Need ideas.

[Virgo_RN]

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

[Virgo_RN, BSN, RN]

Thank you and everyone for your thoughts. I am very interested to hear them, and am taking every response into consideration.

Just to answer this question:

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.

You're right, the nurse probably doesn't even know the new admit's diet orders yet, so interrupting the initial assessment wouldn't be productive. The solution to this is just showing a little initiative and follow through. Once the nurse has had a chance to look at the chart (it's the first thing I do after the pt. has been tucked in and assessed), ask them "Can the new admit in room xxxx have a water pitcher and something to eat?". The nurse will love you for it. Well, I would, anyway. :bowingpur

Every little thing you can do helps so much, and the nurse will appreciate your attention to details like this. :redbeathe If you show a pattern of taking the initiative and following through, you will earn a reputation for being a reliable, hard working CNA, and the nurses will be happy to have you on their team.

[yousoldtheworld]

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

I think these are things that every facility deals with. It's a combination of things that cause it - understaffing, laziness, and lax management. Having a series of inservices might help - discussing what is not being done properly and why it is so important. If things don't improve, your best bet might be to implement a better "discipline" system - things not done properly are documented and can lead to being written up and/or whatever your facility's procedure for discipline is.

While the CNAs certainly need to be doing these things, I'd also remind the nurses that they are in charge of their CNAs and they need to encourage them to get everything done.

Good luck!

[casi, ASN, RN]

First thing I would do is have management call a "how's it going" meeting. Ask the CNA's how things are going and what issues they may have with getting their work done. Also very neutrally bring up the issues you've seen and ask, "How can we change this."

If the CNAs are involved with the motivation and change making they are going to be much more willing to participate.

[GigiNYC]

Hi everyone,

No dont get me wrong, all new nurses are not the same, but after awhile some dont want to do it. Im talking about my experience here at the hospital that I work and what some nurses have notice with some new nurses. Like I said before it is not every case. So Im sorry if I offended anyone.:wink2:

All I can tell you is that we all help each other, there is no small job we cant do, that is the difference. Helping and supporting each others back helps with the load. The night goes by fast.

[Virgo_RN, BSN, RN]

I can't speak for everyone, but you didn't offend me at all. :loveya: