Disrespectful Nurse aids

kanzi monkey · Dec 11, 2007

I really like what you say in your post, but I don't entirely agree with this:

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why does an RN feel justified in spending 20 minutes chasing down a CNA to take a patient to the bathroom/put them on a bedpan/clean up an incontinent patient vs just doing the task themselves? Especially when the RN just finished doing a dressing change or med pass, for example, in this same patient's room and knew before walking out the door that the patient had to go. I mean, seriously, come on! I know this doesn't occur everywhere, but after reading many posts on here, it sure seems to occur more often than not.

On my floor, aides get breaks--they are assigned, and they are free to do with their own time what they will. Nurses, on the other hand, are lucky to have a moment to funnel yogurt down our throats. I always leave the floor once to take a walk--usually early in the day--because I know there is a good chance I won't get the opportunity again when I have discharges, admissions, complex orders, etc. And without a little protein, an empty bladder, and a second to clear my head, I'm a mess by the end of my shift.

Putting a pt on a bedpan can, very often, be a PITA--if you yourself have a turtle head poking out (oh man, sorry...it's just true. Too much coffee in the AM). Pt's in pain, who don't move well, and are constantly asking questions that I can't possibly know the answer to, or are the type that come up with a new request for every 30 seconds I am in the room, can take awhile to get on the pan. Then, I feel bad leaving them there and going off the floor in case it's too busy for someone else to answer their light when they're finished. And it always is too busy for me to expect that someone else can do it. So, if the PCA isn't on break, I may just find them in another room and ask if, when they're done with what they are doing and have a moment, can they please help my pt so I can get off the floor.

I'm usually not bold enough to do this actually, cause I tend to get snapped at. But in theory, I think it's totally acceptable. Today I left work feeling behind, and for some reason the PCA hadn't taken VS on one of my pts, so I had to do that. I didn't stay too late, but I also didn't have lunch. The PCA DID have lunch, and left on time.

This whole issue is so frustrating to me because I think, for the most part, the PCAs oon my floor are quite good and have some wonderful interactions with patients, and also clue me in to issue that I may not have been aware of in my assessment (ie, hard to reach skin issues--our PCA's identify stage Is and IIs all the time, and the entire team ought to be grateful. As it is, we are relieved, and are better able to treat the patient--but the PCAs don't get nearly enough recognition) But most of the PCAs I work with don't treat me respectfully--and me, being soft and non-confrontational--I probably over compensate with niceness, thanks, and understanding. Cause I find that PCAs say no to me a lot--usually without reason, and in an angry tone. A PCA refused a patient assignment from me this morning--she said "no, I will not take that patient. You have to assign someone else to me" what??? Can she do that? At least, please tell me why, and don't snap at me. Cause seriously--what the heck? Did something happen regarding that patient that I--and all other providers--should know about? I asked "did something happen?" she said "I don't want him." (He's the one whose VS got missed too).

I want to give the benefit of the doubt--because this PCA has a heart of gold, but an ascerbic exterior. I don't want to report her--or any of the other PCAs. If she's unsafe--report time. But this is just weird. And I've pretty much come to accept that I shouldn't expect a lunch break (but it DOES come out of my pay check), and PCAs do (which they should, and they deserve). If I need the break, and the patient wants something a PCA can help with, yes, I will search for her.

-Kan

Ms Kylee · Dec 11, 2007

I will help anyone who asks me. Unfortunately, I'm the one who gets the worst assignment of all of the aides (15/17 completes, routinely. You know, the ones that take work and I can't bathe in 5 minutes because they take at least 45). Sometimes, I think the nurses take advantage of my niceness.

Last Tuesday, I came back from lunch and a nurse asked me to get postop vitals on her patient because her aide pulled the magic disappearing act---as usual. I said ok, thinking it was only one set of vitals and I could go on and do my end of shift vitals. Nope. When I got there, the patient had taken off his gown and was laying on top of his sheets stark naked-- with the room door open. So, I had to get him redressed, reoriented, and change his bed because the OR put fitted sheets on his bed when he was on an air bed. Had to run to get linens, chucks pads, under pads, and a new pack of briefs. All of this took over half an hour, and I was late with my vitals and late leaving. I understand nurses are busy, but this nurse pulls this all the time. She's always asking me to do favors like this or take a patient's blood sugar for her. I was talking to another nurse and explained how this nurse has a tendency to "hog" me if she can't find the other aide. Other nurse told me that this particular nurse is trained in vitals signs and blood sugars and should be doing it herself if she can't find the aide. I said I understood this, but it is an ongoing thing. I don't mind helping out, but I really hate being taken advantage of. Because of this situation, I wound up leaving 1.75 hours late and I missed class. (Yet another reason why I hate daylight!)

baldee · Dec 11, 2007

Thanks for some of the tips for a newbie CNA! Go to the restroom when someone explodes in their diapers. RN's have stated they enjoy doing it to check their vital responses inherently during the process.

Its not for me to get out of repulsive work, its so the bonds of societal demands on a RN's image is not a constraint in doing the job they actually love in their heart, but cannot due to professional peer pressure.

This is great! I'm learning how to make the world a better place and contribute to each person's self-actualization goals in the process. And even the patient get more expert attention, and the employer is getting more for their money in labor costs too. It's a (Win-Win)^2 or a Win-Win-Win-Win Scenario!!

:idea:

swee2000 · Dec 11, 2007

kanzi monkey said:
On my floor, aides get breaks--they are assigned, and they are free to do with their own time what they will. Nurses, on the other hand, are lucky to have a moment to funnel yogurt down our throats. I always leave the floor once to take a walk--usually early in the day--because I know there is a good chance I won't get the opportunity again when I have discharges, admissions, complex orders, etc. And without a little protein, an empty bladder, and a second to clear my head, I'm a mess by the end of my shift.
Putting a pt on a bedpan can, very often, be a PITA--if you yourself have a turtle head poking out (oh man, sorry...it's just true. Too much coffee in the AM). Pt's in pain, who don't move well, and are constantly asking questions that I can't possibly know the answer to, or are the type that come up with a new request for every 30 seconds I am in the room, can take awhile to get on the pan. Then, I feel bad leaving them there and going off the floor in case it's too busy for someone else to answer their light when they're finished. And it always is too busy for me to expect that someone else can do it. So, if the PCA isn't on break, I may just find them in another room and ask if, when they're done with what they are doing and have a moment, can they please help my pt so I can get off the floor.
I'm usually not bold enough to do this actually, cause I tend to get snapped at. But in theory, I think it's totally acceptable. Today I left work feeling behind, and for some reason the PCA hadn't taken VS on one of my pts, so I had to do that. I didn't stay too late, but I also didn't have lunch. The PCA DID have lunch, and left on time.
This whole issue is so frustrating to me because I think, for the most part, the PCAs oon my floor are quite good and have some wonderful interactions with patients, and also clue me in to issue that I may not have been aware of in my assessment (ie, hard to reach skin issues--our PCA's identify stage Is and IIs all the time, and the entire team ought to be grateful. As it is, we are relieved, and are better able to treat the patient--but the PCAs don't get nearly enough recognition) But most of the PCAs I work with don't treat me respectfully--and me, being soft and non-confrontational--I probably over compensate with niceness, thanks, and understanding. Cause I find that PCAs say no to me a lot--usually without reason, and in an angry tone. A PCA refused a patient assignment from me this morning--she said "no, I will not take that patient. You have to assign someone else to me" what??? Can she do that? At least, please tell me why, and don't snap at me. Cause seriously--what the heck? Did something happen regarding that patient that I--and all other providers--should know about? I asked "did something happen?" she said "I don't want him." (He's the one whose VS got missed too).
I want to give the benefit of the doubt--because this PCA has a heart of gold, but an ascerbic exterior. I don't want to report her--or any of the other PCAs. If she's unsafe--report time. But this is just weird. And I've pretty much come to accept that I shouldn't expect a lunch break (but it DOES come out of my pay check), and PCAs do (which they should, and they deserve). If I need the break, and the patient wants something a PCA can help with, yes, I will search for her.
-Kan

I also agree with what you said. Nurses should not have to pick up the slack for, or do the job of, CNAs, especially if they're noticeably not busy with any patient-related tasks. Rather, I was referring to helping each other out on the days where nothing is going right and everything is going wrong for both nurse & CNA, as they are busy-beyond-words, running from one patient to the next doing their individual tasks, heads barely hanging on their necks, & w/o a second to catch their breathe. That's all.

madwife2002, BSN, RN · Dec 11, 2007

You know sometimes we expect our aids to do all the nasty jobs, and I have seen nurses really rag upon PCT's all day. So I wonder if they kind of set up a defence mechanism where they show the 'new' staff they wont be walk overs. They could be frightened to be too friendly in case you ask them to do lots and lots of work.

In my 17yrs I have never ever had a problem with aids or PCT's but I am prepared to go work with them, push up my sleives and show then I can do bed baths, incontient clean ups, empty bed pans, answer call lights, get my own ice and water.

I rarely ask a PCT to get somebody a drink or a blanket I go get it myself but when I am busy and I cannot do these little tasks then I know I can rely on them to help me out.

I have seen and witnessed RN's chatting by the desk, when the call light goes off and the pt wants a drink or a blanket-they call the PCT to go and get it. You want respect then you respect them and their job and help them out occasionally. 9 times out of 10 they are really overworked and run off their feet like we all can be.

Carry on being nice and you will get the respect you deserve and more. Team work is the key words here. PCT's are part of the team not the dogs body.

Virgo_RN, BSN, RN · Dec 11, 2007

kaeky said:
I work on an oncology floor so weights and I/O are important. alot of the times they will chart numbers that are way off and when I ask them to do it again they will give me attitude. I always say please and thank you. Well just three of the assistants there are like that. They're all regulars on the floor and have been there many years and are many years older than I am.

When I was an aide, I had a nurse do that to me once. I was certain that my I&O was correct, and it was insulting to have her insist that her numbers were correct, when I was the one in and out of that room all night keeping track. If these aides have been there for many years, and you're brand spanking new, questioning their ability to do their job of keeping an accurate I&O, of course they're going to resent you. You can say please and thank you all you want, but basically you are calling them incompetent.

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Today one of my patients have been having high BP for several days so I gave a bp med and at nine and asked if the PCA would check it again in an hour. Nine is around the time she gets the vs in the chart and reports to me a higher than normal bp. anyway, she says "well I just took it right now...." with attitude.

This aide is not an RN; she does not have the training and knowledge to understand the importance of monitoring for parameters prior to the administration of medication or the effects of the medication following administration. That is your job.

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then in the afternoon comes around and comes up to me and tells my patient's bp is 135/87, then she says she got confused between patients and its actually 178/90, and then after another second she says "no wait, rm 09 its 157/75". I say okay not thinking anything and casually just asked her to record it in the chart. She was standing right there next to it and chatting with someone next to her. The next thing I notice she's going into another room to take another bp and says to me "oh no, i got the wrong patient again, 09's bp is 135/87". This time I was thinking "okay which is it" but i didn't say that I just say "okay can you just record that in the chart please" and she says "YES I WILL LATER, I am taking vs right now, I cannot do that". Ok so i figure she's busy so i say "well could you just read me off the vs and I'll record them just so I have something to work with", then she got irritated and said okay and left to continue her vs. and nothing happen.

Aides have their routines just like nurses do. By telling her WHEN to chart her findings, you were interrupting the flow of her work. This can be quite annoying for aides. They have to organize their work and manage their time, and they develop routines. If you cannot trust that the vitals are accurate, then you need to do them yourself.

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Oh yeah and earlier in the morning she was emptying out stool and asked me to come see it (i was in the room) she had already flushed it at the time but there was still some red tinted fluid left. I asked her if there was urine mixed it and she said that there was not because the urine was dark but normal. Well I didn't see the urine so I was trying to assess the situation her dark but normal can mean something different that me right? so I asked her again "so there was no red in the urine at all?" and she said "OF COURSE NOT" to me in front of the patient. Like I had just asked her a stupid question, I just wanted to know if maybe the urine spilled over to the stool. anyway, she proceded to say "maybe you want to get an order from the dr. to check blood because let me tell her the smell of the poop and the color I think is blood, it does not smell normal". she said that to me and the patient.

It is inappropriate to argue in front of a patient, and when an aide disrespects a nurse in front of a patient or vice versa, it can undermine the patient's confidence in the quality of care that they are receiving. It sounds like the aide felt like you are questioning her ability to do her job and went on the defense. Next time, if you cannot directly observe the specimen, just tell the patient and the aide that the next time the patient voids/has a bm, to save it for you so you can take a look.

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I don't get this from many of the other PCAjust the older ones who have been on that floor for many years. a big part of me is saying just to suck it up, what would you do if you were in my situation?

Some aides do have an attitude problem, as do some nurses. Since this is more than one aide, and they are the more experienced ones, I'd wonder if it is something you are doing. Questioning their I&Os, telling them when to chart, giving them the third degree over a stool sample, these kinds of things might make them feel as if you have no confidence in their ability to do their job.

GadgetRN71, ASN, RN · Dec 11, 2007

mr.ahp said:
I am talking about the way some nurses think they are god's gift to health-care and are above every other profession.

This is not the topic of the thread. The topic of the thread is disrepectful nurse's aides. It has been stated numerous times that not all CNAs are lazy, disrespectful etc. This thread is discussing those that are.:trout:

I feel this way- if you don't want to do your job which is patient care, taking vitals and reporting anything "off" to the RN in a timely fashion etc and would rather spend your time on your cell phone or talking with friends, then maybe you should find a job elsewhere. I also feel that RNs should not be goofing off at work-this applies to us too. No one is twisting your arm to make you work at the hospital. Don't like it that someone younger than you is above you on the food chain? Too bad. Either come to terms with it or go back to school.

I'm sure I sound harsh, but I learned the hard way that people will give you grief for the stupidest reasons and if you try to kiss their fannies too much, that makes the problem worse. It sounds like the OP is doing her job. The NA she's speaking off sounds disorganized at best and lazy/incompetant at worst. She needs to put her foot down in a professional way by confronting this person privately and calmly. If that goes nowhere, then she needs to document these occurences and take it up the ladder.

Agnus · Dec 11, 2007

Share with your aids that you were an aide too. Tell them you know how hard they work and appreciate all that they do. Go out of your way at first to help out the aids. Making a big deal about how appreciative you are of them. Then through out your career do things JUST to help them on occasion. Not just do things that are their job because you have to but because you don't have to. Like go in and make a bed not because you have to get it done but to be nice to the aide.

Listen to their frustrations and sympathize profusely with them.

They will change their tune at least toward you.

holdensjane · Jan 31, 2008

NancyNurse08 said:
When I was an aide, I had a nurse do that to me once. I was certain that my I&O was correct, and it was insulting to have her insist that her numbers were correct, when I was the one in and out of that room all night keeping track. If these aides have been there for many years, and you're brand spanking new, questioning their ability to do their job of keeping an accurate I&O, of course they're going to resent you. You can say please and thank you all you want, but basically you are calling them incompetent.
This aide is not an RN; she does not have the training and knowledge to understand the importance of monitoring for parameters prior to the administration of medication or the effects of the medication following administration. That is your job.
Aides have their routines just like nurses do. By telling her WHEN to chart her findings, you were interrupting the flow of her work. This can be quite annoying for aides. They have to organize their work and manage their time, and they develop routines. If you cannot trust that the vitals are accurate, then you need to do them yourself.
It is inappropriate to argue in front of a patient, and when an aide disrespects a nurse in front of a patient or vice versa, it can undermine the patient's confidence in the quality of care that they are receiving. It sounds like the aide felt like you are questioning her ability to do her job and went on the defense. Next time, if you cannot directly observe the specimen, just tell the patient and the aide that the next time the patient voids/has a bm, to save it for you so you can take a look.
Some aides do have an attitude problem, as do some nurses. Since this is more than one aide, and they are the more experienced ones, I'd wonder if it is something you are doing. Questioning their I&Os, telling them when to chart, giving them the third degree over a stool sample, these kinds of things might make them feel as if you have no confidence in their ability to do their job.

I was an aide to and I can tell you I did not act like the three aids on my floor that i mentioned. Most the time wrong weights for I/Os were because the aids forgot to zero the bed, left extra things on the beds, etc. I'm sorry if my numbers are way off, I WILL have it recheck, i'm sorry you feel different, i wouldn't want to be your patients. I don't care how many years of experience you have, you can have decades of experience and still be unsafe. to your second point, i don't need the aide to understand the importance of BP and the rationale i have for having the bp recheck. I just need her to tell me if is free to do it or not. IT IS MY JOB to delegate responsibility so i don't understand what your point is. I didn't ask her to assess the patient, I just asked her to check bp if she had the time, all i needed was a yes or no. to your third point, i wasn't questioning the accuracy of her bp result, at this point the chart was right next to her hand, I was swamped with many other things that needed to be done NOW, instead she was standing around chit-chatting. If she is going to report an abnormal VS that I CANNOT deal with at the very second, I want to know its in the chart when i refer to it in 25 seconds, ESPECIALLY if she is confused at to which bp belongs with which patient. I know her stuff was written down somewhere so I know if she wanted to she could pull out the accurate bp on the right patient for me. thats all i wanted, something on paper because i'm sorry when I have 7 different improtant things going on at once, I don't have time to sit and listen to her sort out 5 different BPs, if she wrote it down then i would know it was official and thats what she meant. and your last point, again the emotional attachment to this topic with you is blatant. who was arguing?! I'm sorry i would never want to be your patient. if there was fresh blood in the stool OF COURSE I WOULD WANT TO INQUIRE ABOUT IT. i need to know if i need to give plts or not. I would hate to have internal bleeding just because my RN was afraid to ask the aide a few questions. I disagree with you in saying I should wait until the next BM to check for myself. who knows when that will be, in the meantime my patient's plts are plummeting. wow you sound dangerous...

btw, I was an aide and i NEVER acted like this. I've worked with MANY aides since and the three i mentioned are in the minority. i more than a few times have emptied excretions, changed beds, taken vs, etc as a nurse. so if this is the kind of attitude you find acceptable at your workplace, i wouldn't want to work where you work. and since that time, i've found out that the pcas are the three notorious for their "feisty" attitude. they've been found arguing with the charge about which patients need sitters because they know that they will be the ones sitting the next day. how ridiculous.

Virgo_RN, BSN, RN · Jan 31, 2008

I'm sorry you took offense to my post. I was simply attempting to provide an alternate point of view.

chase4myheart · Jan 31, 2008

I also worked as a CNA at my facility before becoming an LPN. I feel very fortunate for the CNAs that I have. Of course there was a transition period where boundaries had to be set. The key to the situation is that everyone has to work together. I don't hesitate to answer call lights, respond to laser alarms, and help toilet a resident, if my CNAs are busy, and I have the time. This earns respect from your CNAs. I also don't hesitate to tell my CNAs when they are doing something wrong. For example, I was in the middle of my evening med pass and three call lights were going off. I don't see any CNAs on the hall, so I lock my med cart up and go to the break area and find both of the CNAs assigned to my hall taking break at the same time. It didn't take me but a minute to explain to them that both of them could not leave the hall at the same time. A lot of it has to do with the tone of voice you use and the confidence that you have in yourself. If you are lacking confidence, your CNAs will pick up on that. Respect is earned. I've found that if you are willing to get in the trenches with your CNAs when they are swamped, then they will go the extra mile for you. I couldn't do my job without my CNAs, and I appreciate the hard work that they do. I also never hesitate to tell them what a good job they do and how much they are appreciated. I also forgot to mention that staffing has been a problem and most of our CNAs work double shifts. I think that they are an amazing group of people. Don't get discouraged as you continue in your job, I have a feeling things will improve.

crazdmomof4 · Sep 8, 2008

NurseKatSteeZ said:
You know what, I think they just feel like they CAN do this to you because of your age and because you are a new nurse. I, myself, get this from some of my CNA's. I feel like I'm not assertive enough, or that I'm too nice. But they really do walk all over me, and I need to do something about it. I try, but I'm just too passive. I'm 24, and have been an LVN for a year now. I always feel like they don't take me seriously. I always catch them lying to me, or tryin to get away with things. I always tell them things in a nice way, but the things I tell them seem to go into one ear and out the other. Finally, my DON gave me a little lecture about being THEE charge nurse. She told me I really need to toughen up my game, and if needed, write the aids up or simply clock them out and tell them to take their attitude somewhere else. Hope everything works out well!!!

OMG are we working at the same facility. I went to my DNS about the same problem and got the same lecture. I truly hate being the bad guy / nagging nurse. But I am at a loss as to what else to do. I feel your pain and frustration.