What would you have said to this CNA

[zofran]

I was almost done posting this but it went away? Sorry if it comes up twice???

Anyway, I am an RN on a busy day shift med-surg/onc floor. The other day it was crazy. It was about 1400 and I had not eaten or peed. I was starting to feel a bit sick. I told the HUC that I was not feeling well and that I was going to take a quick break to pee and eat something real quick. I told her to tell the CNA I was working with that I was not feeling good, would be back quickly, and to give her this note.

The note said - Take temp in 502 and get water for 507. Thanks

Well when I got back, the CNA working with me was livid. She demanded to talk to me in private. She says (and I quote) "I am not your N-word" (but she says the word if ya know what I mean) "You can't just leave me notes and expect me to do what you say"

I was just so shocked! First that she would use the N word (we are both white) and second, that she seemed to not care that I had to get off the floor for just a few min.

So I end up apologizing to HER, explaining why I left the note, and telling her how bad I had to take a quick break. She really didn't care, didn't even give the water or take the temp, and just talked trash about me for the rest of the shift. I heard her later telling the other cna's that 'she put me in my place"

this type of behavior is so dishearting for me, We should ALL be there to support eachother and the patients. What would you guys have done?

[lamazeteacher]

It was a bad day, thats why I waited so long to get a break. I know that waiting until you feel sick is not a good.....And usually take a break sooner. This CNA has been a problem for a long time. And I believe she is in the process of getting fired. Not for what she said to me, but for many other comments overheard by managment. I just could not believe she told me "I am not your

N-word." Who even says this anymore? It just shocked me so much, I didn't really know how to handle it. I did report her to the NM and will not have to work with her again. Thank God.

We don't need NAs like the one who gave you guff. That comment she made, sounds like the very tip of a very ugly, angry iceberg, to me! Lack of self control is always potentially dangerous in our line of work.

I've probably been in admin. roles too long to cope (or not) as you did - BUT I would have said to the NM that I (you) needed to go home sick, and the NA should be disciplined due to insubordination and refusal to do her duties. I'm saying this so strongly not out of disregard for patients, but because they need NAs and RNs who can meet their needs in a responsible way. Even though the NM said you'd never have to work with that excuse for a caregiver, NO ONE should have to work with her. You wrote that she was known to be trouble, and in the "process" of being fired. My sense of the situation, is that no one in a position to get rid of her, wanted to take her on.

I don't know if in your state there are the "at will" laws, but this situation is one for which they were written. All of us have known someone, perhaps not quite so "out there", but definitely an impediment to getting everything done. She's confrontive and aggressive (wanted to get you alone without anyone hearing her nastiness). She neglects her duties, or you wouldn't have had to point out those things to her (she must have gotten away with that time after time). Even if the dietary dept. looks after filling water jugs, they aren't on the floor checking that there's still water in them....... so that becomes a NA's job.

There are many people without hire-fire roles, who simply can't face up to their duties, and that's why she's still there. NMs seldom get training for that, or even the responsibility to do it, which is a problem. Human Resources is supposed to do that kind of thing, in a very displaced type of system which allows such scenarios to be repeated until finally someone takes it in hand. Promising a staff RN that the offensive person won't be assigned to him/her is avoidance that allows what happened to you to be repeated, and even rewards the NA, as she'll have someone else to challenge, with her pervasive authority over more advanced nurses. The NM modeled the behavior of a spineless creature, so there must be other issues, too where you haven't got her support.

Had I been the NM, since your note was probably not sealed, I'd have looked at it, and gone to the NA (if time permitted) to see whether it was realistic given her workload, for her to do those things, anticipating the need for additional staff I'd need to request from nursing admin. A good NM anticipates staffing needs, rather than waiting for them to jump him/her. Other management types might fill the water jug themselves....... another avoidance measure, given this NA's reputation.

[Wishinonastar, BSN]

That is totally inappropriate behavior and what if the patients heard her? Management should show her the door!

"Let those of you who are without sin cast the first stone". Who has not ever made a mistake or put their foot in their mouth? If this is repetitive behavior, yes, something need to be done. Otherwise get a grip people. I have heard even managers say unbelieveable epithets before when they are angry or upset. You have no idea where this person is coming from and what her background is. She needs leadership. She made a mistake, and needs to be told that this is not appropriate for the workplace. She did not call someone the N word. She did not refer to someone as the N word. She was trying to get her point across. What a bunch of hard core people are on this board. No wonder hospitals suck to work in and to be a patient in! No humanity at all.

[r.oxymoron]

I'm sure Connie would notice that I said, "I would've contacted the CNA directly to make sure he/she got the information," but there's no way for any of us to know the exact situation on the floor that day so none of us know whether or not that was her only option. None of us can also say if the CNA might've made the same remarks if he/she was asked in person; the CNA might've been having severe problems as well. On the days that the meconium hits the fan, every member of the team must put aside attitude, personal differences and anything else that can prevent the job from getting done.

[captncourageous98]

Wow! You are totally lost! It is not about Christmas cards and being "liked". I to was a CNA, Tech, Nurse. It is about respect I agree, but it is also about leadership! If you have a code and you ask her to do something detrimental to the safety and survival of the patient and she complains and meanders around while the patient is in a crisis... what will you do? I myself do not understand this type of nursing. You went to school to take care of patients and you were taught to lead and not be ledd. Nursing is not a democracy, or a popularity contest. I think there needs to be mutual respect for one another and a pink slip for those who cannot work together as a team.

[lamazeteacher]

cxg174: It had been said that the NA's reputation was quite poor...... that she was in the process of being fired..... (whatever that meant)......that it would no longer be necessary for them to work together......and she did refer to the RN as being racist (pot calling kettle, um....black).

[systoly]

I would stop the conversation at the first use of any profanity, saying something like, " It's obvious you're upset and I think we can resolve this, but I do not tolerate profanity, verbal abuse or outbursts, so at this time I'm directing you to go back to your assigned station and complete your duties." Later on, I would check with the CNA to see if she'd like to discuss the situation. If she declined, I would inform her that the event will need to be addressed to avoid a repeat. I dont really see this as a title issue as in CNA vs. RN, but rather the usual stressed out, misunderstood, etc., working in healthcare blues. I find it interesting that the CNA felt insulted by the note, to the point of risking patient care, and I'd like to know why. I get notes from my CNAs all the time, telling me who I need to see and reminding me of what I need to do. That's not only a great help to me, but also to the CNAs who don't have to hunt me down.

[macspuds]

I have had days such as yours, but, fortunately have never had a CNA like that.

I believe that all of the above have given you excellent advice. I would feel badly, but the patients come first and she should have known that. To not follow a request is grounds for a write up and possibly more. Your DON would probably have aggo advice and could tell you where to look up the job description for a CNA.Keep your head up high and deal with this in person. This incident and how you handle it will probably wind up in your HR folder. How you handle this will show your maturity and leadership qualities.

Go forward and God bless.

macspuds

[r.oxymoron]

macspuds has an excellent point that I hadn't thought of. It could very well end up in both HR folders. Hmmmmm......

[RedZeppelinRN]

Why did you wait so long to eat, or even pee? What happned to cause you to wait till you felt sick to take a break?

I think it was a mistake to apologize to the CNA. She sounds like a bitter little troublemaker, and if I were you, I would tell that clown that you will not tolerate her behavior, and if it should continue, you will have no other choice than to report her behavior, in writing. If she continues to act like an ass, then follow up on the warning. I see absolutely nothing wrong with the note. It was a reasonable thing to do. Stand up for yourself, and your position. You must be tough when its called for. You dont have to put up with that crap. Choose not to.

I had a similar thing happen to me. I was in the middle of a procedure that I couldn't leave and asked a CNA, who was busy chatting on her cell phone, if she would please get a patient's bell that was ringing. She said, "you can do it." She was a filapina, part of the floor clique. After not getting help from this "clique," I asked the DON to meet with us. The meeting amounted to "I can't disipline the whole floor." She said "there was nothing she could do. They were a protected class." I was then fired. I filed a grievance with the union and I won, mainly they had no possible grounds for the firing.

I don't care if your color is green. I am so tired of someone that has CHOSEN to become a cna, all of a sudden, becomes a poor me martyr. Apparently they do not understand the physical and mental stress on the nurses, and the hard work THEY do. There is a plan for all to work together not only for you, but mainly for the patient. Of course, sometimes anyone would get frustrated with intentional poor staffing, but that is not a credible way to bring attention to the powers that be. And not do you job as stated in your job description. Being rude and refusing to do what is printed in your job description is not acceptable. There are other ways to deal with this kind of problem. The CNAs behavior was totally outrageous. Her attitude and the words she used can only bring nursing down to a ghetto level.

[WYDiceDancer]

I've worked plenty of places that treat the CNA's like ambulatory chunks of gold and LPN's and RN's like dime a dozen pound mutts. Good luck on getting her out the door permanently. She's toxic and to much time around toxins will REALLY make you sick.

[withasmilelpn]

I can appeal to both sides if you don't agree then thats unfortunate , this OP / RN needs to practice time management !

If you think about it honestly, it is easy to go a long time without noticing that you have to go, whether you are at home or at work. Work especially, since you are pulled in so many directions and everything has to be done, nothing is optional. I'm pretty good at meeting my needs, I've been at this a long time, and try to take care of myself. But, there are always times that I might just be absorbed in the work and then all the sudden I realize I really, REALLY have to go.

Consider this scenario: I have reached that point where I really, REALLY have to go and at that moment in time, my patient decides to have trouble breathing. I am not walking away from that patient until they can breathe again, no matter how much I have to go. Because # 1, I care about my patients, and #2 I am not losing my license. 15, 20 minutes later with my patient stable, I walk in the direction of the bathroom, only to see my very unsteady, confused little, old lady patient has made it half way across the room to the bathroom. No CNA in sight, I dash to help her the rest of the way, and grit my teeth as she relieves herself, starting to feel a little desperate. She who was speedy magee when walking on her own, can barely walk and is unbearably slow returning to bed. (And yes, I did put the call light on, but no one responded.)

I can hear the pump of the IV next door beeping the entire time I am stuck with my little old lady. It is not supposed to be done yet, so my heart sinks knowing it is probably air. I am right -it takes me 5 minutes to get it up and running properly again, but the patient in the bed next to her says "miss, could you help me a minute?" The minute turns to into 10, as she slowly thinks of one thing after another to do for her. I leave, promising to return soon with fresh icewater that she asked for and a list of her medications that she wants to go over with me.

As soon as I step out of the room, an irate family member comes towards me demanding I come see her father. The bell she says, has been ringing over a half an hour and nobody has answered it. She says dramatically, "what if he was dying?!" Even though he is not my patient, I apologize for the delay profusely and go see what I can do to help. I am truly sorry about the wait, because I often worry about something happening to my patients when they have to wait for me.

The father it seems, wants to discuss his food choices, and unhappiness with the meals he had so far. Even though I feel just a little bit angry, I listen politely and as soon as they let me have a word in edgewise, assure them I will page dietary for them. The daughter remarks as I leave that she "hopes that the dietary staff don't take as long as the nursing staff around here do."

I am 2 feet away from the bathroom door when the missing CNA says, Mrs. So and so is very sweaty and says she doesn't feel good." Mrs. So and so has a heart condition and is a diabetic. My heart sinks as I realize it could be a much longer time before I can pee, because most likely I will need to page the doctor. Doctors do not like to wait for nurses.

When she is stable - deep breath, the ambulace crew is here to pick up my confused little old lady for transfer to the nursing home she resides at. No, I have not yet completed the transfer sheet. Yes, I can handle the dirty looks they send my way when I choose to FINALLY go to the bathroom and make them wait a little longer. I know they think that I am a disorganized, inefficient nurse right now. I don't care because I know the truth. And the truth is people who aren't nurses often have no idea how busy nurses really are. Not even the other members of the healthcare team. Until they become one of us and walk in our shoes. :wink2:

[Wishinonastar, BSN]

Wow! You are totally lost! It is not about Christmas cards and being "liked". I to was a CNA, Tech, Nurse. It is about respect I agree, but it is also about leadership! If you have a code and you ask her to do something detrimental to the safety and survival of the patient and she complains and meanders around while the patient is in a crisis... what will you do? I myself do not understand this type of nursing. You went to school to take care of patients and you were taught to lead and not be ledd. Nursing is not a democracy, or a popularity contest. I think there needs to be mutual respect for one another and a pink slip for those who cannot work together as a team.

That is not leadership, that is a "I'm in charge of you and if you don't like it here's the door" attitude. A leader does not HAVE to boss people around or pull rank. People follow the leader out of respect, which is earned and not forced. If you were a leader you would already know this. Try reading some of Deming's work. And I did say she needed leadership. Nurses who play the same bossy little games as others who are not professional play are also not professional.