Help with Major CNA Problems

[JSBoston]

The facility I work with has a big problem with CNA laziness and bad attitudes. They refuse to work together for the most part, neglect the patients, lie in their charting, and if they do decide to wash a patient up it's with the help of the nurses and because we asked them to. They won't do anything without us holding their hands and leading them around for each task. This is not every CNA, but definitely the majority. They talk a good talk and rarely get in trouble for their actions.

I HATE asking every two hours "Did you turn this patient?", "Can we go wash this patient up?" and force them off of their butts to go do something while they glare at me. They have read and reread their job description and signed off that they understand what it is they are supposed to do at work. Patient care as a team with the help of the nurse and OTHER CNA's. But that never happens.

Our supervisors say WE (the nurses) are supposed to make them accountable. But all we get is backlash and bad attitude. I don't want to feel like a slave driver. I have very sick patients to monitor and at times critical issues to deal with. Of course I will help wash up patients, even by myself if things are busy, and be dripping with sweat in effort to help the team and have things go smoothly. But when I'm killing myself on the floor, not getting a break so the CNA's have their 2,3,4+ hrs of internet/social time, it really makes me upset. Especially when it's at the expense of the patient. NOT to mention I am not getting paid for doing two jobs.

My question is... HOW do the nurses make the CNA's accountable for their jobs without treating them like children and holding their hands? They really have no motivation to complete their jobs because they know they can get away with it. My complaints usually only go as far as the nursing supervisor, but I think I am going to start writing many emails to our nurse manager, HR person and our CEO.

This has been a problem for years, but I've recently reached my very limit when a CNA made me go cry in the bathroom because I was so frustrated with the bad attitude and being treated basically like dirt.

If anyone has any help or ideas to offer it would be greatly appreciated.

Thank you!

[Kooky Korky, BSN, RN]

op, your only hope is to get a backbone. crying? no more of that. you are legally and ethically in charge of these people, so start acting like it. if your higher-up's don't back you up, then you might consider leaving. but shame on everyone telling you to leave without even trying.

you need to be the cop to them because you are the one who is with them. the don, the administrator, etc. are not there with them, i assume, and you are. and you are, like it or not, knowingly or not, enabling them to take advantage of you and of the patients.

you first need to convince yourself that you are in charge. then act like it. not saying it's easy but are you serious? 2-4 hours of internet/social time? and you are aware of this and letting them do it? what is wrong with you? i know it's scary to speak up, i hate doing it myself. but i'll be d****d if somebody is going to get paid to shirk work, neglect my patients, have me do their job while they get paid to be on the computer and socialize. i think your boss might need to make a rule that aides stay off of the computer while at work. period. no more than 1 can go on break or to meal at a time, all will either do their jobs or be fired. period. there are lots of people who will take advantage of you and of employers if allowed. apparently, few and far between are those who pride themselves on a job well done or who want to bring credit to those who raised them. slavedriver? not by a long shot. you are merely expecting this person to come to work to work.

start small. hold a meeting with one cna individually. point out what you see being done wrong, say what your new expectations are. clearly. do not blink. believe you have a right and a responsibility to make her toe the mark. just start with the one who will be easiest to straighten out and see how that goes. then, when you are feeling stronger, move to the worst offender. once you either straighten her out or get her fired, the rest will be easier.

be prepared for a battle. be prepared to document every violation you see, what you did about it, who you approached when the aide was rude or disrespectful to you about the new program. be prepared to have to defend yourself from false charges. try always to have witnesses around. if there's a house supervisor or other manager, take that person along when talking to these aides.

it might be easier than you think. they are there 8.5 hours i assume. they are entitled to an uninterrupted 1/2 hour meal break. they can take other breaks if time permits. ask your hr department boss if you don't believe me. rest breaks are not guaranteed in most states. and they vary from 10 minutes to about 20 minutes, by state.

you simply have to be prepared for some anger, maybe getting yelled at or threatened. if anyone does threaten you or worse, absolutely make a police report. call the police to come in and take your statement right there at work. i don't care what your boss says about that. you do not give up your constitutional rights or your civil liberties while at work. work is someplace you need them the most.

think twice before quitting. why should you leave a job you like because of these lazy aides, who have just never had anyone take them in hand before?

[Kooky Korky, BSN, RN]

So are you saying that increasing wages will draw in these motivated, conscientious people to replace the lazy, rude CNA's, or that increasing the pay of the CNA's will cause the lazy/rude CNA's to change their behavior?

You should not need a monetary incentive to not neglect your patients or treat your co-workers with respect. It's called basic human dignity and taking pride in your work.

Also from what I've seen CNA's wages aren't too bad, considering. Around here they make an average of $16 an hour, not counting differential. I've lived and supported my child as a single mom with half that.

But I digress...

OP-here is what I would do (and I'm a new grad so take this with a grain of salt) Call an informal meeting with them-nothing official, just like "hey, before we start our shift I want to meet with you guys so we can discuss some things" Then, calmly, rationally, but firmly lay out your concerns. Emphasise that you are adressing them this way because you want to have a chance to improve things, but make it known that if it continues you will have no choice but to take it up the chain of command and their jobs could be on the line, because it's a patient safety issue. Allow them an opportunity to voice THEIR concerns. Emphasise that they are a vital part of the team and that is why it is so important to adress this. Do it in small groups (maybe you could arrange it with the other nurses so that one charge nurse would meet with all of the CNA's on her shift, so it's not a big confrontational thing)

If that doesn't work, report them to whoever you need to report them to and try to find another job...

Nice try but too pal-sy. She's their boss, not their friend.

[Hospice Nurse LPN, BSN, RN]

In the LTC's around here, CNA's make MINIMUM WAGE, so they don't have the cream of the crop. When I was in LTC, I had the same problem as the OP. I'd write them up and the write-ups would disappear. I finally started making copies of the write-ups for the administrator, HR, owner, and myself. Some of the CNA's would sleep, others watched TV, and one would punch in and make rounds then leave for the entire shift.

I complained in writing and in person to the "higher-ups" and nothing was ever done. They told me that they just couldn't find anyone willing to work. I had no choice but to give my notice. I felt bad for the residents, but I just couldn't take it any longer. My advice is to leave.

[himilayaneyes]

Sounds like those CNAs need to get written up which would go onto their personnel file at HR. I know we all want to get along with our co-workers. However, we are work first and foremost to care for our patients. If those CNAs don't want to do that, then they need to find another job...that's something your manager needs to tell them...or maybe he needs to fire them and get a whole new bunch.

[canesdukegirl, BSN, RN]

I have had the same problem in the past with lazy, mouthy and resentful CNAs. It makes me really angry when management tells you to "make them accountable". You have your own job to do, and a manager needs to MANAGE!

So here is what I did:

Every single time I caught one of them NOT doing their job in a timely manner...incident report. Every time I saw false charting...incident report. Inappropriate communication with a patient or any other co-worker...incident report. I was doing so many incident reports I felt like a freaking COP! But eventually, management got sick of the risk management department calling them everyday to follow up on these reports that the house had finally started to get cleaned! If you want to sign your name to the reports, you can. But you can also do it anonymously.

You are there to take care of patients. Hmmm...funny-so are they! You shouldn't have to crack the whip. Your focus should never be, "Dang I wish these CNAs would do XYZ, so now I have to go find them and then get ready for a confrontation." That is the MANAGER'S job. They appear to be shirking the responsibility to the nurses to handle the difficult CNAs.

[wearingmanyhats, RN]

I would also write up EVERY thing that needed addressed...

AND KEEP A COPY for yourself!!!

Good Luck!

[Blackcat99]

I have had the same problem in the past with lazy, mouthy and resentful CNAs. It makes me really angry when management tells you to "make them accountable". You have your own job to do, and a manager needs to MANAGE!

So here is what I did:

Every single time I caught one of them NOT doing their job in a timely manner...incident report. Every time I saw false charting...incident report. Inappropriate communication with a patient or any other co-worker...incident report. I was doing so many incident reports I felt like a freaking COP! But eventually, management got sick of the risk management department calling them everyday to follow up on these reports that the house had finally started to get cleaned! If you want to sign your name to the reports, you can. But you can also do it anonymously.

You are there to take care of patients. Hmmm...funny-so are they! You shouldn't have to crack the whip. Your focus should never be, "Dang I wish these CNAs would do XYZ, so now I have to go find them and then get ready for a confrontation." That is the MANAGER'S job. They appear to be shirking the responsibility to the nurses to handle the difficult CNAs.

This is a great idea!!!! Why didn't I think of that when I use to work at LTC? I left LTC for private duty care and have only one regret. I miss the good paychecks I got at LTC. I think that management needs to fire the CNA's who aren't doing their jobs period. It sends a strong message to the other CNA's. Of course, most LTC's did not fire CNA's so the CNA's knew they could do whatever they wanted and would get away with it. I also think that sometimes you just can't change people's hearts. Either a person cares about their patient's or they don't.

[Kooky Korky, BSN, RN]

I have had the same problem in the past with lazy, mouthy and resentful CNAs. It makes me really angry when management tells you to "make them accountable". You have your own job to do, and a manager needs to MANAGE!

So here is what I did:

Every single time I caught one of them NOT doing their job in a timely manner...incident report. Every time I saw false charting...incident report. Inappropriate communication with a patient or any other co-worker...incident report. I was doing so many incident reports I felt like a freaking COP! But eventually, management got sick of the risk management department calling them everyday to follow up on these reports that the house had finally started to get cleaned! If you want to sign your name to the reports, you can. But you can also do it anonymously.

You are there to take care of patients. Hmmm...funny-so are they! You shouldn't have to crack the whip. Your focus should never be, "Dang I wish these CNAs would do XYZ, so now I have to go find them and then get ready for a confrontation." That is the MANAGER'S job. They appear to be shirking the responsibility to the nurses to handle the difficult CNAs.

Yes, managers should manage. But what if the manager is not on duty when the offenses occur? She has got to stand up to these aides on her own. Yes, write up the incident reports.

[Kooky Korky, BSN, RN]

In the LTC's around here, CNA's make MINIMUM WAGE, so they don't have the cream of the crop. When I was in LTC, I had the same problem as the OP. I'd write them up and the write-ups would disappear. I finally started making copies of the write-ups for the administrator, HR, owner, and myself. Some of the CNA's would sleep, others watched TV, and one would punch in and make rounds then leave for the entire shift.

I complained in writing and in person to the "higher-ups" and nothing was ever done. They told me that they just couldn't find anyone willing to work. I had no choice but to give my notice. I felt bad for the residents, but I just couldn't take it any longer. My advice is to leave.

This response (non-response) by the owner must be reported to the licensing agency in your state, to CMS, to everyone who allows this place to stay open.

[RNBSNxo]

We have issues to with cnas but just a few of them. There was multiple nurses talking about it and finally someone wrote a letter and it was directed to managers from the RNs as a group. If your managers do not step in then you go above your managers, if you want to take it that far. Yes RNs are still accountable, responsbile, whatever but if a CNA is making up vital signs instead of taking them, like we have had happened here, then that is a safety risk and must be taken care of. Guess you all need to come together as a group or need to go above your manager/supervisor now to their's.

[HiHoCherry-O]

In my experience, I have found that treating the CNAs I work with like true co-workers and demonstrating to them that there is nothing I will ask of them that I am not willing to do myself or help with and remembering to thank them for their help goes a long way. Those same CNAs, who willingly, without complaint, help me are the same ones my fellow RN co-workers complain about being lazy and rude. I have watched my RN co-workers talk down to some of the CNAs, tell them to go do something (like turning a patient which may require more than one person BTW) while sitting at the nurses station etc.

I understand that we are all busy and the main reason CNAs are employed is to help do some of the tasks we simply, truely don't always have the time to do. However, by taking the time to show that I am not asking them to do it because I don't want to ("thats CNA work. . ." etc) I am also demonstrating leadership.

[PatMac10,RN, RN]

This seems to be a common trend with CNAs in my area. Many have bad attitudes and I wonder why they became CNAs. I always try to work with my nurse that I am working with because I apsire to be a nurse and will be entering nursing school very soon. I want to learn from them, and want to get along with them so that when I need some help they might think back to me working hard and well and decide to help me.

I see som many becoming NAs just to get above min wage and similar reasons like that.

Communication, like the previous posters said, is the key. Try your best to conquer them with your kindness. That is easier said than done though. I hope it all works out for you.