New RN how to 'manage' CNAs

Been there,done that, ASN, RN · Sep 2, 2013

Know your facility's policies INSIDE and OUT , especially regarding CNA duties. Any facility should have a policy in place regarding the use of personal electronic devices. They are NOT allowed.. that should be grounds for immediate dismissal.

Give them report at the start of the shift.. with a check list of what YOU require during the shift.

Make sure they know ..any abnormal vital signs are reported to you STAT.

They will be testing you to the max. never let 'em see you sweat.

schnookimz · Sep 2, 2013

In my opinion, group tasks are great. When I worked as a CNA, my best friend and I basically did everything together. It helped us keep every patient changed, clean, and turned and we never hurt our backs trying to do it on our own. Plus we never had to bother the RN for help with these things because we had each other.

I would be careful of frowning on this. You need to pick and choose your battles. You are the new face walking into this. Good luck :)

all4neuro · Sep 2, 2013

Do not tell them it is your first job. If they figure it out on their own, oh well. Until then, if they ask, lie!

Tell them you are the spawn of the Terminator and the Alien.

You will be more distracted than their other superiors in the beginning. This is when the testy ones will strike, hide, or defy you the most. Find those you can trust, ask another nurse who they are, they will help you along the way.

(I love most CNA's. Remembering my first job, being new, and younger than those I delegated to was a huge learning curve. So, I apologize if I offend any CNA's).

Keseratops · Sep 2, 2013

Make sure to say THANK YOU for their work. I think mutual respect and communication is key. Also understanding the role of the CNA and what their tasks and routines are is very helpful. Setting a teamwork atmosphere is incredibly important. I am a new grad working as a CNA. However, I have worked side by side with nurses in 3 ICUs, where you absolutely need teamwork all the time with all different members of the group. I am always asking if nurses need help when I have the time, and they even ask me if I need help. No one is afraid to get their hands dirty... literally. When I go to Med Surge floors I have noticed there seems to be more division between CNAs and RNs. I have been expected to have 18-20 patients by myself, take their vital signs q4 and do baths, feedings, etc. etc. etc... Some great nurses will recognize the tasks I have, and take on some of the work and communicate that it was done to me. Others will ask me to do extra tasks that are not my responsibility, and thus, I may refuse to do.

Just be genuine and set a high (but not unrealistic) expectations. Good luck!

Esme12, ASN, BSN, RN · Sep 2, 2013

Hi!
I'm looking for a few tips. I'm starting my first RN job at a nursing home. During my interview, I was told there are a lot of young girl CNAs who like their phones, "group tasks" etc haha. I don't want to come off as a know-it-all or a jerk telling them to get to work. Don't get me wrong, I'll say what I have to say to ensure the residents are continually cared for, but what are some approaches some of you have found helpful where everyone stayed happy? I'm 22 years-old and a little passive/inexperienced when it comes to keeping people in line.

I am not so sure that in your interview it was appropriate for the interviewer to talk about how young the staff is and how they like their phones...for it is setting a precedent of gossip and passive aggressive behavior.....which is probably why they are acting that way is the leadership behavior.

My suggestion is try to engage their trust and NOT "manage" them and "keep them in line". Unfortunately, management needs to get involved in order to "manage" these CNA's.

You are the team leader....NOT their superior/boss. I would be firm but fair. Be friendly NOT flirty. Show them you are willing to work hard and help them when you can. When asking for tasks say please and thank-you...for example...."Suzie, can you please get Mr. Jones in 409 a bed [an...I have to call Dr. so and so with xyz and then I need to medicate 402, 414, and 422....I really appreciate it thanks." Address issues up front in a non confrontational way. Be prepared to be tested and they are going to push your buttons.....especially if the management is telling perspective hires about a personnel problem in the interview..... :no: ....tells me the manager has ineffective management skills.

Your new roll as a RN is going to be challenging just because you are new. Stay organized here are some brain sheets they may help. How long is orientatio and how many patients are you accountable for?

mtpmedsurg.doc

1 patient float.doc‎

5 pt. shift.doc‎

finalgraduateshiftreport.doc‎

horshiftsheet.doc‎

report sheet.doc‎

day sheet 2 doc.doc

ICU report sheet.doc‎

critical thinking flow sheet for nursing students

student clinical report sheet for one patient

jadelpn, LPN, EMT-B · Sep 2, 2013

Great advice. Make all the CNA's part of report. Team them up in pairs with clear expectations. Make sure everyone rotates, so no pair has a heavy assignment all the time. And if there is anything abnormal--patient's behavior, skin, function, vitals, FBS....they are to report it to you immediately.

The best part of a team approach is that you have 2 people going down the line of patients, so it is both easier on the patient, and easier on the backs of the CNA's.

It should be up to the NM to discuss device usage while at work, or that CNA's must work solo. My questions would have been "is there something wrong with a team approach to patient care" and "is there a policy regarding phone usage, and if so, are the CNA's aware of this policy"? It is not fair to put you in a position to bring this to the CNA's attention.

If you set up your shift that is in the best interest of patient comfort and care, be honest and ask the CNA group what works for them--the work has to be done, but give them the chance to set themselves up to be most effective--and have a tool for them to use--CNA group "A" has the ______ wing--with CNA 1 and CNA 2 as one pair, CNA 3 and CNA 4 is the other pair on that wing. CNA 3 is the "lead" on the hall--the one who goes to you with any abnormals. Check on them each hour, sooner if needed. And so on until all of your patient rooms are covered by a group.

Best of luck with your new job!!

raestokes21 · Sep 2, 2013

I'm not trying to be rude but you really just need to chill. It's just like any other job you're never going to know what it's like until you get in there and start working. Having the attitude of I'm putting you in your place is going to do nothing but cause a lot of drama. Lets be real about the phone thing regardless of if there's a policy in place or not we live in world where everybody is attached to the their phone. Administration is probably on their phones behind closed doors as well. If you see someone using one just pull them to the side and tell them the deal. I can tell you never worked as a CNA because the attitude your giving off. Until you've change people who are two times your size and had a blow out or had to bathe and get them out of bed please don't make a comment about group work. Group work not only provide better quality care for residents but it also keeps CNAs healthy as well. What's wrong with having a partner to help you?? When you work when in a environment of that nature there's suppose to be team work!!! At the end of the day everyone that works in that facility has the role of making sure residents are properly cared for. Have a little respect for the people who don't have RN behind their name. If you have and issue with a CNA or anyone simply pull them to the side like an adult and express your concerns.

RNikkiF · Sep 2, 2013

This one IS a fine line, you're right about that! However, you aren't their boss, they know that and they WILL remind you of that from time to time if they feel the need. The thing is, "behind every good nurse is a great CNA"... absolutely true!!!

If you alienate your CNAs, your shifts will be hell! They have their own routines, which sometimes don't mesh with yours. Start off shift by giving them report and a list of tasks that you need them to do and the time frames in which they need to be done. THEN you need to tell them, "If you need anything, let me know, I'm happy to help out". Some CNAs (and nurses) take this as you thinking they can't handle their job, even if that isn't how you mean it... you can't change their interpretation... just extend the offer and then FOLLOW through on it.

You'll have outstanding CNAs... you'll get excited when they're on shift with you... you'll know it will be a good shift... others, you'll groan when you see them... that runs both ways though! Some CNAs will see you and groan (and expect a long shift), others will get excited...

Just work as a professional team member wilth ALL of the other staff members and you should be fine! Good luck to you!!

Esme12, ASN, BSN, RN · Sep 2, 2013

I'm not trying to be rude but you really just need to chill. It's just like any other job you're never going to know what it's like until you get in there and start working. Having the attitude of I'm putting you in your place is going to do nothing but cause a lot of drama. Lets be real about the phone thing regardless of if there's a policy in place or not we live in world where everybody is attached to the their phone. Administration is probably on their phones behind closed doors as well. If you see someone using one just pull them to the side and tell them the deal. I can tell you never worked as a CNA because the attitude your giving off. Until you've change people who are two times your size and had a blow out or had to bathe and get them out of bed please don't make a comment about group work. Group work not only provide better quality care for residents but it also keeps CNAs healthy as well. What's wrong with having a partner to help you?? When you work when in a environment of that nature there's suppose to be team work!!! At the end of the day everyone that works in that facility has the role of making sure residents are properly cared for. Have a little respect for the people who don't have RN behind their name. If you have and issue with a CNA or anyone simply pull them to the side like an adult and express your concerns.

I don't see an attitude....I see a young new RN nervous about their first job and being "in charge" of patients and people when they had little to no experience in the working/nursing world. I see an inappropriate manager/interviewer talking about staff issues they may have with certain employees...which is unprofessional AND shows lack of leadership skills of the manager. No wonder there is an issue on the floor with behavior and compliance.

Lets be real....if there is a policy prohibiting the use of cell phones on the floor....it means no cell phone on the floor. It is the weak leadership that allows this behavior in the staff for they hold no one accountable. While I personally feel during "down time" ....harmless surfing/internet browsing can be appropriate just like any other activity nurses bring in for those times from knitting, homework, studying, to reading a good book.......all other tasks must be completed

I tell the staff that there must not be ANY cleaning, Any checks that need to be done. All restocking must be complete, equipment clean, check lists done, rooms tidy, breakroom and breakroom fridge cleaned and dated old food tossed....that true down time commences. People at work are paid to .....work. Not chit chat and play video games with their eye focused on a computer screen and not the patients. I have not had compliance issues (that I know of;)) for I allow downtime.....at an appropriate time. Like I tell my teenagers ALL the time.....PUT THE PHONE DOWN.........no one will parish if you don't glance at your FB status, post a status or answer your best friend immediately...unless, of course, she has been kidnapped and is asking you to call 911....the phone CAN WAIT. When I get that "But so and so does....." I tell them.......It is not about anyone elses behavior it's about yours....act accordingly.

I think working in teams can be accomplished if the patients are cared for in a timely manner and the pair are not engaged in as if it is the social event of the year being loud and disruptive.. Patient care goes much smoothly when there is 2 to turn, get up and help ambulate. CNA are extremely important member to the team and essentially are the backbone of every nurse for our jobs really could not be done without the hesitance of a good CNA...however have a CNA that is passive aggressive and believes that no one works but them.....and the whole floor falls apart and they drag everyone down with their energy.

I think if we treat each other as we would like to be treated.....everyone would benefit.

MotherRN · Sep 2, 2013

My questions would have been "is there something wrong with a team approach to patient care"
Best of luck with your new job!!

When it is abused, which is probably the case at this location since management brought it up at all, there are no CNA's left on the floor to answer call bells because they are all teamed up behind closed doors. This is a real problem! They can't just abandon the rest of their patients and ignore them while they work in teams.

Depending on what is going on with the nurse's 20+ patients and which procedure she is in the middle of, she can't just stop to answer the call lights of every patient on the floor, beside the one that two CNA's are working with at the time.

If they can still watch the rest of their patients, while working in teams, then I have no problem. But, it has been my experience that they abandon them to me- you know, since I am not doing anything but eating bon bons at the desk anyway(not!).

And, this is why I am not in LTC anymore.

The answer: hire more CNA's. They are cheaper than nurses. Or at least bring in some on a short shift when everyone is being put to be. Happier patients, safer care! They could have extra coverage at say, 5 am to 9 am, when everyone is getting up and being fed. Then again from 5 pm to 9 pm so everyone gets put to bed timely. Why do we have two or more CNA's sitting around from 11 pm til 5 am with little to do, but chat and eat?

MotherRN · Sep 2, 2013

One suggestion that I feel is really worthwhile is if everyone takes 15 minutes around the clock on a rotational basis with the very confused, very difficult dementia patients who wants to get up and will just end up on the floor with a broken hip- instead of disappearing and dumping this one on one care on one person only- who then can't care for her other patients or this one safely.

That would be reasonable to me!

Everyone takes 15 minutes- including the nurse- then they have the other 45 minutes in an hour to get their work done.