How would deal with these type of CNAs?

AshleyO77 · Aug 12, 2012

I haven't read all the responses. I stopped on page 4 because all the posts chastising the OP over the dirty linens made me angry. As an RN if I had a dirty patient and changed his bed only to find no linen bag in the room and another patient called me for a medical need, I too would have shoved that dirty linen in a corner on the floor or thrown it in the trash to go tend to my other patient. We have to prioritize our care and in my opinion you prioritized properly. If you read the post the OP clearly stated they intended to go back and put the linen away AFTER tending to the patient!!!! In the meantime the aide walks in the room, finds the linen, and hunts you down to yell at you???? Ugh!
The risk of infection posed by the linen is certainly real but so is the risk that while you were hunting down a linen bag, putting it on the container and tossing the linen that your other patient who CALLED for help could have suffered some ill effect. Tossing it in a corner minimizes any fall risk to pt./staff. And I disagree with those that say pain is not a priority. It most certainly is to the person who is in pain!!! Have you ever seen a chest tube or abdominal surgery patient throw themselves into respiratory distress due to pain? I have. Patient's trust you when they know you will treat their pain as a priority. If that aide would have yelled at me I would have said if there was a linen bag in the room I would have put it there! The aide can toss the dirty linen, they cannot go administer meds to the patient.
Listen, I have worked with "those" aides/techs. The brutal truth is that you will need to learn to function without an aide. You can educate them all you want to. It does not matter. You can treat them with the utmost respect. It does not matter. You can praise them, thank them, build alters in their image and it does not matter. You can be in your managers office all day and night but it does not matter!
The fact is that being an aide is a backbreaking brutal job, just like nursing! They do not have the accountability that you do and so there is no incentive to change. If I had a dollar for every time I have heard an aide say to me "You only have 7 patients, I have 14" I would not be working today, but lounging on a beach in the bahamas! I have had aides chart fictional vital signs, not tell me when there is an acute change in a patient, refuse to assist me in toileting a person who I stupidly tried to take myself because no one would help and halfway there we almost fell on the floor. I have had aides refuse to let me use their pulse ox when I discovered my patient in respiratory distress. "I am using this one, find your own!"
Here is my real world advice to you and to any other nurse in this situation to make your life a little easier. Do the aides carry phones? If they do make sure to put their number on the patient's board. Tell your patient you can call the aide first if you need water, another blanket, help to the bathroom, etc. Use my number for medications, any medical issues etc. or if your aide does not respond to your request. Make sure you carry a marker with you at all times and check your boards when you go into a room because they will wipe off their phone numbers. (this only works if the aide keeps the phone on them or bothers to answer it.)
Med pass times? Go get a fresh water with the patient's medications EVERY TIME. Even if you end up with 5 waters in a patients room, it will save you from running back and forth and you can toss them on your final med pass of the shift. Get a linen cart prior to assessment/med pass. Make sure it is stocked with washcloths, towels, sheets, blankets, pillow cases, socks, gowns, soap, skin cream, bed pans, scd sleeves and a glucometer (make sure the glucometer isn't due for Q/C). Hide a working dyna-map and pulse ox behind that cart! Place it in a place that is near your assigned rooms when you go in. That way if you find a dirty patient you will have what you need nearby and it will save you time. If a patient is very difficult to toilet by yourself, order them a bedside commode if you can without a docs order. Just make sure to make time later in your shift to ambulate that patient. On your final med pass of the shift empty all canisters and write down totals. (Foleys, NG's, Wound Vac's, etc.) Pull your dirty linen and garbage bags and toss them in the hall in front of the room and pick all of them up when done.
I agree with explaining to an aide why you need their help at that time, but again this only works if the aide actually cares. For example: I need your help to turn the patient in room 2. Aides response "family is in the room, they can help you." My response: "they are on c-spine precautions and it is not appropriate for family to assist." etc. etc. Bring to your managers attention any blatant refusals of appropriate requests, fictional vital sign charting, non-notification of vital sign changes.
Do not be "that" nurse. The one who calls the aide from the patient's room to request they bring water or help the patient on the bed pan. If you call the aide for a bed change and they do show up do not walk out of the room. If you couldn't do it by yourself.....neither can they! If the aide calls you for assistance...please go and assist them even if it is not your patient! We are all busy. Only pull the I am sorry but I just do not have the time right now, find another aide card when you absolutely have to! Always remember that just as you sometimes have to refuse to help because you are too busy so do they!!!
Do not talk down to or disregard the aides input. This is a mistake that I see nurses making often. If the aide tells you something is up with your patient GET IN THAT ROOM AND CHECK!!! They are not stupid. Just like nurses some are smarter, more astute than others, but they have patient care experience that guides their intuition and you would be foolhardy to disregard it! If it ends up being nothing....great for you and the patient! Don't get angry with them. I have heard nurses say terrible things to aides. The worst being "I could train a monkey to do your job." If you do not believe an aide is integral to patient care.....go and ask your patients. They spend the most time with them, provide the most hands on care for them, and most of the time the patient will tell their aide something before they tell the nurse.
It sucks to have to do all this for yourself and much more so when you have patients with issues (and there are always issues!). Trying to stay on top of orders, consult results, test results, lab trends, vital sign trends, assessments and meds as well as these other tasks is daunting and at times seems impossible! Often times this is what aides/techs do not understand. They assume that all we have to do is: asses/pass meds/chart. They do not understand that we have to have a complete picture of the patients hospitalization, even a routine patient. And so when they see us at the computer or chart "sitting around" they do not realize that we are checking orders, reading consults, looking up x-rays etc. Especially if that nurse has refused to help them because they are too busy. All they see is that nurse "sitting." This is why I always included the aides in the plan of care for our patients. Always. Some of them appreciated that, others of them could have cared less, but making that effort let them know I respected their role. Including them in the plan of care helps them to see how important their jobs are to the patient and why I may be asking them to do things out of the ordinary such as more frequent vitals, etc. Even the most hardened aide will be more likely to assist you if they know you are truly a team player.
Finally when you do find yourself working with a good aide, resist with all that is in you the urge to load up on them, because I can assure you all the "I didn't go to school to put people on bed pans" nurses already are! If you have to pull for a sitter do not always only pull the bad techs! The good ones end up burnt out/quitting and you are back to square one. DO NOT PUNISH the good ones!!!!!! Make sure they know how much you enjoy working with them! BRING IT TO YOUR MANAGERS ATTENTION IN WRITING!! A good aide/tech is worth triple their weight in platinum!! They can make or break your shift.
Those are my survival tips you can use until you find a better managed unit. And make no mistake this type of issue with aides is most often a sign of a very poorly managed unit/hospital, and the direct result of the "do more with less" dogma in healthcare. We have too much to do and not enough time in the day. Nurses and aides alike become hardened when in a every man for himself environment. Even towards the patients and their needs. It is a defense mechanism. Be aware that even if you implement all of the above advice you will still encounter those aides (and nurses, docs, housekeeping etc. too!)that make as little effort as possible.
Sorry for the book, it is just that I have been there, done that, and know how much more difficult it makes your job.

This is an awesome post!

FMF Corpsman, MSN, RN · Sep 1, 2012

gmseagle2918, Your post surprised me. At least the very first line surprised me. You wrote, "A lot of this thread really revolves around one thing;" I wasn't ready for the next couple of words to be "being prepared." In my opinion, the most important thing about all of this thread is RESPECT. You may be a new practitioner and have to earn the respect of your colleagues, but you also have to show them all of the respect they deserve. Of course you may come across those who haven't earned your respect, but don't disrespect them, maintain your professionalism at all times and act accordingly. If they deserve a write up, oblige them with one. If the offense wasn't quite so dramatic, simply pull them aside and give them a warning and tell them under no uncertain terms will you tolerate such behavior in the future and if it happens again, they will be written up. Team nursing requires team building and you can't expect that to happen overnight, each person has to learn to work together and a well oiled team can eventually begin to function non-verbally, each member knowing to anticipate the others needs and next moves. Now that's teamwork and respect.

FMF Corpsman, MSN, RN · Sep 4, 2012

As Ashley 077 says, this is an awesome post Sugarcoma, it is very well written and includes most of the accolades due to the aides and ancillary staff. It also gives great tips on how to complete rounds without the help of someone else if need be. I can think of a few things that I considered as imperatives when dealing with all of the floor staff. One thing was, I would be completing their evaluations. Even those of you not in a management position should be being asked for your input regarding the Staffs work ethic, their goals, accomplishments and etc during the last quarter, bi-annual or annual periods. If you aren't being asked, offering your honest opinions to the Charge Nurses would likely go a long way, one way or the other in the careers of the floor staff. It could either enhance their opportunities or make way for new and better staff. It would also communicate to those who are quite as bad as the others but have room for improvement, that professionalism is the rule of the day and things will run according to Team Leaders or how ever the organizational chart dictates and people will do their jobs, not spend time slacking at the desk on the phones or on FB, but taking care of patients. Secondly, if you do have outstanding NA's and CNA's recognize them and give them credit for doing good work, this motivates the others to work harder and want to be recognized for their work as well. When you see this, you must give them credit for trying and they will try harder. Lastly, Have floor events like little get togethers after work or even covered dish meals at work if your facility allows them. It builds morale and high morale brings cohesiveness and stronger team equals a better work ethic. People that enjoy working together do far better work and that makes for happier patients and improved patient surveys.

MichiganPCT · Jan 26, 2013

Hello All,I've been a CNA for many years in an acute rehab facility. I've worked with good aides, good nurses and sadly, bad aides and bad nurses. I do my best to stay clear of the latter.I've shared my section with many nurses, the best of whom were previous aides who still have respect for cna duties. I can't speak for all CNA's. In my personal experience, when I or my nurse take the time to acknowledge to one other that it's a crazy day and we really need to work together, we become friends.Together we can help our residents. As a cna, it is comforting knowing that if I need help transferring, toileting or grabbing someone's weight/ vitals- my nurse is there and has my back. When my nurse needs me to put the pedal to the metal and go the extra mile because the nurse manager is on their back about everything, I will work my butt off for them.It goes both ways. I try to live by the golden rule. I politely ask anyone who is higher on the career ladder than their cna to realize:CNA's do low paying, thankless grunt work and are often treated as such. Please know that we aren't all lazy. Some of us actually care and treat our patients like they are related to us.Thank you for reading my post. I hope I didn't misspell or poorly communicate my intentions.

FMF Corpsman, MSN, RN · Jan 26, 2013

MichiganPCT, Your post was great, concise and to the point, much as your nursing care I suspect. I would be pleased to have you on my team any day.

MichiganPCT · Feb 14, 2013

Thank you for the compliment, FMF Corpsman! I would welcome an opportunity to be part of your team as well. Perhaps our paths will cross someday.

Recoveryroom · Mar 26, 2016

I completely agree. If the manager is willing to participate on any level, you will at least have hope. If the manager "checks out" you won't see any improvement. Give your notice.

NurseNeLz · Mar 29, 2016

I did experience this somewhat as a new nurse. I feel like the senior CnAs like to test the new nurses. You give and take but after a while you need to stand your ground and not be a pushover. That being said I work with some awesome CNAs and some not so much. You will have that everywhere. And lastly I will also side with the aides that in sometimes I see new nurses expecting to not do ANYTHING the aide does such as getting water, putting someone on a bedpan. I dont know what they teach in nursing school now but some wont even help clean a patient! Anyway nursing is about teamwork and the quicker you learn that the better your work day will be.

It's about patients · Mar 29, 2016

Ok if we work without CNAs then what are they being paid for? Sounds like primary nursing to me in which case more nurses are hired and only 1 or 2 CNAs are used. Maybe explaining the risk to them as a job group in whole would motivate some of these people.

cinnybug · Mar 29, 2016

I was fortunate to have decades of management experience prior to becoming a nurse. So I came into the situation with the foreknowledge that employees listed as my responsibility (Aides) are members of my team. I treat them with respect and dignity as they are grown adults performing a specific and well defined job function. I immediately familiarized myself with their job requirements and worked alongside of them to gain a full understanding of their stresses and needs. As a Nurse, I am well aware that making their job easier in turn makes my job easier. I assist my aides whenever possible in order to maintain a smooth functioning shift. A couple of rules that I personally follow are:

1. The Aides are my fellow employees/team members. They are not my friends. My relationship with them is friendly at work but I do not have personal relationships with them outside of the workplace. This keeps the accusation of favoritism/bias out of the picture. It also helps to maintain a professional relationship wherein my position as a manager/supervisor with the right to discipline is respected and acknowledged.

2. I never speak to anyone in a tone or manner that I would not want to be spoken to. I do not yell, sneer, demean, order or call anyone "girl" or "kid". I am polite and I ASK for assistance politely. If I need to let an Aide know that a patient needs assistance I do so with the caveat "When you have a moment ( or chance) Mr/Ms So and SO would like....I told them someone would be in to assist them in a couple of moments". If I am able to assist the patient I do so.

3. NEVER speak to an Aide ( or really anyone) alone. Always have a witness to the conversation. This goes double for any disciplinary conversations. If I am having issues with the floor I will organize a meeting with all Aides and other nurses on the floor. I usually will have an outline of the meeting in written form with expectations fully defined. Best not to list any criticisms. And particularly do not to point out anyone in specific. I usually will go over this agenda with my supervisor prior to calling the meeting so that they are aware and approve of the meeting.

4. Be the model for what you expect. Set the example. I am never late. I have never called off. I do not indulge in gossip about other employees or patients. I maintain a positive professional attitude. I do NOT have my cell phone on the floor. I always let my aides and other nurses know when I am leaving the floor. I give report to my aides every morning. I praise my aides for a job well done most everyday.

One of my favorite sayings is "You get what you advertise for" If you wish to receive respect then you must act as someone who deserves and expects respect. Always remember that respect is definitely a 2 way street and most times we give more than we receive.

LittleOldLadyWho, ADN, BSN, LPN, RN · Mar 30, 2016

I wasn't aware that there were CNA's that were good, lol.
All kidding aside, I've only met one CNA that was actually helpful. 23 year old young man wanting to become a nurse ... he'd come running across the floor to help with absolutely anything. Unfortunately he had the lowest seniority so instead I always saw the other CNA's that hide in the coffee room or something.

You've got to be kidding! Did I misread your post? Surely you worked with some good CNAs if you really worked anywhere. Even the worst had some redeeming quality that was appreciated at times where I worked.

LittleOldLadyWho, ADN, BSN, LPN, RN · Mar 30, 2016

Your first rule of never doing anything with others outside of work stinks in my opinion. Many meals have been shared by me and my coworkers after a hard day or night. Baby showers, wedding showers, going to weddings of coworkers is common when the shifts can be covered. Hospital is not so different from any other company where someone might work. Lighten up some there. The second rule of calling cohorts by Mr. or Miss or Mrs. is strange and too formal for people who help wipe butts and all the other intimate stuff we do with our patients. Your third rule of never speaking to a person alone without a witness seems strange. If you have so little trust of the staff that you're afraid they'll misquote you or claim something that didn't happen - that's a big problem! Are you for real.