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?

[pricklypear]

I somewhat agree with Saude...not in defense of the CNA, but you as the RN did not delegate to the CNA properly from jump (to her directly -face to face)...

I'm not sure how a short note with a few tasks is improper delegating. I receive written orders all day from doctors, I can't just not do them because I feel that I was treated unfairly. It doesn't matter, anyway. Please understand that the point is: the patients' needs were not met because the tasks were not performed as instructed by the RN (yes, instructed), and the CNA displayed wholly inappropriate and unprofessional behavior.

[NurseNighting]

i agree. write her up! there is no excuse for that kind of verbal attack and racist comment.

that being said, what you experienced is probably a typical systemic problem. if you are that busy then you are understaffed. i had a similar situation a few months ago, except my lna was not rude and disrespectful and she genuinely was drowning in all that she had to do. i was drowning as well! it is a lose(rn) - lose(lna) - lose(pt) situation that can be dangerous. what i am seeing go on does not even make good financial sense on the administration end of things. if they could staff enough lnas/hucs then they would not be paying an rns wage to fill water pitchers and answer phones. sure it is great when we have surplus time to run around and do things like that and it permits us to spend more time with patients. but we only have 2 hands and 2 feet and one brain. we cannot do it all unless nurse:patient ratios are in the range where this is humanly possible. nurses have to do the meds and other things in our scope that lnas/hucs can't do, but often we get stuck with all the rest too because someone has to and the buck stops with us. then we leave late and rack up overtime. we need to realize that we are not "angels" who can magically swoop in and make it all right. when we put up with this type of chronic understaffing and high ratios, we are placing our patients at risk and this is not a very "angelic" thing to do. we are not advocating for the best interests of our patients when we do not address the problem of chronic understaffing with the powers that be. it also adds greatly to the cost of healthcare and that ship is sinking fast!

lnas where i come from are to be directed by the nurse. i feel like the system that has developed though is one where they get their assignment and do their own thing - we get ours, and do ours, and away we go. at my hospital there is very little interaction between us and we do not help each other at all except with a lift here and there. we are not working as a team - we are each drowning in our own mess of a busy day where you have time for nothing. i don't think this system works. let's face it some lnas are wonderful and others aren't - same with nurses. but nurses should be overseeing lna work to a greater degree, that is if we have time! i think lna's should work in teams too (1lna a bed 1lna b bed). then they have help with lifting and they will have each other to learn from and model behavior too. it helps with accountability too. we had a patient complain because she had been there 3 days without clean linen, gown, toothbrush, nothing! she was waiting for someone to offer and we nurses just assumed that the lnas were doing this. it was a terrible situation and very embarrassing.

good luck working with this person - it will be hard. document everything!

[lamazeteacher]

Withasmilelpn: Your unit needs more staff!

[nursingstudentinnc]

i'm a tech for almost 3-years & can't figure out why cnas are problamatic? it says on our badge Nurse Assisttant. last time i remember , the english part of that means you help the nurse. that idiot needs to be fired

[rednalg]

All the talk about "writing up" is not the solution. You make the mistake yourself in taking too long to take care of your SELF. Accept that you made a mistake and move on. Never leave a note that gives instructions. Always deliver in person. Go do what you need to do to take care of yourself, then get back to people in person.

[dhinson45]

A long time ago, like maybe 31 years, I would have responded the same way you did. However, this is a new day and I am a much more seasoned RN with over 22 years of management experience. This behavior is totally inappropriate and unless you have a union or your HR dept. tells you otherwise, this gal would be on the street without pay for a few days. In this day and age, you don't talk like that and then to continue to brag that she put you in your place. She needs to be put in her place. Progressive discipline, i.e. writing someone up, giving them verbal warnings, etc. usually aren't very effective with people like this. It is obvious she doesn't give a rat's patoot about the patients either. She needs to be dealt with harshly and swiftly and then let's see who is put in their place!

I stongly agree!!!!!!!!!!!! Refer lic, immediate termination and reported neglect and possible pt abuse. Make sure she NEVER does this to patients or her superiors.

[Di Deanna]

It's difficult for me to understand why I'm being attacked for making and supporting my comments about the OP needing to take better care of her health. It's APPARENT you DIDN'T read my comments because if you had you would have found I made it CLEAR that the 2 problems of the CNA insubordination and the OP not taking care of her health were unrelated.

But even so, you and others IGNORE this fact and continue to attack, most likely because you just like to argue.

For you to not recognize that it's unhealthy or unimportant to go long periods without at least making minor interventions to ward of getting sick from not eating is irresponsible on your part and quite shocking coming from nurses or in your case a soon to be nurse. There is NO, not even ONE excuse for not taking a moment to eat a bite, such as a cracker. It awe's me also that I've been attacked for suggesting to eat a cracker... In reality...if you can't find 2 seconds to stuff a couple crackers in your mouth while your checking out your meds, washing your hands, getting a patient water, charting, etc... then you DO have time management ISSUES. And for all those who think my job is a cake walk... please... save your breath... Instead of attacking maybe you ought to start listening on ways to improve so you DO have time to take care of your patients...and...your health. And for those who have attacked me by ignorantly insinuating that I don't put my patients first...I'd be more than happy to compare my patient satisfaction ratings and also my performance ratings from my last 6 years by my superiors against anyone's performance rating on this website. Excuses, Excuses, Excuses.......

What in the WORLD are you talking about? I read everyone's comments.

This isn't a time management issue..this is a behavior issue on the CNA's part.

--edited out--.

[Rhee]

"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.

In every job that I have ever held, even when I worked at fast food places in high school, it was always made clear that racist comments would not be tolerated. We are all adults and we are all responsible for what comes out of our mouths. Using racist terms is not 'putting your foot in your mouth.' That CNA was obviously trying to get a reaction from the OP.

I don't understand why so many people are defending the CNA. It doesn't matter why the RN had to take a break, when she took her break, the fact is that CNA refused to do her job. A previous poster said that we take written orders from physicians all the time. I've never seen please in a chart, and I've never gotten upset. It's my job to see that orders are carried out correctly. It's the CNA's job to assist the nurse in caring for the patients.

I was an NA on the floor where I work before I became an RN. I know what they have to do, because I did it myself. If I ask an NA to do something for a patient, it's because I don't have time to do it myself. It takes more time to hunt someone down than it does to just go and fill the water pitcher or to help a pt to the bathroom anyway. However, the NA's I work with are wonderful, if we can't find them, it's because they are busy, not hiding.

The OP didn't do anything wrong. The CNA did.

[steve40]

In all honesty, I think that your reason for your not taking break sooner is totally irrelevant to the situation. I think the issue at hand is that this CNA not only acted in a totally inappropriate manor, was insubordinate and very unprofessional. I would strongly question what kind of care she is giving patients if she is capable of this unforgiving behavior to employees. Not to mention the fact that she is answering to you, in all honesty regarding the chain of command. On a personal and professional level I would feel it's in the best interest of both patients and other employees to have her "butt" fired. Your requests where no way out of the realm of delegation and she had absolutely no right to question you.

[nursel56]

I don't understand why people are saying "well, you wrote a note and that was your first mistake".

Since when is it considered tantrum worthy to give someone a note?

[sayitgirl]

I have to tip my hat off to you, because you kept your cool in a situation like this. I don't think I could have ( no, wait...I COULDN'T have) tolerated this. I would have marched with her to the NM or house supervisor, and let nature take its course. When I was a tech, I got notes from nurses all the time. Now that I'm nurse, I find it a very effective way to communicate with my techs. This is horrible, and i'm so sorry you had to deal with this type of behavior. Big hugs (lots of them) your way.:heartbeat:heartbeat:heartbeat

Why are you apologizing to a nursing assistant? Maybe I am missing something. Write her up with a copy to the nursing director and manager. Then treat her only on a professional level. If you have to leave the floor next time, "I am leaving the floor I will be back in ten to fifteen minutes. Any emergeny you can see nurse so and so... That is how I would have dealt with it.

[beverlyeagle]

Well now, I think most RN's have been in this situation already. My response would have been, and has been, to let her know if she doesn't want to do the 2 tasks you have assigned her you can both go to the supervisor on your floor and discuss it with her....This response has ALWAYS been effective. Hang in there, there are many respectful CNAs.