How to get the cna's to follow instructions

[sasha2lady]

We are having some aide issues on following directions on our shift..7p-a. We nurses all do 12 hr shifts now..the aides still do 3 shifts, 1st, 2nd, 3rd. The 2nd shift aides, all of who us night nurses have been very familiar with have become very slack. Write ups have been done to no avail. Some of these aides have been noted sitting at the desk, which is against state regs in this state and they ALL KNOW THIS. We tell them to move....its temporary. WE have a heavy load...we cant babysit. Oral care, nail care, snacks, offering fluids...none of this is being done. They let lights go off for 20 minutes and we have to stop our meds and fuss at them to get them to go do their job. Now, Im not above it..but I will NOT do my job and theirs when they are just sitting around at the desk on the phone or in a room chatting. The nurses are overloaded as it is. We are all easy going and laid back most of the time but now we are all just fed up. Myself and a few nurses were talking and we all agreed its time to take back control and set things straight even though when we reprimand the aides it causes drama, strife and hard feeings. They try to make it harder on us....when we do write ups or scold them for not doing things or sitting around we suddenly have a jump in "skin tears".....which they know is about an hour worth of paperwork we have to do. Its ridiculous. I can be ugly when forced to but I just like calm and tranquility. I dont want to bring out the beast in me. Nor do the other nurses. Why is it so hard to do ones job? And whats worse is that when the aides get slack, it gets pawned off to the nurses....the DON then tells us to pass out their snacks, their liquids, do the nails, do the oral care and all that other stuff.....do we need to just go ahead and do all their work as well? I think a good house cleaning is due. What ways work for you guys to get aides to do what they are supposed to? I usually am nice the first time...but by he 2nd time...Im aggravated. What to do here?

[JSTARZ]

we have the same issue on my unit. However, I treat the CNAs with respect, because they are people just like you and I. I notice so frequently how my fellow coworkers talk down to them and threat them like crap. We all know, were RNs and LPNs and they are CNAs...thats all! it doesnt make them less of a person. I communicate with all ancillary staff members in the most courteous way possibe, and yes at time i do have to PUT them in line, but only if they intefere with my patient care. I am my pts advocate and im going to be just that. All of the CNAs are needed to get our jobs done...nd trust me they most def can make those twelve hours hell. I personally dont have issues with them because im very respectful, besides im the youngest nurse on the unit lol 23 so i guess respect goes a long way

[morte, LPN, LVN]

are you saying the are purposefully giving the patients skin tears?

[caliotter3]

If a housecleaning is due, a housecleaning is due. The nurses need to continue to produce the paper that will back up a firing. The nurses need to put a strong suggestion to the supervisors, up to the person responsible for hiring and firing, until action is taken. In many areas of the country it is just as difficult to get a CNA job as a nursing job. When some of these CNAs are fired and replaced by an eager to work, formerly unemployed CNA, the others will eventually get the message.

[SuesquatchRN, BSN, RN]

When you figure it out please let me know.

[caliotter3]

When you figure it out please let me know.

Nothing like a good firing or two to get things to start to turn around. Of course, this takes effort by the person who would be responsible to do the firing. If this person is not willing to do this aspect of their job, all is lost.

[SuesquatchRN, BSN, RN]

Nothing like a good firing or two to get things to start to turn around. Of course, this takes effort by the person who would be responsible to do the firing. If this person is not willing to do this aspect of their job, all is lost.

..

Yup.

[Peds_Nurse]

I have the same problems at my facility. It's not all the CNAs. We have some dynamite people that bust their humps for the residents. But, there are always a few, and one in particular that disappears during meal times, ignores lights, and has the audacity to tell me how to provide nursing to my resident. I've talked confidentially to a couple of other nurses and they feel the same way about her, but they also cautioned me not to make waves for this CNA because we have a hard time keeping them. Well! Of course you do, who wants to work with someone who is just impossible! They can't keep good CNAs because of the few bad ones they put up with.

I'm with Caliotter3, we need to clean house and when a couple of them get fired, the others will straighten up.

[sasha2lady]

Well I finally buckled down had 2 aides behind the desk on the phone at 6am one am and I had just finished my meds. I called their name twice and got ignored so I literally had to raise my voice like with a child to get their attention and when I did I told them to get to their halls and away from the desk because " you know you aren't allowed behind the desk" and to my surprise all I got was shocked looks of " I can't believe she said that to me" I also told them it would be a write up if I saw it again. Now, the hard part will be getting everyone else on board to keep it that way. I agree about the line of respect as posted prior but I have come to the conclusion that it must be easier to keep bad staff vs going thru the hiring and orientation process for mgmt . Our night aides are wonderful. I absolutely love seeing these girls come in the door at night. It feels like a huge weight gets lifted off my chest. We only have 3. They never give us a problem. It is my personal highlight of a 12 hr shift to work with these aides. I used to feel that way about my old shift before it fell apart and they all started creating internal drama among each other. They have lost respect for each other and the rest of their coworkers. I wrote an aide up several weeks ago for all out neglect of 5 of my residents and she kept her job. This writeup took me 3 sheets to fill out! She was finally let go after 2 more nurses got her for the same thing on a different hall. What irks me is when mgmt says they will back us if we write up someone but at the first whimper or tear they disregard it and that person is off the hook and give a pat on the back. When I was an aide I never ignored my nurses or mgmt. Luckily they always pointed me in the right directions. Thank god I listened.

[Peds_Nurse]

Last night was a bad night. I have one specific aid that never stops talking, I mean NEVER! She rattles on and usually stands next to my cart while she does it. I asked her to please stop because she is distracting me and all she does is give me a smart response because I'm a new nurse on the floor. She tells me what to chart on my patients and tells me what this resident likes and what's wrong with that resident and how to "handle" them. I'm so annoyed! Since I am new, I don't know if I should say anything to management or not.

Any advice?

[caliotter3]

PM Nurse

Start finding things for the talkative CNA to do. Oral care on all residents. An extra incontinence check. Go from room to room and wash and clean all hairbrushes. Go from room to room and empty and clean all suction canisters. Check each bed for number of blankets. Have her write down on a list the status of each so that you can "check" behind her. Come up with a long list of these things. Utilize this approach with her and eventually she might learn to leave you alone. If she gives you a bad time, write her up after you have told her that she is required to follow your instructions. Nobody said you could not give her busy work. And who is going to argue with cleaning the resident's hairbrushes, or better yet providing them with oral care?

[caliotter3]

sasha

You said you wrote an assistant up several weeks ago and mgmt didn't fire her until two other nurses wrote her up. That is progress! Communicate with your fellow nurses and keep up a unified action process. If you don't do these three page write ups, then you are assured that mgmt will do nothing, but if all of the nurses act on the same page, sooner or later, mgmt will have to do something. Another way to look at it is that you will have the documentation to prove that you did your job should something tragic ever occur because of one of the negligent assistants. Do the verbal and written warnings to cover your own behind and don't worry if mgmt chooses to set them aside. Then no one can ever accuse you of not doing your job.