How would deal with these type of CNAs?

Published

I am one among the newest RNs on a busy floor. Every shift I am struggling to help pt's ADLs with minimal CNA assistance. A few CNAs are plain horrible. They won't answer my pager or when they do they would tell me they are with another pt. I told them when they finished with the pt then come help me. Most of the time they don't so I ended up doing it all myself. At other times when they didn't come and help me they complaint that I left dirty linen on the floor. I told them I helped this pt and changed all her linens after she pooped or puke on herself and yes in between I also passing meds while another pt paging for pain medication as well. When they hear that they don't like it.

Up Vote Up Vote ×

New RNs have to earn respect from experienced workers on the floor regardless of position. You may be above them on the ladder, but you are the new kid on the block who needs to earn their trust.

Perhaps you accidentally talked to them as people who work FOR you, rather then WITH you as teammates. Perhaps they are "breaking you in" testing your mental strength seeing if you will crack under pressure.

You need to pull them aside individually and talk to them professionally expressing your concerns. Setting boundaries and expectations. Add that if they continue to ignore their pages that you will have to bring it up with your charge or Unit manager.

Be the bigger person here and rise above their highschool behavior.

Up Vote Up Vote ×

I beg the opposite! I don't tell them what to do like some other nurses would. I ask them politely and those who behave that way are the ones never been through nursing school. They think we nurses don't do jack, while those others who are so helpful and answer their pagers when call are nursing students who working as CNAs. Maybe I should be more assertive and not be so polite.

Up Vote Up Vote ×
Specializes in Critical Care, Education.

I disagree a bit with the PP... I dunno where the myth of "comrade health care worker" started, but the RN actually IS the boss of the CNAs when it comes to patient care. This certainly does not mean that there should be any disrespect toward the CNA, but c'mon on! Keep in mind that peer pressure trumps everything.... chances are, the CNAs are all acting out because they have been allowed to establish their own rules. It would take enormous courage for one of them to violate these rules because they would risk being ostracized by their peers.

It would seem that the lack of respect in this situation may be pretty one-sided... CNAs disregarding RN delegation & failing to comply with existing policy (dirty linens on floor??). The only one who has the power to change this culture is the department manager, but you can start by enforcing policy. Get all your ducks in a row first. Meet with your manager and discuss the situation and find out what steps you are authorized to take to enforce policy and provide quality care. Are you allowed to formally discipline or do you have to fill out documentation and pass it on to your manager? Bottom line - if you do not have your manager's support, you are beaten before you begin.

Then - talk privately with each CNA you work with and tell them what you are going to do and why you are doing it. Use clear examples. Talk about the policies and procedures you will be focusing on. Don't allow the conversation to drift into discussion of the behaviors of others... focus on the one-on-one with you and the CNA you are talking to. Make it clear that the old 'stuff' is not going to be tolerated & that you are going to formally document each and every policy violation.

Then - prepare for battle. You will need to walk the talk and follow through. At the same time, be generous with positive comments and observations whenever you see better behavior - public comments are best. Make sure to formally document this also - and provide it to your manager so that these comments will be placed in the CNA's personnel file also.

It will be a hard, slow process. You will be tested in every possible way. Good Luck!!

Up Vote Up Vote ×

I placed dirty linens on the floor because I had changed the entire bed actual two of my four pts' beds that shift. I didn't have time to run back and forth. There wasn't any linen bag in the room. Like I said most of the time our floor is busy. In that same time my other pts needed me. I feel their medical needs supersede this. So I tried doing the best I could cleaning them up given them new clean fresh linens then move on taking care of other pts. I told myself I would come back for those dirty linens, but other things kept me running and I forgot altogether. This CNA found it on the floor said do I (me) really leave a dirty linens on a floor, really?!

Up Vote Up Vote ×

I have been traveling and agency for 5 years now . I have seen many different areas/hospitals/ CNA's.

The last facility I worked at, had the CNA's with the worst attitude and work ethic(exactly liked you described).. that I have ever seen in 30 years of nursing.

Since the majority of the staff was new grads and agency.. it was accepted as the norm.

I started writing incident reports.. each and every time a CNA refused my direction. (that is usually the first sentence of their job description " UNDER THE DIRECTION OF A REGISTERED NURSE") We are responsible for everything that they do, or don't do.

Management actually thanked me, it did make some difference, the CNA's knew it was me and would no longer look me in the eye.

But they would do what I (always politely ) asked them to do.

My response from thread of May 7 from RNBeauty 23

Up Vote Up Vote ×
I am one among the newest RNs on a busy floor. Every shift I am struggling to help pt's ADLs with minimal CNA assistance. A few CNAs are plain horrible. They won't answer my pager or when they do they would tell me they are with another pt. I told them when they finished with the pt then come help me. Most of the time they don't so I ended up doing it all myself. At other times when they didn't come and help me they complaint that I left dirty linen on the floor. I told them I helped this pt and changed all her linens after she pooped or puke on herself and yes in between I also passing meds while another pt paging for pain medication as well. When they hear that they don't like it.
CNA's will test you . Many want to do as little work as possibly. Read their job description. It is not necessary to go through a period as a newbie , while letting the slackers run over you.

Enforce your direction , each and every time. Write them up for insubordination, They will learn to respect you STAT!

Up Vote Up Vote ×

meet one or two of them in the parking lot after work....

Up Vote Up Vote ×
meet one or two of them in the parking lot after work....

I work in DETROIT! I have had my head up going to my car, after attempting to direct CNA's.

I am quite sure that "meeting them in the parking lot" .. could lead to a physical altercation that I don't need.

Up Vote Up Vote ×

When I was new I had the same kind of problem with a few of the cliquey CNAs that had a reputation of not doing their job and being nasty, I got to the point where I asked, and if they refused to do their job I wrote them up. Their attitude magically changed and right quick. I help when I can and if I am in the room I take care of it, but if someone needs to use the bathroom and 3 others want pain medicine, they need to do it. Charting and routine vitals are not more important than someone needing to use the potty NOW. We need to work together, but that does require 2 parties both working.

Up Vote Up Vote ×

Maybe some people get results with the "I'm in charge" attitude, but I've seen it fail time after time. Maybe holding the threat of a write up over their heads will force them to comply, but who wants to work in that kind of environment?

And if you say your CNAs are horrible, I guess I'll have to take your word for it. But there's two sides to every story. And it's never totally one side's fault. Nothing is black and white.

Up Vote Up Vote ×
Specializes in ER, Med-surg.

When I was in CNA training, one of the CNA's training me got fired because she left linens on the floor. It's an infection control issue. Born2BRN, as a CNA, she probably thought that you as a nurse should have known better.

I also find a lot of CNA's saying that all RN's do is paperwork and never clean up puke or poop or take vitals. Maybe if you had the time to explain your job requirements to them it would help...but if their attitude is that bad, then it probably won't change a thing. Learn to work without CNA's. I read too many things about RN's having issues with CNA's not working. Are you in LTC or in the hospital?

Up Vote Up Vote ×
+ Join the Discussion