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!

[Scarlette Wings]

i hate to have to say this but your authority on the floor or unit is only as good as the support and enforcement of those in authority over you. if your administration has allowed this , then as an individual nurse all you can do is pray for leadership with backbone.

administration/management is not deceived or in the dark. they have allowed this bad behavior by letting them get away with it if nothing else. it is sad if they let the unprofessionalism continue and people ride the clock for nothing. authority must start from the top down and a floor nurse cannot be an effective leader if those in authority do not back them up.

i would talk to who ever is in leadership and find out where they stand on enforcing the policy. it may be that no one was ever willing to document bad behavior and make a paper trail so that upper management could discipline them. a lot of people want to whine and complain but not put it on paper so that something can be done.

if they will take a firm stand and are willing to take disciplinary action when an employees is written up then use the policies and procedures that you have in place and begin to enforce them.

but....if you see that leadership is only going to give lip service without backbone then all you can do is try your best to be a good example and start the processes as per policy leaving the rest with upper management. when there is not support for a charge nurse, then the position turns out to be like a figurehead on the front of a ship. it looks good but can't do much.

[Queen33FutureLPN, CNA]

I really hate that you have to go through this because you have your own job to do not someone elses.I am a Cna and I take my job very seriously I have never been told by a nurse to go do this and go do that especially when its comes to cleaning and patient and turning them.As a Cna that is the reason why we are there to do those things automatically.You should definately go to someone higher and talk to someone about those non workers.Good Luck!!

[tfleuter, BSN, RN]

I was thinking about this problem. When approaching upper management, would it help to point out that if they can afford to pay, say, 20 CNA's who only work at 50% capacity minimum wage, could they not also afford to pay 15 CNA's who work closer to 75%+ capacity and offer an increase in pay? Perhaps suggest clearing out the "bottom" 25% of CNA's and spread out the total of their pay to the remaining 75% as incentive to do a good/better/excellent job? Higher wages attracts more applicants. More applicants means you can pick from the cream of the crop. Those who are compensated well are more likely to value their job and take steps to keep it. Yes, in a perfect world, the CNA should want to do an excellent job for the sake of the patient, but that doesn't always happen.

Of course this could potentially backfire if upper management decides to weed out the herd without an increase in pay and pocket the savings for something else. The important thing would be to stress that it is worth paying a little extra for quality workers.

[Kooky Korky, BSN, RN]

*

--8/te=hihocherry-o;4566364]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.

teamwork is great. leading by example is commendable. the risk, though, is that you will be exemplifying and being a team player while the aides come to expect you to help with everything. they need to do the work for which they were hired without needing the rn or lpn to show them, cajole them, lead them, encourage them, or otherwise treat them like kids or beg them. they are paid to do a job and need to do it. nurses need to be able to rely on them to do their own work. there are some aides, all too many it seems from reading on this board, really, who take advantage of nurses who are always willing to drop their nurses' work and go "help" the aides. the aides need to help each other. sure there's a time and a place for everything, but mainly the aides need to learn to help themselves and each other. nurses should teach their aides how to team up with each other.

nurses have work that only nurses can do - meds, charting, admissions, communicating with docs, labs, therapists, pharmacists, families, social workers, and more. aides are there to do the baths, bedmaking, feeding, toileting, and other direct bodily care that nurses would often love to do but do not have time to do because of having to call docs with problems that need nurse-md communication, do a mountain of papework, assess patients who are suddenly acutely ill or have fallen, and so on.

it's all a matter of the nurse learning that she really is in charge and being courageous enough to require that aides toe the mark - nicely but firmly require that they toe it. and learning good people skills to communicate clearly and using the write-up when needed (sparingly, but at times still needed), and doing the other things i said above.

[Kooky Korky, BSN, RN]

I really hate that you have to go through this because you have your own job to do not someone elses.I am a Cna and I take my job very seriously I have never been told by a nurse to go do this and go do that especially when its comes to cleaning and patient and turning them.As a Cna that is the reason why we are there to do those things automatically.You should definately go to someone higher and talk to someone about those non workers.Good Luck!!

God bless you! This is the attitude all aides should have. All workers, really, no matter their title!

I think before she goes higher, she needs to search her own soul, make peace with herself as the boss on her ward on her shift, and accept that she must reach each aide and work to establish a work relationship with each one. She has to have them see her as the boss, not as the tattletale. Only if she can't reach them should she go higher.

[Kooky Korky, BSN, RN]

OP, where are you? I'd like to get some feedback from you.

[NursKam, MSN, RN, NP]

In response to Kooky Korky...

I think you mean well, but I have to disagree with you on some points. First off, a floor nurse is not the boss or in charge of anyone but herself and her patients, so a floor nurse does not have the authority to give the aides the "do your job or else speech." Maybe at your facility, but certainly not any I've ever heard of or worked for. This is the responsibility of the supervisor or manager. Secondly, having an attitude that you should not be involved in ADLs is not the right attitude. Sure, there are many things that the aide can't do and only you can do, but don't say that assisting with toileting, bathing etc. is only an aide job. You are a NURSE and those duties are part of NURSING CARE. In my hospital they actually frown upon aides working together, because the aide and nurse should work together to take care of their patients. After all, they are YOUR patients and you should be involved in every aspect of their care. Nurses and nursing assistants should work together as a TEAM to provide the best care possible for their patients. With all of that being said, there are lazy CNAs that hate their jobs and don't want to help out with anything. This should be brought up to MANAGEMENT. It's not the floor nurse's job to manage them. And with THAT being said, where there are lazy aides, there are lazy nurses. The two feed off of each other and make for an unproductive and work environment for everyone. Rant over.

[NOADLS]

This was posted nearly 5 years ago. I would have loved to be in charge at this place.

[Purple_roses]

Go tell them McDonalds is hiring.

[~PedsRN~, BSN, RN]

I feel your pain, OP - and I also know that without the support of your management, this is a problem that will continue to fester. Good luck.

ETA: Why do I never look at the original post date? LOL - how was this even drug up from five years ago? HA!

[Libby1987]

Hours on the Internet?

If that's not a gross exaggeration, my patient advocacy instincts would be kicked into overdrive, crying wouldn't be on the radar.

The first thing I would secure is my mgmt's support, if they refused then they would have to replace me.

[dream'n, BSN, RN]

That's all fine and dandy. Heard a CNA at work tell one of the nurses that she "is a great nurse because she always helps the CNAs." I wanted to point out that that nurse is always in trouble because she does a piss poor job of NURSING. She is one of those nurses that does the bare nursing minimum and doesn't use critical thinking. I am not answering call lights when CNAs are playing games on their phones. Not going to do it. Anyway I have all the responsibility of delegation and what the CNAs are doing or not doing, but I am not authorized to write them up or discipline them in anyway. My management says that their duties are really the RNs duties and it's the nurse's responsibility that they get completed correctly, but don't give the nurses any authority. How is that supposed to work??? If am to be responsible for them then I MUST have the authority to discipline or my word is completely hollow.