New Grad RN with Skilled Nursing Job - Advice Needed Working with CNAs

[Bizaleth]

I was just offered an opportunity to work in a skilled nursing facility as a new grad RN. The facility looks great, has good ratings, a seemingly adequate and supportive orientation, and definite growth opportunities. I live in an area where it has been very difficult for new grads to get a job, so I am thrilled I have found one in my own community.

The one thing that I was warned about by the DON was that there were some difficulties with the CNAs in the facility. She asked if I had experience supervising others and whether or not I would feel comfortable giving direction and having to possibly deal with difficult CNAs in an assertive manner. I do have experience supervising others from a previous career, and was taught delegation skills in nursing school and feel I can be assertive. Yet because I am a new RN, I'm very unsure the reality of the situation and what it is I'm going to expected to do.

I guess I am just looking for any experiences/advice anyone can give who has been in this situation. As a new nurse, I'm still unsure of just how much I am going to be directing CNAs and how I should approach them from the start. I've always gotten along well with CNAs during clinical rotations, but know that this is going to be a different type of situation as I am now officially an RN and there are greater expectations of the types of interactions which need to occur (not to mention existing issues/power dynamics at the facility). Any insight would be really appreciated!!

[anewsns]

I just try to stay polite and reasonable but keep your boundaries up. If they are doing something really wrong I call them into the office.. I accidentally made people cry before (nobody likes to be called into the office even if the nurse is nice!) usually in that case I just try to resolve the issue with them but still mention it to my manager (who is also very reasonable so it's not like I'm throwing anyone under the bus cruelly. I try to help them if they are straight out and I send them on mandatory breaks if they are like really wound up or chaotic. Needless to say things run really smoothly with my CNAs now and the communication between us is really good. Know your policies too.. Like what to do if your patient tells

you a CNA was too rough with them , and if you run into a bad situation and you arent sure how to manage it you can use your manager as a sounding board .. Mostly just common sense stuff.. I try to remove any negative emotions and stay as professional as possible all the time. I notice my managers often use me as a sounding Board when they are in these situations now too as I am trusted to stay objective and professional .

[DanaerysTargaryen]

Show your aides respect, praise them and thank them for the things they do well, and ask their opinion when it comes to situations where they may legitimately know better than you do. (You have more nursing/medically related knowledge, especially when you begin work in the facility, they will know the resident and his/her personal quirks in a way you won't.) This will go a long way in forming the kind of positive relationship where you can give feedback if it's needed. CNA's in LTC are overworked, paid half what you will be or less, and may have years more experience than you. You're ultimately responsible for managing what goes on on your floor, but you are right to think through how to make this happen without burning any bridges, because it is a delicate situation especially as a new grad.

[CoffeeRTC, BSN, RN]

Welcome to LTC!

We all know that the CNAs are the backbone of LTC. I work with a great bunch of CNAs....makes a world of difference. How do you get a good relationship and manage the staff? Respect and professionalism. As a new nurse, you are still learning your game. Some of the CNAs you might work with could have been working longer than you've been alive. Respect their experience. Be approachable, be fair. Realize that some rules are dumb and might need changed or bent. Listen to what they have to say and act. Listening is one thing, but acting on it is another. Many times I hear them complain that they've mentioned a problem a few days ago and no one did anything about it. Now the resident is super sick. Educate them. If you are not doing what they think needs done, tell them why.

Be available and able/ willing to help out. This doesn't mean doing their job. I can't tell you how many times I've seen nurses hunt down a CNA for a simple thing instead of just doing it themselves. Keep any discipline private and don't get caught up in the gossip.

[casi, ASN, RN]

At the beginning of the shift make sure your aides know what you expect. It's nice to have a quick report with the aides.

"Mr. Smith had a suppository on nights, please let me know if he has results. I need weights on Mrs. Johnson, Mr. Jones, and Ms. Anderson before breakfast. Mr. Doe has been combative with cares, from report PM shift had a lot of luck talking to him about his daughter while doing cares which kept him calm. Oh and Ms. Thompson has Shingles, if you are pregnant or haven't had chickenpox or the Vaccine stay out of her room, otherwise gown and glove. If you need any help holler and I'll try to help."

When and if you can help out. As a new grad you'll be running like a chicken with their head cut off, but if you can help a little it helps gain some respect in some instances.

[caliotter3]

Do not pass up opportunities to assist a CNA with care. While cleaning up an incontinent resident, you can do a skin assessment as well as impress the CNA with your willingness to pitch in. There are those who will notice that you help and they will develop a positive attitude about you. This helps all the way around.

[NJstudent2012]

I agree with you caliotter3. I found that CNAs will thank me when I help them out and they especially notice which nurses never help.

[stippie09, ASN, RN]

As a new grad RN last year in a LTC I found I difficult to supervise my aides at times. Like the other posters said, be respectful and assist your aides as much as you can, they do back breaking work all day. Tell them what you need done first thing when they come in, and follow up on that a few hours before they leave. Most will be respectful to you but there are definitely some that will push and push you. Take them aside to hash it out, then tell them what you need done. If it's still a problem, you might have to write them up. Good luck!