Management question - page 2

The supervisors at my long-term care facility are getting rather frustrated with the lack of respect given their authority by the Certified Nurses Aides. A supervisor will tell an aide she needs to... Read More

  1. by   Kayzee
    I have to agree that mgt. needs to make a stand. I have worked with some excellent CNA's, and I have also worked with those who have bad attitudes and are plain lazy. Everyone is afraid of losing their help. Changes have to be made from the top and followed through. I've found it's very hard to change things when they have been running the floors for so long. Many nurses are afraid to even speak up to some of these people. Sad....if everyone would just do their job and drop the remarks and attitudes, things would run so much more smoothly.
  2. by   canoehead
    If you believe you are right then call their bluff, but make sure they don't have any valid gripes about patient care before you do it. Compromise if possible, perhaps more training will make them more willing to take an unwanted assignment. If you want to keep someone as an employee make sure you give them a graceful way to back down too.
  3. by   ChainedChaosRN
    I don't believe unsafe nursing care was an issue in the original post. It was staff refusing to take an assignment because they didn't want too...that's what I was responding too. That's what I was dealing with.

    A nurse refusing a directive because of believing it's unsafe is a different ballpark. BUT...If we are talking short staffing..a nurse refusing to work and walking off...I'm not sure that would even look good in union arbitration or with any board of nursing.
  4. by   debRNo1
    Originally posted by VickyRN
    I have worked in one or two facilities in which the CNAs actually DID run the facility. It was an upside-down world. You dared not complain about it or make waves. The CNAs would disappear, goof off, or, actually try to boss the nurses, while the nurses were running their bottoms off all shift long. Management always sided with the CNAs.
    Sounds like where I worked for 8 years. It was a backwards, upside-down, bizzarro world where the CNA's ran the show and the nurses had no control over anything !! I did speak up and I did make waves because it was the residents who suffered......

    I had the unfortunate task of doing staffing for the AM shift and Ive had my share of run ins with CNA's who refuse to take a certain assignment, play with the schedule, and take charge over the nurses, boss them around, threaten to leave. I once had a CNA who wanted to complain/gossip to me tell me to "get a witness" for our conversation !!! Role reversal perhaps

    In my case management usually sided with the CNA (who got no more than a slap on the wrist) and a no nurse but me would go to the extreme of sending them out the door. Refusing an assignment or a task that is fully within their scope of duty IS the definition of insubordination. Somebody HAS to be in charge and these CNA's resented that because THEY wanted to be in charge and run the facility. Most nurses were afraid and let them walk all over them. They broke into the office and looked up everyones rate of pay. Then made a stink and hollered about why the 3-11 supervisor made more than me !!!! bizarre and scary.

    They would come in early, get hold of the schedule and "fix" it so everyone was where they wanted to be-nevermind the good of the facility we had to cater to selfish, spoiled and lazy staff.The first time I sent someone home was a big to-do. We changed some assignments and I asked them to re-arrange acct. books. The loudmouthed leader of the pack instructed them that it wasnt in their job responsibility and began tossing the books around. After much wasted pt care time I asked, "who is refusing ?" They all knew what my next request would be and the big mouth replied YES and the others kept their mouths shut.
    PUNCH OUT AND LEAVE I told her...... The rest ran after her to the clock and CRIED "dont leave".

    The funny part was it was ME they would come to with a legit problem and I always backed them when push came to shove. Whats right is right and I was able to get many asses out of the sling where they didnt belong. I felt that I was fair and always treated them with the respect I thought they were due. I always thanked them for their hard work at the end of the shift, THEY are the backbone of the facility.

    I resigned in Dec and left LTC after ten yrs. My next to last day was A nightmare, they played with the schedule and when I arrived I found "my" unit to be usafely under-staffed while the other was fully staffed with a lower census. As I tried to call in CNA's and rearrange the staff they began to refuse to come to "my" unit and the best was the nurses were backing them by making nonsense excuses !!!

    That morning made me confirm that resigning was my best decision. Of the mgt team I had come from "the floor" so I was accustomed to helping them with their work (when short) and many times I did pt care when we had no staff.

    I felt like I was on the JERRY SPRINGER show that morning, the hooting, hollering, and fist waving that went on was just too much and Im sure it made the residents frightened. They even got the DON as she walked in and chanted and hollering in a mob-like group. She later "spoke" with them just another slap on the wrist. They didnt care about the residents they were just spoiled and selfish. Always hollering about something unrelated to the residents care.

    When I handed in my resignation I was offered the ADN position.
    Thats what happens in the bizarro world !! NO WAY. I now work in acute care and have absolutely no regrets about leaving LTC. I am trying my best to steal away the handful of good CNA's to work on my unit at the hospital.

    The nurse who took my spot as "unit coordinator" resigned after 6 weeks. The 3-11 FT supervisor has left, the dietician and food service coordinator have resigned. They are soooo due for survey and I am soooo glad I wont be there this year for it.

    I have no regrets (I do miss the residents)and LOVE working in the hospital. Good luck to those who stay and survive in the backwards bizarro LTC facilities that exist. I had had enough.

  5. by   mattsmom81
    I agree that refusing to float for selfish, bytchy and lazy reasons is a bit different than refusing due to unsafe conditions or lack of orientation/knowledge of a unit. But we all also have to learn how to approach our supervisors properly...throwing books, grandstanding, etc. is unacceptable for anyone.

    When I was a hospital supervisor our written policy, agreed upon hiring, was that CNA work was generic and they were EXPECTED to float. Refusal was grounds for termination and we did utilize this as a warning.

    I agree bossy insubordinate staff can be dealt with by supervisors who stand their ground, but they need support of the managers ..who must be willing to put up with complete turnover of the offending staff. Many managers are reluctant to terminate in today's shortage, so I agree offensive coworkers feel empowered by this.

    On the other hand I see units abuse their CNA's and expect them to do an unfair and inhumane amount of work...which needs to be brought to management attention and be dealt with fairly if we are to keep our good CNA's.
  6. by   mother/babyRN
    Refusing to do something like staffing when someone in charge determines you must float, is grounds for dismissal in many places. I am not saying one shouldn't put forth the case for not doing so and even pursue it, tell the supervisor of your displeasure etc., but where I work, if you just flat refuse, you can be suspended right then and there, with a warning and then dismissal if that continues...
  7. by   tinkagain
    I believe there is a huge difference between voicing concerns and insubordination. When a boss tells me to do something, I might ask if there's a better way, or let him know that I would "prefer" not to, but I would only refuse if patient safety was an issue.
    I once asked an employee to do a task and she folded her arms and said "Well, I'm not going to".
    I took her aside and explained that it was okay to tell me if she didn't want to do it and why, but it was insubordination and disrepectful to talk to me the way she did. I also informed her that insubordination was grounds for immediate termination. I also explained the concept of "communication" and that I was not a mind reader and had no way of knowing that this particular task was onerous to her.
    I treated her with respect and manners and she learned to communicate very well with me once she knew what I expected from her.
  8. by   tinkagain
    Oh, and another thing. Here's what I have found that works in terms of the disciplinary process. Follow through!
    First, your team members need to know exactly what the rules are even to the finest details, i.e. no tongue studs, no talking on cell phones while working, no blue jeans, etc...
    Then they need to understand the disciplinary process in place.

    First issue : Verbal Warning
    Second issue: Written Warning
    Third issue: Termination

    If you use the disciplinary process with the team members that you are managing consistently and fairly, you won't have as many complaints. Worst thing you can do is say there'll be consequences, then not follow through.
    Worse yet is to discipline one employee for something and not the other. You must stay consistent and fair. No one can argue with that.
    Finally, if you don't have a written and signed discipline form, it never happened. The one with the most documentation wins.
  9. by   renerian
    Sounds like someone needs to be disciplined especially since the super already tried talking. I personally would follow my P&P. I would have been canned for refusing to float.

  10. by   debRNo1
    Originally posted by mattsmom81
    Many managers are reluctant to terminate in today's shortage, so I agree offensive coworkers feel empowered by this.
    well said

    This behavior does empower these staff members and it just seems IMO to make matters worse in the long run. My DON who I once HAD the uttmost respect for had worked at some rough facilities prior to joining our "team". I was so glad when she came to take over and felt that soon all would be good. Unfortunately I lost respect for her rapidly as she let the worst of the worst get away with murder. She practically rewarded bad behavior which re-inforced it. I know for a fact that CNA's would laugh outloud when they got away with something like out and out insubordination.

    Follow thru is essential and she had laid down the law upon her arrival and at the top of the list was congregating/chatting, cell phones and many of the basic things NOT to do while
    on "duty" :imbar The staff took great offense to what she said. I was left to re-inforce her rules and she wouldnt back me when it came time for discipline. It will never work.............

    Some places are worse than others but I truly feel this is one of the worst ever. A particular CNA who in the past has been accused of "fixing" her time card to the point of forging a nurses initials is still there. The employee handbook clearly list what are grounds for IMMEDIATE dismissal and fixing the cards or punching each other in and out when not in the building is certainly a NO-NO as is insubordination !!??

    I heard-The other day this CNA left the builing to cash her check and pay her mortgage (nice huh) While she was out (her) residents daughter C/O her mom completely COVERED and DRIPPING with vomit and feces. (nice way to find your mom)Charge nurse ignored the womans pleas for assist as she talked on her cell phone and didnt even check the resident, daughter had to see SW and administartor for help !!! Another CNA finally had to come clean her up while the one assigned to her was out of the building for 2 hours doing her personal business and getting paid for it !!!!

    Couldnt this be neglect on the part of the CNA and the charge nurse ???? Again- Im so dam glad Im out of there.

  11. by   tinkagain
    Sounds like elder abuse to me.
  12. by   blondie
    Thanks for all of your responses. The best suggestion seems to be the verbal warning; written warning; termination--all done with fairness and consistency.

    The aides do have a tough job, and there are plenty of good, underpaid, underappreciated ones out there. I have been known to back them when they are right, but there's a time and place for disagreements. I was not suggesting threats as a form of management, but thought that if the aides knew of the possible consequences for their actions, they might decide for themselves to do the right thing. How many times have we been at the end of our rope and not thinking we could possibly handle one more task, then we stop and think of the worst-case scenario, with ourselves on the witness stand, and decide we'd better find the strength to do the task, anyway?

    BTW, I found the website for our state department of health--they license the aides. You have to do something pretty drastic to lose your license. Leaving someone unattended who is supposed to be under constant supervision is considered a minor offense, and is handled thru monetary damages and reprimand. Hard to believe, huh?!