Need guidance from seasoned leaders

[ComeTogether]

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. 

[summertx]

47 minutes ago, Hoosier_RN said:

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.

Look, I never said I would not do CNA duties. You really need to read. I simply stated I am not going to be taken advantage of by administration and especially if they are ungrateful. I AM NOT sacrificing my duties to do CNA duties. That is final. Chest pain, pulmonary edema, falls, injuries, & trach care comes first. I'm not risking trach suctioning and aspiration to do CNA duties. Nurses aren't superhuman. Hire more staff, schedule more CNA's per shift if you have an issue with staffing. You're undertone was not great to begin with when you accused me of not doing CNA duties. 

[Hoosier_RN, MSN]

1 hour ago, summertx said:

You're undertone was not great to begin with when you accused me of not doing CNA duties. 

I had no undertone. You said you weren't doing the duties without extra pay; staffing isn't your problem. Your own words, read them 

[summertx]

On 12/21/2022 at 8:18 AM, Hoosier_RN said:

You said you weren't doing the duties without extra pay

Well, you if you give an inch, they take a mile. You know that's how it works in LTC. You shouldn't accept that as a manager either. To just run your employees dry until they can give no more. 

[Hoosier_RN, MSN]

3 hours ago, summertx said:

Well, you if you give an inch, they take a mile. You know that's how it works in LTC. You shouldn't accept that as a manager either. To just run your employees dry until they can give no more. 

I'll agree with that premise. But, again, no employer is going to pay the extra. Never heard of it in 30+ years. But we can always dream

[ComeTogether, LPN]

On 12/19/2022 at 10:37 AM, 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.

Last time I checked patient care was in the job description of a nurse. 

I'd never expect my nurses to forgo their primary responsibilities but I absolutely expect them to help when they have time, especially when it directly affects the outcome and care of their patients. 

Honestly, not helping because your own work isn't done is a much better reason than not helping because you did your job and youre not there to do CNA work. (no such thing, by the way) 

 

Anyway, I digress - the problem solved itself thankfully. 

[ComeTogether, LPN]

On 11/24/2022 at 3:53 PM, offlabel said:

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...

She actually WAS fired about a year ago, then got a lawyer - corporate made us take her back because our attny said she'd win if she sued.  Not enough of a paper trail (most of it happened prior to my role change) 

About a week after I wrote this post she refused to float to another unit - knew full well that she was to go and came in early and took her cart so the other nurse would have to go. When I addressed it with her she caused a scene and left in the middle of her shift.  Then she quit - (before she got fired).   Good riddance, for real. 

I hate this aspect of my job.  Just the sheer amount of complaints and bitching that I get from the staff is more than the patients, to be honest.

I know there will always be personality conflicts and we all have our strengths and weaknesses, but good grief! 

 

[ComeTogether, LPN]

On 12/20/2022 at 5:35 AM, 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

THIS.  

It is the NURSE's job.  ALL OF IT.  The CNAs help with nursing tasks that don't require a license.  Hence why nurses delegate and prioritize based on the needs of the unit at the time.  

I loathe the phrase "CNA work". Its ALL nursing work. 

And I don't have any expectations that I wouldn't meet myself.  You will find me doing almost anything that needs to be done at any given time, it just depends on who needs me the most.  Sometimes it's the CNAs and sometimes it's the nurses.  Hell - sometimes it's even housekeeping - if it gets the unit where it needs to be, then my patients are better for it - and I have no problem busting out the virex to get a room ready if I have to.  

Argh!  I know people have jobs to make money and live their lives but there is just so much more to it in this field because the ones who suffer at the end of the day are the patients.   

[ComeTogether, LPN]

On 12/20/2022 at 8:58 PM, 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.

You're missing the point.  It's just one job.  You just get an assistant to help you do the aspects of it that don't require a license.  If there are enough CNAs, by all means - you do you.  If you feel you should be better compensated for the work that you do then by all means, ask for a raise. A raise for your job. 

 

 

[ShayNeq65]

Both of you nurses have excellent points but the bottom line is...be a decent human being and help when if you are able to. You want more $$$, of course who wouldn't? But the reality is staffing is terrible and we all should pitch in to help the patients, the residents or any person needing care.

We have some nurses who will not help  the aides at all. And they have the attitude also of,”it's not my job to do aide work" but it is nursing work! Yes, meds come 1st but come on! Again BE A DECENT HUMAN✌️?

It's amazing how things come back to you when you are in the right heart space & help out your fellow human being?