nurse aides rules

2LTCnurses · Jul 15, 2001

Just my 2 cents worth here..............if anyone is hearing a CNA or ANYONE "yell" at a resident, that is verbal abuse and if you are aware of it and do not report it, you could be charged with abuse also! I find that verbal abuse is so rampant and a lot of people don't realize when it happens.

Aside from that, many times they do try to see how far a nurse can be pushed.......the only way to break this cycle is stand your ground. If they are going to administration and not coming to you, then they are breaking chain of command and this HAS to be addressed! YOU are their direct supervisor and push comes to shove, are responsible for anything you "let" happen on your shift. If you don't have support of management then you can't do your job correctly and IMO I would look elsewhere for a job that allows you to take responsibility and charge of your residents and staff.

NANOO21 · Jul 17, 2001

I am a 21 year old nurse aide. I think that you need to sorta rephrase your comment. I am a nurse aide and I work in a hospital. I did my clinicals in a nursing home. NOT ALL NURSE AIDES LIVE OFF WELFARE. I became a CNA in order to help my parents put me through nursing school. So you see, not ALL nurse aides are lazy, untrustworthy, and stubborn. Granted, I know a little more than the "average" nurse aide, but I am in no shape, form, or fashion a lazy. Yeah, I have experienced the aides that think they are RNs, and I feel like telling them to quit being a wanna be and go back to school, but I am a professional. I just think that some nurses need to give credit where credit is due. Where I work is a small town, and we are the lowest paid in the healthcare field, but sometimes we have 100% more contact with the patients than the nurses. Wat I am merely trying to say is that all CNAs are not bad! :)

grandmanurse1 · Aug 3, 2001

I am a nurse in a long term care facility and do not have many problems with the CNAs. To begin with, if a CNA yelled at one of my Resident's they would be suspended on the spot, reported and investigated for abuse and almost certainly terminated. The CNAs I work with are 99% extremely hard workers. They know and care for their residents. It bothers me that they think of themselves as butt wipers....who has made them think this?...who has tried to correct this impression?.... My CNAs all know that I think they are the most important team member...they are my eyes and ears....they are the ones who tell me that Mr. A just isn't quite right today...so I can go look at him...I let them know what to do, but more importantly, the why for doing it...I almost never get any flack... Of course, I also let them know that I am a butt wiper too... I have cleaned my share... and they know it... maybe more training and a change of attitude is the answer

night owl · Aug 4, 2001

let me begin by saying that it all has to do with attitude. we all have to want to make a difference in someone's life not just go to work for a paycheck. i will be the first one to admit that there have been times that i drug my orifice into work for the paycheck, but it wasn't until i changed my attitude towards my staff, not the residents, that things began to change for the better. i had alot of problems with cna's on the night shift. then i found that instead of looking for the bad things that happened, i began to give praise more often for the things that they were doing a good job at. i pitched in more than usual to give them a helping hand even if it ment that the meds would be alittle later than usual. if a resident needed to be cleaned up, instead of telling the na, "so and so needs to be changed," i'd say, "so and so needs changing come on, i'll help you with him/her." after awhile you start to see a difference. you start earning their respect, and things began to look brighter. there were less call outs, and everyone began to help each other more and that my friends is the beginning of what they call in this profession, teamwork. if you don't have teamwork, your job becomes so burdensome that no one even wants to go to work and if they do, it's just for the paycheck and believe me it showed.

let's face it, taking care of the elderly at times is no picnic. they can be very "trying " on your nerves sometimes, but i just happen to love taking care of them. when we can all do it together as a team effort, it makes the job that much more rewarding. not just for the residents, but also for each other...

so let's stick together and help each other out instead of worring about what job is for what person, we can all do it together. night owl;)

zuchRN · Aug 5, 2001

I have been reading the posts here and felt compelled to reply to what everyone has said. I have a slightly different perspective than some of the others who have poated. I can look at this situation from the point of view of the director of nursing. I have been the DON at the same facility for 2 years now. I really love this job, but dealing with CNA and nurse relationships is frustrating.

If there is a problem with a CNA, I expect the charge nurse to handle the situation. I handle disciplinary action in the following manner. I will not write someone up on the first offense unless it is just a blatant disregard for the rules. The first instance, I chalk it up to lack of knowledge. I educate....you have to give someone the proper knowledge to be able to complete a task. If after this the CNA is still not meeting expectations...it is a write up.

I think someone said that the DON doesn't do anything when the charge nurse has written someone up. That is not necisarily true. By writing the CNA up, you have done something. tHIS SHOULD BE PUT IN THE EMPLOYEE FILE AND AFTER AN ACCUMULATION OF WRITE UPS TERMINATION WILL OCCUR. yOUR EMPLOYEE hand book should have the particular guidelines for your facility. However, if a charge nurse is writing someone up, and the DON is just throwing it away, that is wrong.

Now I must also say that charge nurses cannot just go write up crazy. They need to try and investigate what the problem is. Talk with the CNA. Maybe something happened and they are having a really bad day and you ended up being the person that it was vented to. Use compassion. I am sure you have had a bad day and rolled your eyes at your DON or have had some smart remark for your supervisor.

Never ever tolerate a CNA or anyone yelling at a resident.

Sometimes, it is needed to send someone home for the night. If someone is having a horrible attitude, you have to write them up and they go off on you---send them home. They don't need to be there throwing attitude--who knows what will happen when they go in a resident room.

I would also like to say that it is not always the CNA that is at fault. You have to set your expectations and hold people to those expectations. I have only really used CNA's as examples...but remember, all these disciplinary issues happen with everyone...nurses, housekeeping, maintenance...everyone.

Remember to treat others as you would want to be treated and you should be ok...also you should expect people to treat you with dignity and respect.

nursenel · Aug 15, 2001

I think the original post here was rather swept under the rug. i too have experienced cnas who sleep...leave the facility for hours at a time.....refuse to do work whether the nurse helps or not.......the list goes on and on { the song that never ends }. Anyway my don at the time althoughgiving lipservice to the nurses as to what they would personnaly be held accountable for....she herself was afraid of the cnas!!!!! the nurses who complained were.....guess? FIRED The only way they got rid of the ring leader cna was when she beamed the don in the back of the head with a coke can! I'll bet tho that the cna involved still has her certificate and is still employed in her field! I think the facilities should take the same action against the certificates as they would take against a license. Don't have a clue what that would involve but I bet the aid would think twice about being an A hole.

SYDNEY · Aug 15, 2001

[The only way they got rid of the ring leader cna was when she beamed the don in the back of the head with a coke can!

NO DOUBT? Hmm, and I thought working nights with less than 10 employees in house was a hazardous job! We had problems for awhile with the "them that do's being tired of the them that don'ts"..it really hurt the team because those doing would finally adopt the attitude of why the heck should I when so and so isn't and gets the same pay as I do? Coaching wore thin after awhile..I think they reached a point where even if they COULD visualize the resident as their own parent, their morale was so low that they probably would have told Mama to go jump in the lake, too.

- and when we did the official write ups we got a lot of backlash for it..suddenly doctor's orders would appear stating so and so was on restriction from such activities or had to take a medical leave..can't fire someone off on workman's comp. - or we'd be accused of one form of prejudice or another against that person, race, sex, sexual orientation, socio-economic status, personal differences, disliking them for wearing two different colored socks to work..you name it. It turned into quite a three ring circus there for awhile, but for now those issues have been settled. The thing that got me the most was that it seemed like adm. quivered and caved to such nonsense that it was suddenly OUR fault that these things were happening.

But this isn't just a CNA problem. We have the same issues with nurses and even supervisors. We have a supervisor who gets handed a list of honey do's, doesn't do them, and then comes to nocs saying, "if YOU don't do these things, we're BOTH going to get written up." Hmm..now, if law says we can't get them up in the middle of the night to give them a shower, which might help them actually fall asleep, what do you suppose the law would say about getting people out of bed to WEIGH them in the middle of the night?!

Sometimes I feel caught in a no win situation..by reporting failure in job performance, I'm told I'm a trouble maker. But if I don't report it and a supervisor catches it, then I'm an accomplise. A routine task for nocs is to change out supplies, i.e. O2 tubing, septo syringes, etc. Evening shift's task is to change the dressing on the peg site. Normally I take the new septo to the room with me and put it away, use the old one for my feeding and then throw it away. So, if I go into a room and find a peg that either has no dressing or the same one from yesterday on, and a septo unopened with its protective cap still on the tip, survey says that resident hasn't been fed since my last feeding, right? Well, now, I don't know what the circumstances were..so and so swears she did feed that resident, and since I wasn't there, how do I know....

But then at the beginning of the next month when that resident's weight has dropped, guess what..we're ALL in trouble because we OBVIOUSLY haven't been feeding her correctly.

I guess the point to all of this rambling isn't that its necessarily a CNA problem so much as it is human character and how management deals with it. I suppose they too get tired of complaints and b*tching. I try to remember that anyway, that I get tired of hearing the cna's gripe about the previous shift and what they did or didn't do and repeating the same old mantra that if you didn't do walk through I don't want to hear it.

jschut, BSN, RN · Aug 18, 2001

You know, I am a CNA in school to become a LPN. I love my people I work with, and am tired of seeing them (and hearing them) being mistreated. I work with a nurse (LPN) who I have personally heard laugh and giggle about one elderly lady who has a mark on her nose, asking another CNA, "Wonder if she was a witch? She has that big ol wart on her nose!". Then turn and look at the resident I was with and proclaim loudly about how her hair looked like a 70's afro! Professionalism? Oh yea...

And tell the DON? Why? She surely won't do anything, and the ADON runs with this click of aides and nurses who all go out and drink on a regular basis. (It's pretty obvious when that's all you hear them talk about.)

I love those people, and am so sick and tired of the way they are treated. I'm tired of the way they are yelled at, threatened, and treated.

I realize it's a long goal. butI want to open my own small nursing home. Kind of like an assisted living place for only 5-6 people. Someday, after I get my RN. I know it's only a small part to help America's elderly, but something HAS to be done!!!

Thank you for listening~

Julie

(Future Nurse:) )

SYDNEY · Aug 18, 2001

I once heard it said that we should load all the elderly up on buses and send them to the white house lawn, where they could proclaim VERY loudly, 'NOW, what are you going to do for US?"

At the time, I laughed at the bizzarre image of my people rolling up to Pennsylvania Ave. Now I don't laugh about it so much anymore.

I printed and read the web report posted, and the future doesn't sound much better. They keep referring to nurses as aging at a quick rate, and at first I thought, "geesh, there's a nice thought." Then realized that, oh, yeah, I'm not in my 20's or 30's anymore, myself. So as the nurses get older along with the rest of the population and the $$ gains of being a nurse continue to be on the lower list of professional jobs..yup, I can see the shortage. The report acknowledged something that I try not to acknowledge myself very often; the low perception/opinion of nurses working in LT. In thought of going into LT, my own parents have said take us out and shoot us first.

The report went on to identify cause and effect that I can't say I ever thought of. "We" always blame the facility for being cheap..we know the cost per resident to stay there, should be loads of cash floating around, right? - Except the report better explained that although, yes, the general fee for residents seems high, if they are medicaid/medicare recipients (which most are), the government decides how much they are going to pay for that stay (hmm..sounds like an hmo to me!) - and when the money runs out, I know my facility eats the cost and the resident stays. - I did laugh at the average pay for nurses in LTC; I'm no where close to that range.

In any event, referring to residents as witches or ridiculing their appearance, particularly in the work setting, is not only distasteful, and unprofessional, I would think that it borders on verbal abuse. If you can't depend on your DON to take action, what about the adm.? Suggest an inservice on proper work behaviors and abuse..that way they've been warned and if they don't get the message, they can get out.

Does it do any good to contact our representatives? I know some have - and I know this bill is going up before Congress again soon. The concept of 15 or 20 residents to care for rather than 40..what a dream.

Oh, here's that website with the report; I warn you, its 48 pages long!!!

http://www.ahca.org/news/staff-02-2001.pdf

Laura79 · Oct 15, 2001

First of all, if your CNA's act like this, they should be reported for abuse, In Kansas you cannot work as a CNA ever if you have been convicted of elder abuse once.(NOT sure about other states) We have reported nurse aides and a couple have lost their certificates for abuse. This does tend to make other CNA's a little less vocal. Another thing that works for me, go into the room, ask if YOU can help them. Ask for thier opinions about changes they see in residents. Answer their concerns with legitiamte replies. I work with nurses who cannot get a decent answer out of an aide because they are disrepectful and not very interested in their problems. My nurse aides come long before paper work. If you want respect you have to earn it. Your title does not automatically give it. I have been a kitchen aide, CNA, LPN and RN. My nurse aides are VERY important in my days work, Yes there are those I can trust with about anything and others, I feel the need to follow up with, but I also think I am giving them the education to continue to grow in their field and feel good about themselves. Some are hopeless cases and need to move on, this type of work is not for everyone. Some will never want to work, others do better in other fields. My DON does not always see things my way either, but I feel she takes into account everyone's side of the story - not just the nurse - not just the CNA. That can be beneficial for both sides. If the problems are as bad as described, I would think resident care would be so poor this would be obvious when survey time came. I don't know all the answers, but this is just my opinion. Hope things get better.

nur20 · Oct 17, 2001

YES, you are correct, some C.N.A,s do resent nurses, for various reasons. The fact of the names they call themselves reveals low self esteem and feeling under appreciated, not valued and respected. Believe me i understand, i used to be one until i took the next step. I feel that if you show them respect, you get respect. I must admit some nurses walk around with an air of superiority and look down on C.N.A's or would never think of doing something that they think is a C.N.A.duty. I'm glad i'm not one of those. I feel that if you need to reprimand a C.N.A. first have your facts straight and second, for goodness sake don't yell at her in the hallway or where ever. Take her aside. If you can't settle it amoung yourselves then the next step is obvious. I have also run into the situation where C.N.A's feel that they run the facilities. Quite often they feel that way because, in my experience some were around years and years and has stood by and watched nurses come and go !!!! C.N.A.'s check out the second page of my website, dedicated to you !!!!!!! VISIT MY WEBSITE

Michelle_nurse · Nov 6, 2001

I work in a geriatric hospital, they are all veterans (mostly from WW2) I was a nurses aid for 3 and a half years before I became an RN at this hospital, so I have played both roles.

I think they are definitely some bad apples, but some aides are really good too. I am 25 years old now (started there at 21). My problem was that many other aides had been working there longer than my life, so they feel like they owned the place, and treated me like a kid, as an aide and as a nurse.

I think they were also alittle threatened that I am a nurse and look a lot younger than my age.

I can see how it can be hard to manage some aides into proper modern techniques if they have been doing something a certain way for so long.

Nurses aides have a lot of contact with the patients, sometimes more than the nurse does. The aides just don't want to feel like they are at the bottom of the scale. They want to be recognized. Like I said some are good and some are bad. The nurse has to be able to identify who is trustworthy, and recognize all that they do. It is also important to draw the line, since some aides feel like their experience as an aide makes them a nurse. This is not the case!

It is true that some patients are no picnic, some are violent and aggressive verbally and it is hard sometimes.