Multiple CNA's refusing assigned task

Nurses General Nursing

Published

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.

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.

Curious to know when the last time this nurse toileted a disabled patient who uses a wheelchair? Certainly I hope one understands by the time one transfers a person from bed to a wheelchair, and then from wheelchair to toilet takes significantly longer than stepping out of the room to request assistance from a CNA, SITTING at the nurses station. Maybe your nurses station is REALLY REALLY FAR away from patients rooms or you are really fast at transferring disabled patients. If you think the two take the same amount of time.

1 Votes
Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.

I've been nursing a long time and after experiencing a bazillion shifts running my a** off only to see support staff sitting and shopping online, reading books, playing on their cell phones...I'm sick of it. I should not have to 'baby' other working adults and I should not have to prove to them that I'm 'really busy' so they will do the job they are paid to do. I respect those with a good work ethic. I'm reliable and friendly. But I will not enable another adult. I'll help when I can, but DO NOT tell me "no" while playing on your phone. I won't argue about it and for the patient's sake, I'll take care of it myself. But I will report it and will lose my respect for them.

I have stayed overtime many, many times making sure the patients get excellent care, but I very rarely see support staff do so. I do not think that it is too much to ask someone to do their job.

And since I'm on a rant, I'm sick of the nursing mindset that we are martyrs. Anything that another healthcare provider doesn't want to do becomes the nurses responsibility. Seems the only ones held accountable are the nurses; not transport, not dietary, not EVS, not radiology, not CNAs, and management encourages it. Reality is that one person (the nurse) cannot do everything by themselves. If management wants it that way, then decrease the patient ratios so nursing is able to do it all. Otherwise, hold ALL staff members responsible for their job duties.

Everything you said is true, but what would happen if the RN's and/or LPN's just start saying no? Hmm. It would not be tolerated and could even end up with licensing actions. I don't know of any job where you can just say no. It happens all the time in with CNA's that think that nurses are doing nothing. Nevertheless, all that you and the patients are expecting from them is for them to do their jobs, something known as adulting and this is a temper tantrum. Nurses should not be enabling this behavior.

This sort of behavior is in all types of employment. And the corporations are instructed to hire an underdog, a single parent, someone with a disability, etc... to prove that they are about lifting people up. I am for that and it's always refreshing when the employee is a keeper. This does happen on occasion. So often tho, they show up ( like that deserves a reward ) and pick and choose the tasks they want to do. They feel they are doing the corporations a favor by being there. And employers put up with it so they can say, "see, I'm compassionate. Look who I hired..."

My husband is not in healthcare, when faced with this he was shocked. He'd never come across a worker who was truly stupid ( but hired anyway, while other qualified applicants were overlooked ), or completely unmotivated ( but allowed to stay on anyway ). For a while, not knowing how to relate to this sort of situation, he took on the extra work. Then, after a while, he became resentful and stopped. Then, he began to hammer and make fun of the administrator for allowing this employee to run over everyone in the entire office, call in repeatedly ( and still somehow think she was entitled to a paid two week vacation ), refuse tasks or claim that after two years of repeated instruction she still didn't know how to do a task. The list goes on... I guess my point is that this does happen everywhere, nurses just don't have the leisure of allowing the patient to sit in soil while the CNA get's reprimanded. TIME... If time is on your side, you can hunker down and fight back. With time working against you, you have to cave. There must be another avenue to pursue this effectively.

Specializes in Mental Health, Gerontology, Palliative.

"This needs to be done"

If they still refused.

"This needs to be done. If you choose not to do your job, I'm going to have to elevate this matter to management and I would really rather not"

I once had an aide having a melt down on shift who told me she was going to walk off shift before it concluded. I said honestly "hey look, I get this is distressing for you, if you choose to leave before your shift is finished I am going to have to elevate the matter to management which could result in displinary action, or even worse you loosing your job"

The aide stayed and finished her shift

Its important to keep a very neutral tone of voice and to not let your frustration show, even though you may have every reason to be hacked off

1 Votes

You were correct, you had to focus on the med pass. CNA's work under your direction.

Too bad that it escalated to the supervisor, but now they know... you're not fooling around. Good job.

1 Votes
Specializes in Critical Care; Cardiac; Professional Development.
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.

Goodness I get very tired of this mindset. This is NOT ACCURATE at all. Even if the patient were not requiring a wheelchair, we all know that many patients have mobility issues. They are connected to telemetry and IVs and SCDs and wound vacs and chest tubes. They frequently move very slowly. Often they need a walker plus assistance, both sitting down and getting up. Some insist on wearing underwear, which must be gotten up and down without a fall. Many times they are soiled - gown, underwear or skin or all three- and then they need clean up. And then need help washing hands. And then maneuvering all the equipment again and slowly turning around, negotiating the distance back to the bed. IV plugged back in. Chest tube arranged properly. SCDs hooked back up. Telemetry pads may need adjusting or replacing. Wound vac resecured. Then the bed and pillows adjusted, blankets arranged, the snacks or drink procured, TV station turned, personal items replaced or fetched or looked for then fetched then placed, then questions and small talk, boosted up in bed after which documenting the output.

No, it is NOT faster to just do it ourselves, even if already in the room, when in the middle of a med pass....or someone is waiting for pain meds........ or someone needs meds to bring down high BP... or a family member is waiting for an update... or orders need putting in/acknowledged..... or a lab sample drawn and sent... or a physician needs to be called... or someone needs escorted down to CT/MRI... or an admit is coming... or a discharge is pacing and waiting to go... or charting needs to be done... or just plain review of the patients we've been assigned to make sure we aren't missing anything....or team huddle is happening and we need to go report off.... etc etc etc etc. The norm is several of those all going on at once.

We won't even bring up our own need to pee or grab a bite to eat and check on our kids. We'll just leave the RNs personal needs out of it. Heaven forbid we are seen sitting down after asking a recalcitrant CNA to do. their. job.

I don't want to hear this argument anymore to be honest. It borderline infuriates me for the dismissiveness of it. Yes, a nerve has been hit here and maybe I am just tired but honestly, just tired of this sense that we can be everywhere at once and liable for all of it. Taking care of people is time consuming. Taking care of the elderly, the sick, the injured is TIME CONSUMING. It isn't like the people in room wanting to be toileted are going to bounce right up, do their business and bounce right back to bed! If they could do that chances are they would not be in the hospital in the first place.

That is why the CNAs are there. To do the stuff the nurse can delegate so the nurse can do the stuff only the nurse can do. It is literally why CNAs exist in patient care. Get rid of that and CNAs are no longer needed. If a nurse has nothing to do, fine. He/she should absolutely take care of it and most of us DO. But usually...the VAST majority of the time... that is NOT the case. The willingness to look away from all we are responsible for because we want someone else to do their job so we can do ours is just...maddening. Not one nurse should have to "prove" they are busy, even if they were "already in the room". It simply is not true that one can toilet a needy patient faster than task it. Nursing is busy as heck to the point of insanity many days. I think we can all just plain concede that at this point. Don't shame us for needing help, especially when people are getting paid to provide it.

Don’t be that nurse!! Honestly, taking someone to the bathroom is not going put you behind on a med pass. If it does sounds like you need more training.  We seriously had RN that refused to even stop get a patient juice and none of techs  wanted to work with her. 

On 3/12/2018 at 9:12 AM, Nurse SMS said:

Goodness I get very tired of this mindset. This is NOT ACCURATE at all. Even if the patient were not requiring a wheelchair, we all know that many patients have mobility issues. They are connected to telemetry and IVs and SCDs and wound vacs and chest tubes. They frequently move very slowly. Often they need a walker plus assistance, both sitting down and getting up. Some insist on wearing underwear, which must be gotten up and down without a fall. Many times they are soiled - gown, underwear or skin or all three- and then they need clean up. And then need help washing hands. And then maneuvering all the equipment again and slowly turning around, negotiating the distance back to the bed. IV plugged back in. Chest tube arranged properly. SCDs hooked back up. Telemetry pads may need adjusting or replacing. Wound vac resecured. Then the bed and pillows adjusted, blankets arranged, the snacks or drink procured, TV station turned, personal items replaced or fetched or looked for then fetched then placed, then questions and small talk, boosted up in bed after which documenting the output.

No, it is NOT faster to just do it ourselves, even if already in the room, when in the middle of a med pass....or someone is waiting for pain meds........ or someone needs meds to bring down high BP... or a family member is waiting for an update... or orders need putting in/acknowledged..... or a lab sample drawn and sent... or a physician needs to be called... or someone needs escorted down to CT/MRI... or an admit is coming... or a discharge is pacing and waiting to go... or charting needs to be done... or just plain review of the patients we've been assigned to make sure we aren't missing anything....or team huddle is happening and we need to go report off.... etc etc etc etc. The norm is several of those all going on at once.

We won't even bring up our own need to pee or grab a bite to eat and check on our kids. We'll just leave the RNs personal needs out of it. Heaven forbid we are seen sitting down after asking a recalcitrant CNA to do. their. job.

I don't want to hear this argument anymore to be honest. It borderline infuriates me for the dismissiveness of it. Yes, a nerve has been hit here and maybe I am just tired but honestly, just tired of this sense that we can be everywhere at once and liable for all of it. Taking care of people is time consuming. Taking care of the elderly, the sick, the injured is TIME CONSUMING. It isn't like the people in room wanting to be toileted are going to bounce right up, do their business and bounce right back to bed! If they could do that chances are they would not be in the hospital in the first place.

That is why the CNAs are there. To do the stuff the nurse can delegate so the nurse can do the stuff only the nurse can do. It is literally why CNAs exist in patient care. Get rid of that and CNAs are no longer needed. If a nurse has nothing to do, fine. He/she should absolutely take care of it and most of us DO. But usually...the VAST majority of the time... that is NOT the case. The willingness to look away from all we are responsible for because we want someone else to do their job so we can do ours is just...maddening. Not one nurse should have to "prove" they are busy, even if they were "already in the room". It simply is not true that one can toilet a needy patient faster than task it. Nursing is busy as heck to the point of insanity many days. I think we can all just plain concede that at this point. Don't shame us for needing help, especially when people are getting paid to provide it.

Patient care is everyone job. Nurses need to stop think their sole role is do med pass. I had nurse delegate to me and then go sit on their butt and watch a movie. 

Specializes in Mental Health, Gerontology, Palliative.
On 6/12/2022 at 7:53 PM, Mandiann09 said:

Don’t be that nurse!! Honestly, taking someone to the bathroom is not going put you behind on a med pass. If it does sounds like you need more training.  We seriously had RN that refused to even stop get a patient juice and none of techs  wanted to work with her. 

When I have four people on insulins, six people on controlled drugs as well as having to pass bog standard meds eg paracetamol, omeprazole, metoprolol etc to fourty residents at a meal time. If you have a way of making that faster, while ensuring that all of those medications get to the correct person at the correct time without med errors. I'd be interested in your perspective

 

3 Votes
9 hours ago, Tenebrae said:

When I have four people on insulins, six people on controlled drugs as well as having to pass bog standard meds eg paracetamol, omeprazole, metoprolol etc to fourty residents at a meal time. If you have a way of making that faster, while ensuring that all of those medications get to the correct person at the correct time without med errors. 

9 hours ago, Tenebrae said:

 

Are you seriously using those as an excuse to not do help do patient care ????. Let me guess you are lpn and only ever worked in LTC ????. Yeah, never go work in a big hospitals please ???. My nurses  do their med passes and still  helped with their patient care.  I got floated to a unit last night who didn’t have tech for most of the night. The nurses had done their med passes and had bathed the patients, change them all night long.  Even after I arrived they still were doing their own patient care mostly . I got their vitals and the nurses still helped me with their two assist patients. One nurse even told me I know your the only CNA so I already changed my people by myself. So what happens if you walk in and have no CNA’s you going leave your patients wet ?

Specializes in Mental Health, Gerontology, Palliative.
3 hours ago, Mandiann09 said:

 

In a public hospital here ICU 1-2 patients, med surgical 3-5 patients, mental health 2-4 patients, inpatient hospice 1-3 patients, aged care 1-40-70

I will happily take public hospital ratios over aged care. 

You have yet to explain how a nurse could deal with the above tasks and still do what you think they should be doing. 

I've found most health care assistants CNAs have their opinions about what nurses do with little or no understanding what we actually do. 

The teams I have worked with are brilliant. They know I will go to the mats for them. I always tell nursing students that the HCAs are an integral part of the team and if they support them, HCAs will go to the mats for them. If they don't the job is much harder than it needs to be.

Fortunately my opinion of myself is formed by the people that I work with, rather than random strangers on the internet who seem to be carrying a very large chip on their shoulder

3 Votes
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