lunch time insubordination

Nurses General Nursing

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i am a young charge nurse in a facility... everytime i ask them to do something like one example...

i was dcing a pt. pt ask if someone could help them go to the car.. i asked my cna to help them to the car she said no im busy while just standing in the hall way saying shes waiting for the pt to finish up in the bathroom is this right? and sometimes in lunch time they come back from lunch early and just ask them to assist a resident and they tell me their on lunch.. i mean wth?? a resident needs help... is that an excuse to not help them?

Start the documentation process:

1. verbal warning, and state it is so and duplicate in writing (email),

2. written warning at same time handed to them, and

3. suspension or dismissal depending on policies.

It will only take one incident. And start filtering out replacements in the meantime. You owe it to yourself and those you care for, period.

Be careful if they are on lunch and assisting with other patients. Be reasonable and practice empathy.

how far was the car, if the cna was waiting for another pt to finish in the bathroom, I assume that that pt needed help when done....

and those that stated they were still on lunch, if they were clocked out and helping someone to the car, that may make them late clocking back in, and...did that mean that when they came back they would get the rest of their lunchtime (on the clock)??? Regardless of where they are, that is their time. So, I am a little perplexed, and not to be rude...but, when you got done dcing the pt, what was your next chore that you couldn't walk them to the car? :confused:

how far was the car, if the cna was waiting for another pt to finish in the bathroom, I assume that that pt needed help when done....

and those that stated they were still on lunch, if they were clocked out and helping someone to the car, that may make them late clocking back in, and...did that mean that when they came back they would get the rest of their lunchtime (on the clock)??? Regardless of where they are, that is their time. So, I am a little perplexed, and not to be rude...but, when you got done dcing the pt, what was your next chore that you couldn't walk them to the car? :confused:

This is not the point. The point is that the CNA was asked to help the nurse and made excuses to do so. When a subordinate is asked to help, unless they are in an emergency situation, they should stop and help. I find that CNA's are reluctant to do alot of things for RN's especially if it interferes with lunch and smoke breaks. Unfortunately, the only one you can depend on is yourself and hopefully you get a good RN co-worker that will help you when you need it. This CNA should have been reported and written up.

Specializes in Geriatrics, Med-Surg..

That is certainly not good if these CNA's are just saying flat out "no" to your requests. I would have spoke to that CNA about saying no to you when you ask her to do something. The CNA could have even said, I'll check on the res. in the washroom and quickly get her back to bed or her chair so that the dc'd res could be walked to the car, but to just refuse, uggh! Typical though.

no one has a right to interfere w/another's lunch break.

it is their time and their time only.

as for the cna who was waiting to finish toileting a pt, you could have either asked her to assist the pt to the car afterwards, or if able, to do it yourself, or asked someone else.

in times of actual insubordination, follow your p&p.

some places it starts w/a verbal warning:

other places, starts w/written warning.

best of everything.

leslie

Specializes in Community Health, Med-Surg, Home Health.
i am a young charge nurse in a facility... everytime i ask them to do something like one example...

i was dcing a pt. pt ask if someone could help them go to the car.. i asked my cna to help them to the car she said no im busy while just standing in the hall way saying shes waiting for the pt to finish up in the bathroom is this right? and sometimes in lunch time they come back from lunch early and just ask them to assist a resident and they tell me their on lunch.. i mean wth?? a resident needs help... is that an excuse to not help them?

I am only able to respond based on what you said, but I am thinking this way:

1. The CNA waiting for a patient to finish toileting-did you offer to be the one to take the patient off? If not, and she abandoned the patient and there was an injury, she would have been blamed. I think she was looking out for the patient's safety until or unless she was able to endorse the care to someone else.

2. Coming back from lunch early just may mean that they went to pick up their lunch and go to the lounge to eat. Is there a schedule that says that someone else is responsible for that assignment until they return? Did anyone offer to allow compensation for shortening their lunch-like can they leave early that day or before the pay period is over?

I ask these questions because I remember two incidents that happened when I was a CNA. One was an alert and oriented x3 patient with a broken hip. He has a urinal at the bedside, but he wanted to go to the bathroom to make a bowel movement. No instructions to keep him in bed. I took the patient to the bathroom and waited for him. Meanwhile, breakfast is served, I am supposed to be in the dining room to help feed. RN supervisor comes to the floor and demands that I be in the dining room. I tell her about the patient on the toilet. She yells "You are SUPPOSED to be in the DINING ROOM" and offered no solution for the patient on the toilet. I knew better than to leave this man because of the broken hip so, I stayed there. I knew that I would be in trouble if I had left.

Situation #2- Another CNA has an assignment where she has two male room mates. They are alert and oriented x3, but comprehend Spanish better than English. She puts one of them on toilet and goes to lunch without telling the relief person she left. Patient falls off of the toilet, has a seizure and hits his head. CNA blames the relief person, but the relief person reports that she did not know that the girl left, or that one of her patients is on the toilet. CNA #1 was wrong, I believe, not so much because she went to lunch, but she should have alerted someone else and better yet, not place this person on the toilet until that patient was endorsed to another responsible person.

You, as the nurse, have to come up with a solution that provides patient safety, and maybe someone else could have been assigned to escort a patient to the car. I can see a nurse not being able to leave the area, especially, if she is the only one. But, you have to consider how to cover for situations or pitch in when needed.

Specializes in ICU, CCU, Trauma, neuro, Geriatrics.

pagandeva, nice overview. Nursing assistants are responsible also about patient safety and if a nurse takes them away from a patient in a safety issue the nurse needs to provide supervision while that person is away. The nurse is ultimately responsible for patient safety and you need to provide for that safety when you redirect other ancillary staff.

This is not the point. The point is that the CNA was asked to help the nurse and made excuses to do so. When a subordinate is asked to help, unless they are in an emergency situation, they should stop and help. I find that CNA's are reluctant to do alot of things for RN's especially if it interferes with lunch and smoke breaks. Unfortunately, the only one you can depend on is yourself and hopefully you get a good RN co-worker that will help you when you need it. This CNA should have been reported and written up.

My point EXACTLY, was, what was the nurse doing after dcing the patient that she was completely incapable of walking the patient to the car? Did she have another pt in the bathroom? Was she not back from lunch yet? Or is it not 'her job' to walk the pt to the car?...regardless of how you feel about CNA's, her "excuse" was not that, it was a response of fact...one WAS waiting on a pt in the bathroom, and the other WAS NOT on the clock.

I agree with a lot of the comments above. I don't see the CNAs as wrong in these cases. The CNA was right to say no as she was waiting for a patient. If you wanted her to walk a different patient out to the car you would have needed to replace her outside of the bathroom. God forbid the patient fell and no one was there to help them you can imagine the liability issues. This CNA showed good work ethic here.

If your CNAs clock out for lunch they shouldn't be helping patients at that time. If something happens to the employee they might not be covered under WC or hospital insurance as they weren't technically working at that time. That's a crapstorm no one needs.

If you had an urgent need ask them to clock in and come back early with the promise to make the time up to them later that day.

Specializes in Community Health, Med-Surg, Home Health.

The OP did not say anything in her post that these CNAs were consistently insubordinate or spiteful. The post seemed to illustrate to me that 1. a patient was on the toilet, which, meant that the patient should be supervised, and that 2. CNAs on break being asked to care for a patient when there are usually staggered breaks and reassignment of responsibilities to cover those patients that are not being observed at that time.

I can't speak for other facilities, but mine is very funny about nurses leaving the floors themselves if there is not another licensed person to cover. Or, if the other nurse is an agency employee who is not as familar with policy and procedure in case of an emergency. Therefore, I can see if the nurse could not leave the floor herself, but that someone else can go and escort a client to the care (another issue of safety that the nurse is responsible for). In fact, at my hospital clinic, if a patient is unstable and has to be escorted to the emergency room, an LPN will be sent with that client, and the RN will remain on the floor unless the situation is extreme.

At the moment, this shows me that a discussion of safety, teamwork and roles should be discussed amongest the unit before writing people up occurs.

Oh, and just to comment on the fact that you hope you have another good RN-coworker to help you....

I'll just throw in my :twocents:...I was working Friday, night shift, and went to walk a pt to the restroom. She got out of bed, took 3 steps and collapsed...completely out. The way I "caught" her, I could not get back up without injuring her leg. I screamed, and I mean screamed "Help, I'm in XXXXX's room" MANY times, at least 6. After about 3 minutes, another CNA from the front of the building came running, and the nurse that was sitting about 4 doors down at the nurses station, finally came in behind the 2nd CNA and said, "oh, I thought that was so-and-so yelling" (another resident) I looked at the nurse and said I don't really care who you thought it was, when someone is screaming like that, you need to find out why!!!!! So, it's not just the CNA's, and Im not 'one of those' CNA's. Im one of those people who will stand up for the CNA or the nurse, whomever is right!

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