nursing assistants

RNHawaii34 · Dec 17, 2006

heyyyyyyy congratulations! you made it there for 3 months!! well, i working in ltc facility for not even a month, but i kinda picture what you are experiencing right now. so far, our aides are "pretty good" at taking care of our residents, but i have a few who has that bossy, rude attitude and seems to ignore the call lights. let me tell you, if they don't answer the call lights now? they could have been doing this for a long time way before you step in that facility, you can try to establish a rapport with them, be nice to them, ask them politely to help you out, probably right now they are trying to " feel" " or test" you since you are new. i was an aide for a long time before becoming an rn, but i never leave lights unanswered, nor give my rns a hardtime..some aides do think that they shouldn't be doing this hardwork, backbreaking stuff, because they don't get paid like the rns..i cringed everytime just thinking about this, because the bottomline? our patients suffers..my trick? which always work? i kinda help them with the lights at first,...then, i politely ask them to help me with mr. so and so....it always worked. other than than, probably you need a back up help from your unit manager or director of nursing. hope this would help?

banditrn · Dec 18, 2006

Have you talked to your DON to find out what the expectations are? Is the nurse supposed to be in charge? These are just a couple of questions you need answered.

At the last LTC I worked I worked a different shift, and found one of the aides sitting in a resident lounge when lights were going off - she told me that each aide only answered their own resident lights - I was pretty sure that wasn't true, but I didn't care, I asked her to please answer lights.

I also mentioned this to the DON the next time I saw her, and she straightened the situation out - everyone answers lights!!.

I started recently at a new LTC, at night, and I have some absolutely wonderful aides - but I also sat down with them when I first started and told them what my expectations were - and to let me know if they needed me. They are responsible for most of the lights, but I try to do my share of them, too - if they come to me with something, and it's not high priority, I tell them when I will be able to get to it. These gals should be cloned!!:)

Daytonite, BSN, RN · Dec 18, 2006

ejsmom. . .one of the things you learn about being a charge nurse is that doing med pass, treatments, calling mds, answering the phones, taking off new orders, answering family questions, and making sure that each resident is safe is a big part of the job. but, if you look at your job description it also says something in there about supervising the nursing assistants. it may not say it in those exact words, it's there and you are expected to do this as well. the problem for most new lpns and those who are new to the job of being a charge nurse in a nursing home is that nursing school doesn't adequately prepare you for call lights going unanswered for 20 minutes or more, requests of yours that get ignored or "attitudes" such as rolling of the eyes, ignoring you or giving you the silent treatment, muttering under the breath or deliberately muttering things for you to hear their dislike, public displays or tantrums, deliberate weird behavior, using rude or insulting language to you, deliberately behaving to make themselves unapproachable, insisting on doing something their way, or for aides who politely listen to you and then don't do what you ask anyway (this is procrastination and/or passive/aggressiveness). it's a real slap in the face when it happens at first because up to the first time it happens we've all pretty much worked with people who knew their jobs and were eager to do them. well, welcome to the world of ltc and the difficult employee!

i learned so much about dealing with difficult people in ltc. i owe most of what i know to all the hard to work with aides over the years who i had to learn from. there are two books that i keep in my home library that i found very helpful:

managing difficult people: a survival guide for handling any employee by marilyn pincus and working with difficult people by muriel solomon. books like these will help you to identify what is going on with people who are doing these kinds of things.

on a practical level, however, you have to address and confront the behavior immediately just as a parent does with a child who misbehaves. banditrn is correct. you should first have a talk with your don. let her know what is happening. ask about what you can do. you need to know that you have the support and backing of your don. you should also look at not only your official job description, but the job description of the aides as well. one of the things that manipulative and/or intimidating employees will try to do is cite rules or regulations at you. many times they are wrong, but you won't know that if you haven't done your homework yourself. you need to be confident in order to say something like, "that's not true. there's no such rule." and when the employee jumps up and says, "i'm telling the don," you can confidently respond, "and you're going to get the same answer from the don. now i'm telling you again, this is what you are supposed to do and if you aren't going to do it then i am writing you up for insubordination." it's very difficult to actually say these kinds of things the very first time(s). you get very emotional yourself. that comes from a fear of the unknown reaction on the part of the other person as well as an unfamiliarity with the skill of doing this kind of confronting with people. always remember to be respectful and not to get angry. you are merely enforcing rules the facility has laid out. blame the facility if you have to blame anyone. we all have rules we have to follow.

i don't subscribe to this smile and be kind and the aides will come around theory. yes, smile and be kind. but if you don't confront and correct them, they will continue to walk all over you. at first, you may have to take the time out of what you are doing to hunt down missing people to find out where they are hiding. once they know you are willing to come looking for them and follow up with discipline if they keep on doing it, they'll either stop doing it, or they'll have to be disciplined. in one facility i had a problem with employees going to a sitting room where there was a big screen tv that they would watch. if i caught them doing that i would routinely pull the plug on the tv and send them all back to their assignments. that's another thing you'll have to find out about and follow facility policy on. another place had wall phones in all the halls as a convenience for the charge nurses, but the aides would make personal calls on them. when that happened i took the phones off the walls and wrote the employees up. the ones who end up being arrogant enough to continue being disciplined either quit or refuse to work with you. either way, they're no longer your problem.

what i found over the years is the good aides who do their job and follow the rules are usually very grateful when you catch on to what the crummy ones are doing and do something about it. all most people ask is that everyone be treated fairly and that work be distributed fairly. when the good aides see the crappy ones getting away with murder it really ruins their morale more than you can image.

Lovely_RN, MSN · Dec 18, 2006

amen! i was an aide for a while and you cannot imagine how difficult it makes your job when you are one of the few who is willing to do the work. i used to dread working with some nurses because they were so meek that chaos would reign and i would have to work twice as hard on their shifts. you don't have to be nasty about it but you must learn how to manage the aides, it's your job to do so. remember at the end of the day it's your license that is on the line. allowing the aides to slack off can come back to bite you in the butt big time.

what i found over the years is the good aides who do their job and follow the rules are usually very grateful when you catch on to what the crummy ones are doing and do something about it. all most people ask is that everyone be treated fairly and that work be distributed fairly. when the good aides see the crappy ones getting away with murder it really ruins their morale more than you can image.

TheCommuter, BSN, RN · Dec 19, 2006

My following comment might be interpreted as controversial, but here it is.

A hefty portion of today's nursing aides have been 'forced' into the workforce through welfare-to-work programs and are, essentially, doing a job in which they truly possess no interest. The vast majority of welfare-to-work graduates end up securing employment as cashiers or nursing aides due to the brief training time and high demand for these jobs.

I am not stating that all nursing aides fit the aforementioned description since I have worked with many wonderful CNAs. However, the roughest and least compassionate CNAs were also the same ones who would regularly attempt to sell me their excess food stamps at the end of the shift.

banditrn · Dec 19, 2006

Amen! I was an aide for a while and you cannot imagine how difficult it makes your job when you are one of the few who is willing to do the work. I used to dread working with some nurses because they were so meek that chaos would reign and I would have to work twice as hard on their shifts. You don't have to be nasty about it but you must learn how to manage the aides, it's your job to do so. Remember at the end of the day it's your license that is on the line. Allowing the aides to slack off can come back to bite you in the butt big time.

Falon - I've actually heard other aides saying the same thing as you - the lousy aides make it twice as hard for the rest of you.

I worked it all out in the first LTC I worked at, so that I knew what I wanted by the time I got to the new one. I don't want to be an army sergeant, I expect that we're all there to take care of the residents, and I told the girls that is their #1 priority - we're a team, we just have different duties. I want to know when they are taking a break, and I'll let them know when I leave the area, because someone must always cover. And they answer ALL the lights if they aren't busy.

nurseangel47 · Dec 19, 2006

Boy, have I had identical problems with CNAs! Especially in LTC settings. It seems that they have an attitude just because they a) have to work, and b) don't make enough per hour. Is that OUR problem? NO!

I have had it with the cnas who run to management right before I get fied up and write them up causing me to look like the one who has a problem with staying on "their back" and "picking on them!" Honestly, I had one particular male cna who had a "friendship" with the ADON at a particularly biased LTC facility I worked at for approximately a year. He had the ADON and the DON snowed regarding his performance in general and whined constantly and loudly enough to them all that I was this hardened and mean nurse who stayed on his a** all the time! I did not. I simply monitored his behaviors/performance since I was his nurse and I was responsible for his behavior/performance. He actually sold drugs to the ADON for her stay at home no good significant other and I couldn't believe she'd risk her reputation and license as a RN for her SO who wouldn't/couldn't work due to numerous DUIs which ultimately cost him a driving license and totalling the only running car in their household.

I got off subject, I know, but that is part of the story about him and how far the CNAs were led to run all over the paraprofessionals in the setting I worked in.

I ended up leaving the facility because of mandatory 12 hour shifts when I was hired for 8 hour shifts. They mandated this due to low staff ratios since no one would work in that particular LTC facility....gee, wonder why?

With CNAs like that for care, no wonder no one wanted to work for that company!

I digress, again, sorry. I have always had this particular problem no matter where I've worked, always in LTC, I mean. I think that hospitals in general and other places where there is generally more higher ups that hold staff to higher accountability than LTC facilities, expect at least minimum performance from everyone, CNAs included!

Vent over. I just can really empathize with you on this particular topic!

JohnBearPA · Dec 19, 2006

I've had issues with some of my CNA's, and can only suggest standing firm in what you expect from them, and writing them up when they don't follow facility policy. Sooner or later they fall into line, and do what their job description says they need to do. Until then, they b*tch, moan, and gripe about me, but I'm not really there to be their buddy, I'm there to supervise, make sure the care is given, and make sure the things they sign for are done.

At my facility, I instituted a policy of giving the aides report after I get report. Letting them know why I need temps on all these people, or Mr soandso needs to get up when he really just wants to sleep. Found that seems to work, they now know WHY VS are so important, and feel more a part of a team. I'm still the only nurse that gives the CNA's report, but they all seem to like working with me now, and things get done.

As for rudeness, I will tolerate only so much, and issue a verbal warning it needs to stop or I'll have to write them up for insub. That also worked, and now I have a great group of aides, who tell me when they're leaving the floor, ask for help when they need it, and give me help when I do, not to mention telling me any status changes in a timely manner instead of ten minutes before the end of the shift as they did to the other nurses. Good luck, and I hope you find something that works for you!