working together. One of us asked, "Who are our nurses, tonight?" and another replied, "Does it matter?" Because we all felt we could pretty well handle anything we were likely to encounter, working together.

Now, as a nurse, I see occassional shifts where the aides are so good that they could ask, "Does it matter?" I see a few where it doesn't seem like it would be much different if there were no aides. Mostly I see in-between times, when the aides do their jobs and I do mine, and we work together as best we can and it usually goes pretty well. I do get "aide" calls at times because my aide is busy with something else, and at times because my aide left her phone somewhere and can't be reached. From time to time, an aide will need my help with a bath, and from time to time I'll need an aide to help with a dressing change that puts her behind in her own work.

One thing I try to keep in mind is that I'm getting paid 2-3 times as much as the aides I work with, so I figure that entails 2-3 times as much responsibility. Of course I can't neglect the tasks only I can do, but when it's just a matter of one or the other of us missing a break or taking a quickie lunch, I feel that burden is more properly mine.

I think I might be on the right track, here, since one of my favorite aides (the type who makes a night go better) recently told me she was glad I was going to be her nurse.

nursemike, ASN, RN · Mar 8, 2006

Let's not be so hasty to dismiss the Miracle of Super Bowl XL, okay?

SmilingBluEyes · Mar 8, 2006

The bottom line is:

without backup from management and administration, you are POWERLESS to do anything positive about this.

Now what you choose to do next, up to you.

postmortRNhere · Mar 8, 2006

Hi, I understand your situation and had a similar experience with several aides in my unit. You will have to try to do the very best that you can and do not focus on the work within your scope of practice in comparison to hers... within reason of course. What I did was address the issue with her directly and express how we could work better together. Sometimes people can be resentful due to your position in comparison to theirs. Please understand aides are usually overworked and underpaid and they deserve much more. I really believe they are every nurses support system. Show her you appreciate her help. Just a thought.

FocusRN · Mar 8, 2006

Well I am a CNA and I don't care what anyone says, I do the minimum. That's is not saying that I don't work hard because I do, but I won't break my back, or take a fall for running back and forth either. My stand is that I am on my nurses lisence meaning whatever my work is she is also resposible for, but I find that not many nurse find it this way, and some will even try to get me to do their work for them. And I don't put up with it. If I got paid more I'd be willing to go an extra mile but I don't. And I don't want to hear crap about how it should not be about the money, with my position it it. If I go to work and break my back, I have nothing to give when I get home and nothing to show for it, now if I got paid more and went to work and broke my back I would have something to give when I got home, such as extra savings. I know a lot of nurse work hard and at the same time a lot of them don't, but whomever I am working with doesn't change my stance. I work my hall the way that I want, I have had it out with my nurse, and my administration tice since the start of this month, over what i will and won't do. You'd think I'd been by now, but they on't let me go, as a matter of fact I turn in my notice to quit a couple of weeks ago and I had my manager near begging me to stay. That is because I do my work, it may be the minimum but it gets done. I have had no bed sore, mouth ulcers, slips, falls, "lost patients", I never once had to change a complete bed, and my patients rooms are always fresh, I have had 3 of my pts to go from fully inco to partialy inco, and one to go from fully inco, to cont. I do more than enough. Now the way that I get that done is my way, and I am not willing to change it. I will toliet a person, tell them to say until I get back and move on to the next, and the next without a problem. And none of my pts are amb. Now if some of those patients started to wind up on the floor then of course I would change my routine, but mine don't, because I let them know if I am asking you stay until I get back you need to. I have too many full care pts to sit in there with every one of them while they discharge. And if a patients happens to need something while I am with another they can wait. Unless the are falling, have fell, can't breathe, are about to pass out, they can wait. And if my nurse doesn't like it she can get up off her stick and go do it herself, which I have to sometimes emind her of. Do CNA's run the floor, well I run mine, simply because I will allow no one to order me to do anything, and esp anything that will run me into the ground. And another thing I hate being called an Aide, it sounds like I am a tool to be used how someone wants to use me.And any nurse working with me wil get an earful for it. Asking from extra help from me will get you an attitude because I do too much already. I never ask for help because I can do it just fine on my own, but I will do it MY way, and it someone doesn't like my way I always suggest they do it themselves. As the old saying goes "If you ant something done right, do it yourself".

Marie_LPN, RN, LPN, RN · Mar 8, 2006

I hate being called an Aide, it sounds like I am a tool to be used how someone wants to use me.And any nurse working with me wil get an earful for it. Asking from extra help from me will get you an attitude because I do too much already.

I could almost see where you were coming from, till i got to that part.

First, the word "aide" would have to be addressed to the Board, it's not the nurses you work with that legalized the term, and they certainly don't deserve the earful for that.

Second, there's no excuse for an attitude. Actually, if i'd even done that as an aide, i probably would have been collecting a pink slip.

It's not a bad idea to treat others the way you want to be treated. If someone walks in to a job with the mentality that most are the enemy, then that's what they'll get.

nursemike, ASN, RN · Mar 8, 2006

Well I am a CNA and I don't care what anyone says, I do the minimum. That's is not saying that I don't work hard because I do, but I won't break my back, or take a fall for running back and forth either. My stand is that I am on my nurses lisence meaning whatever my work is she is also resposible for, but I find that not many nurse find it this way, and some will even try to get me to do their work for them. And I don't put up with it. If I got paid more I'd be willing to go an extra mile but I don't. And I don't want to hear crap about how it should not be about the money, with my position it it. If I go to work and break my back, I have nothing to give when I get home and nothing to show for it, now if I got paid more and went to work and broke my back I would have something to give when I got home, such as extra savings. I know a lot of nurse work hard and at the same time a lot of them don't, but whomever I am working with doesn't change my stance. I work my hall the way that I want, I have had it out with my nurse, and my administration tice since the start of this month, over what i will and won't do. You'd think I'd been by now, but they on't let me go, as a matter of fact I turn in my notice to quit a couple of weeks ago and I had my manager near begging me to stay. That is because I do my work, it may be the minimum but it gets done. I have had no bed sore, mouth ulcers, slips, falls, "lost patients", I never once had to change a complete bed, and my patients rooms are always fresh, I have had 3 of my pts to go from fully inco to partialy inco, and one to go from fully inco, to cont. I do more than enough. Now the way that I get that done is my way, and I am not willing to change it. I will toliet a person, tell them to say until I get back and move on to the next, and the next without a problem. And none of my pts are amb. Now if some of those patients started to wind up on the floor then of course I would change my routine, but mine don't, because I let them know if I am asking you stay until I get back you need to. I have too many full care pts to sit in there with every one of them while they discharge. And if a patients happens to need something while I am with another they can wait. Unless the are falling, have fell, can't breathe, are about to pass out, they can wait. And if my nurse doesn't like it she can get up off her stick and go do it herself, which I have to sometimes emind her of. Do CNA's run the floor, well I run mine, simply because I will allow no one to order me to do anything, and esp anything that will run me into the ground. And another thing I hate being called an Aide, it sounds like I am a tool to be used how someone wants to use me.And any nurse working with me wil get an earful for it. Asking from extra help from me will get you an attitude because I do too much already. I never ask for help because I can do it just fine on my own, but I will do it MY way, and it someone doesn't like my way I always suggest they do it themselves. As the old saying goes "If you ant something done right, do it yourself".

I suppose I could say I do "the minimum," too, since I wouldn't feel comfortable doing less than the best I can, and also because the best I can do isn't always all that great--I'm still fairly new, and still developing my skills. Nor can I argue with the premise that "breaking my back" won't help my patients or me, in the long run.

At the same time, I'm not about to tolerate "attitude" from an aide. I don't for a moment pretend to be god's gift to the nursing profession, but I am a nurse. As you observe, it's my license, and that means it's MY patient.

Happily, I've never really had to "butt heads" with an aide. There are times when I do find it easier to do it myself, and there are plenty of times when I feel it is perfectly legitimate for me to take some of the load off an aide who is overworked--as noted before, that's part of why I get paid more. But if push comes to shove, I am the nurse, and if you don't want to take orders, get your own license. (Of course, you'll still get orders, from docs, charge nurses, management--but not from aides.)

I hope I'm not naive in disagreeing with the idea that one is powerless in such situations. It's probably true that there are some in the world who can't be reasoned with, but my experience so far has been that one can be fair and considerate while still avoiding being a doormat. Even before I became a nurse, working in healthcare taught me a lot about the need to be assertive, and in the few months since graduation, I have occassionally amazed myself with my ability to "Be The Nurse" when it's necessary.

ljds · Mar 8, 2006

Wow. If everyone did the minimum, think how, uhh, well, average the world would be. I think I have more personal pride and integrity to do more than just the bare minimum; I can't believe that you are so passionate about your job (and chose the name "Dream Nurse") with the attitude you espouse. I suspect either 1) you are no dream or 2) you have a crummy day of it, and in fact really are a good aide who is just letting off some steam. I really, really hope the latter is true.

I must be incredibly lucky; all our aides are awesome, and none of them have such an attitude. Neither do our nurses. It's not all roses, but when there is an issue, we tend to work it out. It is too difficult a job for each person to operate as their own island, their own little entity. It's so much easier, ejoyable, and better for everyone involved (including the patients!) when you view yourself as part of a whole.

It would really suck to work in such an environment as you and some of the others describe. You reap what you sow, you know.