Difficulty with a CNA

Nurses General Nursing

Published

I am an RN and I view myself and my CNA as team. Most of the time it works out... I treat the CNAs with respect. At the beginning of the shift I go over our patients with the CNA and at that time delegate appropriate tasks. I usually don't have a problem, like I said.

K back to me... I'm an easy-going nurse that has a very good sense of humor, I'm also not as good with confrontation as I should...but I start losing my sense of humor when I have to ask a certain CNA to get a BP like 5 times or if there is a scheduled task like rechecking a temperatiure or discontinuing a foley... and I ask if she has those scheduled task results... no I didn't do it. Or how about at the beginning of the shift, I tell her so and so needs to be repositioned every 2 hours and that I will help her if there isn't another CNA available. What is it that she doesn't get? I am not delegating things that are difficult or that she hasn't done a million times.

I feel like I'm constantly going over her work and either doing it since she didn't, or redoing things... She CONSTANTLY is saying "Why, I normally do it so-so way or only once a shift for vitals" to everything. I've tried to be nice about it, but I'm to the point where I want to say, "Well this is what I need done, and if it isn't, there will be problems." Of course I'm too chicken with confrontation...

I guess the point to this is, how do you deal with a nursing assistant (or even other coworkers) that deliberately does not do what I ask them to do??

Thanks in advance (o and I'm working on this communication problem of mine by reading a book);)

Thanks...Jenn

I worked at a facility where I went from CNA to LPN. As I could have suspected, I was not successful. The place was a disaster area to begin with. My DON treated me like I was supposed to be superwoman and get people to work when they were not only allowed to, but encouraged to, sleep on night shift. All the CNAs would do a half-way first round then pull out geri-chairs, pillows, blankets, into the hallways, or other favorite places, and sleep the night away. I was told that the DON encouraged this b/c she was sympathetic to everyone's need for two jobs. Of course, residents would spend the night in their own wastes, most CNAs would not even clean them up on first rounds. If they cleaned their residents at all, it was done on the last rounds in the am. Etc. etc. etc. Then the DON came down on me when I witnessed pt abuse by a licensed nurse (one of her favorites) and reported it up the chain of command. I did not last long after that. Why I stayed in that fac as long as I did, I will never know. But you can get very desperate when you need a job. So my from the hip advice to anyone who is working at a fac as a CNA, go somewhere else when you get your license. Unless, of course, you are at one of those one in a million places where there actually is a good working environment, where mgmt backs up their nurses and most people effectively work as a team.

Specializes in Psych, Assertive Community Resource Team.

My clinical group has been having problems with the PCT's at our clinical site. This is the first semester we have been on this floor (surgical max) and I don't think they really understand what the term NURSING student means. They seem to have this mentality that if we are assigned to one of their pt's that they shouldn't have to see that pt. all day. I have absolutly no problem pitching in and doing aide work or answering call lights if I have downtime, but I am there to learn RN duties, and when it comes right down to it I need a lot more practice passing meds or inserting a NG tube than I need dumping bed pans for lazy PCT's.

The other day I was pulling up AM meds with my instructor and getting insulin coverage for my pt whose BS was in the 500's when the aide for my pt. came up to me and said, "Your pt's call light is going off and she is dirty. You need to take care of that.", then she walked off. I looked at my instructer kind of shocked that she was so rude about it and my instructor said, "Here's lesson #42 for you: Delegation. Show me what your made of." So I walked over to the aide and (very nicely) asked her if she could take care of that for me because I was getting ready to pass meds and only had a small time frame to get it done in. The aide launched in to this tirade about how incompetant nursing students were and how I shouldn't be a nurse if I couldn't even keep up with the needs of 1 pt. when she was already taking care of 5 others. At this point I was losing my cool with her, so I just smiled real big and said, "Here's how I see the situation, Mrs. so-and-so needs someone to clean her up and she needs someone to give her her insulin coverage. Which one are you qualified to take care of?"

Long story short she shut up and took care of her job but I certainly didn't make a new friend that day. Now she is trying to start this war between the students and the other PCT's. The whole thing is rather childish in my opinon. Oh well, what are you going to do. You can't make everyone love you!

This sounds like something that should be discussed in your clinical conferences. I'm glad that your instructor took the steps she did with you that day. The earlier you learn to delegate, and get practice, the easier time you will have all along. I used your retort about the differences in job duties. One CNA, who had a negative attitude, did not like it when I told her point blank, that I could do her job but she could not do mine. I got less lip from her after that.

Be careful during the rest of your schooling, that your clinical instructors make it clear about the differences in expectations. Our clinical instructors always made it clear with us and our nurse preceptors, where the lines of resp were. I had a primary assignment one time where I was resp for all care and I knew it. Never ran across snooty CNAs or PCTs. Most of them went out of their way to be helpful to us students.

when i was a cna i was taking car of 10 to 12 patients a night and all of the other cna's when they got done with there assigment they went to the nurses station and sat there and not one of them came to ask do ou need any help and i was like could one of you help me and all they did was sat there. so then Finaly a nurse hear me asking for help and she came and said i would be glad to help you and a another cna came to help me. So i can see both sides of it CNA's beging helpfuil and some being darn right lazy. But after that night the nurse harpped on the other aids to go and check on the patients and just have the new adios do all of the work.

Specializes in LTC, Rehab.

I do believe that if you think what you just stated, well, they may be able to see through the attitude if your genuine or not, and I'm not making excuses but your the professional and dont expect them to be, so you need to be more assertive and get your point across straight forwardly and to the point, tell them I'm need this at such time, try to educate them on the seriousness of their duties as brief as possible and, if they still dont comply not only document it for yourself but verbally confront them on how you cant tolerate not having the appropriate help they are suppose to give. After that I would report it to the supervisor everytime and dont forget to keep your own Journal. I do believe that CNA's should be held to some accountability and many times employers treat them as if they dont know better and arent suppose to know better just because they lack schooling, Yea bull to me too. You dont want to be agressive or stir up friction but try and empathize with them and at the same time tell them that you if you have to do it all by yourself then management will have to get involved. I

Specializes in EC, IMU, LTAC.

Honestly, this is what you get when you utilize barely educated people to do such important jobs. Don't get me wrong, I was a CNA once, and I knew many wonderful CNAs, but I've met too many who couldn't even grasp the concept of the importance of wearing gloves or washing hands. Many had attitudes that made it obvious why they couldn't get jobs anywhere else, and took advantage of the fact that the nursing home was too short staffed to fire them. Don't ask me how they passed a CNA course. Yes, there is no shortage of people who need jobs, and there are constant shortages in healthcare facilities, but I wish that standards of being a CNA would be raised.

Specializes in Med/Surg, Home Health.

I have the exact same problem with one PCA in particular. When I started out, I busted my butt to help them do their work plus mine because I wanted them to know I wanted to be a "TEAM" and I didnt expect them to do something I didnt want to do myself. Ya know? Well, that was meant with all good intentions, but in the end it backfired on me. Now, we have 2 that will flat refuse to do anything unless told to. They know that vitals are every 4 hours. They know that I/O's are their job to keep up with (along with me). They know when fingersticks are due. And if a patient needs turned every 2 hours, they dont get it done and the patient ends up with a decub (so I end up doing ALL this by myself). I have discussed it with them, it did no good. So I went to the nurse manager, who said she would address the problem. It made no difference. I give up. I refuse to do my job and theirs too unless I get their paycheck since Im doing their work. So, Im now actively looking for another job. I just am so scared because this is the only job Ive had as a nurse.

Even though a new job may very well be in order, be warned that similar conditions are usually found everywhere. The chances of finding the perfect work environment are very slim. You should be prepared to pick up and move often until you find some place that you can at least stomach, if not be happy at. At some point, you will need to improve your ability to cope b/c there is a physical limit to how many employers you can go around to. And yes, occasionally you can be asked on a job interview, concerning "job hopping" and your suitability for positions.

I notice you are 24? Well, I am 23 an a new RN..I have the same problem but only with a few of the aides. I think they feel threatened and jealous that the "new and young nurses" are telling them what to do...well most of the time it is just ridiculous to try to ask some of them to do something.

I took the issue to my nurse manager and she has done nothing about it...so what I do is if I need a BP, foley emptied, someone repositioned, whatever..I just do it myself. It might take you an hour to find them and then talk them into doing what it is you want..just do it yourself..atleast that is what I do. It usually is a task that will only take 2-3 minutes anyways.

mostly...there is no teamwork haha. I get a lot more done with the RN/LPN helping me than what meI could ever get from an aide. I guess in the end we are the liscenced personnel anyways.

As a CNA I take offense not only to this comment but to several others that I read. First of all it is not fair to lump together all CNAs the way you have, it's comparable to classism. I work with several nurses who are much younger than myself and do not feel "threatened" by them. However, most of these nurses have never worked a single day as a CNA and do not understand that we are not only capable, responsible adults who take great pride in our jobs, but that many of us know a great deal more than any new grad. Some of us have more years in patient care than our nurses. It may come as a surprise to you but most CNAs are intelligent people who could probably teach you something if you bothered to listen. We are also more experienced in managing our time and in prioritizing than any new nurse could be and know whether it is more important to get a temp for the third time or to clean up the patient covered in feces. There are classes available at most local colleges in management skills and communication. Maybe you should look into this as it seems that you are the one with the communication problem.

Specializes in Lie detection.
my clinical group has been having problems with the pct's at our clinical site. this is the first semester we have been on this floor (surgical max) and i don't think they really understand what the term nursing student means. they seem to have this mentality that if we are assigned to one of their pt's that they shouldn't have to see that pt. all day. i have absolutly no problem pitching in and doing aide work or answering call lights if i have downtime, but i am there to learn rn duties, and when it comes right down to it i need a lot more practice passing meds or inserting a ng tube than i need dumping bed pans for lazy pct's.

the other day i was pulling up am meds with my instructor and getting insulin coverage for my pt whose bs was in the 500's when the aide for my pt. came up to me and said, "your pt's call light is going off and she is dirty. you need to take care of that.", then she walked off. i looked at my instructer kind of shocked that she was so rude about it and my instructor said, "here's lesson #42 for you: delegation. show me what your made of." so i walked over to the aide and (very nicely) asked her if she could take care of that for me because i was getting ready to pass meds and only had a small time frame to get it done in. the aide launched in to this tirade about how incompetant nursing students were and how i shouldn't be a nurse if i couldn't even keep up with the needs of 1 pt. when she was already taking care of 5 others. at this point i was losing my cool with her, so i just smiled real big and said, "here's how i see the situation, mrs. so-and-so needs someone to clean her up and she needs someone to give her her insulin coverage. which one are you qualified to take care of?"

long story short she shut up and took care of her job but i certainly didn't make a new friend that day. now she is trying to start this war between the students and the other pct's. the whole thing is rather childish in my opinon. oh well, what are you going to do. you can't make everyone love you!

good move by your instructor. the aide tried to put you in a tight spot but you beat her at her own game. there are many aides lke this (not all). the ones that are great will stand out in your mind and you will never forget the awful ones either.

stand your ground as a student and it will serve you well as a new nurse! the method you used does seem to work best. the cna's seem to think that unless we are cleaning up poopy butts, we are not actually doing any work. well, i don't know what passing meds, starting iv's, charting, lab runs,calling central, paging docs, picking up orders, and a zillion other nursing duties are considered but... i guess only their work is real work.

and please i am definitely not talking about all cna's. i know there are plenty of hard working , smart ones that i'd love to have by my side. the others know who they are...

again jelli belli, good for you...

After reading your comment I was asked by my infuriated charge nurse to send the following comment...

I've been a nurse for 25 years, in those years I have learned that you can get anything accomplished when everyone on the TEAM works together as one. It is all in the way you approach someone with a request, not a demand, to have something done that gets the best results. Usually when you give the reasoning behind your request you shouldn't have any problems. If you simply state "because I said so" you raise the other persons' defenses. You also have to realize that without the CNAs there are alot of things that can be missed by nurses. You have to also know how to communicate with each of your co-workers regardless of who they are, Physicians, RNs, LPNs or CNAs. I have worked with RNs/LPNs who think that because their degree is "higher" than a CNAs that they are above them. I feel sorry for those people because they can never have a good working environment with their peers. Even after 25 years of nursing, I still learn something new everyday. Unfortunately for you, it is often from a CNA. I count on their eyes and their familiarity with my patients to pick up the slightest changes in my patient that I might be too busy to see as I am doing meds. Unless you change your mentality, you will have this problem no matter where you go.

Specializes in med/surg, telemetry, IV therapy, mgmt.
as a cna i take offense not only to this comment but to several others that i read. . .most cnas. . . are intelligent people who could probably teach you something if you bothered to listen. we are also more experienced in managing our time and in prioritizing than any new nurse could be and know whether it is more important to get a temp for the third time or to clean up the patient covered in feces.

yes, many cnas are very skilled at providing hands on care and in managing their time and prioritizing their cna tasks. however, the on the job experience of a cna is not an equitable substitute for the techniques of time management and prioritization that an rn learned in school. to make that leap of logic is wrong. the newly licensed nurse will eventually surpass the cna in the performance of those skills with time, practice and experience.

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