New Nurse having trouble with CNA

Published

I am a new nurse and younger than a few CNA and less medical experience. I am dealing a few nursing assistants who will often question me and my interventions in front of patients. IE how to position patients with increased ICP. That a patients blood pressure cuff needs to stay on in the CVICCU. Etc. Honestly, it’s exhausting. I already have a lot on my plate and a huge learning curve without having to deal with a CNA who is constantly fighting me. All nurses know how much we still have to learn and how horrible it feels to feel inadequate as a new grad. I’m tired. And not to mention having to do their job too because they simply will not do anything I ask. I was a CNA and I will help with any and everything. But I have work to do too. I am non confrontational and super respectful. Unfortunately, I bottle things up and smile. But I will eventually blow up and it won’t be pretty. I am trying to avoid this. Any suggestions? 

3
Up Vote Up Vote ×
Specializes in Outpatient Cardiology, CVRU, Intermediate.

I'm so sorry you're dealing with this. I don't have experience in the ICU (regarding positioning for ICP), but in regards to the BP cuff, you could reply, "It's important to be able to make frequent adjustments and monitor the patient's BP very closely here. It wouldn't make sense for anyone to go in to the room every 5 minutes to take the cuff off and on, so we need to check the position of the cuff throughout the shift when we round, but we need to leave it in place. Would you please help me make sure this happens?" If they still are questioning this, question them back. "Why are you taking the BP cuff off when I asked you to leave it in place?" If it still happens, take it up the chain.

I've been a RN for 8+ years, and I worked with a CNA last week who was asking all sorts of questions that I didn't know the answers to yet, and spending time telling me every item the patient ate for each meal. All valid questions and some of the information I do need to know, but not in a stop everything and have a 10 minute chat about it early in a very hectic shift. The CNA was Close Obs for 2 patients, both confused and one was impulsive. The CNA is also in the final semester of nursing school, and sometimes they ask a lot of questions sort of like they are in clinical. That is good and OK, but it is also OK to make a boundary for that; I needed that CNA to be a CNA at that time, not a student following me or someone I'm precepting.) I finally had to say, "I don't know the answers to these questions yet. I need you to stay close to these two rooms while I figure stuff out. I have all 3 of these patients I am trying to get a handle on, and I need to look at them/orders and make sure I know what's going on. I will touch base with you in just a little bit. Let me know if anything major changes with these patients that you need help with right away."

You could also have a more one on one conversation with the CNA about questions/talking in front of patients. I worked with a wonderful CNA who would chat with patients about everything and would include me, my children, family, etc, in the conversations when we were all in the room. Nothing terribly inappropriate, but I did pull that CNA aside and ask her to not bring up my kids, etc, with patients if I'm not already doing so in the conversation. ?‍♀️ I don't volunteer personal information like that unless I am comfortable with the patient. She seemed truly surprised about my reasoning/request, but was totally understanding and respectful of my request. You could try wording it like, "I appreciate working with you. If you have a true concern about the position a patient is in, please do speak up appropriately to ask when we are re-positioning someone. If you have a more general question that isn't directly related to the time we are in the room, would you mind waiting to talk with me about it until we have a free minute outside the room? I want to help and educate all of our patients, and answer all the questions I can, but sometimes I need to move on or complete another task that is higher priority before I can circle back to explain something to a patient."

Hopefully some of that makes sense or is helpful, and others will reply also.

3
Up Vote Up Vote ×
12 hours ago, Lyslys said:

All nurses know how much we still have to learn and how horrible it feels to feel inadequate as a new grad.

Your (normal) feelings of inadequacy may be significantly coloring your interactions with others. In fact, I would wager to say that it's practically a certainty that they are.

It's a big deal and you need to recognize it and get it under control. You don't feel completely comfortable right now. Not many of us do feel completely comfortable when on a huge learning curve like this. But it becomes wrong when we attribute feelings and intentions to others while we're looking through foggy lenses on our own face.

If your knowledge and ideas about the b/p cuff (for example) lead you to a different conclusion than that of the CNAs' then either inquire about their thought process or do things according to your own thought process (if you are quite sure that you're correct). But either way, don't make it into some big thing in your mind where they practically came to work that day just to challenge you because you're a beginner and be a thorn in your side at every turn.

 

12 hours ago, Lyslys said:

I am non confrontational and super respectful.

Yes. That is also a personal problem. Let's just say I know this type very well. ? It is, in fact, a form of dishonesty--with yourself and everyone who interacts with you. You have to be willing to engage when it matters; when it is important to do so. You can choose to engage respectfully and professionally--this isn't all or nothing like the world you are living in right now where you're going to either smile or (eventually) blow up. You are allowed to engage in a fair and respectful manner. Then...then...others' response is on them.

Focus on the concept of engagement rather than confrontation. Engagement can be positive, but confrontation is....confrontational.

This is tough love but I'm pretty sure of what I speak/write. You are stuck blaming others for a lot of what you feel.

???

2
Up Vote Up Vote ×
Specializes in New Critical care NP, Critical care, Med-surg, LTC.

When I was newer in hospital I had a few similar interactions. I was also the smile and non-confront personality, for a little while. And then, as JKL33 mentioned, I realized that nothing would change if I didn't speak up and I wasn't doing anyone any favors by not addressing it. I pulled the individuals aside and told them how much I appreciated that they had information to share with me because I was new in the hospital, and that was my genuine feeling. However, I told them I did finish nursing school and I do have some experience in areas of nursing. If they have a question about why I'm doing something, I'm happy to discuss it when we are in nonpatient areas. Also, often when we were providing care, I would provide information about why I was doing a certain intervention, so they felt more involved in the process because they knew why I was doing things. Was it perfect? No. Did everything instantly get better? No. But I knew that I had stood up for myself, appropriately, and it set some professional boundaries that were mostly respected. Good luck!

1
Up Vote Up Vote ×
4 hours ago, JKL33 said:

Your (normal) feelings of inadequacy may be significantly coloring your interactions with others. In fact, I would wager to say that it's practically a certainty that they are.

It's a big deal and you need to recognize it and get it under control. You don't feel completely comfortable right now. Not many of us do feel completely comfortable when on a huge learning curve like this. But it becomes wrong when we attribute feelings and intentions to others while we're looking through foggy lenses on our own face.

If your knowledge and ideas about the b/p cuff (for example) lead you to a different conclusion than that of the CNAs' then either inquire about their thought process or do things according to your own thought process (if you are quite sure that you're correct). But either way, don't make it into some big thing in your mind where they practically came to work that day just to challenge you because you're a beginner and be a thorn in your side at every turn.

 

Yes. That is also a personal problem. Let's just say I know this type very well. ? It is, in fact, a form of dishonesty--with yourself and everyone who interacts with you. You have to be willing to engage when it matters; when it is important to do so. You can choose to engage respectfully and professionally--this isn't all or nothing like the world you are living in right now where you're going to either smile or (eventually) blow up. You are allowed to engage in a fair and respectful manner. Then...then...others' response is on them.

Focus on the concept of engagement rather than confrontation. Engagement can be positive, but confrontation is....confrontational.

This is tough love but I'm pretty sure of what I speak/write. You are stuck blaming others for a lot of what you feel.

???

LOL. Every new grad nurse feels like they have a lot to learn. You are unreal and unsafe if you feel like you know it all. 
 

Up Vote Up Vote ×
21 minutes ago, JBMmom said:

When I was newer in hospital I had a few similar interactions. I was also the smile and non-confront personality, for a little while. And then, as JKL33 mentioned, I realized that nothing would change if I didn't speak up and I wasn't doing anyone any favors by not addressing it. I pulled the individuals aside and told them how much I appreciated that they had information to share with me because I was new in the hospital, and that was my genuine feeling. However, I told them I did finish nursing school and I do have some experience in areas of nursing. If they have a question about why I'm doing something, I'm happy to discuss it when we are in nonpatient areas. Also, often when we were providing care, I would provide information about why I was doing a certain intervention, so they felt more involved in the process because they knew why I was doing things. Was it perfect? No. Did everything instantly get better? No. But I knew that I had stood up for myself, appropriately, and it set some professional boundaries that were mostly respected. Good luck!

Thank you for your constructive input. The thing is that she’s a very smart girl and knows why. Honestly she’s just being difficult. I will use what you said though, mostly so that it turns the attention back on the patient.

Up Vote Up Vote ×
9 minutes ago, Lyslys said:

LOL. Every new grad nurse feels like they have a lot to learn. You are unreal and unsafe if you feel like you know it all. 
 

Noted.

Take care.

Up Vote Up Vote ×
Specializes in Pediatrics, NICU.

I am so glad I am not the only one with this issue. At 22, I was asking people way older than me (like women in their 60s) to do tasks for me which they were very bitter about. They always say no too (which like ? this is your job) but I've talked to my higher ups about it and they agree it's been an issue...very awkward when the managers talked to them and said "you have to help pinkdoves when she asks"...

Up Vote Up Vote ×
+ Join the Discussion