How can I help my aides?

Missingyou, CNA · Oct 16, 2015

Tell her what YOUR priorities are for your patients.

My nurse tells us "I need blood sugar on Rm 14-2 within the next 30 minutes or "when your finished doing "that", I need vitals on Rm 19-1 ASAP. This way we know what the priorities are and how urgent they are. We can't guess the importance of what the nurse needs and how quickly they need it.

My bet is she is spending too much time with each patient and trying to do things "too perfect". Sometimes you have to just toss the sheets over the bed (or leave it unmade)instead of making "hospital corners" and fluffing pillows (or some other less important task) in order to get more important things done on time.

It may seem impossible but, there are CNA's who are "TOO compassionate". They do too much for their patients and are not multitasking. The patient can wait 10 minutes for ice water until you are at that end of the hall for something else instead of making a special trip. It's the little tasks that only take 30 seconds, that when multiplied, will put you behind very quickly!

hookyarnandblanket · Oct 17, 2015

Would it be possible to have her shadow a more efficient CNA? We have a CNA at my hospital who cannot manage time, either. For a while, we chalked it up to her being right out of CNA training but it has been over 90 days and she still can't prioritize. The previous poster has some great suggestions, too.

She needs to know how and why vitals and blood sugars are first priority. Just yesterday, I had a patient's family member ask me to feed her love one and I had to politely explain that at that exact moment, I was the only CNA on the floor with five more trays to pass in the long term care dining room and I would have to be there until my coworkers could take over. She wasn't happy but I had to prioritize. I never said I wouldn't help, just that I had to see that everyone else got trays, too.

Maybe explain it as a hierarchy of needs: Vitals and blood sugars are top, turning, toileting, etc. are next, and so on.

If the suggestions given in this thread don't work, then maybe this line of work isn't for her. We have two CNAs who are not efficient enough to work the floor. They would be great sitters and companions, but they lack the speed and efficiency to be CNAs.

verene, MSN · Oct 17, 2015

As other poster's have suggested clearly communicate priorities to her.

I would also ask some of your CNAs who are good with time management how they breakdown their shift. When I started my current job I asked several of the more experienced CNAs how they utilized time during the shift. I now have a rough guide of "where I ought to be" in terms of tasks given where I am in the shift.

An example:

3pm - report

3:30pm - Initial rounding and pt check-ins

4pm - Vitals

5pm - Turns

6pm -15 min break, call-lights and misc tasks

7-pm- pt dinners

6:30pm-8:30pm (fit in staff dinner breaks)

8pm - initial close down of wing (close blinds, lock outer doors to pt rooms, etc), misc tasks, empty foleys, etc.

9pm- turns and HS care

10pm - Second 15 min break, full lock up (main doors etc, switch to evening lights), finish any housekeeping tasks (trash out, dishes washed etc), complete any room stocking that may have been missed earlier

11pm - double check charting is complete and rooms ready for night shift

11:30pm - leave

Obviously there has to be some flexibility - If I have a pt where my nurse has requested hourly vital signs I'll need to fit that in, maybe there is a late admission or discharge, perhaps I have a family that needs a lot of extra support that takes up time. Maybe only one pt is immobile and needs turns so I'm done early and can go on break before 6pm. I may not be exactly on this schedule but it is a good mental check of "am I on track?"

I'm also really surprised management has not had an issue with her staying 2 hours late for paperwork! If I stay more than about 10 minutes past the scheduled end of my shift I need to be able to justify that time to charge RN and/or manager.

KThurmond · Oct 17, 2015

Its nice you want to be considerate about it. Not everybody does when it comes to CNAs

la_chica_suerte85, BSN, RN · Oct 17, 2015

Oh man, it's my worst nightmare that I was going to end up being this aide. I commend you for wanting to work it out with her. Is she aware this is an issue? How is it that she is able to keep racking up 2 hours OT to chart and finish up without admin coming down on her? I think you can communicate your expectations to this aide but if there is no identifying what it is that is taking so long, then the problem might not get solved.

For me, when my RN tells me they need something, it's done right then and there. If I have a patient that has several hundred things for me to do for them, I make a list, repeat back the list so they know I heard and understood them, and give them a time frame for when I'll get it done -- I cannot wait on them hand and foot all night. I also help out with tasks for other aides' patients. If the RN can't find them and asks where they are, I will be more than happy to go move a pt with them or help with a wound dressing.

I just wonder what it is that bogs her down that is keeping her so behind. That is up to the nurse manager to address with her. In the meanwhile, if you can identify what on god's green earth is taking her so long, then maybe you can gently redirect her and remind her of the priority of things, especially concerning issues like the s/p surgery pt.

Good luck! Again, I commend your patience and willingness to work it out with her after a year of putting up with it.

hookyarnandblanket · Oct 18, 2015

The overtime issue: Yeah, my DON would have a cow if we stayed 2 hours over to chart. The only times we have been able to stay over that late have been to cover until all of 2nd shift gets there, complete baths, or for meetings. If we have a consistent string of overtime days, we get cut hours on the next schedule. I am surprised the DON and HR haven't been all over this.

LightMyFire · Oct 23, 2015

Thanks for the suggestions! OT has been discussed but I guess they haven't found a solution. Some will just leave and not chart. Maybe the other shift balks at having to do all the stuff left over, putting them further behind.

She does spend too much time in a room, that I've seen. I try to make a point to let them know if something isn't a priority but I'll also do many things myself to keep from piling on the list with small things. I'm busy too and they can't pass my meds or do my admit/discharge so I have to delegate. Also, my charting takes more time than theirs. And I want to work it out because we're all on the same team.

neuron · Oct 30, 2015

A lot of our nurses do their own vital signs. Just as a safety reason. If too much time passes when you are giving meds or doing other tasks that requires vitals, what is the point in waiting for a CNA to get them? Let admin deal with this CNA, you have really your own stuff to do, right?