How do you deal with an insensitive CNA?

[arelle68]

I'm a new registered nurse, I work on an Alzheimer's unit. There is a CNA who is being repeatedly scheduled on my shift, and to tell you the truth, I just don't know what to do with her. She is way older than me, and has been a CNA since I was 8 or something. She feels like she is firmly in charge of the unit, and tells the other CNAs what to do, when to take breaks, and when to go home, and then loudly informs me of her decision.

What concerns me the most is the way she treats the residents. When my one my residents was talking about her husband, the CNA informed her quite flatly, and publicly that her husband was dead. This made my resident cry. Later, the resident was talking about her home and family, and the CNA told her, "You're not home. You're in a nursing home. Your family brought you here and left you." The resident started to really cry then, and say, "My family would never do that to me!" "Well, they did!" is what the CNA said back, and laughed. My resident was distraught by this time, and so was I.

Later, this same CNA ignored me while I was desperately trying to get her attention to get her to get up and put a walker in front of a wondering resident who is a fall risk. She was chatting it up with the girl from housekeeping. I finally shouted at her to get her attention. I never shout at anyone. I didn't know I had it in me, and I shocked myself. It still feels hot in my chest. It gave me a headache.

I am frusterated. Please give me advise on what to do about this.

[Valerie Salva, BSN, RN]

This CNA is being verbally abusive to the residents. Write down eveything that has happened, everything you wrote here- do it factually with no opnions and present it to your mgr. If the CNA is not fired, I would look for another place to work.

[bluegeegoo2, LPN]

That is definitely abuse, plain and simple. Like Valerie said, write it up exactly as it happened. "I observed CNA "X" speaking with res "Y" and overheard res "Y" state...". You get the point. Include the res response, and the fact that the CNA laughed at her. You really want to highlight the damage this aide caused this res simply because she is likely to have done similar things in the past, and likely will in the future as well. Do not feel bad if this aide gets fired and reported to state, she needs to be. Can you imagine this woman taking care of your loved one? Families entrust their loved us to us and expect us to protect them from any and all harm to the best of our ability. You have an obligation as her nurse to take any and all necessary action to protect her. Don't be terribly suprised, though, if the facility doesn't do much about it. At least that's my experience. I had an aide that literally "spanked" res on the bare bottom while I was helping her change the res' brief. The res was aphasic, and appalled judging by the look of horror on her face. I reported it, and the facility's solution was to move the aide to another unit. ???? (I'm in the process of leaving that facility now). Good luck to you, and thanks for caring about your residents!

[CapeCodMermaid, RN]

This is abuse, plain and simple. Report it to the DON and if nothing is done, report to the ED. If still nothing is done report it to the DPH yourself. You will have done everything necessary to protect the resident. I've had to fire CNAs for verbal abuse. It isn't pleasant and many times it's he said/ she said. I find it harder to get rid of these horrible people in union facilities. The union protects the worker no matter how horrible they are.

[DusktilDawn]

Your statement that she feels like she is firmly in charge of the unit and that she basically tells the other CNAs what to do etc. sums up the big issue you have with the CNA. She appears to be unchallenged in this belief and is in effect firmly running the unit. When she "loudly informs" you of her decisions, she is, in fact CHALLENGING YOU, in fact almost daring you, to go against what she believes is within her authority to do. Right now she does not feel nor believe that you have any authority over her. Guess what? She wins each and everytime no one says anything. She has effectively usurped supervisory authority away from the CN. What she cannot usurp is the responsiblity. YOU ARE RESPONSIBLE because you are the one that is supposed to hold supervisory authority over her. Also bear in mind that YOU, as her supervisor, can be subject to disciplinary action from your superiors and the SBON if/when the crap ever hits the fan because YOU have allowed her to make decisions she is not qualified to make.

Regarding her abuse towards patients, as Valerie put it, write it down, factually without your opinions and submit it to you manager. Also bear in mind, her abuse towards patients may also be part of her belief that she is running the show. She may think she's untouchable. Perhaps this person is still there because no has started a paper trail. Also keep a copy for yourself and include details such as the date you submitted it and to whom.

The problem is that this was a situation that has been allowed to develop over time, probably long before you ever set foot there. Realize that she has become embolden over time, she will become even more so as long as this situation continues. Recognize that she is not going to like it if ANYONE tries to change the status quo. Realize that if you takes a stand and refuse to her allow her behavior to continue, it will get worse. She will up the ante in challenging your authority. She will see you as some snot-nosed newbie that knows crap trying to tell her what to do. Realize that if you stay firm and hold to your ground, she will eventually back down and back off.

Before you do anything, you need to sit and discuss this situation with your manager. It may help to write things down, what you believe the issues are, and if possible provide specific examples with dates and details before you have a meeting. If management refuses to support you, than you may want to consider looking elsewhere. This CNA is not worth YOU LOSING your license.

[FA to CRNA2b]

Report her to the board. Have her license revoked. If someone treated my mother like that, I would take it to the top.

[texastaz]

I hope you follow through with reporting her and let us know the outcome. I am an Agency CNA and I have seen the same thing - the verbal abuse - in many places. The CNAs that do it are typicly bullies even with the staff and assume that their services are too valuable-like this one you pointed out. I am sure the other CNAs will also be grateful for you taking charge and relieved to have a strong leader that sets the example. You can teach them kindness is not a weakness. Good Luck!

[FireStarterRN, BSN, RN]

What an awful person! I agree with the above, this CNA is going out of her way to be hurtful and cruel to these helpless residents.

This is a very common scenario, btw, for a new nurse to be steamrolled by an older CNA, especially in LTC where the aides outnumber the nurses. I sympathize with that problem. Meanwhile, this particular CNA is a nasty, mean person who is adding to the suffering of these poor people.

[Debilpn23]

I agree with the above, she needs to be reported. If the Don does nothing go higher,

[Thankful RN,BSN]

She doesn't need to be fired. She is used to having her way. Maybe this new nurse can speak with the CNA about her behavior. Then if she continues she can report it to her manager. Then it is up to the manager what is done. Wow, i'm glad that i don't work with any of you all. You guys are quick to want to fire some one.

[FireStarterRN, BSN, RN]

She doesn't need to be fired. She is used to having her way. Maybe this new nurse can speak with the CNA about her behavior. Then if she continues she can report it to her manager. Then it is up to the manager what is done. Wow, i'm glad that i don't work with any of you all. You guys are quick to want to fire some one.

I agree, someone needs to talk to her first. Realistically though, from my experience, these older, long time CNAs in nursing homes are extremely set in their ways, have been bullying new nurses for many, many years, and have seen many of them come and go. One senior CNA in a nursing home can be accustomed to practically running the place.

[CapeCodMermaid, RN]

Report her to the board. Have her license revoked. If someone treated my mother like that, I would take it to the top.

Just so you know, CNA's DON'T have a license..they are certified nurses' aides not licensed ones. But I get your point.