Need ideas.

Hello CNAs!

I am an RN on an acute care unit at a large medical center. I'm joining our unit based council, and one of the issues that I'd like to spearhead is improving our CNAs' performance.

What types of education, training, and support, in your opinion, would be the most effective in promoting a more proactive way of doing your work?

Thanks in advance! :bowingpur

[RN2BMU2009]

Knowing that you can go to your RN for any assistance. I work on a medical unit and some RN's WILL NOT do tech work. I have witnessed some of them walk out of a room, look for the tech, tell them someone needes cleaned up, and go and sit down. And then there are some who will assist you whenever they can. Every nurse on every level should do whatever work that is within their scope of practice if they are able to. Every tech or CNA can tell you the name of each RN or LPN on their shift who will not help a tech or refuses to do primary care. This lowers moral among techs and CNA to have to work with someone like that. Everyone should help out when necessary. It's not fair to the tech or to the patient to have to wait on help just because someone paid more for their education than the next person. I hope this helps and Good Luck!

[casi, ASN, RN]

My first question is what kind of performance issues are you having with your CNAs?

As a CNA I think the biggest thing that motivates me is having open communications with the nurses I work with.

Another thing to address is the role differences. As a CNA it is sometimes frustrating to see the LPN/RN sitting at the desk charting most of the time, I know it is vital for the nurses to chart, but for those that don't there are misunderstandings. If both sides understood the others role a bit better it may help.

I think that it needs to be established that LPNs/RNs/CNAs are all apart of the SAME TEAM. There should be no us and them.

[rancelumsden]

I worked in both LTC and hospital. You may or may not do this already. In hospital, I had almost 2 weeks of full-time training before I got on the floor. Some of the training was basic hospital rules and info about the hospital, management, what was generally expected of staff, etc.(orientation kind of stuff). We had a fair amount of training on the computer system as everything had to be input via PC's. Everyone had CPR that needed it, initial EKG training (that went on after going to the floor).

We then, as is customary at many places, had a preceptor that we worked with for several weeks. We basically followed the preceptor around for a couple of days and assisted, then would be assigned only 4 patients. There was a large checklist the preceptor had - several pages. We needed to learn where all the equipment was stored, how to work with it (oxygen, suction, heart monitors, SCD's, post-mortem care, we were checked that we were entering everything properly into the software, i/o's, sending/picking things up from the lab, post-op procedures, isolation rooms, discharge procedures, knowing which test bottles to use, etc. So, essentially, we were in training for 4-6 weeks. You still didn't learn everything in that time, but you got at least exposed to most of everything.

That system seemed to work. Of course, some CNA's still didn't perform --- not everyone, even with training, can be competent. But you were given every chance to train and ask questions about what you didn't know.

Of course, in LTC, a lot less orientation is needed. I went to LTC after being in hospital for a couple of years, so I was pretty well experienced by then.

BTW, we had good nurses (no, not all, but the majority) at hospital so I don't have the complaints many CNA's have about working with nurses. People worked pretty well together. You know better than I how bad some days can be --- everyone on the call light, none of the patients happy, management coming down on everyone. But, we got through it...

By the way, we were always cursing (quietly) you people in telemetry. We carried phones in the hospital. Every time someones heart monitor got disconnected, we got called. We had more calls from telemetry than we did from patients (LOL).

[locolorenzo22, BSN, RN]

I work on a pt satisfaction committee, and speaking as a former CNA, my biggest issue is that often RNs would NOT answer a call light...even if you were 1 aide with 15 pts....

Often, I find that it is NOT a matter of training or education...it is a matter of personality. I would go answer call lights on the other half of the hall if I was caught up or if the light had turned "green" (signifying over 3 minute response time). I would be happy to go see what others needed when I was caught up. however, I would go up by the station some nights when I was "in the weeds", and see the other CNA sitting down, either charting or taking 5 minutes...and I would be MAD!

I personally tell all my CNAs that "hey, if you need help with one of MY patients...and I can help, I will. However, don't feel like I'm too good for it if I have meds to pass, docs to call, or admissions to do. We have different jobs now, and I have to do what I have to do."

I will answer lights if I'm caught up with what I gotta do, and I know the CNAs are overloaded. Last night, I just had to help someone cut up their food for dinner...

But it works both ways. The aides know I will do whatever I can, but I will not return the favor if they are not working.....

Also, on days, nurses will NOT answer lights and even the emergency light will not get a response...I helped put another nurse's pt in a bed because they were having a seizure, pulled the light....and there was NO response. I had to send the aide out to go get the nurse....after 5 minutes.....(they had relaxed, but I was not leaving the patient.)....It's just sad.

Also, customer service training would help...sometimes the patients are nasty or mean to our CNAs, and if I overhear that, I call em on it. Knowing that the aides have support means a lot. GL to you on trying this improvement.

[fuzzywuzzy, CNA]

Put more of them on the floor!

[RN2BMU2009]

Put more of them on the floor!

I second that!

[GigiNYC]

Hello CNAs!

I am an RN on an acute care unit at a large medical center. I'm joining our unit based council, and one of the issues that I'd like to spearhead is improving our CNAs' performance.

What types of education, training, and support, in your opinion, would be the most effective in promoting a more proactive way of doing your work?

Thanks in advance! :bowingpur

Hi, as a Nurse Tech I can tell you that one of the problems is communication. I have noticed that the new nurses coming in to the hospital do not want to do any type of care. They refuse to put a patient on a bed pan. :angryfire They only want to give out medication and chart.

How are you going to chart on a patient if you havent seen their bottom for skin breakage.

I think you should talk to the nurses on each floor, see what their complains are. Then talk to the techs, get the same information.

Have a meeting and discuss all that has been said and done; ask how can we improved the situation and better our staff. We do them here with our Director of nursing. She does a meeting and request that the nurses and techs come and we talk about the problem.

It would help if techs work together but their are some that are lazy, thats just the honest truth, but you got some very hard working people out there that deserve the respect and gratitude from your fellow workers.

I am sorry if my spelling is off but Im at work and its 3am and my eyes are cross. I do the graveyard shift and I havent been able to go on brake yet. I wish you luck!!!

[Virgo_RN, BSN, RN]

My first question is what kind of performance issues are you having with your CNAs?

That's a good question. I have a lot of examples, but I don't want to come off as complaining or CNA bashing, which is why I didn't go into detail initially. Some specific performance issues are:

Turn Q2s not getting turned

Toilet Q2s not getting toileted

Inaccurate or no I&Os

No or not enough help with routine vitals

Patients not OOB for meals, and dinner trays carelessly placed in front of arthritic LOLs/LOM who cannot cut their own food or open those juice/milk containers

No HS care

Patients not being ambulated

Loose tele leads not being fixed/batteries not being replaced

BSCs/urnials/sani pans not being emptied

No water pitchers/food/toiletries provided for new admits

Incontinent pts not being changed

We have 36 beds with 4 CNAs on my shift. That's 9 patients apiece. Most of our patients are walkie talkie, continent, alert and oriented, with a few total care patients in the mix. Most of our nurses have been CNAs in the past, many having started out as CNAs on our unit. The nurses answer call lights, assist pts to the BR/BSC, help pass dinner trays, and everything on the list above.

I hope this additional information is helpful.

Thank you to everyone who has replied thus far. Keep the ideas coming! :typing

[Virgo_RN, BSN, RN]

Hi, as a Nurse Tech I can tell you that one of the problems is communication. I have noticed that the new nurses coming in to the hospital do not want to do any type of care. They refuse to put a patient on a bed pan. :angryfire They only want to give out medication and chart.

I'm not arguing with you here, just wanted to throw in some thoughts. :typing

When I was a brand new nurse, it was all I could do to keep my head above water just doing my assessments and charting and passing my meds. It wasn't that I didn't want to do any patient care, but rather, I had to learn how to prioritize and manage my time. It takes time for a new nurse to get their feet on the ground and get to the point where they are able to do more than assess, chart, and pass meds on a full patient assignment. These things are time consuming, critical components of patient care, and new nurses are slow at them.

I'm not saying that there aren't nurses that just don't want to help with basic patient care; there are lazy people in all professions. But for me, and I think I can speak for a lot of new nurses, that wasn't the case at all. It was a matter of survival. I was literally triaging my patient care, only doing the critical things that had to be done, and putting the less critical stuff on the back burner. I can't tell you how many times I cried in the bathroom and thanked all that is good that I hadn't killed anyone after each shift. Every single night, I'd lie awake until 3am thinking of things I had forgotten to do, wondering what other things I had missed, hoping that I hadn't missed something potentially life threatening. I often missed my days as a CNA, when I could simply tell the nurse if something didn't look right. Now, I WAS the nurse, and it was up to me to follow through on patient problems.

I'm sure it might have looked to the CNAs like I just didn't want to get my hands dirty, but that simply was not the case. The CNAs were my lifeline, and they didn't even know it. How could they know it? To them, it looked like all I was doing was passing meds and sitting on my butt in front of the computer.

I think this speaks to a chasm that exists between the two where each side feels that they are not understood or respected. Maybe getting some dialogue going about this at my workplace might be part of the answers I'm looking for. However, it is such a loaded topic that I'm not sure it would be wise to open that can of worms. I want to identify and implement team building strategies, not cause further division and resentment. :redbeathe

[fuzzywuzzy, CNA]

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[fuzzywuzzy, CNA]

Before reading this site I didn't realize how busy the nurses are. The nurses where I work don't do any CNA duties, period, but I don't expect them to. Still, a thank-you at the end of the night as you're leaving makes a huge difference. I work for some nurses who treat us like scum, and it makes for a really uncomfortable night. Especially when you're supposed to respect them and they have absolutely none for you.

Some of your specific concerns (q2h turning and toileting, improper I&Os, vitals, ambulation, HS care) can be documented. We have a book where we sign off that we did those things and document refusals. Then CNAs are accountable, and you at least know what did and did not get done and if not, why.

I don't understand why bedpans are being left out or inc pts are not being changed. That's just disgusting and neglectful. Are they too busy to empty a commode? 9 patients can seem manageable or it can be overwhelming, depending on how much they use their call bells. I know there were nights in the beginning where I didn't know the routine, and everyone on my assignment was glued to their call bells because they wanted to go to bed RIGHT NOW. I left all the rooms a complete mess after HS care and then went back later and cleaned it up when I was done with everybody. Maybe an in-service on time management would help with some of that. Or do they just assume someone else is doing to do it? Do they stick with their assignments? Do they know who and what they're responsible for by the end of the night? Signing off on these things might help if that's the problem.

So... things that might help are more documentation, clearer care plans, in-services on time management, and educating on what everyone's job descriptions are.

As an aside, I don't give food or fluids to new admits because I don't know what they can have yet... diabetic? low sodium? allergies? thickened liquids? fluid restrictions? If they don't have a care plan in the book yet, I don't give them anything and I don't know if I can interrupt the nurse for something like that when she's doing an assessment.