How do I manage difficult CNAs?

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Specializes in Adult/Geriatric.

This is my second year as an RN and my first job was at a psych facility. Now I work at a Rehab/LTC center and I like what I do, but the CNAs have the worst attitude! I am having a hard time dealing with them and I would like your advice. It's been almost a month since I started, and I already had 2 conflict situations with the CNAs. The problem is, there is no chain of command in this facility like there is one in a hospital. The CNAs and LPNs and RNs are all considered equal, and the charge nurse or DON or the assistant DON can say something to those who are not doing their jobs. It's a problem because a lot of times the call bells are not answered because the CNAs are sitting around doing nothing, while I run around like a mad woman taking care of 30 patients, and it drives me nuts when a patient tells me she needs help changing her diaper when I need to give meds to 20 other patients and do the dressing changes. If I dare tell the CNAs that the call bells are on and ask them very nicely to answer them, they bark back at me, or they bark at any other LPN or RN that dares to tell them what to do. Or they simply ignore you, while the others bark at you saying that I am being "disrespectful."

I also have to say that I am one of the only 2 white nurses in the facility, and the CNA tend to take everything as a racial discriminative comment even if it is not the case at all. They are extremely defensive and behave like they are the victims of the "racist empire" of some sort, and cannot understand that some criticisms are just plain criticisms of behavior that has nothing to do with their race. If anything, I feel discriminated against by the CNAs because I am the only white nurse on my floor. At least the LPNs and RNs are nice to me.

The patients, the DON, and the assitant DON love me and they are on my side. I spoke to the DON and the assitant DON about my concern, and I was told that unfortunately in a LTC type of a facility, the CNAs get away with a lot of bad behavior towards coworkers as long as they are good with the patients because there are not many CNAs and they know they can get away with it.

I feel it is unfair that I have to pick up their slack, and my license can be at stake if the CNAs don't do their job, and I don't even get the authority as an RN that is backed up by DON to tell them what needs to be done so that my license is not in jeapordy. :o

I documented a complaint today against 3 CNAs and I hope something will be done, but I don't have high hopes because I've seen the CNAs bark back at DON, and it seems that there is no authoritative figure or respect towards people in higher positions in the facility...

Any advice??

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Specializes in oncology, trauma, home health.

Leave! Quickly! Go! No one who "loves" you will support this behavior! Good luck and please keep us updated!

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Specializes in Adult/Geriatric.
Leave! Quickly! Go! No one who "loves" you will support this behavior! Good luck and please keep us updated!

I would love to leave, but unfortunately I have a 2 year contract with them in exchange for supporting my immigration papers. So I am trying to make my life as managable as possible while I am there. Of course I will leave as soon as I can :cry:

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Specializes in Emergency Room.

quit now. it won't change.

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Specializes in Acute Medicine.

Boy! All these posts I read about how hard nurses jobs are and how over worked they are and no breaks and then I read how CNA's sit around doing nothing! Perhaps I should quit nursing school and just go be a CNA! lol! I'm starting to get scared! :lol2:

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Specializes in LTC.

I found myself in a very similar situation when I started my job at the LTC I'm currently working in. I have been there for over a year now and finally seem to have earned the respect of the CNA's. I was a newbie fresh out of school and this was my first job. The aides are predomanatly black and some, not all of them have the attitude that you described. In the begining, I had a LOT of trouble getting them to do anything I asked or even to just do their job. I am not the type of person who likes confrontation and was also a little uncomfortable being the one in charge. My DON however, is a barraccuda. She sat me down and explained to me that if I was going to continue to work in this facility, that I had to learn to manage my CNA's. First thing I did after this was try to get to know my aides. Ask them questions about themselves, family, life, future and offer some info about me, my family background etc. Sometimes and fortunately in my case, once my aides realized that I was intersted in them as people not just butt wipers as they called themselves, they were much more willing to work with me. I also showed them that I was not afraid to or above getting my hands dirty. When I have the time and they are short handed, I jump right in there and help out with meal passes, feeding and changing residents. I also had to write up two very outspoken aides at seperate times. They didn't like it and they let it be known to everyone within ear shot, but I let them know that it was nothing personal and explained to them why they got the write up and that if they didn't do it again they wouldn't get another. However, if they continued what they did to get the write up in the first place, I'd do it again. There was tension for a little while but when I didn't change my behavior toward them and continued to do everything I was doing before, it blew over. Just keep trying with your aides. Earn and keep their respect and stay firm when you need a task done. If they give you a hard time, remind them that you are only asking them to do their job. (sorry for the long winded answer)

Good luck

Dawn

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Specializes in nursing home care.

Make your complaints formal and if nothing is done, go to your inspection authority. Poor care cannot be ignored or you risk your own license.

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When I first started in LTC I was worried since I had such bad experience with the aides in the hospital, and nothing was every done about it. The best advice I can give is always be willing to help. Validate that their job is hard (and it is!) I honestly would tell them that CNA work is much harder in a LTC than a hospital. I had done aide work in a hospital before I was a nurse, and do believe pt care was easier there, but thats my opinion. And I talked with them on a personal level, just like you would any co-worker. (I like to talk and I'd strike up a conversation about anything.) Honestly, the CNAs I work with are awesome, and I don't feel they get the credit they deserve. They'll always be ones that tend to disappear, however, when I built up a repore (sp.??) with them, the ones that use to disappear, don't. They will tell me if they are taking a break. I'm not a stickler either. Face it, if someone does have a very poor work ethic, and managment won't back you up, you won't turn them into a stellar employee, but I would remind them that the pt is #1. Sometimes I would find them in a pts room (a very confused, unaware pt) talking on their cell phones. This has been going on long before I got there and my managment won't back me up either, so I tell them, if you want to sit a talk on you phone, I don't mind as long as your pts are all good and you are in ear shot of the bells (to hear them going off) They also know that if their pts weren't all good, and I find them talking on their phone I will be talking to them about it. Our floor actually runs well since I give a little so it doesn't seem like I'm running their lives. I tell them, we are all here to earn our pay checks and feed our families. I don't want them to dread going to work, or seeing my face. Or like wise, so lets do our jobs and not make it harder for each other. I also frequently remind them how inportant their jobs are. I level with them, that when they don't do their job, I can't do mine. :D

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They'll always be ones that tend to disappear... :D

I meant to type "there'll" always be the one... not "they'll" It actually changes the meaning of the whole sentence!! I tried to edit it, but too much time when by. Sorry!!:imbar

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Specializes in Adult/Geriatric.
She sat me down and explained to me that if I was going to continue to work in this facility, that I had to learn to manage my CNA's.

That's exactly what my DON and assistant DON said to me. They also said that even though the aides behave like they are hot stuff that own the place, I know that I am smarter than them and above them. They told me that the important thing is to know my place, but not to show it to them that I am above them.

First thing I did after this was try to get to know my aides. Ask them questions about themselves, family, life, future and offer some info about me, my family background etc. Sometimes and fortunately in my case, once my aides realized that I was intersted in them as people not just butt wipers as they called themselves, they were much more willing to work with me.

I think that's a great idea! :bow: So far, I have been friendly with whichever CNA I can, since I know that they bond very strong and talk to each other about others a lot. I also try to compliment them whenever I can if I see them do something good or if they look nice that day. Not a fake praise, but a genuine praise.

I also showed them that I was not afraid to or above getting my hands dirty. When I have the time and they are short handed, I jump right in there and help out with meal passes, feeding and changing residents.

That one is hard for me to do. I don't have time most of the day, and changing a diaper really takes a lot of time. It's hard to do when I need to do a dressing change on a patient right above the sacrum and the patient is covered in poo. But one of the charge nurses that has been there for a year and a half told me that she gave up on on the CNAs and that sometimes she just changes the diapers herself if it needs to be done.

I also had to write up two very outspoken aides at seperate times. They didn't like it and they let it be known to everyone within ear shot

I did exactly the same thing and got exactly the same reaction!!

I hate to stereotype, but it seems to me that it is a culture of the CNAs in my facility, or specificly Haitian CNAs in my facility, to talk extermely loud. Once they get excited, they don't stop yelling and screaming and it is very hard to talk to them like two civilized people, where one is listening while the other is talking, and then the other talking when the first one is done.... This doesn't happen with the Haitian CNAs in my facility, and I've been told that it is the same way at other faiclities as well. It is difficult to communicate anything to them because of that.

I tried being nice to the big mouthed ones today even though they were nasty to me yesterday and today, and I think they were surprised. I did tell them that one of them was being unprofessional by yelling in front of patients, and another CNA caught it on and told one CNA jokingly that she was being unprofessional.

I hope it gets better. Unfortunately quitting is not an option right now, although I would like to do that.....:o

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Specializes in Adult/Geriatric.
Make your complaints formal and if nothing is done, go to your inspection authority. Poor care cannot be ignored or you risk your own license.

I made a complaint on a plain sheet of paper describing the incident, time and date "Complaint" written at the top of the paper. I don't know if that's considered an official complaint. The management recognized that the CNAs are harrasing me and that something needs to be done. I realize that my license is at risk, but what I am wondering is how it can affect my license, and what I can do about it... Any ideas??

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Although it is not GOOD, it is good to know that this is not an isolated incident....

I worked as a CNA for the county run NH before I went to LPN school.... I understand that their's is not a glorious occupation, but they chose it, and they get PAID to do it.

If they are not going to do their job, and treat our resident the way they should be treated.... then they need to be shown the door!

I have left my shift so often feeling like I am spitting into the wind, and because I am the agency nurse, I cannot effect change... it is very stressful to me to know that the residents I am charged to care for, are not being cared for as they should... no one should have to sit in a wet brief for extended periods of time, or be left sit with a tray in front of them for more than 2 hours because "I forgot"....

ARGGGGHHHHHHH!!!!!!

Faye

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