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

[JohnHood, BSN]

I would take this right up the chain of command. His behavior could be considered insubordination. Yes, you could do every single thing that he does. He can do little of what you can do that requires a license. His only function is to free the RN from those tasks so that you can do the things that require a license.

[MarilynM]

Goodness Londonflo!  I wasn't Paying them to be nice to me.  How Jaded can you be?  I was gifting them because as the only RN on the floor, That CNA was always helpful and a Joy to work with.  We worked together and I knew I would never get attitude from her.  Goodness Gracious!  What a tacky response.  Surely many Nurse know what I meant. 

[londonflo]

londonflo said:

  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. 

I am sorry if I read this comment differently that you intended. . 

[alfredbo1]

this is tough I'm sorry!

[missaretha]

happymama said:

I can see your point.  A little back story since we are training off site I have only worked with the CNA for a week and really only had 2 interactions with him.  One was waiting for him because to greet since week one of working/training was at a different site (there are 2 techs) and 2nd I was teaching and showing everyone and incentive health program to get money (I have worked for the organization so know where to look and it needs to be completed by end of month).  The nurses and I (the ones that will be working in the new location) have been taking our own patients out because we had assigned preceptors in only Phase 2.  This particular day the PACU nurse had to do both phase one and phase 2 so they couldn't really leave just in case the patient comes out of OR.  I offered to take the patient  out to my preceptor but he (my preceptor) asked me to ask them if one of them can take the patient so we can finish charting. 

They were both making the beds and looked to be almost done and I asked both of them politely  if one of them could and when he said we are doing something I said no worries when you guys are done.  From my understanding patient takes priority and one could of continued with beds and one could of taken the patient. 

When I was helping one day a nurse asked me to escort a patient while I was making a bed and I immediately stopped to take the patient because I can always come back and finish dressing a bed

Like I stated before prior on multiple occasions this tech stated that the he will not be taken advantage off.  One time I did state that in my other location we didn't even have a tech so I don't see that happening (which is true) and his response was Good then you know what to do (okay that might be the third interaction).  And when one of my coworkers stated that he keeps stating that to her and another nurse (I was not present) and she stated why do you keep saying that we haven't even started.

Regardless I do not think my request was out of line.  I did not ask rudely.  The other tech actually came up do me and said sorry I do not know whats going on.  They both left without telling anyone and the charge that we are working under and they needed patients moved and they kept asking me where they were and I did not know. They have been off the unit for 2+ hours.  That is when the charge stated that I should address it with my manager because that is unacceptable.

Hey Mama,

I'm curious to know how things turned out. I wanted to let you know that I read your original post and every single reply...all 3 pages of them.

There will be people here who agree with some things I have to say, and some who will disagree...possibly including yourself. Hopefully, in addition to all of the other replies, this will be of some help and comfort to you. I have also looked backwards. I can see you started as an LPN and are now an RN (good for you doing the bridge). You are not new at this and you know your job. It is merely the situation that is new.

As for this guy, sounds like HE needs to talk to someone about his previous experience working in an environment that is ALWAYS stress level 100, and that he was likely taken advantage of in that role. This is NOT your fault. I'm guessing he may have changed over to this new location because of it. But he needs to use any benefits that he may have, and that are usually available through the job, to talk to some kind of counselor or therapist for a few sessions, which are usually free. There is no shame in therapy for ANYONE who works in healthcare, working directly with patients. Even therapists have therapists. ;-) 

As for your request to escort a patient out, well, it's not really an ask. Your preceptor was telling you, to tell one of these nursing assistants, to take the patient out. If it were me, and this is just from experience, I would have gone in and politely told one of them to do it while the other stayed behind to make the beds. It sounds like you were polite but it doesn't sound like you were direct enough. As in, this really was not a choice for either of them to say "no." It's literally their job for them to do, what the nurses who are managing them, tell them to do.

You have a license with a scope of practice. They have certifications with a wildly limited scope of practice. My first time through nursing school (LPN), we were taught to always get done with everything no one else can do. In other words, get everything done that only the licensed nurse can do. And if you wish to assist nursing assistants after all that is done, it's up to you.

The reply you got, which was completely insubordinate to you, followed by being asked if your legs are broken, are 100% completely out of line. I have verbally requested for CNAs to please exit a patient room to correct and direct. Always polite but always firm. My best friend, who I went to school with for my LPN, has done the same thing. We did this while still students. 

None of this makes you mean, dictatorial, unreasonable, or unprofessional. The patients, whether they're in a bed or leaving, always come first. They definitely come before making a bed. 

I'd like to hear how all that worked out. I hope it did not discourage you. You weren't wrong, and you did exactly what you were told to do.

BTW, I did an LPN to RN bridge program as well. And when I went back into clinical hours, I got tested by existing CNAs working the floors. They thought I was just some student. They changed their tune when they realized I was already a nurse who was also a student, and was actually working my regular job in the SAME facility they were.

I would work my job one day and be a student the next day. Because of turnover of CNAs, many of the CNAs I worked with while doing the bridge program didn't know me, nor did they know I was literally working at the same facility. That actually helped with the ones who tried to test the boundaries.

Would love to hear this all turned out. Hope your transition to the new location is working out better now.

[missaretha]

londonflo said:

I am sorry if I read this comment differently that you intended. . 

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

No worries. A lot of us nurses do this when we have CNAs that we work with on a regular basis. I've given Christmas cards with money, home baked cookies, handmade baskets with all kinds of goodies, gift certificates, gift cards, etc. It's basically just a gift over the holidays to say, "thank you and I appreciate you." Most of us are their direct supervisors. They rarely see management on the floor. So like any other boss, we treat them as well as we can.

I've brought my CNAs birthday cakes, pizzas, hoagies, etc. Sometimes I do it for no for no reason at all. CNAs are overworked, mostly underpaid, and management treats them awful. It should not be that way. I found that, in general, the little things keep up the morale. We are all always busy from the time we arrive to the time we leave. The little things that show them they are not forgotten can be contagious. Many do reciprocate even though there is no expectation to do so.

[NutmeggeRN, BSN]

londonflo said:

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

Nah, only if it is more than $600...

[Tweety, BSN, RN]

I've found that techs hate being interrupted to ask to do something that they think the nurse can do.  (They especially hate when you're in a room and a patient asks for something and you hunt down the tech to do it when you could have done it while you were in the room).   Responding with "are your legs broke" needed to be nipped in the bud and I hope by now it is.

I try to be helpful when my techs are busy by doing things they could be doing, but also when I need to do stuff I expect them to do their jobs.  I will sometimes approach them and say "when you're done, I need you to do.....so I can finish charting/do a dressing or whatever" setting up that it's an expectation and not a negotiable request but lets them know I'm busy as well.  99.9% of the times the tech agrees, but sometimes they can explain why they can't and I respect that was well.

RN/Tech battles are legendary. 

[delrionurse]

heron said:

All that being said, you get the respect you give. If you want him to respect your job - and your authority to direct his work, then you need to respect him and his job the same way. It's highly likely he doesn't want to work with you, either, and has less choice about it.

I don't see how the OP was rude in any way. That's the CNA's job to assist in transport. No explanation should be given for someone else to do THEIR job. They know what they sign up for and this nurse assistant seems to know full well what he's suppose to do with his response 'are your legs broken'. Sorry, with a response like that he would written up, sent home  and lucky if he was able to return. That's just me.