mskiesharn. . .hello, fellow clevelander! yes, this is very common to see this kind of behavior and attitude in stnas. stick to your guns and keep writing her up. you are in charge and responsible for those patients. she has to understand that. if you don't think that the other stnas aren't aware of her 1 hour lunch breaks, think again. there is more of a silent majority who is watching to see what you are going to do and what is going to happen to this stna that wants to blatantly defy the rules. your credibility and respect as a charge nurse have to be earned and this stna has just drawn the line with you. time for you to demonstrate your authority and power.
i've worked in ltc off and on over the years in addition to acute hospital work and i will tell you that i really learned more about dealing with attitude and discipline in ltcs with the cnas. many acted like brats and children. not good for them because i was a brat and snotty teenager myself, so i know a lot of the tricks. some children act better than the cnas in ltc. after you go through the aggravation of having to seriously deal with a few like this one you've described, the rest of the stnas will respect you and do what they are supposed to do. the problem will be that you will probably have to really run after and follow this idiot closely (the proper term is "closely supervise" her) until she finally comes around, quits or gets fired after you've written her up enough. write her up for everything she does outside the scope of her job and for every facility rule she breaks including not clocking out or reporting when she is taking a break. i would, in particular, remind her at the beginning of every shift that she is to notify you when she takes her breaks and that she is to clock out. that nails her when she goes ahead and doesn't do it and makes your write up of her even stronger as to her insubordination. she might try staying out a long time and "forgetting" to clock back in. refuse to initial her time card if she pulls that one on you because you can't verify the actual time she returned. let the don deal with that--never hurts to pass the buck and let the boss take care of some problems. chances are, however, that she won't be fired if she's worked there a long time. still, take the time to document and write her up. you never know that a brave new don might come into the place and decide after reviewing all the write ups that she's just not worth all the trouble anymore. also, if she makes a big boo-boo with another charge nurse of a similar nature to messing around with the enteral pumps who also writes her up, it may be enough to get her otd (out the door). one of the biggest problems ltcs have with not being able to fire people is that they all know who the bad workers are, but no one takes the time to document their bad doing. then, when a really bad incident occurs, there is nothing else documented to back up the one bad incident and the administration's hands are tied and they cannot terminate the person. there are also state unemployment laws that administration has to deal with that most charge nurses are not aware of. there are a good many cnas who will go right to the state unemployment office and file for benefits if they are fired and a facility will have to pay the state for any unemployment benefits paid out to a person that is fired without following their own written disciplinary policies! with any luck she's more likely to request to be moved to another unit where she won't have to work with you any more. to me, that's a win for my team. with some more luck another charge nurse with some balls will also write her up and this stna will be intimidated enough to realize she needs to leave and move on to become some other facility's problem. ha! ha!
don't let your bosses try to feed you any bs about how badly they need this stna, if that happens. your license is the one on the line. i've had personal experience with how the state ombudsmen personnel for the ohio department of aging work. they are on the side of the patients, believe me. i'd run this stna ragged until she hated the sight of me. of course, i'd always be fair minded and nice to her, but firm and assertive. every time she turned around i'd be behind her. make sure you know the facility rules and disciplinary policy and follow it to the letter with her. you have the authority and power to do this. i might even sit down with the don and tell her how bad i felt this stna was and that she could expect to see documentation from me for every thing i caught her doing that was wrong. notice i'm not telling the don i want the stna gone. that would be presumptuous on my part. i would just tell the don that i think she's a rotten stna and that i will be carrying out the authority i have to discipline her at my level. this is just being assertive and making a statement of my intention. you have to act a little hard nosed until people realize you are serious. after these kinds of stna problems are solved, then you can relax a little and be more lenient with the stnas that are still around and perfectly willingly to follow the rules as they as are supposed to. got it?
in one facility that i worked the cnas took long breaks or disappeared all the time. i often found them in a visitor's lounge that had one of those large screen tvs, watching the tv. i started checking the lounge when lights were going off and no one seemed to be around. i would march into the lounge and find 6 or 7 cnas sitting on the couches watching the tv. i'd pull the plug out of the wall and tell them to get back to work. i did this not once or twice, but probably 5 or 6 times. they were like kids and just wouldn't give up! i took phones off the walls of hallways in one facility that had them (as a convenience for the charge nurses!) when i would find the cnas making personal calls and hanging on them instead of doing their work. had a couple of cnas that would hang out at the nurses station on either the facility phone or their cell phones while everyone else was busy feeding patients in the dining rooms and us charge nurses were out in the hallways passing medications! there were other favorite hangouts. when other worker cnas found out that i wasn't afraid to confront the slackers they started telling me where these hiding places were. i got suspicious of any patient doors that seemed to stay closed too long. it was even worse when i first started working a night shift in one facility because cnas started disappearing because they were going off and sleeping. i found one cna--get this--it took me awhile to find her. . .she turned a very nice high-backed upholstered chair in one patient's room just enough so the back of it was to the door. then, she had settled into the chair and kind of crunched herself into a corner of it so she couldn't be seen by someone just looking into the patient's room from the doorway. she also pulled the privacy curtain just a few inches from the wall to cover about half of the chair. from the doorway, it looked absolutely innocent, almost normal. i had looked and looked all over for this aide for maybe a half hour. i had to walk into the room quite a way and look around the chair before i actually found her in a fetal-like position sleeping in this chair! wrote her up. can't remember if she got fired by the don, but i don't remember her being a problem after that because i don't think she was working there much longer. found another cna who had put a bath blanket down on the floor between the far wall and a patient's bed and was lying down sleeping on it! it was also hard to see him from the doorway of the patient's room! the thing is this, when these "children" realize that you have caught on to some of their little tricks and games it becomes too much of a bother for them to pull them off. most will do us all the favor of quitting and moving on. always keep your temper because you never know if one of them is nuts and wants to retaliate. you don't want to give them a reason to retaliate. you are always just doing your job.
good luck! keep up the good work!