How and when to talk to CNA's

[lstk8888]

I've been an LPN for twenty years but I am new at this nursing home. I realized this one CNA, I'll call her the first aide, was sitting in the lounge most of the evening while the second aide would be busting her butt taking care of her residents. And she and I were taking care of this other aides residents. One evening the first aide went to put this resident to bed who is a two assist. I asked her if she needed help, she said no. I didn't see another aide around so I went in as she was hooking her up to the lift. I said she's a two assist, right? This aide said yes but she puts her in by herself. I told her not to do that, calmly told her about what could happen if she or the resident were injured, and I assisted her. The brief was saturated. I asked when this resident had been toileted, she said three o'clock, it was now 9:45pm. I can't remember what I said at that point. I was calm but it was upsetting this was going on and I said something about how she needed to be toileted before dinner. The next time I worked with her, when the aide was sitting in the lounge again, early in the evening shift, I went up to her and calmly and a little quietly, asked her to toilet this resident before dinner. The next time I worked with her I did the same. The other nurse decided this was harassment, that I was harassing the CNA when I talked to her in the lounge where other people were. Later in the evening when I calmly tried to talk to this aide, away from other people, about the amount of time she spends in the lounge instead of taking care of her residents, the other nurse got involved and spent over thirty minutes of what I call harassment telling me I shouldn't talk to the aide in the lounge where other people are and I shouldn't have told her twice to do the same thing and that was harassment. I pointed out to him that he was doing the same to me as he was saying I was doing to this aide. He wouldn't shut up.

I had talked to the nurse manager about this after the first incident and she assured me she had my back. But when we had a meeting between me, the other nurse and the nurse manager, she looked at me the whole time and mostly repeated what this other nurse had said. I pointed out that I didn't feel I was harassing the CNA but that I felt I was being harassed. I was told this aide is uncomfortable working with me. No one seemed concerned about whether the residents are being properly taken care of. The NM said she feels this nurse solved a lot of problems they've had on the floor and I can see she puts a lot of trust in him.

These are a few things he's said to me in the course of working together. He told me to fill a large Styrofoam cup with prune juice for one resident, instead of the 180 cc's I was going to give her because she wants the larger cup which I think is around 500 cc's. I pointed out she's on fluid restrictions. He actually said, "prune juice doesn't count!"

We have a schedule of times each staff member is supposed to have 'lounge duty'. He told me when he's working we don't have lounge duty. Of course, that's AFTER the nurse manager leaves.

I came back from dinner the other evening and saw the nourishment's sitting out. He has several diabetics on his side, I have a couple. It was around 6:30 and the residents were eating their dinner. I went to put the tray in the fridge and he stopped me and said "I'll take care of that." I put it down and turned to walk away and he said something about how he just dumps that. I turned around. He said I could take the stuff for my people but he just dumps it. I took my residents nourishment's and left. I had to go back after I calmed down a little and I asked him what he meant and did he at least offer his residents their HS snacks. He fumbled around, oh, yeah well, he knows who wants it and who doesn't and if they don't eat it then he tosses it. I know from how he was talking he probably does just toss all that food in the garbage.

No one seems concerned that there is not a nurse in the dining area/lounge when people are eating dinner. It's NYS regulation that a nurse is there at all times when residents are eating and this was a major concern where I used to work. Here, they are very casual about anyone being there.

I had a resident whose blood sugar bottomed out. First finger stick was 65, gave him orange juice with sugar and it wouldn't come up. Gave him two of the glucose tubes, went down to 48, the supervisor went to order IM glucagon. This nurse comes in and says I did the wrong finger and he sticks this resident again like it's going to be higher from another finger and it's 47. And he says, "I'll go get him some ice cream, that will get it up." I went to get check the order and get and give the glucagon. His Bg came up after the injection.

One evening I was still orienting and he and the other nurse were at the nurses station talking about how they have to have short cuts or they can't get the med pass done in time. He said he doesn't sign for any of the medications until he's done with the med pass. I had to say something. I said so you're not doing your checks. He said oh, he looks at the MAR, he just doesn't sign for anything until later. I told him about how I was called to take over the med pass for another nurse who had fallen and broken her arm. She had signed everything off in the beginning of the night and couldn't tell me what she had given or not given. I pointed out if he had an emergency and had to leave it would be difficult for anyone else to do the med pass. He blew me off.

He also tried to book off the floor one evening without counting with the oncoming night nurse. He said something to her about how he had left the narc's and the keys for her and headed for the elevator. She told him to come count with her.

This man seems to want to find ways to make his job easier and has no respect for how things are supposed to be done. And there is a reason we have policies and procedures. Now, I'm not perfect and I don't claim to be. But this guy is really getting on my nerves.

I have twenty years of experience mainly in long term care but had not worked in a nursing home for over a year. Most of that time I've floated as Per Diem or as Part Time Float nurse at the last nursing home where I worked for seven years. I've been at this nursing home for three months. Most of the nurses I work with respect me and are happy when they see me come to their floor. The residents are happy to see me too. And I still work for an agency and went to a floor at another facility where the nurse and residents remembered me after four months and were happy I was there. I help out as much as I can with the other nurse and with the CNA's. More so than a lot of nurses.

I didn't like the first floor they had hired me for at my present nursing home. I ended up going to the ADON with my concerns and told her I did not want to work on that floor. I became the problem child. The nurse manager on the new floor watched me do the med pass and was very picky. And yet I'm seeing such a lack of professionalism from others on her staff. One evening I had to talk to another CNA about this same resident who she was transferring by herself. This is a CNA going to nursing school. Later that evening she was toileting a frequent faller and he fell and hit his head. Next time I went in to work the NM said there was a "rumor" that I didn't answer call lights. Another time I was helping another CNA transfer people. Then one time I was in the middle of a dressing change and told her I couldn't help her right now and could she get another CNA. Next thing I know another CNA is handing me the phone and it's the NM telling me she's being told I refused to transfer someone.

I couldn't sleep last night as this kept coming into my head. I feel the most important people are the residents but it seems the nurse manager and this other nurse are more concerned about not hurting this CNA's feelings. This CNA that almost every other CNA on the floor has complained about. I feel like I'm in the twilight zone.

I haven't told her about what this nurse had said and done when I've worked with him. I already complained about the first floor I was on. I think I have to try and move to another floor again or just quit the place. I'm putting out applications but it's not that easy anymore to find a nursing job. I'd really like to hear other nurses opinions about this. Should I just tell the nurse manager everything?

Sorry this is so long.

Thanks

[KRSLPN, LPN]

After reading your entry, the first thing that comes to my mind is, don't bother talking to the nurse manager except to inform her that you are turning in your 2 week notice.

If the previous scenarios are accurate, I'd certainly not want to work in a facility that condones such lack of nursing professionalism.

[nnancy627]

You're a bit too involved in your job. Take a step back, and look at the whole picture.

[applewhitern, BSN, RN]

I don't think it would do much good to talk to the nurse manager. It sounds like they already have their way of functioning, and don't want anyone to rock their boat.

[Karma1130]

Too involved??? There needs to be more nurses or people in general who care about these residents properly. Not just their health but their dignity also. So sick of the lazy incompetent idiots who have no business in the health care field. Good to know that when we get old and have lived out the best of our days, we will more than likely be left to sit in our own urine and feces for HOURS because of understaffing, poor attitudes and work ethic.

[Blackcat99]

Don't talk to the nurse manager about your complaints. They don't want to hear about any complaints. You are indeed "rocking their boat" and they will label you a "trouble maker". They don't like "trouble makers" and will find a reason to get rid of you.

[salvadordolly]

I've been in these kind of facilities too. It doesn't sound like your NM cares much about your concerns. If you already had trouble on another unit, I'd just try to find another facility. As blackcat said, they've already labelled you a troublemaker. I'd just get out. the only thing that will probably get this NM's attention is a bad survey.