I'm writing up the CNA at my LTC facility - page 2
I told this CNA last Nov. that vital signs are due by 12 midnight. She has been doing them for me by 12 midnight ever since. I recently learned that she is not doing it for the other nurse and I am... Read More
Jan 24, '05Give us an update!
I agree with the others...the other nurse should be involved. Unless you are the supervisor I wouldn't go it alone. In my facility (small) I would have to do the write ups for the other nurse who is an LPN. Just remember to get the facts...Im sure you will.
Jan 24, '05Thanks all for your great advice. :hatparty: Oops it looks like I may have accidently gotten 2 different threads started on this same subject. Yes I think I will urge the other nurse to write up the CNA and I will offer to back her up or confront the CNA with her. Or yes maybe we can write her up together. I will leave it up to the other nurse whatever she decides. No we don't have a union here. My nurse friend is the main night shift nurse in charge. I am the charge nurse on that unit only on her days off. Yes the CNA is taking advantage of the other nurse. It makes me furious because this particular nurse has been so very helpful and wonderful to me. I want to do something for her too. I am worried that this wonderful nurse will get fed up and quit because of this CNA.
Jan 24, '05I work in LTC and I know the way I run the unit when "i'm on duty" is a little different than the way the other nurses run it when they are on duty...
I would say that vitals by midnight is a good idea that way the patient can get the most uninterupted sleep possible. Also it is good for the nurse to be able to get some of the charting out of the way and to know if anything is going on with a patient early in the shift! I prefer for any shift I'm working to get vitals as soon as possible because if something is going on I want to be able to get the patient the care they need as soon as possible!
Maybe if you do talk to the CNA you could explain the rationale for early vitals and make it more of a learining experience as maybe they think it's more of a power trip for the nurse?
I would say if the other nurse talked to you and asked you to intervene I would still probably encourage them to try to take care of it themselves if they could but if they had a hard time doing it then I'd probably talk to the CNA for the nurse. Just keep in mind that maybe the other nurse is telling you one thing but not telling the CNA the same thing?
I am not a big advocate of Write-Up's! To me the only time to use it is if you have a really bad employee who needs not to be taking care of patients and you need a paper trail to get rid of them! I've been fortunate I guess because for the most part most of the CNA's I've worked with have done a pretty good job!
I can count on one hand how many times I've had to write anyone up.
It's not that I won't do a write-up but it's got to be something pretty severe to get me to that point and that is probably going to be working with a person who truly does not care about the patient and needs to be outta there!
As I said I guess I am pretty fortunate because I work with many wonderful people who do care!
I've found that a more effective way for me to work with the Nursing Assistants is to talk to them and work with them especially when there's a problem... We start out our day with a brief report of what's new then work together as much as possible the rest of the day. Things just seem to go better when we have a caring attitude for all the people we come in contact with regardless of if it's a patient, visitor or coworker and a good attitude can become contagious and make just for a better work place for us and better patient care!
Try talking before writing...
Jan 24, '05Is the CNA not getting vitals by midnite just to cause trouble, or is there just a misunderstanding? maybe you like your vitals to be done by midnite, but unless you come out directly and tell her that ALL vitals for ALL patients need to be done by midnite (or if this is the facility policy perhaps) you cannot expect her to be a mindreader. It is not uncommon that different nurses have different ways of doing things and will ask different things of an aide.
also, what is the number of patients the CNA is expected to get vitals on? is this difficult for her because she is busy doing other CNA duties? remember that CNA means certified nursing ASSISTANT- they ASSIST the nurse. In the end it is ultimately the nurses responsibility to have vitals for their patients. Delegation is a great thing, but so is helping. If the aide is having a problem getting all of them done by herself and there is a nurse present, why can't the nurse help? is the nurse that much more busy than a CNA at that time of night? Somehow I doubt it.
Jan 24, '05It kind of seems to me that you see the RN as your colleague and the CNA as the outsider. Even though the CNA is not on your level educationally...you do need her. So maybe you need to start treating her as a member of the team instead of the outsider. I say confront her in a non-confrontational way with the other nurse. You get more flies with honey than vinegar. If you write her up she will do her job grudgingly and she will always hold it against you. And hey, you never know you just may need that lowly CNA to scratch your back someday.
Jan 24, '05Well, I gotta put in my 2 cents worth, too.
When and if I get in the nursing home, and somebody comes in and wakes my a$$ up at midnight to take v/s on me, they're gonna get their a$$ chewed out. I'm not a good sleeper anyway, and when I can catch some of it, I want it.
When I worked in LTC, I made my aides get the v/s by 9pm on the ones that it was possible to do that, like the ones who did not have to be turned and checked q2hr.
That's ridiculous to be waking folks up at midnight for v/s.
Jan 24, '05I think the nurse involved should be the one to take care of it. Your not doing her any favor by doing it for her.
Jan 24, '05do you know for a fact that the nurse had told the cna when she wanted the v/s...if you come on at 10 or 11 you ae going to be making rounds p report so you have eyeballed the patients...plus the off going v/s would probably be made maybe at 9p ... maybe the other nurse really didn't want them at the same time that you did...talk with the other nurse and let her know that you and the facility will back her up..but she needs to be the team leader..that when she requires v/s esp on a patient who has the potential to go bad then they should be delivered to her
Jan 25, '05Quote from blackcat99it sounds like you need to sit-down with your shift supv, nm, cna staff, along with the other nsg (who's not only the full-time 'charge nsg' on that unit...but also your charge nsg!), & come-up with a standard of routine practice (that's necessary) for that particular shift so that there'll be continuity for all.thanks all for your great advice. :hatparty: oops it looks like i may have accidentally gotten 2 different threads started on this same subject. yes i think i will urge the other nurse to write up the cna and i will offer to back her up or confront the cna with her. or yes maybe we can write her up together. i will leave it up to the other nurse whatever she decides. no we don't have a union here. my nurse friend is the main night shift nurse in charge. i am the charge nurse on that unit only on her days off. yes the cna is taking advantage of the other nurse. it makes me furious because this particular nurse has been so very helpful and wonderful to me. i want to do something for her too. i am worried that this wonderful nurse will get fed up and quit because of this cna.
i agree with a few other posters regarding v.s. at midnight. most ltc facilities require v.s. to be done on residents on antibiotics (on days/evenings x5 to 7 days), new admissions or re-admission (again on days/evenings x5 days), whenever an incident occurs (based on what occurs...i.e. neuro check q/* x4 hr....etc), or per sub-acute protocols (usually per shift for the first 5 days of admission...then it's down to per day...usually day shift) for mds reimbursements. just how many v.s. are required from each aide at midnight every night & how many residents are they required for?
sounds to me like you really should step back a bit & follow your chain of command here. the other nsg in question *is* the charge nsg & as such she *know* very well what she needs to do when it comes to insubordination! perhaps you're getting a little itch to write this person-up for yourself? could it be this particular cna rubbed you the wrong way before & now it's time for paybacks...perhaps writing this individual up using your charge nsg's problem as the perfect excuse would surely do the trick because the problem isn't with you this time...perhaps your prior attempts/efforts failed :uhoh21:? i don't know but only you can look at yourself in the mirror & truly answer that with sincerity :stone. just how often do you write your aides-up anyway? not an attack but some some self reflective questions...you really shouldn't allow your anger to be a motivating factor behind disciplining your nsg staff . btw....just how many threads have you started over this one individual anyway? that right there speaks volumes in terms of your anger at this individual & wanting to vent. how long have you been a nsg? can't really tell by your profile as you haven't disclosed as of yet. it sounds like you don't really have all that much experience in this area...again...refer to your charge nsg, shift supv, & nm for advice where disciplining is concerned.
why don't you talk to this charge nsg (regarding this issue) & allow her to make the choice to discipline her full-time aide staff. it may just be her wanting to vent over personalities types...or quite possibly...her dissatisfaction with your facility's demand of her? if this *good* nsg leaves this facility because she can't stand-up to her aides, then maybe she shouldn't be there after-all. like i'd said earlier, this nsg does have her shift supv & nm to turn to if she's unable to deal. you must pick & choose your battles (not others) wisely. trust me, this is but a small thing....there are wayyyyyy more serious things that this cna could be written-up for! stay fair & just & you'll get respect from your nursing staff. just keep that in mind & you'll do fine good luck ~
moeLast edit by SKM-NURSIEPOOH on Jan 25, '05
Jan 25, '05please, especially during a heated discussion/debate, keep the focus on the topic and not on your fellow bulletin board member. remember that it is against this bulletin board's terms of service to personally attack another member.
also, rather than directly respond to a post that is a personal attack in nature and may be against the terms of service, please report the post to the staff. let the staff deal with the situation.
thank you for your consideration
co-administrator of allnurses.comLast edit by Ted on Jan 25, '05
Jan 25, '05OK folks. Let me explain this one last time. This CNA knows vital signs need to be done by 12 midnight period. Not only does she know this I had her sign an inservice paper last Nov. that clearly state that vital signs are to be done by 12 midnight. It is also the policy at this facility. She is usually assigned to do vital signs on 4-5 residents at night. And no the nurses do not have time to do the vital signs for the CNA's. At our LTC the nurses are usually running all night. The CNA's work hard too but they usually have time to sit and rest for 1-2 hours during their shifts. Even the other CNA's are mad at this CNA for not doing her vital signs and helping this nurse. Anyway, I hope the nurse will write up this CNA. However, this CNA does do her vital signs by 12 midnight when she works with me. It is not my job to "babysit" these CNA's. If they don't want to do their assigned tasks they should be written up period. I am too busy at night to play these silly games. If you don't want to do your CNA job then that is insubordination and it's a write-up. I never have to remind the other CNA's to do their vital signs and have never had to write up any CNA's at this facility.
Jan 25, '05Quote from Blackcat99If that is the case then the CNA should be written up no warning needed. You didn't explain that she is fully aware of her job duties. If she signed a paper at in-service back in Nov and the other CNA's are doing what they are supposed to do then she NEEDS to be written up. It isn't your job to baby sit the CNA but it isn't your job to baby sit the nurse either. You can let her know that you support her but she has to develop a spine and stick up for herself. If it isn't that CNA it will another one in the future that she will have to deal with.OK folks. Let me explain this one last time. This CNA knows vital signs need to be done by 12 midnight period. Not only does she know this I had her sign an inservice paper last Nov. that clearly state that vital signs are to be done by 12 midnight. It is also the policy at this facility. She is usually assigned to do vital signs on 4-5 residents at night. And no the nurses do not have time to do the vital signs for the CNA's. At our LTC the nurses are usually running all night. The CNA's work hard too but they usually have time to sit and rest for 1-2 hours during their shifts. Even the other CNA's are mad at this CNA for not doing her vital signs and helping this nurse. Anyway, I hope the nurse will write up this CNA. However, this CNA does do her vital signs by 12 midnight when she works with me. It is not my job to "babysit" these CNA's. If they don't want to do their assigned tasks they should be written up period. I am too busy at night to play these silly games. If you don't want to do your CNA job then that is insubordination and it's a write-up. I never have to remind the other CNA's to do their vital signs and have never had to write up any CNA's at this facility.
Jan 25, '05be careful Blackcat! As long as the cna is satisfying you than don't be concerned about she/he does with another nurse......we don't need to fall in to 'control freaks' and this is the way many take situations....take care of your shift and trust me.....let the other nurses do the same