How should I handle CNA

[happymama]

We are opening a new hospital and training off sight.  I was asked by my preceptor if I could ask one of our techs to help take the patient to the car so we can continue charting before we get another patient out of the OR.  I walked up to our techs (the ones that will be working in the new hospital with me) and asked very nicely "Hi guys can one one of you guys take our patient to their car please," one tech responded we are making beds.  I said "no worries whenever your done" they never came and another tech did.  When I was in the nursing station the tech that stated they are making beds came up to me and asked if my legs were broken.  I looked down because I thought something was on my legs.  When I asked what he meant he said that I asked him to do something while he was doing something implying I could of done it myself.  I said I did but I said when you guys were done. 

Another nurse stated the day before that the same tech keeps coming to the our new hospital staff and keeps stating he is not going to be taken advantage of and that not to wait on him to do things.  The nurse stated she told him that he keeps saying that and we have not even started.  I don't want to feel uncomfortable asking him for help.  Mind you that was the first time I asked for his assistance the whole week.

I was advised to reach out to my manager because that was not okay.

My manager stated she will 100% reach out to him because that is not okay but now I do not want to work with him

[Prokash]

Wow! You're not even off the ground running and you're getting push back.  From his reaction, it sounds like he feels he has a history of being taken advantage of in his mind, but maybe he has? The request made wasn't out of line, and patient care should always come first. I'd have explained the need for the help, "patient will be arriving soon & I need to complete my charting, if someone could help me?.” For myself, personally, if I could spare the time to transport the patient I'd just do that & complete my charting when I'm able.   I would definitely keep a written log of poor behavior, if it's not an isolated incident. Most importantly, I would pull the colleague aside in private and have a conversation of what each of you expects of the other as colleagues. Also, I would add, "going forward, if you have a concern with me, please give me the respect to speak to me in private, just as I'm doing with you right now.”

[Myruby]

Too bad for him. Document. He is about to be fired. How sad, he's mad, too bad. 

[londonflo]

Prokash said:

From his reaction, it sounds like he feels he has a history of being taken advantage of in his mind, but maybe he has?

This is a new start on a new unit.  This is a new job and he needs to approach it as such. 

Prokash said:

I'd have explained the need for the help, "patient will be arriving soon & I need to complete my charting,

There is no reason to explain a professional responsibility. It is indeed an important part of your job. 

Prokash said:

For myself, personally, if I could spare the time to transport the patient I'd just do that & complete my charting when I'm able.

Why have individuals employed with  patient transportation or duties assisting the (nurse --as  in 'nursing assistant) written into their job description?

On the other hand..Your professional job is to complete your professional cares (assessment, charting, reviewing orders and lab/radiology reports, implementing orders, charting in a timely manner and MORE!) And this guy cannot be interrupted when making a bed?  Bybbbbbby. 

Myruby said:

Too bad for him. Document. He is about to be fired. How sad, he's mad, too bad. 

At his next job he will tell everyone he ran "the unit". Couldn't function with out him.

[abbnurse]

londonflo said:

 

At his next job he will tell everyone he ran "the unit". Couldn't function with out him.

I literally laughed out loud at this !!   So So So true, don't you just know it ?  💯💯💯    

[MiamiRN1]

I think you are on the right track judging from the answers above.

[STP]

"tech that stated they are making beds came up to me and asked if my legs were broken.”

the above statement is all I needed to see to know what was happening. Some techs think nurses have the "easy job", not understanding the additional responsibilities involved and they become resentful. If they feel overworked or understaffed, they need to take it up with the manager, not refuse to work with others and display a bad attitude and create an unhealthy work environment for everyone - which ultimately affects patients too. If they do not like their line of work, they should find another. But someone with this lack of interpersonal skill that makes the above type of statement is not one many employers (or coworkers) welcome.

[STP]

Also regarding taking a patient off the floor to their car.. I don't know what this nurses's assignment was, but likely she had more than one patient in her care. CNAs must take the patient off the floor, so RN is not abandoning care and responsibility on other assigned patients.  The RN oversees the work and assignment, Not the CNA!

[nightwingcreations, CNA, LPN]

Ultimately the nurse is within her job description the one to delegate jobs to the nursing assistant.... It is his job to do as he is directed, as long as it's within his scope of practice. My answer to "are your legs broken" would of been "No, you're right next time you can do my charting while  I transport the patient" And if he continues with the behaviors, he would be reported as not performing his job.

[MarilynM]

I'm sorry, it's Site, Not Sight.. Moving on.  As a Nurse we can do all the tasks.. THE CNA Cannot.  If this Tech opposes your request my response is EASY.  He/She won't be coming along.  Seriously.  The bed can wait, until the Patient is discharged.  No One is taking advantage of anyone.  The only response to a request should be Yes Ma'am or Sir.  I have worked with CNA's that were so awesome, that I gave them and only them a $50.00 Bill for Christmas.  And I told them that every day I reported for work and saw them assigned to me, I knew my Day would be Great!  I helped them in any way I could, but I also knew they would follow my directives.  This Person has a chip on their shoulder and should not be coming to new location.  We are paid to do whatever is required in our shift.  So, shifting a priority shouldn't be an issue.  Transporting a Patient is in their scope.  Not taking advantage.  Good Lord.. Sheets are more important?  I don't think so.. Kick this loser to the curb and don't bring him along...

[londonflo]

You have a job description and so do I.

Quote

 Most importantly, I would pull the colleague aside in private and have a conversation of what each of you expects of the other as colleagues. Also, I would add, "going forward, if you have a concern with me, please give me the respect to speak to me in private, just as I'm doing with you right now.”

NO! he has a job description!  Next I would never, never, never do that, Don't the CNAs have a job description? 

 

 

[londonflo]

MarilynM said:

I have worked with CNA's that were so awesome, that I gave them and only them a $50.00 Bill for Christmas. 

YOU are paying them $50.00 to be nice to you? Wouldn't the IRS want to know This?

[broken wing 2.0, BSN, RN]

Been there,done that said:

CNA knows you are a new nurse. He is attempting to prevent you from asking him for help in the future. Best way to handle it is.. be firm and repeat your request. " The beds can wait. I need to make room for this OR patient now."

Being concise, confident, and assertive is a good way when communicating needs/requests of delegation. Establishing rapport and delivering delegation with respect is also a seemingly optimal approach. And my requests always started off, with "when you are done with what you are doing, can you help me with cleaning up this patient"  etc. 

However, I have on too many occasions, been demeaned/belitted by nursing aids as they flat out refused to help with delegated important direct patient care tasks, such as incontinence care. I remember my first negative experience with nursing assistants as a new grad RN which seemed to set the unpleasant tone when interacting with nursing assistants the rest of my nursing tenure in the hospital. Multiple experiences/observations of nursing assistants (particularly the first 5 years after graduating school) led me to conclude and/or believe: 1)they thought that they were actually registered nurses and we were the assistants (at least that is how they behaved).  2)They were jealous of registered nurses because they failed nursing school.  One aid confided in me that she failed nursing school, but because she had been a "NURSE" aid longer than I had been a registered nurse, she knew more than me. 3) Some nursing assistants showed favoritism.  Most assistants never refused task requests/delegated orders by certain RNs (I discovered that some of the certain RNs were former aids too). And if they couldn't at the time of the requested task/delegation they would not yell at them. 4) Simply flat out mean and fractious. 5) Charting in a computer took priority over patient care. 6) I hate to say this word, because I am lazy right now as I type on this couch, but LAZY and put EVERYthing they possibly can on RNS because they know we are ultimately responsible 7)Beyond burnt out and/or HealthCARE should have never entered their mind when applying. 

Often times I (as well as other RNs )were late in passing medications esp first am medication pass (and heaven forbid someone called out for PRN pain medicine too) due to the aids confiscating all of the WOW carts (there were only so many mobile computers with medication scanners available and or that worked) so they "could chart patient's vital signs."  I had asked one of the RNs what to do about it, and she simply said "nothing, some have been here so long, they run this floor." I also found out with my first floor experience on med surg that one of the seasoned aids, another one that claimed they had been a "nurse for 25 plus years" did not even know how to check manual blood pressure. Another time the same aid aforementioned, I overheard talking to another new oncoming aid to the unit and they said: "just go slow or say you forgot because the RNS will do it when you don't." 

I will never forget (and unfortunately neither will the patient) one day in particular. This unforgettable day was also one of several instances that truly motivated me in applying to another unit in the hospital for an overdue/necessary change. I stayed on this med Surg floor after graduating nursing school for 5 years. Most new grads left in a year and others- 6 months or less. One of my hopes during those 5 years (and maybe until retirement?) was that the RN-na relationship would evolve with team nursing in mind.  To my dismay, I concluded that the unicorn term mentioned in school was actually a myth. The sad reality was that nurses (and nursing aids) really do eat their young.  It was for the majority, persistent blow ups/melt downs/awkward encounters/toxic/sans team nursing which equaled non quality patient care and my departure from that floor (coupled with lingering thoughts of maybe I should exit nursing all together). 

It was the early part of the shift, I had nearly completed my patient assessments prior to am medication pass. I said hello good morning to the aid that was assigned to me for that day as I was walking into the patient's room. She responded with a calm and pleasant "hello and thank you." I thought briefly to myself, this is going to be a great day! This aid must be in a good mood and is being nice to me for a change. It would be a perfect day if I also have all of my assessments charted in the computer by 11 (and I may even have time for a lunch break!)!  Little did I know after I had walked into the patient's room, the patient needed help that required 2 person assistance for incontinence care.  The same seemingly sweet sounding aid that I said hello to was just outside of this particular patient's room charting vitals on the computer blew up at me when I asked for help. Her immediate response when I had walked to the door to ask (so loud the patient overheard and proceeded to cry) "NO!! I CANNOT! I AM TOO BUSY charting these vital signs!" I had to spend the next 30 minutes trying to calm the patient and dry her tears.  After she settled down, she admitted to me that she was crying because she felt "guilty"  for feeling like "such a burden"  because I was "yelled at" and the "aid became upset." 

We are all human and have stressful life/patient situations/ heavy patient load(pun intended) but I believe that the "poopy" aspects of nursing would not be as bad if we had staff (be it CNA, RN, MD) etc that were also not so "poopy" and were patient oriented and were nice to fellow coworkers. I don't want to say that all aids/other staff are terrible, I encountered a few(some new some experienced) during my first 5 years, that were great communicated/behaved respectfully, as well as the added bonus of: focus on patient care!!