Need advice for CNAs in hospital...

[dloeffel]

We changed the requirements for our "care partners" (also called techs, nurses aides, CNAs, etc) last year. They no longer complete vital signs or blood sugars as the hospital felt that reporting values to the RN was taking too long this way. Since this change we have had an issue keeping our unlicensed staff accountable; the change in their requirements has almost given them an identity crisis. We need to find a way our personnel answerable to their other tasks such as bathing, feeding, recording weights, etc. Does anyone have any ideas on how to do this? Any templates to incorporate?

[Here.I.Stand, BSN, RN]

My suggestion is a verbal warning, a written warning w/ performance improvement plan, and termination if said performance doesn't improve.

When employees are not doing what the employer is paying them to do, it really is that simple.

[dloeffel]

Well it's kind of become a culture thing that needs improved because even new hires begin acting this way.

[Lev, MSN, RN, NP]

Well it's kind of become a culture thing that needs improved because even new hires begin acting this way.

Culture can change very quickly if management begins holding people accountable via discipline.

[Been there,done that, ASN, RN]

I've seen this many times, in many facilities.

I was a per diem nurse in a large inner city hospital. I was appalled at the work ethic and disrespect to the nurses.

I wrote them up, each and ever time... it worked.

[HouTx, BSN, MSN, EdD]

Wow. That is quite a blow for the UAP's. Those kinds of "nursing" tasks are generally a huge point of pride. I hope the change was made with sensitivity and respect.. explaining why it was done.

In my experience (and this is borne out in the literature) UAPs are much more likely to be fully engaged if they feel that they are respected and valued. This message has to come from the nurses with whom they work. They should be included in the shift planning 'huddle' so that they understand the game plan. If nothing else, nurses should set aside a few minutes to synchronize their work plans.

It's important to make sure that everyone is on the same page. For instance, YOU may think that leaving your CNA alone is an indication of how much you trust him, but his perception is likely to be entirely different. (trying to say this without offending anyone) Incumbents in many lower-level or entry-level jobs tend to value "attention" from their supervisor more highly than people in higher level jobs. They want to hear the nurse say "thank you" on a regular basis and acknowledge their work - "I see that you put Mr Jones back to bed after an hour - exactly like his plan of care for today. I really appreciate that."

My suggestion? Make sure that 'your' CNA understands how important their work is to the overall plan of care. Rather than empty verbiage, say something like "Please let me know if you notice any new skin lesions on Mrs. X when you bathe her because we need to keep an eye out for development of any pressure ulcers" or "Mr. Y's family told me that he always rests much better after you bathe him"

​It will take time - but the outcome is worth it.