Published Sep 6, 1999
Our facility is asking us to sign with our signature a form daily that the CNA's have performed their job responsibilities. They are saying that we are responsibile even if we do not sign, this document. there are 10 questions on the form where you state that they did or did not do these tasks. I have 26 patients and 2 or three CNA's, most of them are new US residents, they most certainly do not understand English completely, they are defiant, refuse to do what you ask, consistently do things they are told not to, I could go on and on. i have refused to sign this, along with a few other Nurses. Any advice. Do not misunderstand, I am a new nurse and I thought that by setting example by doing what I can to help them out would help in getting their cooperation. I change patients, when I find them incontinent, I feed patient, because they do not encourage them to eat, I explain the rationale of why they should do things, to no avail. Help!
I HATE having to "babysit" my staff!! And that is what signing off THEIR work amounts to, in my opinion. Admin. needs to realize that they are hiring incompetent caregivers and NOT make you responsible for whatever they might screw up or omit! (pet peeve, can you tell??) If you have to, use anecdotal notes or document somewhere what was and wasn't done, and make SURE you have input into these people's performance appraisals. You are professionally responsible for how your staff cares for your patients, but NOT to cover for them by signing off "good work" sheets when it isn't done well or completely. If enough of you are consistent, then the CNA's will HAVE to pull up their socks, and do their work. Document document document.
At the same time, you need to have consistent "rules" about the care that is given. The people that are in charge when you aren't around can't let them "get away" with things, or it just makes you look like an ogre. Nursing is supposed to be a team thing, and if you approach it in that spirit, and not in a threatening "Do it my way" manner, it SHOULD work out okay!!
Good luck, anyway!!
We have developed a flow sheet which includes all 3 shifts. It has the various cares listed for the CNA's to initial. That is if they gave a partical bath, nail care etc. they initial the flow sheet. The flow sheet also includes an area where they initial and sign their name, just like med sheets have. When our CNA's are given their assignmnets they are also required to sign the flow sheets to indicate the care they have given. However, if you are the charge nurse, under law, you are responsible for the care delivered to your patients. This is not an easy assignment, but with the flow sheets, CNA's are less likely to say(sign) that they did something they didn't. If a patient complains about something it is much easier to track who was the caregiver and check into problems. You sound as though you need an administration who will also back you up and help you establish authority lines. If you boss is not willing to impower you, than you will have very little control. If this is the case, I would look somewhere else for employment.
I have worked in Long Term Care almost my entire nursing career. I have always faced these problems. As an RN, however, I am responsible for the LPN's and CNA's under me when I am supervising. Let me tell you that this is not an easy task. To make rounds and check up on these staff members who know their job but often get lax in their caregiving. At my present place of employment, we have a bunch of very lazy CNA's and LPN's...and don't get me wrong..i am not trying to put down LPNs and CNAs..im just saying we have some lazy ones..who really try to get away with everything..No one seems to want to work anymore. There is always things that don't get done around there. The CNA's have for instance bath flow sheets similiar to our skin audit sheets..They are to put the residents name, if they had a bath or shower or bed bath..give the condition of their skin, and sign thier name...the charge nurse, LPN usually..signs after them that the above is correct..well most of the time, that LPN doenst know for sure if they had their bath or not..They were busy with their own tasks..although they are sposed to make rounds..this doenst get done very often. I feel that our nursing homes are in a sad shape..Any suggestions?
I have heard this complaint from my nurses that they do not want to be baby sitters, however they are legally responsible for the care rendered under their liscense. Nurses and CENA's each have very important job responsibilities. I tried to have my nurses to moniter through a checklist but I made it too long. That did not work. I found that having the CENA's moniter themselves worked much better. Each day I assign two CENA's to moniter certain care issues and they are responsible to me to complete or they are held accountable. The CENA's help me come up with care issues and then they are part of the solution instead of the problem. I do stand behind my nurses and they are allowed to do write-ups.
Unfortunately, it doesn't matter if you sign off for the CNA staff under your supervision or not, nurses are still legally responsible for the "supervision, direction & guidance of unlicensed assistive personnel" (CNAs or UAPs).
This is federal law regardless of where you work. Develop great written communication & reporting tools, ask CNA staff to sign for what they have done & purchase some Liability Insurance because that's the deal.
Unfortunately Maeve is right. I realize my nurses do not have time to follow up on what the CNAs do, just like I do not have time to follow the nurses around to make sure that they have done the B/Ps, tx, whatever. I know that there are lazy people on every level of health care. What has helped me is to do spot checks. I admit I do hone in on the residents that my lazier peiple have. I believe this has helped. I stay in the dining room to help feed, which I noticed has spurred on more attention at mealtime. There is less chatter between staff, and more staff to resident. (My pet peeve is they talk to each other while scooping in the food, and not saying: here's your oatmeal, now some juice, something to help the resident focus on meals.)
When I walk down the halls, I do room checks, are the beds down, call lights where a resident can reach it. These are little things, but they have helped me to direct my staff to follow up and make sure things are done right. NA
I agree with everyone who says that they don't like to babysit there staff but we are bound by law appreately to be resopnesale for our staff but it would be alot easyer if we could have some back up from our higher ups at least when we approch them with a problem if they would atleast talk to the cna or something most of the time the problem that i encounter is that i am either written up for something that my staff did not do or they find some way to make me responable and that i beleive is why alot of lpns don't make an attempt to suppervise there staff a well as they could for fear of loosing there on jobs or licenses because of their staff we have a staffing problem to are staff on 3rd shift is horrible as for as our cna we find that not only do we have to do our work but we have to do theres as well because we don't have enough staff to go around and the ones we have do not want to work as they should so go figure
I have worked as a charge nurse in long-term care for five years. I have found that long-term care is not a profession that many people (including CNA's) want to get into. I do have some excellent CNA's but at times I get some that do not care about their work. The problem that we have at our facility is not having a large enough selection of interested CNA's to hire so that we can weed out the CNA's that are lazy. CNA's at my facility are only paid $6.15. Let's face it, until coorporations want to pay for the amount and quality of work expected nursing homes will continue to struggle with not enough help and poor quality help. Nursing the elderly is a very difficult job and state regulations is putting more and more pressure on facilities. When are nursing homes going to put up the money required to give excellent care?
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