New RN how to 'manage' CNAs

raestokes21 · Sep 2, 2013

below

raestokes21 · Sep 2, 2013

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.

What I basically was saying was don't come in trying to be a drill Sargent based on what you heard. As far as the phone issue goes I was stating the fact that no one now a days is without a phone and simply correct the person if they're violating the policy and don't act so shocked. I do feel as if there was a bias and stereotyping in his statement brought on by what was told to him. I said nothing about it being ok for people to chill and not do their job. A lot of nurses are quick to try to make it seem like they're the only ones who their job correctly and its always the CNA doing something.

all4neuro · Sep 2, 2013

Being a new RN in LTC it is perfectly appropriate to ask how to delegate CNA's. One RN delegating to 5 CNA's for 25 patients on the special care unit, I asked the same thing. I WAS THERE 5 evenings, which means the 5 CNA's were different from day to day.

That is a lot of personality types to adjust to, as well as adjusting to everything else.

Special Care= non ambulatory, dependent, foleys, TF's, dressing changes, skin checks, rectal checks and daily charting on all 25. Everything was paper, no computers, not even orders.

I am not sorry when I say the CNA's were not all from a story book with fairy tale work ethics.

Reality, it just takes one testy CNA to rattle the evening.

Reality, is being prepared for reality.

I had maybe 4 out of 30 CNA's that tested me. The rest were awesome and I learned a lot from most of them. The testy ones, well it worked out eventually.

They all had to get to know ONE person, I had to get to know ALL the patients and 25-30 CNA's. (some prn)

I am not judgmental, nor is the OP. Why do human study sociology, psychology, ethics, etc.? Human nature (which means I am the only perfect one? :sarcastic: )

They helped me:

know why Mrs. Doe is spitting her meds out - "she hates choc. pudding".

remember to order supplies.

"give Mr. H his treatment last, he likes to watch the evening news in his chair"

"Mr. T has a dermatologist come in qThursday at 6pm. We bring him to the nurses station right after dinner."

I would have sunk without them. My floor orientation was 3 days, who helped me know the little things THAT MEAN A LOT, CNA's!

It was my first job, and I am blessed that I had such a wonderful experience, and fond memories.

Spending 40 hours a week with same the patients and employees, you become a family.

ThePrincessBride, MSN, RN, NP · Sep 2, 2013

I wouldn't go in with the mentality that you have op. I am an aide and if someone came in with the attitude that they had to "manage me" it would rub me off the wrong way. Just treat your aides like they are your equals and tell them what you expect and what needs to get done. Coming in the way you are planning won't make any friends, for lack of better words. Also, there is nothing wrong with group work. Just yesterday a coworker and I HAD to team up because we had three confused patients who were high fall risk and one kept having incontinent episodes involving urine and stool and had to be clean frequently. We managed to prevent any falls AND keep the patient clean.

Teamwork....learn it. It will be your best friend. Trust.

nurseladybug12 · Sep 2, 2013

I think cell phone use at work is very unprofessional and to be seen on your phone scrolling through facebook etc looks really bad to visitors and also very unprofessional. When I was 17 working at dunkin donuts if we were caught on the phone we got went home right on the spot. Why are health care facilities not upholding the same standards as fast food restaurants? Anytime I see a PCA on the phone, I ask them to do something for me, very nicely because obviously they have time to spare and there is always something that could get done. "If you have time to lean, you have time to clean" is a saying they use in the food industry, they dont really allow "down time". If I need to use the phone, I go in the restroom or in the break room and make it quick.

Glycerine82, LPN · Sep 2, 2013

Personally, I think expecting people to keep their cells in their locker is unrealistic. I would just make it clear you don't want to see it out.......ever. Some people do need to occasionally glance at it to be sure there isn't some kind of emergency at home or whatnot.... JMHO, I know others disagree.

I like what others have said about making sure they feel appreciated. It won't take long to figure out who the lazy ones are and which ones want to work. A good CNA will inform you of changes in the patient in regards to skin issues, mental changes, output issues etc. I would say to pick and choose your battles at first. Make sure you ask nicely when you need them to do something and don't hesitate to help them when you are able. I know nurses in LTC have a whole lot on their plates but the facility I worked at had LPNs that flat out would not help the CNA's regardless of whether their work was done or not. It was simply our job, not theirs. Nurses like this DO exist, and it is really frustrating especially when they don't fully understand how hard our job can be. No, its not mentally challenging but It is physically demanding, exhausting and can get down right overwhelming at times. I know the nurses job is like that also, but I feel like some nurses thing that because you don't need much of an education to be a CNA its not a hard job.

Learn quickly what tasks they really need help with. I hate it when someone asks me to help them with something I would be doing myself if it were me. You absolutely can change a larger person alone if they can follow instructions. Sometimes they just don't want to be bothered and automatically assume they can't do it alone. Well, when you've no other choice you figure out how to do it alone and for me, there are very few patients I need help with from beginning to end.

I used to love working with another CNA. As long as the work is getting done I wouldn't frown upon this. If two CNAs work together they are unlikely to need help from anyone else. I've never understood why facilities didn't like this, as long as the work was getting done and the patients were cared for.

motherof3sons · Sep 2, 2013

As far as cell phones go, lead by example. I can't expect them to leave the cell phone in their pocket if I am checking mine/texting every 10min. I leave my cell in my car or in my locker.

I work evenings in LTC and have many CNA's that are under 18 and for many this is their first job. Encourage, encourage and tell them when they have done a good job. It is easier to tell someone what they have done wrong than what they have done right. Make sure you are checking in with them thru your shift and listen to them....they know the residents and when someone looks "bad" to them~ pay attention, they are usually right on.

Some of my CNA's call me a hard a## and sometimes I am. I expect a lot....and the standard is set high when I am there. But I am the first to jump in and lend a hand when I can. At the end of the shift I try to make sure to thank them for their hard work.....they deserve thanks.

MedChica · Sep 2, 2013

-- 'Group tasks'?

Aides double up to make the floor work more efficient. Some aides work independently (the deeply experienced ones). Some aides pair off with 'work besties' and help each other throughout shift. If they complete their work in a timely manner, there's no need to go busting up the established order.

-- Phone Regs?

If they're on the phone while on the floor, tell them to put the phone down. That simple. People know the rules. You didn't implement the regs; you're just reinforcing them. To be honest, I'm kind of soft on the phone use. I don't really understand why some people have to be staring into their phone every 5 minutes but I only say anything if the violation is too obvious. "Really....in the hallway? 'Screw you, nurse! I do what I want'! " It's an inside joke. LOL We (the nurses) made up a song about the aides entitled, 'We Do What I Want' sung to the tune of 'Baby, Come Back' .

-- Squeamish nurses are a strange sight.

Don't be afraid to get your hands dirty. Sometimes, you will have to help out on the floor or it won't run correctly.

-- Respect knowledge and experience in whatever form it presents itself.

The more experienced aides have taught me some things, I'll tell you that. There's something to be learned from everyone. You know the sort of day you're going to have by the aides on the floor. When you have crappy aides? You can't get crap done. For a NEW nurse? Veteran CNAs can either be hell to deal with if they're used to getting their way...or they can be an incredible asset! I have a few who rotate on my halls. They're great. Anytime, they hit my halls I know that my residents will be clean and the rooms orderly. I know that I'm not going to have to run behind them to make sure that they do their jobs. They go the extra mile. I know that I can trust them and their insight. If somethings wrong, they'll be the first to spot it.

No, you don't 'save the day' entirely on your own. Your aides will know when the resident is 'not quite right'. Your aides will know your residents better than you. Pay close attention to your 'eyes' and 'ears'.

-- They're nurse assistants, not nurse slaves.

I cannot stand working with people who, upon being confronted with some unpleasant task, are quick to clarify what isn't in their job description. "That's not my job." Don't be a lazy nurse. Don't 'pass the buck'...and, most times, it takes less energy and time to change the pt yourself than run all over the facility hunting down the correct aide to do so. Something else that I cannot stand: The aides, shortstaffed and scurrying all over the place while the nurse with nothing to do shouts threatening orders to go to 'this' room or 'that' room because the call-lights on over the intercom but never gets up to help. I don't work with nurses like that now but when I was an aide? I did and that woman was just plain sickening. Now that I'm a nurse, I can appreciate just how lazy she truly was.

Lastly, if you mess up a residents bed during feedings and whatnot? Clean it up! Used to tick me off...nurse comes out of the room making a mess of everything. Formula and BM all OVER the bed and resident. Left for ME to clean up...when I'd just come out of that room!

-- Sometimes, you've got to 'walk a mile'....

Cut people some slack. If the aides are running late to the dining hall or whatever...don't just assume laziness and throw down the paperwork. Have you ever been an aide? There's a million and one reasons as to why the residents aren't 'dressed and in the dining hall'.

-- Mind your work relationships. Don't blur the lines.

Do not gossip about coworkers with coworkers. Do not 'run down' a CNA in front of other CNAs. Do not allow with one CNA what you wouldn't allow with the rest. You're their coworker, not their friend. That sounds cold but you'd be surprised by how many allow 'friendships' stand in the way of doing what's right for the workplace. I don't keep 'friends' at work. I may hang out with people in the workplace on my off time. I may have coworkers who are friends to me outside of work. Yet, when we are at work? Our work relationship supersedes this. So, do your job because I'm not 'hooking anyone up'. You don't get special privileges just because you are my friend. You don't get to skirt the rules just because we are 'cool' with each other. You are not above reproach if the situation calls for it.

-- Don't be a dope. Don't let people run over you.

Sycophants and butt kissers? Nip it in the bud. Testing boundaries (coming back late from breaks, not in the dining hall on time, residents look a mess, they neglect to change the residents/do rounds)? Get to the bottom of it and 'handle it', the first time. Use paperwork sparingly but if the situation calls for it? Don't be afraid to throw it down.

Don't bend over backwards doing 'aide work' to make friends with the aides. There are plenty of aides who want you to be mindful of their tasks...when they aren't the least bit respectful or understanding of the job of a nurse.

Make them understand. Yes, I help out on the floor but it's not about making friends. I help out because that floor and those residents are my responsibility. I help the aides because those are 'my people' and that's how I was taught to lead: FROM THE FRONT!

If I'm not busy and I can assist, I will.

However, you don't do their work for them when you're drowning in paperwork. You don't put people down when you're trying to complete a 40 patient med pass. Catch my drift?

When I was an aide, I never asked the nurses to help me lift/change anything. I don't quite understand the few aides who've done it, either. It's one thing if I'm just sitting at the nurse station on my phone or running my mouth with the med aides and nurse...LOL Ok, like, I'm obviously not busy. So, of course, I can help you change the resident. But...if you see me surrounded by charts with my head down scribbling and a multiple piles of forms scattered about my area? If I'm at the cart with my BS and insulin up? If I'm pulling Med Nurse? Forget it. I'm not going to stop and help you. No, I'm not going to do a round with you. That's what the oncoming aide's supposed to do.

Nurse tasks take precedence.

Hell, they'll be home at 10p while you're staying OT scrambling to get your work down because you burned 15 minutes helping them.

-- Learn how to speak to people.

Learn how to delegate. I 'ask' aides to do things even though I'm really directing (ordering) them to, if that makes sense. I say 'please' and 'thank you', often. I'm prior service military and had to learn how to soften it up and not 'give orders'.

kayern · Sep 2, 2013

First and foremost, everyone needs to be polite and leave their attitudes at the double doors. We are all at work for one purpose....the patients. With that being said I tell my new nurses as well as my ancillary staff that "NO" should not be in their vocabulary when a RN asks them to do something. Communication is key, if they have competing priorities they should be asking for direction. I have explained to the ancillary staff that although a nurse may not look busy, she is probably critically thinking, putting all those pieces to the patient puzzle together.

My feeling is we are all at work to work together, to meet the needs of our patients. Let's try to do it together, with please and thank your and I'm in the middle of whatever,,,,,,,what would you like me to do first".

LadyFree28, BSN, LPN, RN · Sep 3, 2013

^^^^^YES@ MedChica and kayern!!!^^^^^

Long Term Care Columnist / Guide · Sep 3, 2013

I've never really seen CNAs as "workers" to be "managed". I prefer to treat them as adults who are there for the same reason I am---to care for our patients/residents, and make a living while we're at it.

Therefore, I expect them to behave as adults......and you know what, people usually will live up (or down) to our expectations if given half a chance. I've really had very few problems with attitudes or texting in rooms. If I do run into a troublemaker, I simply make it clear that I have certain standards and I'll do what I can to help the CNA meet them while on duty. I don't give people a lot of rules to follow---all I want is for them to work as a team and have respect for each other, as well as for the residents and management.

Of course, I'm old enough to be the mother of most of them, and we have one or two who could even be my grandkids! So I do have a little advantage over a younger nurse, especially a new grad. But I learned early on that some CNAs will challenge ANY new nurse, regardless of age, and the newbie has to earn their respect before s/he can direct them in the performance of their jobs. R-E-S-P-E-C-T, that's what it's all about. Remember that, OP and you'll do just fine. :yes:

monaa · Sep 3, 2013

I agree. Working in groups make you learn faster.