HELP! How to get my CNA's to do their job

[KDubMSDir]

I am the med/surg director for a small rural hospital. I have only been in this position for a few months. I have had my long-standing nurses on one shift complain to me about how the CNA's just do the bare minimum. The CNA's never have more than 10 patients, so it's not that they have too many patients. When I was director of another unit, I still knew that these CNA's were doing everything they could to avoid their job. They take vital signs and fingersticks, but that's about it. The 2 worst offenders are both CNA 1's, which we don't even hire anymore, but they're grandfathered in. Again, that also means if they lose their job, they will not be eligible to ever come back. I have witnessed my nurses sweet-talking then CNA's in order to ask them to please, please, please do (insert job duty), and it shouldn't be that way. The nurses should be delegating tasks, but every time they try, they get major attitude in return. I would love to know what some of the more experienced nurse managers and directors have done to help with this kind of issue. I do have a meeting scheduled with the CNA's next week....

[cyc0sys]

I've performed an on the spot correction with the CNA by defining their job duties (not just finger sticks & VS), consequences if the duties weren't performed to the standard, asked them if they understood and would comply. If they didn't understand their duties, schedule retraining. If they refused to comply, write them up and send it to HR.

This would accomplish three things:

Establish the standard of acceptable behavior, for not only the CNAs, everyone on the floor at that moment.

It would let the nurses know you have their backs.

You're working to fix the problem.

I'd implement this as a policy for everyone under your supervision. If you allow this behavior to continue unchecked, it will bite you in the butt and you will lose the respect of your UM and floor nurses.

[SummerGarden, BSN, MSN, RN]

OP: Just as the above poster posted, it is important to start from scratch with these CNAs. With that said, start now and be consistent in reviewing with every CNA the expectations of his/her duties and responsibilities and start writing up those that do not continue to work in this manner. This is going to be very time consuming on your part because it will require you to closely monitor and discipline them as soon as they deviate from their duties and responsibilities to include the expectation that they behave professionally and have professional attitudes in the workplace. However, you will then have the documentation to fire those that continue to offend and the power to influence those who know that he/she needs to change his/her ways and will do so to keep his/her job.

[amoLucia]

I don't see it mentioned, but be careful to comply with any UNION stipulations (IF you're unionized). Union representation is usually required for any disciplinary writeup.

Also check with HR to make sure you're compliant with whatever you need to be compliant with.

You want to make sure you've crossed all the T's and dotted all the I's!

[SDboyy]

So for transparency's sake, I am not a nurse manager, but in my past life was a manager of many people in a large company. You have received some good advice here. I only wish to offer a structure for the conversations that should take place individually with your CNA's. Start with their job descriptions, and make sure that they sign-off on the job duties as outlined in the description. Many HR departments require this, but you should have it locally, too. Also, for department specific tasks and/or individual deficiencies, supplement the job duty sign-off with a letter of common understanding. This would be a more specific list that generally falls under the "other duties as required" that all jobs have. Again, be detailed as to your expectations, and have them sign off, and give them a copy as well.

These documents can then be pulled out when you are engaging in warnings and write-ups, as proof that they stated they understand what is expected of them--or did at one time. It is also great HR documentation for any firings that might occur, protecting you and the company from any frivolous wrongful termination lawsuits that can pop up.

Also, ask the CNA's if there are any barriers preventing them from completing their duties as outlined. You will get some complaining, I am sure, but you need to give them an opportunity to voice any issues. This also has the effect of taking away any excuses that they may have later when they are not performing.

As others have stated, get HR involved and union reps, as needed. This is alot of work, but the key is to monitor, inspect, and address issues immediately, so they all get the hint quickly that previous bad behavior will not be tolerated.

[Orca, ADN, ASN, RN]

The stakes for not addressing the issues are potentially very high. People coasting through the shift not doing their jobs is very tough on morale. Eventually it could lead to you losing nursing staff, as people get tired of dealing with it.