nurse aides rules

sassynurse78 · Nov 8, 2001

As a CNA for three years and now a Nurse for three years, I have come across many bad CNA's and as many bad Nurses. I also know from experience that a nurse that helps out, remebers how to answer a call light and can be a "butt wiper" theirself gets alot more respect then the nurse, that will walk down a long hall to find a cna to put Jane Doe on a bedpan. Respect is earned and must be given to receive. I also have found that there are many CNA's that will push a nurse to see how far she can be pushed. I remember once as a CNA that a nurse walked in with a tube of cream for a paitents bottom, he stood there as I changed this confused and very combative resident and watched. After I got the paitent cleaned, the nurse said ok hold her there so I can put this on. I was so annoyed by him just standing there and not helping while this patient hit, bit and attemped to kick me, that I nicely said "well hold on I am not finished" I then proceeded to position the paitent onto her back very comfortably, replaced her covers, looked at the nurse and said "Watch when you roll her over, she doesn't like it" and walked out of the room. By standing there (I will never forget the annoyed look on his face from waiting for me to finish) he clearly showed a disrespect for me, So why should I respect him or his authority? At that very moment I made myself a vow that I would never be a nurse that doesn't respect their CNA's. I can also remeber how when I told the other CNA's on the floor what had happened, they too lost respect for him. Now with one episode of disrespect, he not only lost mine, but the five other CNA'S. I am sure he thought to himself "why won't they listen to me, I clearly gave them instructions?" I have since learned that he is now a nursing instructor. I hope he is not teaching nurses how to apply butt cream this way :cool: !! I have found with respect you develop a sense of teamwork.

squaw nurse · Nov 9, 2001

I am a DON who values all my staff- charge nurses as well as CNA's. I am very familiar some of the above situations. The facility where I work was once labeled as one of the facilities where CNA's rule. As a previous CNA I understood the philosophy of many charge nurses that CNA's are merely "butt wipers", and as a previous LPN I also understood how it felt to have my write-ups trashed by the DON. I was determined to make teamwork my priority. I started by purchasing a set of videos called "Nurses Aides Are OKAY", which help to build self-esteem and self-worth. I watched them with my nursing team (nurses aides and nurses watched them). My next step was a workshop on how to be a charge nurse for LPN's. They were taught the importance of the nursing assistant and ways of improving performance like talking to your staff the way you would like to be addressed. I even asked the most domineering LPN to teach the specific segments of the workshop. Though after 22 months we still have problems from time to time, all staff respect each other as human beings and caregivers, and all understand the chain-of-command. The LPN's realize I will not tolerate abuse of the nursing assistant any more than I will tolerate abuse of a resident; the nursing assistants realize they are a valuable member of the team with a valuable contribution. As a team they will not tolerate new persons who do not buy into the team concept. Though time consuming, it has overall been a success.

My goal this next year is to work on dietary and housekeeping departments so that all function as a team for the good of our residents.

sissib · Nov 6, 2006

I also work in LTC, having problems with a CNA, (don't know for sure which one yet but narrowed down to 3) that tied a resident's feeding tube into a knot and opened the pump and kinked it in the pump. I will speak with the DON my next work day and I feel she will back me up. Does this fall under the abusive pattern, using that just to get to me? Yea, I think so. Hope this gets better. Just finished LPN school and looking forward to my career and Yes I was a CNA too but if I had a problem with a nurse, I went to her and talked with her/him. I did not use the resident/patient to get revenge.

Do they screen applicants for CNA school now? they sb screened just as we are for nursing school.

ebony2 · Nov 7, 2006

It sounds as if you are dealing with a difficult situation. All of the respondents seem to have touched on the many facets that create this situation. I have been a nurse for many years and have found that in dealing with those of different personalities and status, the one thread that creates the best results is respect for others. Resident abuse is not an option for any facitlty. Employees should never have to come to work in fear. Every employee needs to know and understand what is required of them and what will not be tolerated. The lines need to clear and any violation of this lines needs to be handled consistently for all. I have worked with others who have difficulty with authority. A lot of this stems from a lack of understanding of what is being asked of them, feeling devalued and feelings of having no say in what is going on. Validation of feelings and working as a team to resolve issues works very well. Having an open door for venting, holding regular staff meetings attended by each position from every shift helps people to become vested in making things better . Even with all of this done,there will come a point where those whose main goal is to keep and make bad situations worse, will have to go. If you are witness to these situations you have to step up to the plate and reveal what is happening. You have to stand by your principles, rock the boat if it needs rocking by whatever means necessary and abide by the Nurse Practice Act and the regulatory guidelines which drive our performance as nurses. Remember ABUSE(physical/mental), NEGLECT are never okay and neither is silence. Our resident's have placed their trust in each of us to provide them with the best care possible. Stand firm and don't compromise your values. If you continue to run up against a brick wall with support from the administration, If I were you, I'd run the the next job opportunity. I have been there and done that- Good Luck!

lovingtheunloved, ASN, RN · Nov 7, 2006

I just hate the type of CNAs the OP mentioned. It gives those of us who work hard and take pride in our jobs a bad rep. Every new nurse I work with I have to bust my butt to prove myself to, because they've had such bad experiences with aides before. It's really sad.

lovingtheunloved, ASN, RN · Nov 7, 2006

that tied a resident's feeding tube into a knot and opened the pump and kinked it in the pump.

OH...MY...GOSH. I hope they fry.

chatter · Nov 7, 2006

I was a CNA for 2 yrs. then a med-aide for 2 and during that time i watched many of my nurses in disgust because they were "always" @ the nurses station sitting on their butts, so i thought (keep this in mind). Now i'm a nurse and i know there is just a little more to it than just sitting . I went back to the facility i worked @ before i became a nurse and all the aides thought i was going to be an "nice" nurse. I'm not so nice in many of their eyes, it took about a month or so of constant teaching and writing them up and now they know what i expect. Some of them truly care and the others well its money to party or whatever they do. My advice is to take an occasional minute to ask them about their life, its means a lot and make sure that administration will stand behind you on your decisions.

Hellllllo Nurse, BSN, RN · Nov 7, 2006

I was a CNA for several years before becoming a nurse. I got nothing but respect from the nurses I worked with, because I was respectful to them. I knew that there is a very distinct line between what a nurse can do and what a CNA can do, and I never tried to cross that line.

I knew my job well, was very good at it, and took pride in it.

Other CNAs were nasty to me, but a nurse never was. I've been an RN for several years, now. Dealing with insubordinant, ignorant, agressive CNAs and techs is the hardest part of my job. A good CNA/tech is a precious gem.

If you want the situation to change where you work, you must have the full backing and support of mgmt. If you don't, all your efforts will just work against you, in my experience.

hazeleyedbabygirl · Nov 8, 2006

Yes, I believe everyone has experience this at some time or another. First of all, nurses aid's should NEVER rule. If the charge nurses allow this to happen, then the charge nurses need not complain to the DON or administrator, but should be provided instructions and training on how to get those nurses aids back in line. If the charge nurses are afraid of the retaliation from the aids, then probably that aid should go. Remember 1 bad apple spoils the whole bunch. LOL. Train those charges to take control of their shift and if that is not feasible, then seek other charge nurses who can.

thsnursluvsgeriatric · Nov 11, 2006

I agree that one should take charge. But today I had an interesting situation.

I asked a senior aid at 945am whether a certain resident was going to be fed.

She said in a rushed way, oh ya it's been so crazy, we'll get it done. It did not get done each time I approached her it was some story. I approached a senior nurse and she said that she had never noticed it before, I've noticed this from the start, this girl always has an excuse for everything. She is a busy person on the ward but I am not sure how much is work and how much is just 'spinning your wheels'. The harder I work on the ward the harder I have to work. I believe that at times these girls just hang back waiting for someone to pick up the slank. I'm not the type to report things. I love my new job and am still on probation. The other day one of the nurses did not take a break on her ward until 2pm, she said it's either I feed or these people starve to death. She also said that they have complained for 6 years that they need more help but don't get any. Honestly I do not mind doing alittle double duty but today that same girl with the excuses did not step into the dining area after the trays were out. I asked her to check on someone and she did not. She just kept on writing in her binder and chatting to the girls. I am really ticked about this. I've discussed this with my fiance and he says that in order to get control I'll just have to be so much firmer when it occurs again. I am a bit of a softy and people mistake this for vulnerability. But I can be as authoritative as the next person. I just feel that adults should know better. I am very disappointed in that team member and am unsure how to approach the situation the next time.

banditrn · Nov 11, 2006

As a CNA for three years and now a Nurse for three years, I have come across many bad CNA's and as many bad Nurses. I also know from experience that a nurse that helps out, remebers how to answer a call light and can be a "butt wiper" theirself gets alot more respect then the nurse, that will walk down a long hall to find a cna to put Jane Doe on a bedpan. Respect is earned and must be given to receive. I also have found that there are many CNA's that will push a nurse to see how far she can be pushed. I remember once as a CNA that a nurse walked in with a tube of cream for a paitents bottom, he stood there as I changed this confused and very combative resident and watched. After I got the paitent cleaned, the nurse said ok hold her there so I can put this on. I was so annoyed by him just standing there and not helping while this patient hit, bit and attemped to kick me, that I nicely said "well hold on I am not finished" I then proceeded to position the paitent onto her back very comfortably, replaced her covers, looked at the nurse and said "Watch when you roll her over, she doesn't like it" and walked out of the room. By standing there (I will never forget the annoyed look on his face from waiting for me to finish) he clearly showed a disrespect for me, So why should I respect him or his authority? At that very moment I made myself a vow that I would never be a nurse that doesn't respect their CNA's. I can also remeber how when I told the other CNA's on the floor what had happened, they too lost respect for him. Now with one episode of disrespect, he not only lost mine, but the five other CNA'S. I am sure he thought to himself "why won't they listen to me, I clearly gave them instructions?" I have since learned that he is now a nursing instructor. I hope he is not teaching nurses how to apply butt cream this way !! I have found with respect you develop a sense of teamwork.

Sassy - I was with you all the way up to leaving the room and letting him do his own darn butt cream.

I wasn't with you when you went to the other aids and told them all about it. You handled YOUR situation well, why not let others form their own opinion. Sounded a little like ganging up on him.

When someone comes to me with an incident, I listen, but I also like to form my own opinion.

Daytonite, BSN, RN · Nov 11, 2006

hi, sissib. . .i assumed you had resurrected this very old thread from 2001 because you had similar problems. some ltcs just seem to be magnets for nasty cnas like you've got. i cut my teeth in management and supervision in ltc. it's a challenge, let me tell you. it takes a nasty person to do something like this to a patient and their equipment. even nastier if they are trying to deliberately cause problems for you. the thing is that you, however, have the education and training far beyond that of a cna to recognize the foolishness of whoever has done this. is it possible the patient might have done this? just asking. got to consider all possibilities.

in ltc your greatest tool and protection is to document. this kind of documentation is not something you were taught in school, but it's easy enough to figure out. you should document the facts of what you found with this feeding tube and pump with the date, sign it and give it to the don. i would also make note of which cna was assigned to care for that patient on that day as well. any old piece of paper will do. i used to do mine in memo form on my computer at home. keep a copy for yourself. this will start the chain of recording evidence. if you suspect a particular cna then watch. this is what i used to do. i had a hawk eye for these kind of people and the minute i found anything they did out of the ordinary--and i mean really way out--i confronted them about it and wrote it up. this documenting lets the don know there is trouble and also gives him/her the written evidence they will need to fire the person, if it ever comes to that. you never know what kind of disciplinary problems the don might already be aware of with a particular cna. something you discover and document on may be exactly what the don needs to get a bad apple out the door.

i'm sorry you've encountered this. unfortunately, being a charge nurse in ltc is going to toughen you up to these kinds of shenanigans. you don't see this kind of stuff happening as much in acute hospitals. also, you won't see cnas who would do something like this going into licensed nursing programs. they would be screened out pretty quickly for either their negative attitudes or a discovery of their dishonesty somewhere along the line. it's sad, but we can't permit people like this to be around patients. the only screening that is really done on cnas is usually a criminal background check. unfortunately, that doesn't reveal poor moral and ethical standards. it's a crappy part of our jobs as nurses, but running cnas like this off is something that we have to accept as part of our responsibility to patient care.

hang in there. protect your patients and yourself.

to others of you who have recently replied to this thread. . .are you aware that you are responding to posters from 5 years ago?