How to get cooperation from CNA

[taty]

:confused:I am considerably a new RN on telemetry/stepdown unit, working since 03/03/08. And I will appreciate any advice how to get CNA cooperation to clean patients. Only a few CNA take their job seriously and are compationate with sick people, but most of the CNA that work on my floor, work just for money or something else. I was reprimanded a few times by my nurse manager due to patient's family complains, that their beloved family member wasn't cleaned/no perineal care provided. Every time when I ask my CNA for help, she says that she is busy, or she is on break, or some other excuses. During the last complaint and discussion with the Human Resources Department, I was advised to report any CNA that refused to perform her duties, but I don't feel comfortable in doing so, and I think it's supposed to be a last resort.

[RosieD]

Is it just one, or all of them? If it's all of them, the issue might be you in some way... When I was an aide, there was one nurse who always seemed stressed out, she always was sort of freaking out, didn't have time for anything (and then when she DID have time, she didn't round on patients to preemptively avoid anything, she sat in the conference room and always fell asleep. Poor dear, she had 3 young kids, and was always exhausted at night, but still.)

We were super busy unit, it was pretty awful. But, this was the only nurse who would call me to do something that a patient had asked her to do personally- like, she would be giving a med, and the patient would tell her they had to use the toilet, and she would call me instead of doing it herself when she was already in the room. We had a HUGE unit, and I would often have 20 patients, so that was a problem.

That said- if you are having a real problem with one person, talk to them! Tell them you want to talk, maybe get you both a cup of coffee, get someone to cover for you guys for 5 minutes, sit down and talk. Give her a couple of examples of things she does well, then tell her what your concerns are, and ask her what's going on. If she's having trouble doing her job, maybe you or someone else could help her organize. If she's seriously just sitting around, then maybe she doesn't know how important she is to you. Tell her you need her! Try to give her encouragement- praise the **** out of her when she does something right, even though it's just something that's what she should be doing without being asked in the first place, just like you would with a toddler.

Also, there might be times when she is really busy too, and you're sitting down charting or taking a quick chat break. Sure, you notice when she's being a little turd, but you wouldn't notice when she was busy, as she'd be in a room with a pt. Maybe once a night or so, call her when you do have a second to breathe and ask HER how she's doing and if she needs some help.

Try that for 4-5 shifts with her, at least. Ask the charge nurse for some confidential advice, and try phrasing it like, "I've talked to her about it, and I wonder what we could do to help her improve"- that way you're not trashing her, but still alerting the charge to the situation. If things DON'T improve, then yeah, full-on complain to the charge and the manager, but be fair and give real examples.

Lastly- sometimes the best way to get people to help you is to get to know them better personally- take a few minutes at the beginning of a shift to ask her how things are going, ask about her boyfriend, school, whatever, find something in common, whatever. Making someone your friend is the easiest way to get them on your side.

[Virgo_RN, BSN, RN]

Yes, reporting them should be a last resort.

I agree with the above poster, that it helps to show an interest in them as a human being. Ask about their family, their interests, their goals. Share something about yourself. Show respect for the fact that they are busy too, and be flexible and willing to collaborate and compromise with them. Remember that they are an integral part of the patient's care, not just someone to help you.