Multiple CNA's refusing assigned task

[Dawnkeibals]

I'm looking for input on how you would handle a sutuation. There are 5 CNA's assigned to the unit they are also assigned halls.

The CNA assigned to the hall I was working had just left to take a lunch break. I went in to give a patient his medication and he told me he needs to use the restroom. I came out of his room and asked a CNA SITTING at the nurses station to help the patient go to the restroom. She responded with "No, I'm not going in his room, he is mean and ran me over in his W/C, he kicked me last time I was helping him." So I asked another CNA standing near the nurses station and she said "sorry I'm leaving". She was scheduled to leave at that time. Then one other CNA starts to walk by and I ask him. He also refuses. I was ready to scream.

While I understand that I am also capable of helping the patient to the restroom, I feel like if I am in the middle of med pass and there are CNA's literally sitting down that I shouldn't be the one toileting him. I always read the advice about time management on here saying "stay on task, delegate tasks that others can do, avoid interuptions while doing med pass".

I ended up calling the unit manager and a CNA ended up helping the resident but I fell like I could have handled the situation differently. By the time all of it was said and done I could have toileted him, but if I start doing anything they don't want to do they will let me do everything. I am sure of that.

[Kitiger, RN]

Well, alright, then, Kitiger!

If you want to be all ethical and morale about the whole thing!

Sorry. I just couldn't resist. I debated whether or not to post it ... but I just couldn't resist.

[Davey Do]

I would assign this task -- not ask. Doing one's job isn't optional, and refusing is called insubordination.

You know, Here.I.Stand, I agree and have written up a couple of techs for insubordination after informing them, "You will have to deal with the ramifications of your actions or inactions".

But I've also found that all it takes for some subordinates is a little push. And I know you know this: You can catch more flies with honey than with vinegar...

"Maybe I shouldn't be butting in here, but you can catch the most with dead squirrels."

-Woody Boyd

[Davey Do]

Sorry. I just couldn't resist. I debated whether or not to post it ... but I just couldn't resist.

I am such a delicate flower, but I understand...

I left this one for you, also:

Well, alright, then, Kitiger!

If you want to be all ethical and morale about the whole thing!

[KelRN215, BSN, RN]

These sound like the CNAs I used to work with and they are an example of why I'm glad to have not worked in an environment that employs CNAs for the past 6 years. I'd have just done it myself because I know I could have it done and be on to my next patient in less time than it would take me to fight with the CNAs about doing it. Of course that doesn't solve the root problem but if the culture of the unit is such that CNAs can behave this way with no repercussions, that's something that needs to be addressed by leadership. When I worked in the hospital, in our new grad program I specifically recall being warned about the "career CNAs." On some floors, they were all like those described in the OP. Ours would hide in the locker room and play on their phones all day. When people complained, we got told "that's just how they are."

[QuietIsntAWord]

I have formed a very good relationship with my CNA's, if I ask them to do something not on their assignment, they know I really need the help. I've not had to write anyone up (yet) due to this. They know I will do anything I can to help them out if I have time. I even empty trash and pull bed covers down when I'm not busy. It's all about teamwork, if they feel like part of a team then they will act like part of it. Unfortunately, you get a few bad apples that are just actually lazy.

[Kitiger, RN]

I am such a delicate flower, but I understand...

I left this one for you, also:

Quote from Davey Do

"Well, alright, then, Kitiger!

If you want to be all ethical and morale about the whole thing!"

Oh, my goodness! I'm going to have to turn in my Grammar Police badge!

It was such a pretty, sparkly one, too.

[KatieMI, BSN, MSN, RN]

That being said...

I saw more than once CNAs being abused by patients for quite a while without anybody else noticing it. In quite a few such cases, patients "behaved" and controlled themselves with nurses because they knew too well that RNs, not CNAs, hold those eagerly expected syringes with dilaudid and it also was up to nurses, not CNAs, to reach to doctors and report their behaviors. Those patients appeared to smell the lack of communication between staff like hunter dogs and they knew more about ways the hospital worked than the majority of staff employed there. They thought, therefore, that it was safe to abuse CNAs who, in their turn, had no idea what to do and in any case had the "customer service" stuff pushed down their throats for too long and were afraid of being fired if they had complained.

I cannot be sure that it could be similar case, but I started to speak with CNAs in private after a few of such "experiences" before heading toward the management's office. CNAs, too, can know things I have no idea about and without which the puzzle of "Mr. John Johnson from 567/1" just doesn't click together. It can be worthy to spend a few minutes with them before crying "insubordination".

[djh123]

And I thought *I* had had some bad ones at times. I guess maybe I had someone refuse something once or twice, but as a rule, no. But regardless, I was too lenient - with the not-very-good ones, that is - in my previous job. I think you have to set expectations up front, which I'll do in my new job. I probably wouldn't be this 'hard' about it, but a co-worker said she told her CNA's when she started that "I can be your best friend or your worst enemy", and went on to lay down a few rules/expectations.

[Persephone Paige, ADN]

I am currently seeking employment and the jobs I have applied for are ones where I could survive without a CNA. I graduated in 1990, it was rare that a CNA would deliberately refuse, but still happened often enough. It has become a factor in my work environment choices for my entire career. Depending on the type of institution, if I require the cooperation of a CNA to keep from having a disastrous shift, I won't work there. This may sound harsh, perhaps it is, but it's been my experience. I have a support group that I go to and the 2 LPNs who work in long term care are constantly frustrated. All the CNAs stay outside on the grass smoking, or disappear, or fall asleep on night shift. The administrative staff walk by them, are notified of them, are aware but for some reason it is not worth it to them to address the issues. The solution seems to be to just pray the nurse shows up for their shift. It's so awful for the poor old people, but I can't handle it. And the majority of the nurses I know feel the same way. I look for jobs where the patient to nurse ratio is manageable, because I am banking on having a dud for a CNA. Don't mean to offend, it's just my truth. And apologies in advance to all CNAs who show up prepared to work. I hope to meet you someday.

[cjcsoon2bnp, MSN, RN, NP]

This is such an enigma for nursing. No other profession allows the support staff to say no, nor do any other professions have, let alone condone, overlap in duties. The fact that ADLs are not the exclusive responsibility of CNAs belittles our profession. The problem, management encourages this.

I think that CNAs/techs have a role in the delivery of healthcare as do nurses (RNs/LPNs), advanced practice providers (MD/DO/NP/PA) and all of the other disciplines (pharmacy, social work, case management, psychology, physical therapy, occupational therapy etc.) and sometimes we have roles that will overlap between the disciplines.

I will respectfully disagree that the problem with nursing is that we have an overlap in duties and I am glad that ADLs are not the exclusive responsiblities of CNAs. When I see nurses in the ED running up and down the hall calling for a CNA to help toilet a patient or attend to some other ADL because they are "too busy" or have "too many other tasks to do" I find it frustrating. That is not to say that as an RN I didn't ask CNAs for assistance or delegate tasks to them but I believe that as the RN it was part of my role to oversee that the ADL related tasks where completed (either by the CNA, myself or together as a team) and some of that is related to time management. If I as an NP can stop what I'm doing to help to boost a patient in the bed or walk them to the bathroom then I think it shouldn't be beneath the LPN/RN to do the same.

Before I get a ton of frustrated/angry responses please hear me out...

1. I know that the majority of nurses don't believe that they are above doing these tasks but we all can think of a few people who fit the bill.

2. I also know that there are CNAs/techs out there who either don't enjoy their jobs, don't have the best work ethic or would rather rather do tasks that are in the scope of the nurse. However, I don't think that the majority of CNAs/techs are like that (at least that has been my personal experience).

3. I have been an RN for 7 years now and I found that when I took a few extra minutes to help my patients with these tasks myself and recruit the CNAs to work with me to get the tasks done (versus putting them all on the CNA) then it resulted in a better working relationship and better patient care. I also noted that the more I offered to help the CNAs/techs with the ADL-type tasks in the delivery of care to our patients then the less I would actually have to do it. On more than one occasion, I would go to get the supplies to put my patient on a bedpan only to see that one of the CNAs/techs ran into the room to do it for me just because I didn't always hunt them down and ask them to do that kind of stuff.

4. Over the years I have oriented new nurses and noticed that some nurses really connect well with support staff and integrate as part of a team while others really struggle to develop this skill. There are multiple factors that impact this but sometimes a bit of humility and a few well-timed gestures can really make a huge difference.

!Chris

[Dawnkeibals]

When I see nurses in the ED running up and down the hall calling for a CNA to help toilet a patient or attend to some other ADL because they are "too busy" or have "too many other tasks to do" I find it frustrating. That is not to say that as an RN I didn't ask CNAs for assistance or delegate tasks to them but I believe that as the RN it was part of my role to oversee that the ADL related tasks where completed (either by the CNA, myself or together as a team) and some of that is related to time management. If I as an NP can stop what I'm doing to help to boost a patient in the bed or walk them to the bathroom then I think it shouldn't be beneath the LPN/RN to do the same.

I do not feel like assisting patients with ADL''s is beneath me. I often assist when I know the aides are busy. Like I said in my original post, I was doing med pass and there was an aid sitting at the nurses station.

[EaglesWings21, ASN, RN]

I feel like something is broken in teamwork reading these comments. I already know this isn't going to be received well but even if the CNA or tech is the subordinate we are all on the same team and providing quality patient care should be our goal. The CNA is the non professional. It is up to the nurse to act like a professional. Ask the CNA to give examples of the patients bad behavior and address it. If this is a pattern of behavior address it with the CNA directly before going to management. Above all else work together as a team. ADL's should never be below the nurse. I'm kind of hurt that some people feel they are.