Need guidance from seasoned leaders

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I manage a short term/mixed unit with an amazing team for the most part 

 

I have one problem nurse who just isn’t meant for this population.  I can’t even get into how wrong this nurse is without getting red in the face 

 

my primary issue at the moment though, is that when the unit is running short handed she isn’t helping the CNAs.  She seems to purposely make things take far longer than they should, will spend time chatting to whoever will listen, will focus on things that’s aren’t the priority etc. 

 

I need her to help - bottom line.  If I approach her she will say hat she does help, that she is sooooo busy and that it’s just unbelievable how much work there is.  Always, always, always has an answer or an excuse. 
 

What else can I do?  I mean at the end of the day I can’t change her, and I know that - but the patients need better and so do the CNAs 

I’ve gone to my boss about moving her but even if I do that she will still be on my floor, just not on the same section every time and not as often. 
 

she’s been written up so many times I can’t even count; has been educated and re-educated and she will get better for awhile and then it’s back to her old ways. 
 

This is one area I’m really not strong in, I could use some (kind) tips or advice. 

offlabel

1,466 Posts

Sounds like you have all you need to fire her in terms of documentation for when she threatens to sue you. You're already down a nurse with her there, with her not there, doesn't sound like anyone will notice. If you're not willing to fire someone like you're describing, who would you fire (short some criminal activity)? If you can't fire her, just count it in with the cost of doing business and ignore her crappy service.

Nothing you're going to say or do is going to fix it. Even if it gets better in the short term, it'll go right back to where it is today. Bet you didn't even need someone to say that, either...

summertx

183 Posts

Has 3 years experience.

 

On 11/23/2022 at 9:49 PM, ComeTogether said:

my primary issue at the moment though, is that when the unit is running short handed she isn’t helping the CNAs.  She seems to purposely make things take far longer than they should, will spend time chatting to whoever will listen, will focus on things that’s aren’t the priority etc. 

Is she doing her job description? If she is, that's all she's required to do (within the rules). She's not there to do the CNA's job. Sorry but short staff isn't her problem. If the nurse is outright lazy, and doesn't even do her own job, I can see that as a problem. It's not a problem helping CNA's when you have time but when you have your own patients to manage sorry that takes priority.

Hoosier_RN, MSN

3,656 Posts

Specializes in dialysis. Has 30 years experience.
4 hours ago, summertx said:

 

Is she doing her job description? If she is, that's all she's required to do (within the rules). She's not there to do the CNA's job. Sorry but short staff isn't her problem. If the nurse is outright lazy, and doesn't even do her own job, I can see that as a problem. It's not a problem helping CNA's when you have time but when you have your own patients to manage sorry that takes priority.

The CNA duties are part of the job description, with the other duties as needed line

summertx

183 Posts

Has 3 years experience.
5 hours ago, Hoosier_RN said:

The CNA duties are part of the job description, with the other duties as needed line

No, nurses duties come first. 

Hoosier_RN, MSN

3,656 Posts

Specializes in dialysis. Has 30 years experience.
8 hours ago, summertx said:

No, nurses duties come first. 

So what happens if there are no CNAs?  Many of us have had to work in those conditions, with call outs and such. "CNA duties" cannot be left because it's beneath nursing duties. Oh, wait...its part of nursing duties. If you didn't learn that in nursing school, your school did you a huge disservice. Some tasks can be delegated to CNAs, but at the end of the day, they are nursing responsibilities. If you doubt what I'm saying, look at your state's nurse practice act

summertx

183 Posts

Has 3 years experience.
2 hours ago, Hoosier_RN said:

So what happens if there are no CNAs?  Many of us have had to work in those conditions, with call outs and such. "CNA duties" cannot be left because it's beneath nursing duties. Oh, wait...its part of nursing duties. If you didn't learn that in nursing school, your school did you a huge disservice. Some tasks can be delegated to CNAs, but at the end of the day, they are nursing responsibilities. If you doubt what I'm saying, look at your state's nurse practice act

I didn't say once that I thought CNA's duties are beneath nurses duties. I said staffing isn't the nurses problem. If there are no CNA's the nurse will have to fill in as needed. but that is not what the OP stated. The nurses duties come first to any CNA duty to the nurse. We aren't there to do to 2 jobs if you can't find CNA's.  If someone is having chest pain, cleaning a patient isn't priority. The OP stated when they are 'short staffed', we all know that in LTC short staffed is every day. Nurses can't get their jobs done if they are bogged down doing CNA's duties. Staffing isn't the nurses problem. It's bad management. Not sure what you mean about not learning that in nursing school but that comment is not appropriate.

Hoosier_RN, MSN

3,656 Posts

Specializes in dialysis. Has 30 years experience.
5 hours ago, summertx said:

I didn't say once that I thought CNA's duties are beneath nurses duties. I said staffing isn't the nurses problem. If there are no CNA's the nurse will have to fill in as needed. but that is not what the OP stated. The nurses duties come first to any CNA duty to the nurse. We aren't there to do to 2 jobs if you can't find CNA's.  If someone is having chest pain, cleaning a patient isn't priority. The OP stated when they are 'short staffed', we all know that in LTC short staffed is every day. Nurses can't get their jobs done if they are bogged down doing CNA's duties. Staffing isn't the nurses problem. It's bad management. Not sure what you mean about not learning that in nursing school but that comment is not appropriate.

How is it not appropriate? CNA duties are literally part of nurses scope of practice. The OP says that they are constantly reminding this nurse that she needs to help, to which she just doesn't, she spends time talking, doing other things slowly. In the OPs words:

my primary issue at the moment though, is that when the unit is running short handed she isn’t helping the CNAs.  She seems to purposely make things take far longer than they should, will spend time chatting to whoever will listen, will focus on things that’s aren’t the priority etc. 

That in and of itself isn't a staffing issue, that a personal behavior issue. If it were you or your loved one in that bed, your feelings would be much different I'm sure. Again, look at your states nurse practice act and review nursing scope of practice. CNA duties are very much our responsibility, whether we like it or not, regardless of time constraints 

summertx

183 Posts

Has 3 years experience.
7 hours ago, Hoosier_RN said:

How is it not appropriate? CNA duties are literally part of nurses scope of practice. The OP says that they are constantly reminding this nurse that she needs to help, to which she just doesn't, she spends time talking, doing other things slowly. In the OPs words:

my primary issue at the moment though, is that when the unit is running short handed she isn’t helping the CNAs.  She seems to purposely make things take far longer than they should, will spend time chatting to whoever will listen, will focus on things that’s aren’t the priority etc. 

That in and of itself isn't a staffing issue, that a personal behavior issue. If it were you or your loved one in that bed, your feelings would be much different I'm sure. Again, look at your states nurse practice act and review nursing scope of practice. CNA duties are very much our responsibility, whether we like it or not, regardless of time constraints 

Just because it's in the nurses scope of practice doesn't mean it's her/his job duties. You simply can't pin down CNA job responsibilities on the nurse just to cover your own bottom, which is the case in most LTC's. I'm definitely helping, but the admin will be paying me more for not finding staff and paying me more to do two jobs. I absolutely will and I don't need the nurse practice act to see it, but you will be paying me for the job of the nurse and the CNA if you can't find a CNA. Fair deal, isn't it? I think we can agree on that.

Hoosier_RN, MSN

3,656 Posts

Specializes in dialysis. Has 30 years experience.
56 minutes ago, summertx said:

Just because it's in the nurses scope of practice doesn't mean it's her/his job duties. You simply can't pin down CNA job responsibilities on the nurse just to cover your own bottom, which is the case in most LTC's. I'm definitely helping, but the admin will be paying me more for not finding staff and paying me more to do two jobs. I absolutely will and I don't need the nurse practice act to see it, but you will be paying me for the job of the nurse and the CNA if you can't find a CNA. Fair deal, isn't it? I think we can agree on that.

If it's in the scope of practice, it's very definitely covered in your duties. I don't know why you're having such a hard time understanding that concept. Sometimes worded as "other duties as needed" or the like in job description.

If it truly worked that way, getting more pay, it would be great. Unfortunately, it doesn't. And in the off case that there's an incident with a resident that gets reported to state or other entity, they simply won't see it in the same light, and they won't care about staffing, as long as the metrics are met. Is it nice or fair? No. Is it reality? Definitely 

summertx

183 Posts

Has 3 years experience.
1 hour ago, Hoosier_RN said:

If it's in the scope of practice, it's very definitely covered in your duties. I don't know why you're having such a hard time understanding that concept. Sometimes worded as "other duties as needed" or the like in job description.

I understand you fine. I state it's not the nurses duty, it's your job to find staff to cover the CNA's responsibilities. That's why you have CNA's. Looks like those 'nurses' include you also, and you can get on that floor and do the CNA's duties. 

Hoosier_RN, MSN

3,656 Posts

Specializes in dialysis. Has 30 years experience.
8 hours ago, summertx said:

Looks like those 'nurses' include you also, and you can get on that floor and do the CNA's duties. 

This "nurse" does work on the floor, sometimes understaffed. My manager joins and will work 16 hours if necessary. I work in dialysis, and work as a tech more days than not. Tech is the equivalent of dialysis CNA.

When I was a DON in LTC, I did more than my share of 16+ hour days giving showers, doing feeds, turns, and incontinence care, as well as the rest of my managers who were qualified to do, just so the other staff could their jobs less stressed. And, because as a nurse, it fell into my scope of practice and was part of my job. So please lose your attitude with me. I've been in healthcare 30+ years, almost 30 as a nurse, and have seen the good, the bad, and the ugly. An attitude and comments like what you've posted on this thread are definitely not in the category of good. I agree we shouldn't be doormats, but saying you aren't going to do certain tasks unless x, y, z doesnt shine a great light on you. Now, have a great day