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.

[All_night]

As a CNA, I have never said "no" to any delegated task. However, I will ask the RN to help me if they can when the task requires 2 people or if I'm worried about patient safety. I don't understand how CNAs get away with hiding and avoiding work altogether. Please stop grouping all CNAs into a group of inferior, lazy, thank-you-seeking people. The fact is, they do a lot for about 1/3 of your RN pay.

[Persephone Paige, ADN]

I guess I feel like we, as adults and health care professionals, know what our jobs are. I know that when I come to work in a clinical setting, I will need to do report, meds, labs, assessments, vitals, answer call lights, do skill related tasks and whatever comes up during a shift. I've seen nurses have to run other nurses down to give/get report. The oncoming nurse is ready to get started, or the offgoing nurse is ready to leave. Yet, it's still an issue. We know this is a part of the job and forcing another to chase, remind, rundown, etc... is a form of aggression. We don't have eyes in the back of our heads, we can't be two places at once. If I'm in the room and able to assist the patient, I'm not going to call a CNA away from whatever she/he is doing because I don't want to deal with a bedpan or bathroom assist. But, if I am constantly have to ask, remind, suggest, it's aggression I'm dealing with. And, for my sanity, I've chosen not to deal with it. Not to have to ask, because I'd rather do it myself then become resentful. That's why I know my reasons have nothing to do with being above the task, too good, etc... I'm happy to do it all in a setting where the nurse/patient ratio is safe and manageable.

[Dawnkeibals]

I haven't mastered the quote feature yet, but I will figure it out eventually, hopefully.

[Wannabenurseneko]

What i say will not be liked ,but if I was the nurse in this situation I would of written up for insubordination, except for the two CNAs who's shift was over and the one with the bad patient ( I think we could work together on dealing with that patient ) . It's not like they were busy doing other tasks they were sitting there doing nothing, when they were supposed to be working ; If the people at the top decided to do nothing about this I would start looking for another job, because when your tasks doesn't get done you will be blamed for it, the CNAs can't do your tasks or help you with such as med pass since it's out of there scope of practice .

[Wannabenurseneko]

As a CNA, I have never said "no" to any delegated task. However, I will ask the RN to help me if they can when the task requires 2 people or if I'm worried about patient safety. I don't understand how CNAs get away with hiding and avoiding work altogether. Please stop grouping all CNAs into a group of inferior, lazy, thank-you-seeking people. The fact is, they do a lot for about 1/3 of your RN pay.

I honestly don't get how they are able to get way with that either , I can understand if you're on break , or currently taking care of a patient . I have actually witnessed this once during my hospital clinical ;At least she was the only one, but it shocked me that she was hiding and everyone had to go looking for her .

[Neats, BSN]

Your systemic problem will only get worse. I would require/mandate all C-NA to have another in-service/training about residents rights and about responsibility for the N-AC, ensure each attendee signs a attendance form and place in their employee file. I would also require random C-NA to attend at least part of the multi-disciplinary team meeting. Care plan with the C-NA together for they will be implementing this plan. I would also encourage/mentor the charge nurse and other licensed staff... helping them find their managerial balance. I would also place similar form in their file.

This is the thick of insubordination and I would not tolerate this from my licensed staff why would I tolerate this behavior from my certification staff. I would not tolerate this from anyone... period.

There are ways to correct bad behavior without compromising/neglecting patient care and this is one example where the patient is truly being neglected.

If your leadership does not listen then I would quit immediately.

[leilo0, BSN, RN]

Too many reasons why our working standards are below par compared to other healthcare professionals and I wonder how we got to this. I see PTs and OTs work with assistants that are exclusively assigned to them and they never work with patients alone while we on the other hand have to struggle for help because there isn't any or someone just doesn't want to do the job.

[Garden,RN, ASN, RN]

I agree with you 100%. With the excuse of "teamwork" the overlap of duties creates these types of situations. We are expected to put our licenses out there and be responsible for the actions of others weather we like it or not. We should not be responsible for the ADLs, it really doesn't make sense any more. It would be better that they hire enough support staff to begin with and if nurses are going to be truly supervising they should not have to convince or beg the staff to do what they were hired to do.

[kbrn2002, ADN, RN]

Interesting responses. I can mostly tell by the responses which nurses, like myself, work in LTC. Of course I can't speak for all nurses, but for the most part we are more than willing to help where we can. The problem is when we start becoming too helpful with tasks the CNA's need to be doing we can't get our own work done.

I am passing meds, doing dressing changes, managing diabetics, doing respiratory treatments and tube feeds, calling family members and doctors, making appointments, taking and processing orders, etc. Then I still have to do all the charting that goes along with that for 24 residents. The CNA's I work with can do none of these things. Yet I am still expected to add answering call lights, helping residents to the toilet, fetching drinks and snacks, dropping whatever I am doing to help boost a resident to my already overwhelming workload.

I am not at all saying the CNA's aren't pulling their weight. With very few exceptions our aids are wonderful, dedicated and hard working. They run their behinds off the full shift and truly do the best they can to provide excellent care to our residents. It's just that not any of us can be in two places at once and it's sometimes just not possible to meet every residents wants the second they ask. The immediate needs come first, for those less pressing wants it's usually "take a number and wait in line" and we get there when we can.

[cjcsoon2bnp, MSN, RN, NP]

Interesting responses. I can mostly tell by the responses which nurses, like myself, work in LTC. Of course I can't speak for all nurses, but for the most part we are more than willing to help where we can. The problem is when we start becoming too helpful with tasks the CNA's need to be doing we can't get our own work done.

I am passing meds, doing dressing changes, managing diabetics, doing respiratory treatments and tube feeds, calling family members and doctors, making appointments, taking and processing orders, etc. Then I still have to do all the charting that goes along with that for 24 residents. The CNA's I work with can do none of these things. Yet I am still expected to add answering call lights, helping residents to the toilet, fetching drinks and snacks, dropping whatever I am doing to help boost a resident to my already overwhelming workload.

I am not at all saying the CNA's aren't pulling their weight. With very few exceptions our aids are wonderful, dedicated and hard working. They run their behinds off the full shift and truly do the best they can to provide excellent care to our residents. It's just that not any of us can be in two places at once and it's sometimes just not possible to meet every residents wants the second they ask. The immediate needs come first, for those less pressing wants it's usually "take a number and wait in line" and we get there when we can.

I don't work in LTC but I have a deep respect for those who possess the skills and disposition suited for that setting because I do not. My experience in LTC is limited to what I saw in nursing school and briefly as a CNA before I worked in a hospital setting. I think that what your talking about is appropriate delegation and good time management and that is exactly what we should be doing. I want to be clear that I have no issue with nurses delegating tasks to CNAs and working as a part of the team.

The issue I have is there are certain nurses who NEVER have time to help clean/toilet their patients or get their own vital signs and always need to have the aide do it for them. I know nurses who flat out say "I didn't go to school to spend my life wiping *** all day". When I was a staff nurse and I saw this happen I would see that these nurses tried to justify this by saying how far behind they were with charting or doing XYZ task but then they would go back to doing something not related to work (surfing the web, using cell phone, chatting at the desk) while other people were running around busy. I'm a big fan of the "if it's too busy for one person to sit, then no one should sit" rule. Obviously some nursing tasks like charting, taking orders, and making appointments require sitting but many times the "I'm so behind on charting" excuse is used and it's a cop out. The point about this post is knowing what your job is and being a good team member. If you put yourself out there and go the extra mile to be a good team member then it's easier to get other people to do the same for you, even if it means you have to remind them sometimes.

For me when the OP said she had to involve the manager for this matter it shoots up a red flag that this is part of a bigger issue. The CNA(s) involves need to be spoke to about their role, professionalism and job responsibilities. As the nurse manager I would speak to the nurse to determine why she felt this needed management level interventions. It seems like it was escalated quickly and makes me wonder how she interacts with the CNAs on a regular basis if they are refusing to help her.

!Chris

[nursegj]

This is a pet peeve of mine, nurses working in silos. That's what this sounds like. There are a couple of problems here. First, the RN was IN the patient's room when he asked to go to the restroom. So she had to LEAVE the room, go to the nurse's station to ask the CNA to help the patient. She was IN the room! The time it took her to go get the CNA, she could have taken care of the patient's needs herself. Secondly, since she did go to the CNA for help and the CNA refused, I would have suggested that we do it together (teamwork). I would talk to the supervisor about the patient's inappropriate behavior toward the CNA. This way, the nurse shows she's not "above" doing the dirty work and the CNA feels supported.

[Nunya, BSN]

Her job at that time was passing meds, which a CNA cannot do. I think it's good that you're a FORMER DON.