Have a serious problem with night shift CNAs

[heathert_kc]

I am a new RN in my mid-20s, though I have been at the same facility as an LPN for 2+ years, a CNA for 2 years before that (though at a different place). Because I was in school last semester I had to transition to working primarily weekends. I work mostly nights, and some evenings. Night shift on weekends, one day in particular, is a real makeshift crew. On that night one aid is a relatively new CNA (scares me to death she wants to be a nurse) ,she has an attitude and is down right lazy. She fell asleep while the other aid was on break!! so basically I was the only one on the floor Needless to say I was not happy. The other one is a bit older, and been doing it a bit longer but still lazy!! There is a resident who is at the front of the hall and he cannot remember to use his call button and he whistles when he needs help, though I explained to them that that is so and so and when he does that he is trying to get someone's attention, he whitles and they just sit around. When they are busy doing rounds call lights are all but ignored and in the morning I leave an hour earlier and am very busy with med pass, but the idea of prioritizing is so foreign. I had a meeting with the DON, we drafted a list of espectations for them to sign, little that has done. The very same day half were broken: the men they get up were not shaved, a motion alarm not being heeded led to a resident having a fall and skin tear, the break room was a mess, and she fell asleep.

This was this past week. I thought I was about to have a panic attack, I mean I help out more than probably any nurse, but I am coming to the realization that I cannot do it all! Compaining to management does little or nothing. I had my ADON (who is less tolerant of bs, though has little power, unfortunately) to print me extra write-up forms. I wrote them both up, but the young ('I know how to do my job') with an attitude girl refused to sign so of coorifice the other one followed. The DON wants us to meet and talk about it, but I really am not interested in working that shift at all. In fact the idea of going in next week as me anxious. I am not usually short tempered, but the frustration is making me act like someone even I don't like. I take my work personally and I work my tail off only to hear countless (legitimate) complaints about my shift/ staff. I used to trade one of my shifts with another nurse, when it was convenient for one of us and she has since told me that she cannot take my shift any more because she, who has been a nurse a lot longer than me, cannot handle my staff... I am feeling so discouraged. I used to truly enjoy my job, but now I am considering just resigning. Not sure if that is a rational thought or me being overly emotional. Don't know what else to do.

[joanna73, BSN, RN]

Call a staff meeting or ask your supervisor to do so. Outline your expectations and their roles clearly. Give them a reasonable amount of time to adjust and improve. If after a few weeks they aren't pulling their weight, start documenting the occurrences and writing them up. Either they learn to improve and do the work they're paid to do, or they leave. Simple.

[joanna73, BSN, RN]

They all need to get the message from your DON that it's serious. At the moment, it's still a joke to them. You all need to unite and stand firm. We had to take the same road at my facility. The environment has improved since. It's either, "Do as you're asked, or there are consequences." If they refuse to sign the write up, document that too.

[CoffeeRTC, BSN, RN]

Yep. Have a meeting with them and try to get the DON or someone else present. Give them time to change, but not forever. It is hard to be young etc and probably the only nurse in the facility/ unit but I can tell you it can be done! I have the BTDT and T shirt to prove it!

[Deb-RN]

Print out the cna job description and rn for your review. A disciplinary report should be given with another nurse as a witness. Don't expect the write up to do anything more than sit in their emplyment file! At some point, they will be a repeat offender on record, and will cause an injury, then management will fire them when it costs the facility money! Don't sweat the small stuff- okay? It'shard not to. Here is what i do for my really lazy, tired, bad attitude cna's. I always respect them, greet them by name, engage them, get them to talk about their life, the weekend, family, and thank them for the hard work they do thru the shift. I also let them know what i will write any cna up for. With report, let them know what you expect them to do with or for each resident. Ask them to talk to you after each rounds, to update you on how their shift is going. Ask them specific qustions, like: how is John doing? How many x's has Jill been toileted? Does john still have his coccyx patch on? What position did you turn jill? Often, they will "forget" and thenwill do as you ask. The big point is to then say: let me know when you completed that. Some will even lie completely. You will find out who can betrusted by following them on rounds and entering a room they just left or before they finish rounds on a particular wing. Then, say john needs his heels up or mat on floor, is asking to be toileted (push their call light too). It gets your message across, that they are to do their job. A lot easier than writeups. Eventually, they will do what they know you expect because it is easier for them than always having to go back into the room. Thank them for their hard work, how they handled a resident, etc. In front of the next shift. You'll be surprised how it works. They have to want to do a good job. I was in your shoes before too. I love my job now and feel we are really a team. Yes, i still have lazy, liars, and have to do writeups at times, but the best way to find a happy balance was to answer more call lights, before my med pass and to check on them myself after the cna left the room. Hope this helps.

[LuvScience]

Deb-RN's advice sounds like a good plan. I normally work 2nd shift and I used to pick up night shifts once in a while but I stopped because of the night shift CNAs. They either ignored me or refused to do the things that I asked them to do and had bad attitudes overall. As a floor nurse at my facility I do not have the authority to write a CNA up but that has never been an issue on my normal shift. I don't understand why the culture is so different shift to shift but I know if I ever try to switch to night shift I'll have an uphill battle.

[*LadyJane*]

I am generous with my thanks and praise for hard work, and a good job done. I do praise CNAs in front of other CNAs and staff, and I am sincere with my appreciation for a job well done. When I order someone to do something that they really do not want to do, (they do it, or they get fired at my place of work), I thank them profusely for doing whatever, esp. if they do a good job.

Result? The CNAs love me. They tell me this frequently, and thank me for treating them with respect. (There are a couple nurses that they hate to work with, as they can act quite unprofessional and rude to their CNAs). I just tell them that I will only treat them with respect because that is how I expect to be treated, too.

Jane

[heathert_kc]

Oh to work in such a place, where anyone can be fired for not doing there job.... jk they just don't take things seriously and management is too lax, not that everyone walking on egg shells is better, but in time I think things will correct themselves as far as management is concerned, with families complaining and problems not getting fixed.

I think you guys are right. I definitely think that I could do a little more praising, though I generally have a good and appreciative relationship with most of the aids. More follow up may help as well. I am meeting with the DON this week. So we will see how that goes.

I just start thinking if I don't do it, it won't get done so I do so many 'CNA tasks' (not to down such tasks, I was a CNA not too long ago) that my own work suffers and I am exhausted.