New LPN troubled with CNA's

[TBLPN]

I am a new LPN. I have had my license for 8 months now. I have worked at my current facility (LTC) for 7 months. But I recently changed shifts. I now work weekend opt. I love the hours and being able to be at home all week with my kids, but the CNA's that work my unit, well, basically are horrible. They have worked this shift for (most of them, there are 4) at least 2 years. They are good aids for the most part. They only work 16 hour shifts Sat. and Sun., which in my opinion is too many hours for any CNA to work. Being a CNA is hard work, I know, I was one before I became a nurse. I have a lot of respect for CNA's, but only for those who have respect for their charge nurses, which they do not. They truly feel they run that unit and anything the charge nurses ask them to do, they take great offense too. Unfortunately about 2 weeks ago, I had a horrible experience with a patient who climbed out of bed and fell face first and hit the floor. This patient suffered some pretty serious injuries. I felt horrible, had to endure a lot of paperwork and sit in on many meetings with my supervisors, luckily the patient is fine, and is back with us. But now I am even more cautious and aware of what is going on on my unit. And the past few weekends I have noticed that some patients were not put into pajamas for bed, personal alarms not on, mats not down for those in low beds, and this is the kicker, a certain resident, 2 weekends in a row I found had no O2 on, which is to be on at all times. When I approached the CNA's about this, they became very defensive. Although, we talked, I thought it went well, and that was that. I came in that night, (I work 12 hour shifts) and they weren't speaking to me or the other nurse, they behind our backs, called the ADON in for a meeting at 10pm, I had no idea that they did this. So, during our "meeting" these 4 CNA's were yelling at the top of their lungs at the two nurses and the ADON. A truly pathetic display of immaturity and disrespect. These are the things that you are not taught in nursing school. The DON has now called a meeting with the two nurses involved, the 4 CNA's and the ADON. They say it's the nurses chance, and theirs, to let these CNA's know who is in charge. I'm not sure that this meeting is going to go well. I have a truly bad feeling about it. I have never had any trouble like this before with CNA's. I normally have no problem with them. I'm told it's just a "power struggle", but there should be NO power struggle, I'm the charge nurse.....period. Any suggestions on this problem would be greatly appreciated.

[tmiller027]

The solution is to get rid of all CNA's...they never have, nor ever will, be worth the effort to keep...I got rid of a boat load a few years back at an ED that I directed, and with the money saved, gave all the full time staff raises to the tune of $8-10.00 an hour per RN. The complaints about never knowing where the aids were were gone, and the RN's did not mine doing the additional scut work, since the hefty raises more than made up for the abscence of no loads.

Sure, and while we're at it, lets get rid of all LPNs too and give the RNs another $8-10 raise. Talk about generalizations.

Tim (a worthless CNA)

[tmiller027]

Not to start a flame war here, but there are a lot of us CNAs who take a LOT of pride in our work and work our butts off. I've had a few nurses that could use an attitude adjustment too.

A few weeks ago, one RN came up to me and wanted me to switch out a patients catheter (NOT in my scope of practice by any stretch). I told her I wasn't authorized to do that. She says "Whats the big deal? All you do is pull the bag off the tube and stick another one in!" I told her the big deal is that the Indiana Dept. of Health says I'm not to do such procedures, therefore I wont' do it. She said "Fine, I'll find someone else!"

Now, we were right outside the patients room. She walked clear down the hall to find another CNA to do her work. She went to MORE trouble finding someone else to do her job for her, than it would have been for her to do her job.

About a week before that, I worked with another nurse who seemed to like following behind us nitpicking every little thing as we put people to bed. Now keep in mind, I was working on the heaviest unit with the most lifts with a much weaker CNA who couldn't move as fast. We have 2 hrs to dress, change, clean and put to bed 22 patients. As well as make sure they have alarms, heel protectors, etc. What I always do when I get everyone down is go back through the unit and double check everything and make sure everything is where its supposed to be. This nurse stopped us every 5 minutes to tell us we forgot so and so's heel protectors, or that so and so had food on their face. Nothing she mentioned was an immediate safety risk like alarms or anything, it was all small things that we would have fixed on our rounds. When putting people to bed, we just want to get them IN BED or else we get in trouble if they're not all down by a certain time.

On the other hand, we have a lot of nurses there who are awesome to work with and the night goes really smooth when they're there no matter what is going on.

[tmiller027]

Whether it's jealousy or not, many of them just don't see the load we're under. To them it looks like our job is easier than theirs. Many of us have been aides before. How many of them have been nurses before? (I know of one.)

I can't speak as one with a lot of experience because I'm just getting started as a nurse, but I know there's a lot more involved than I realized when I was a CNA.

Being in charge is going to be a difficult part of my job, because I'm not naturally assertive. I avoid conflict whenever possible.

On the same note, we have nurses who think that because they dont' see us right in front of them (because we're in a patients room giving care) that we're not doign anything. One even said to me "You need to stop hiding and be where I can find you!" Hello?? Look for the CLOSED DOOR.

If you ask me, everyone in LTC is at each other's throats. The DON is on the unit manager, who jumps down the charge nurse's throat who comes down and jumps down our throat for whatever.

You have 2 CNAs who have 1 hr to give 4 patients showers in the shwoer room down the hall. Now, often I'm on the heavy unit with people who are unresponsive, don't walk and bear little if any weight. We have about 1 to 1.5 hrs to get all four in and out of the shower room, so we try to have both CNAs take a person at once, but we can't because the nurse wants to sit at the nurse's station and chart instead of charting on the unit, so one of us has to stay on the unit while the other does showers.

That is if we get there in time since the shower has three stalls for 3 units of 22 patients each. Especially if the one unit, who has a male to do alm ost every day gets there first, then (our unit is al most all female patients) Then the whole shower room is shut down for about 20 minutes. So our showers don't all get done and we get yelled at for not doing our jobs.

I know the nurses have a hard job too. I think theres too much generalizing on this board. Male vs. Female, med students vs. nurses, nurses vs. cnas and so on. Aren't we all part of the healthcare team and play an important role in patient care? I know some think we CNAs are useless, but I'm sure you'll find a doctor who thinks nurses are useless too. The nurses I work best with are the ones with a "team" mentality not a "I"m your boss dammit!" attitude. I think we all need to have this attitude. I've had nights where I"m stuck with a useless CNA as well. I still try to make the best of it regardless, might make for a rough night, but I will be in the DONs office that next day telling them how someone doens't pull their weight.

Sorry for my rambling, but I have a lot of good friends who are nurses and CNAs. We all have tough, demanding jobs. I have a lot of respect for the nurses I work with and many on this board, so I'm pretty upset to read some of the comments I've seen about CNAs. Yes, the healthcare system is poorly managed and is messed up. Our job is to give the best care we can despite the system. We can only do that by WORKING TOGETHER.

Okay, I'm done ranting, sorry if I upset anyone.

[kids]

the DON and ADON have called a meeting with the 4 CNA's involved and the two nurses involved (one of them being me). It's scheduled for tomorrow.,snip>

Please let us know how your meeting goes.

[Marie_LPN, RN, LPN, RN]

Aren't we all part of the healthcare team and play an important role in patient care?

Not acccording to some. But i feel sorry for people that have the kind of "get rid of them all" mentality though. They're usually the ones griping that everyone else (of course!) is lazy and worthless, that if it weren't for THEIR OWN effort, their workplace would just crumble, when in actuality, they're stuck doing jobs alone because their attitude and work ethic are such downers for anyone to tolerate working around.

[shel_wny]

The solution is to get rid of all CNA's...they never have, nor ever will, be worth the effort to keep...I got rid of a boat load a few years back at an ED that I directed, and with the money saved, gave all the full time staff raises to the tune of $8-10.00 an hour per RN. The complaints about never knowing where the aids were were gone, and the RN's did not mine doing the additional scut work, since the hefty raises more than made up for the abscence of no loads.

As a CNA myself...ouch.

We're not all irresponsible attitude problems, you know.

Some of us are student nurses who are there to do only good and wish to gain more experience and skills in the nursing field.

And as for what to do with the bad apples, one word - INSUBORDINATION.

That's all you need to write them up. And never ever underestimate the power of documentation - issue + name of person + time + date.

Shel

[MsLpn02]

Quite honestly i can't agree with the jealousy theory. Jealous of the job (nurse) that has a similar kind of understaffing issues as NAs, yet 5 times the responsibility? Please point out what's to be jealous of, because i am not seeing it.

Well, where I work at, the CNAs usually gripe about the nurses' lack of work and the better pay the nurses receive. Most of the ones that are jealous would say "I don't know how so and so became an LPN." Or they would point out that we get paid too much money for not doing hardly anything. They think that we just pass out medicines. If they only knew what we really go through, then they would understand why we get compensated the way we do. Although in my opinion, neither CNAs or nurses get paid enough for what we do.

[Betty_SPN_KS, LPN]

Tim, you didn't upset me. I agree with you, that you can't generalize. I know there are CNAs who take pride in their work. I like to think I was one of them. I'm such a new nurse, my name badge still says CNA even though I've been training as a GPN for several days now. And I want to take pride in my work as a nurse. It's scary because I still have so much to learn.

Personally, I'm glad there are different levels of opportunity in health care. What would it be like if we all had to have BSNs to do anything at all?

I got a little paranoid the other evening. I feared some of the CNAs might be saying amongst themselves, "Why can't she help us like she used to? All she does is stand at her medcart." Well, I'm standing there a while because I'm a new nurse and it's taking me a while to think this through, and I want to do it right! I really would like to help them, but then I wouldn't get my work done. But I think they really understand that my job may not look hard, but is time-consuming, like theirs (not to mention problems that may come up, that the nurse is responsible for dealing with). Many people at work (nurses, CNAs, and residents) have been very supportive of my becoming a nurse. I don't want to disappoint them.

[Betty_SPN_KS, LPN]

TBLPN, how did the meeting go? How are things going now?

[oldfolksnurse]

Our DON is a little more "vocal" and she has promised me this will go well and all will be fixed. She kept telling me not to "bail" on her and to give her a chance to fix this. But what was even more upsetting was that she told the other nurse who is involved that she is tired of these CNA's running off her good nurses........

There is the problem. If your DON is allowing the CNAs to run off good nurses, then she needs to do her job a little bit better.

You need to be documenting and providing personnel actions on the CNAs that will not perform their duties as assigned. The LTCs that I have worked: 3 strikes and you are out. If your CNA continues to be insubordinate to you and you have the documentation/actions to back that, then there is no reason that the DON should not terminate them.

As I have told CNAs in the past, "The charge nurse is not going to instruct you to do anything that is going to harm the patient. Even if you don't like it or know the reason behind it, the charge nurse does and you are expected to perform accordingly." That is not to say that I haven't eventually terminated a CNA for continued failure to perform duties...they all don't heed advice.

Hope your meeting goes well and you decide not to "bail." There really is a shortage of good LTC nurses that do care.

[nurseem]

CNA's probably feel like they do more dirty work than the nurse AND the nurse is still making more money. I think its the money. I don't personally think that CNA's get paid what they should for the jobs they do, i used to be one and am now going to nursing school.

Quite honestly i can't agree with the jealousy theory. Jealous of the job (nurse) that has a similar kind of understaffing issues as NAs, yet 5 times the responsibility? Please point out what's to be jealous of, because i am not seeing it.

[ktwlpn, LPN]

Finally, someone who really put it out there the way I feel!!! It's crazy. I have such a hard time being "responsible" for everything and anything the CNA's do. I love LTC, I don't want to leave it, but I'm not sure I have much choice. I really thought I could make a difference there. And to top off all that went down between myself and the CNA's now the DON and ADON have called a meeting with the 4 CNA's involved and the two nurses involved (one of them being me). It's scheduled for tomorrow. I'm hoping the DON backs us up and let's them know that we are the one's in charge and responsible. But I'm not sure that is going to happen. The ADON is already mad at me and the other nurse because we said we didn't feel like she backed us up, and truly she didn't. She allowed the CNA's (all of whom are supposed to be grown women) scream at us (the 2 nurses) and at her. You could NOT hear yourself think in there. And I decided that I was not stooping to their level. If a meeting could not be conducted in a mature, professional, and rational manner, then I didn't want to be a part of it. The only thing that truly was reinforced was that they were "good" CNA's. That's it. Nothing about you need to deal with these issues with the charge nurse and they are in charge, they are responsible for the unit, nothing. Our DON is a little more "vocal" and she has promised me this will go well and all will be fixed. She kept telling me not to "bail" on her and to give her a chance to fix this. But what was even more upsetting was that she told the other nurse who is involved that she is tired of these CNA's running off her good nurses........how is that even possible????? How can 4 CNA's be let to run amuck like this and no one say anything??? I just don't understand. As I said, I was a CNA before I was a nurse, and I would have never dreamed of speaking to any of my charge nurses the way these 4 spoke to us and the ADON. I'd like to say it's the age, but they are all in their mid 20's except one, who is 40+........I even had another nurse that works days tell me these CNA's are the reason she left weekend opt in the first place.......:angryfire I just don't get it I guess. But what it boils down too is that I really like my DON, she's been more than helpful and understanding with all my questions being a new nurse. She always tells me to call her if I need her, and I do, and she is soooo nice about it. I just hope she is going to do the right thing. I worked 3-11 Mon-Fri up until about 2 months ago, and I never had a problem. I loved working there, I loved my job!! No so now!!

I think this has gone on for so long because many nurses are intimidated by that kind of behavior or can't be bothered to document it and follow through.Where I work you become known as a "squeeky wheel" if you get into conflicts-the DON tends to like to ignore these situations until it boils over and staff ends up quitting..It sounds like she is going to back you-I agree that your ADON did not-she should have taken control of that meeting...I wish you had walked out...Staff like that will do themselves in-they are not exactly interacting in a calm and rational manner...I have worked with several "aides from hell" and been in the DON's office more times then I can count.I have found that all I need to do is just sit back and keep my mouth shut-and watch the performance....Bottom line is-you ARE their immediate supervisor-doesn't middle management suck?