Insubordinate CNAs

[Jo Dirt]

I'm not on a power trip, far from it, but I'm having some issues with the new nurse aides on my floor (LTC). We first had an issue with the older ones trying to run off the newbies, but after a few go 'rounds and the pecking order among them was established things are better with that.

I'm just having an issue mainly with one aide. She is in her mid 20's and is very stubborn and even argumentive when given a task to do. I try to leave the aides alone to do their jobs but sometimes I need help (I also help them with things like putting patients to bed or feeding them during mealtime as I am able). When I ask this aide to do something she gives me an argument. I asked her to accompany a patient to the car because their were going LOA with their family and she said, "Well, I'm busy, I'm about to go pass out snacks." On another occasion, it was 9pm and there were patients waiting to be put to bed. This aide wanted to work alone and do a round drying patients who were already in the bed. I told the aides that it was long past bedtime for the ones who were still up and they needed to be put to bed before worrying about doing a round.

She just flat out didn't listen to me. That is when I turned into my alter ego and showed a side of myself I don't like to show to others. This is what I had to do to get her attention. Thing is, I don't like being Nurse Ratched.

I don't want to write her up or run and tell on her. She isn't lazy, just new an inexperienced and has a real issue with taking direction. She would be a great worker if she would just take direction.

Does anyone have any strategies for dealing with a person like this?

[CHATSDALE]

be firm and consistant and get the other nurses to go along with you

some people never get over their attitude and some will learn their job and be an asset

[leslie :-D]

i've always preferred direct 1:1 communication.

verbalize your concerns w/her.

start w/your positive perceptions, then share the issues at hand.

explain why you delegate what you do...

give her insight.

also remind her that ignoring you is a form of insubordination.

don't worry if she doesn't like you.

she needs to respect your role as a nurse.

if she continues to be insubordinate, at least you'll know you tried talking with her and will feel more justified in subsequent write-ups.

leslie

[caliotter3]

It is important that the other nurses present a united front with you concerning how this person is treated. If you progress to written writeups, they should do the same. She should see that she can't push her will on any of the nurses. Don't let her identify one of you as a patsy. Then, if necessary, bring this subject up to the next person in the chain, your DSD or DON, whoever oversees the CNAs. This person should back up the nurses in the disciplinary process. If your admin staff does not follow through, it won't take long for the CNA to figure out that she can run all over the nurses and nothing will happen to her. She needs to learn how to take direction. If she has to learn the hard way, then that is on her. When other CNAs see that the nurses won't put up with any bs, they will be less likely to follow suit. Whenever you speak to this CNA about her work behavior be sure to emphasize that she is responsible for providing good care to the residents and that you won't tolerate any deviation from good care.

[BradleyRN]

When i was in LTC, when i asked a CNA to do something and they

complained, then i would give a reason why i would like it done in that order. For example, once i had an Alzheimer's pt that said she had wet herself. I told her to hang on and id have someone right with her. I told the CNA to see her next. Well the CNA says "it's not fair to the other pts", so i explained that the other pts werent at risk for climbing over the siderail and falling as she was. Beyond that full explanation, she still complained leaving me no choice but to say "i am your boss and this floor is my responsibility, so i need things done in the order that i ask". The CNA's get together and talk about you. Soon, all will know that you mean business. I had 35 patients and no time to waste with insubordination. If it continues, id start writing her up. No need to run tell anyone else. Show them all that you can handle yourself, and very soon that type of behavior will be a thing of the past.

[caliotter3]

I required that my CNAs work in teams of two when I had enough to assign that way. I had one who insisted that she wanted to work alone. I was not falling for that. I knew that she worked a second job and that she was only in that particular facility at night to sleep if she could get away with it. This person also was aware that all she had to do was to run to the DSD and she could push around the others as well as the nurses. I insisted that she do things the way I wanted them done. That put me in the position of having to deal with whoever she ran to in the facility in order to get her way.

[pagandeva2000, LPN]

I had one today that tried to badmouth and I set her in her place as well. I had a patient who spoke Haitian Creole and didn't ambulate very well-in fact he had crutches. Gave him clonidine 0.1mg for bp that was 220/124. Doctor wanted him to be educated on medication adherence, return for a bp check on Monday and low salt diet. By the time I went back to check the patient, his visit was complete and rather than take up the space of the doctors room by calling a translator, I asked a Haitian speaking PCA to interpet what I wanted to communicate. She does it, but then, says to me that I 'owe her'. Now, she is one of the same girls that will come to me and ask for a motrin for monthly cramps. We do try and keep motrin in the clinic for some of us.

I told her that she is there to be a service to the patients the same as I, and didn't ask her to do anything out of her title; just asked her to repeat what I said. And, I told her that the next time she asks me to give her motrin, that I can easily say the same...that she owes me and it is not my job to give her the bottle of medication for her to open and take two for herself. Shut up real quick.

[JB2007, ASN, RN]

I have had this problem a time or two myself. When a CNA tries to not listen me or argue with me I ask them to go into a room with me so we can discuss the matter. I basically tell them that I am held accountable for what happens during my shift. Therefore, they need to do what I ask them to do. I also make it clear that if they can not do what I am asking them to do they need to talk to me. However, in the end they must do what I am asking them to do because one of the residents could get hurt. I totally understand that they are busy and trying to do many things at once. I then ask them if there is anything that I can do as a nurse to help them.

Most of the time this little talk is all it takes to stop the bad behavior. If not, I can and I will write them up. I have not had to write anyone up so far, but all of the CNAs that work with me know that I will if I have to.

I hope this helps you.

[chevyv, BSN, RN]

If she's new and will be very good if only she could take direction, maybe you can tell her that. Sometimes as a new CNA, she might have gotten word not to let nurses walk all over her. If you can take her aside and let her know that you think she will/is becoming a great CNA, then maybe you can add in the few points she could work on next to continue to grow. Thank her (and the other CNA's) at night before leaving to acknowledge her/their hard work and see if you can kill her with kindness. Keep us posted and good luck.

[locolorenzo22, BSN, RN]

Speaking from the CNA(soon to be RN) role....I would much rather you be fair, and tell me exactly what you want....as well as making sure that if I ignore you, that there is no possible way that I could have misinterpreted what you meant.

Start off with what you note that is GOOD that I am doing, then tell me "Hey, sometimes we have to change the order we're doing things just because that's the way the night is going..."

GL!

[Hausfrau]

I just want to add my two cents as a CNA.. and especially remembering what it was like to be a NEW CNA.. I am not speaking for her, because this may not be her problem.. but it might be...

I remember having so much stuff to do.. and stuff I *had* to get done.. vitals, weights.... brief changes...so many people to get into their pajamas and into bed... and if someone asked me to do something in addition to all of that it would throw me off schedual and important other things wouldn't get done. Which would usually get me into trouble with the nightshift RN and staff. So it just became really frusterating. Obviously if the nurse needs me to do something, I would like to do it.. but what about my never ending list of things I have to get done that shift?

I remember it very well.. it just seemed like there was never enough time or enough CNAs..

On top of that I've had nurses in other departments give me tasks on top of my own and on top of what my nurse has asked me to do.

Sometimes I wish I could just said "Sorry, I have to much to get done"..

and then while you've been sent in all these other directions you have one resident who is still waiting for her dinner to be sent up and you get yelled at when you are an hour late..

It can be such a HARD job when you have others waiting on you..

[BradleyRN]

...if someone asked me to do something in addition to all of that...

That is not the case here. The nurse wanted the CNA to put the patients that were still up to bed before doing a round and the CNA wanted to do it the other way. In the case of helping a family member get a patient to the car, well i used to do that but so did the CNA's and i would guess it would be on them before me. I know how hard your job is and i alway told my team that if they felt they couldnt handle the load, then they should get together and complain to the administration. Unfortunately, if i had to do a dressing change and needed someone to hold the patient to one side, then id have to get a CNA and though it may not be something you do all the time, it would still be your job. The Head Nurse's on my floor would come and go, demanding more staff (CNA's), which the administration would not give, so they would eventually quit. I dont know why the CNA's never banded together to make the same claim. The squeaky wheel gets the grease, and if it doesnt, then squeak louder!