Lazy CNAs, New Nurse

[elderlylove]

So let me just start this by saying I was a CNA for 3 years before I became an LPN. I have been a nurse now for 3 months. I am at the same facility that I have worked at for the past 3 years, and am on full time day shift. I have two particular aides that are lazy. For example, yesterday I found my aide sitting in the back of our building talking to other caregivers. I informed her that her call light was going off. I also told her that I have had complaints from higher management that she is sitting around talking while on the clock, and that this is my first and only verbal warning that I do not want to see her sitting around talking again. Sure enough, I walk to the front of the building (where she was suppose to be), and her resident is ON THE FLOOR. I wrote up a statement and gave it to my higher ups. (She was already talked to two days prior by my boss for doing the same thing.) Another example, I ask all of the aides to get me when they give showers, so i can verify that the shower is being done and so I can preform a skin assessment. Yet, they will come up and give me a shower sheet to sign saying they completed the shower, and I tell them I will not sign that because I did not see it done like I asked. The same CNA will sit in the corner of our dining room all by herself, when she is suppose to be helping the activities department with an activity. When you have 30 residents in a room, you would think someone who really wants to help would at least talk to a resident or get to know them. At least have SOME interaction. These caregivers are not tolieting residents, or showering them. I understand I was once their co-worker, and now I am there supervisor, but short of sending the staff home I don't know what is left for me to do. I do not have the authority at my work to write staff up, only document and give to my supervisors. I help them serve meals, I will help toliet their residents, and answer call lights. I say please and thank you for anything I ask, even when they don't thank me for helping them. I am a young nurse, only 22. They talk bad about me, and that is okay, as long as their job is getting done. Which it isn't. I love my residents so much, they are my family, and it frustrates me when these caregivers just act like they do not care. Any suggestions for handling this situation? Please and thank you,

[ArtClassRN, ADN, RN]

Get out of LTC. Bad CNAs are in hospitals too, but it was nowhere near as bad in my experience.

[VANurse2010]

Well, first, I would stop referring to them as "their" (the CNA's) residents. You're the nurse and it's your rear end that's going to be on the line if someone falls or isn't taken care of properly (e.g. ADLs like showers not met). I've been where you are and unfortunately in LTC the nurse is so dependent on CNAs it's hard to do anything about bad behavior. Make sure you document in your management communications specific incidents with specific residents, dates, and times, and continue to do it each and every time. That's the only way anything has a chance of getting done.

[classicdame, MSN, EdD]

I have a solution that will not be accepted. Pay the aides higher than normal and then weed out the ones who do not live up to expectations. The ones who really want the higher paying job will do their job. The rest will just wish they had.

[icuRNmaggie, BSN, RN]

Ask your nurse manager to meet with you and the worst offender.

This meeting is not about your feelings. It is about setting expectations for patient care in a calm polite professional manner.

You could begin by saying " The last time that we worked together you were on another unit and did not respond to your patients call lights. "

Patients need to be toileted at least every X hours.

Patient XXXX was did not receive the shower that was scheduled.

You were off the unit from XX to XX and XX to XXX. I did not know where you were and I can not leave the patients alone by themselves to find you.

Your break is for 1/2 hour at 11:30.

You were not engaged or attentive to the patients at mealtime.

(It is everyone's job to interact with the residents - even the maintenance and kitchen staff).

Write a very concise and unemotional summary of the above incidents.

Ask your manager for some advice ahead of time on how to best manage the unit and workflow.

Let your manager run the meeting.

Chances are very good that the employee will deny everything. At that point you have to confront it head on and say that's a lie and we both know it.

Once one of the problem employees is disciplined, and I would ask for her to be given a written warning, the others should start making more of an effort.

Any incidents that you document should focus on patient care and patient safety. Do not make it personal. Do not discuss the problems that you are having with anyone other than your manager.

If the employee continues to neglect her patients ask her to come with you to a private place and say we talked about this in our meeting. Mrs XX needs XX. If she refuses to do what you are asking say then I will write this up.

No games, no outbursts, 100% honesty .

You are only 22 but you must model professional behavior at all times.

[caliotter3]

Find a new place of employment where you can start over as a supervisor without the "she was one of us" baggage. In the military, they typically move a person who becomes a new supervisor so that they don't deal with this type of attitude. That obviously can't be done here, but you can change that yourself. Good luck.

[laKrugRN]

I am so sorry you are going through this! I was a CNA and I worked with awful co-workers who were lazy and mistreated patients. I eventually quit because my tires were slashed and I got tired of harassment for "making them look bad." As a nurse though, I would not quit if I were you. Report these lazy butts and put them in their place! Do it for your patients sake. At the end of the day, you are younger, you are new but you are their BOSS! Please keep us up to date on this situation! Sending prayers of encouragement and strength your way! :) HUGS!

[doodlebuttRN]

I agree with icuRNmaggie.

As a new nurse, you need to practice conflict management, and this is an opportunity. (I have been a nurse for over a decade and conflict management is something I still have to work on, on a daily basis, as a nurse and as a person.) In this situation, your best bet is to be 100% honest, straightforward, and totally professional. Yes, it is ABSOLUTELY the nurse's responsibility to make sure that the resident's needs are met; and working in harmony with CNAs is ideal but, unfortunately, not always possible. You may have been their peer at one time, but as you said, you are now the nurse who is ultimately responsible for the residents. (And I mean that as EVERYONE's resident. My pet peeve is "that's not my patient," or "that's not my job.") Lead by example. As a former CNA you are well aware of the job description, and in my experience in LTAC, leading by example has always worked best for me. Like this: "I see that you still need to feed residents A, B, and C, and the call light is going off for Mr. D; he needs to get off the toilet. Why don't you continue feeding the residents and I will see to Mr. D." When your aides see that you are willing to help them, not just delegate in a way they may view as hostile or as "she thinks she's better than me now that she is a nurse."

As nurses, all of the duties of a CNA fall under the purview of our responsibilties. If the CNAs see that you are willing to help with these duties as needed (as you know, they get swamped too), they may be more likely to work with you in the future, in a positive interaction that ultimately benefits you, the aide, and of course, the resident. Unfortunately, it is always hard to go from being someone's peer to being their supervisor, but if you continue to handle yourself in a professional manner, you have good chances of success. Please don't give up; these things often take time. Being a new nurse is hard enough without worrying about the type of behavior you have described.

At some point, we all have to decide what type of nurse we will be (not necessarily a conscious decision), and you are still trying to figure out who you are as a nurse. Just keep your professionalism, and remember that you are doing your best.

I wish you the best, and hugs hugs hugs!

[laKrugRN]

Lots of great advice! This has been a great thread to read!

[MedChica]

This is half the reason why I want to go to the hospital. I need a job where I don't have to be bothered with aides.

I manage the same aides that I worked with when I was aide, too. So, I don't know about you leaving the facility. Much of your difficulty centers around your newness (and lack of power to affect change). You're going to have to learn how to manage people. Running to another LTC won't solve the problem.

Anyway, reading you post I was like, 'WRITE 'EM UP AND SEND THEIR (expletives) HOME!" LOL

Why not? Everyone's pulling their weight, anyhow.

...but you don't have that power.

People need clear standards and clear limits. I'd talk to the RN supervisor, first. Get them on your side. The RN Supv needs to back their nurses up. You need to explain what's going on. I don't know what the heck yours is doing that they can't see what's going on, to begin with?

Where I work, the RN has nothing but free time. She has nothing to do BUT 'supervise', guide us and screw around with the end of shift report. The LVNs run the floor. Our DON did the CNA-LVN-RN-MSN route so, unlike some facilities, the charge nurse role is not an 'in name only' title. The LVNs are 'charge' and the RNs 'supervise'.

THEN, I'd call a 5 minute 'briefing' with the aides (supv and other LVN) where I'd outline our goals, state what is/not acceptable, inform the aides of the consequences for not following through...then FOLLOW THROUGH if any fail to meet the standard. Period. Of course, thank them all for their 'hard work' (yada, yada, yada...) and end the meeting. The end.

The CNAs and LVNs? You're a team. I'll be honest: Im fundamentally a 'laissez-faire' type of manager. Basically, I don't like having to 'run behind' adults. I want everyone to do their jobs. I don't like managing people.

However, I do not have the same management style with all shifts or all personalities.

Some teams can function autonomously. Some individuals can work with little supervision and I don't have to second guess them.

Some teams can't handle little direction. They goof off, disappear, etc... Some individuals require limits because they can't function with too much freedom. They need direction.

You've got to adapt to your team.

If it comes down to 'cleaning house'? So be it.

Trust me, I was always slow to write people up. I'm a team-player. 'That's not my job' is not in my vocabulary. I pass trays; I work the floor when our aides need help. My coworker is the same and we don't do it to earn brownie points with the aides. We do it for the residents and when the pooh hits the fan, it's ALL hands on deck.

In fact, anything you do on that floor should be motivated, primarily, by a need to help your residents. If you're doing it to appease the aides, it'll be a thankless task.

...and plenty of aides will abuse such a nurse. Believe it.

One day, I just said, 'F-- it!'

It began with an aide disappearing for an hour and ended with the same aide not showering/shaving my people. The aide left but there was a fresh write-up waiting for him to be administered by the ADON in the morning.

Now? I'm the dress-down/write-up/send home Queen. The aides (some individuals more than others) know that I'm not here for them or their (expletive)

The aides will make or break you on that floor. Your people aren't being toileted or showered... You will tire of telling people to do the same task. You will tire of family members tearing you an a-hole because the aides aren't doing their job. You will tire of sitting in meetings, getting in trouble for neglectful CNAs.

I was an aide, too. So what? Wouldn't matter if we didn't have CNA exp, we have a freakin' job to do.

You are responsible. Those are your residents. Take charge. Be 'charge'.

[jadelpn, LPN, EMT-B]

Staff meeting! You are a new day supervisor. You can run the floor however you see fit. You should not have to go looking for CNA's who are not doing their job.

I would ask if you could have a staff meeting. Have them once a month if feasible. Discuss clear expectations. Maybe it is a matter of teaming up 2 CNA's for max patient safety. Be clear (and ask if this is possible) on progressive discipline--that in other words, you will submit a "verbal warning" form to your supervisors.

There are a number of CNA's who would like to have the opportunity to work full time days with benefits. Seems like those positions are currently held by at least a few who are thinking they are at the club as opposed to work. Another thought about this is that after a verbal warning, if things do not change, a "probationary period" will occur in which the CNA will then be per diem. You will call if they are needed. Then, perhaps someone from another shift would like to work days. All of this has to be approved by your supervisor, however, if residents are falling, not being toileted, or showered, then in fact it is not safe.

The showering may have to be done by "appointment"--meaning that resident such and so has a shower at 0900, and you shall meet them in the shower room. Period.

Also, be encouraging of the CNA's that you have that are awesome!! They are worth their weight in gold.

[blujazz25]

I have worked in an LTC as well and have encountered such employees who are lazy and even those who undermine my authority. As far as I can know, you can write them up. That's your job, youre the supervisor now. And your license is on the line whenever you work with them. What I do is I try to 'rub it in their face' so to speak, it takes extra work but it gets me to a better place with my residents rather than relying too much on the CNAs. If you have a spare moment and the resident is capable, toilet them..answer call lights...help them with transfers...when your supervisor sees that you are doing these they will question the CNAs on the floor and ask why you are doing this. At least your supervisor knows that you are trying your best in keeping your residents safe on top of doing nursing duties. Eventually, they will hate you for it...but in the long run the ones who do care for the residents will remain and be more helpful, your supervisor will have more trust in you.

I ended up loving my shift and staff because the bad ones got weeded out so to speak. And eventually my CNAs enjoyed it when I am there because they know I am always going around with them, try to help them and I ask them questions about the residents, they hate it when someone else floats on my floor or another floater CNA is on the floor. Any important changes or issues on the floor I report it to the supervisor before I leave so they have information (especially helpful for their MDS charting).