RN- How do I get the most from CNA/s while not causing major conflict on the unit

Susan9608 · Aug 27, 2007

I've never had the privilege of working with CNAs or techs of any kind. When I worked on a regular pediatric floor, we were piloting a new program which eliminate the role of the CNA and had slightly better nurse to patient ratios, so that the nurse could do total patient care. Then I worked in the NICU, where we also did not utilize CNAs; again, nurses were expected to provide total patient care. And now that I work in the PICU, we again do not utilize CNAs. Nurses provide all of the patient care.

When I float to our pediatric floor at this current hospital, although we use CNAs up there, I always tell them I will provide all care for my own patients. I prefer it that way. I especially prefer to take my own vital signs. Vital signs, to me, are part of my assessment, as are I&Os. I don't want to rely on someone else taking those vitals and then having to either track that individual down or having to look that information up.

Sometimes, I wish we did have CNAs, especially when I have a very busy patient and then a baby who is alone and could use some attention. Or when I have a very heavy patient and need help lifting. If we did have CNAs in those situations, I think I'd bend down and kiss the ground they walk on.

I remember being in nursing school and working as a CNA myself. It was a very thankless job, most of the time.

hopeful50 · Sep 7, 2007

I changed my life completely and just became a STNA. I was in retail all my life. I started my first job 2 months ago in a small town church ran nursing home. The other STNA's act as if the nurses owe them something. The nurses act like they are afraid to address any issues with them. I will probably be let go soon due to the fact I have reported abuse and neglect to my DON twice. Once for a STNA yelling and telling a resident to shut up. The second was not feeding a resident at dinner, but sat and ate soup herself. Both of these incidents were with nurses and other STNAs present. But no one else reported anything. So you can guess, nothing has happened and this STNA continues to work. So someone tell me, what do I do now? Beside lose my job for doing the right thing.

leslymill · Sep 14, 2007

It's been years since we've worked with CNA's on a regular basis. Now we occasionally have one when we are really wild. We're trying to get a permanent CNA, however that means when we do get one on a wild day, we have to keep her busy. Any down time, and that is seen as no need. We explain that, they love coming to do postpartum with us, and so often it's menial jobs we hand out (like redoing a triage bed) just to keep them occupied, if some mucky-muck wanders through.
That being said, here's my advice, especially to the new RN 's. As a graduate nurse in 1976 (so long ago that we took our board exams over a weekend, and waitied 6 weeks or more for the results) I worked in a small med-surg unit. The two CNA's I worked with for nearly a year, had at least 40 years or more of experience between them. I made it a point to LEARN from them. They had seen and done way more than I had, and they were more than willing to help me. If they told me, "you need to go to room 000" I went and quickly because I knew they were giving me a valuable message.
I had a great relationship with them, learned more than I can ever relate and stuff that remains with me to this day. I think I am very appreciative to all ancillary staff and "how to get the most from the CNA's" suggests to me a negative approach. Just my opinion, of course.

I graduated HS in 77. Nursing in 81. I had great relationships with NA. Then they became certified and developed a sort of autonomy that seems to be getting worse.

What would you do at 3AM if two CNAs are blaring HIP HOP music at the station and you can't get your charting done?

Under your scope of pratice you would think you could ask them to turn it off. WRONG

How about you do that

You don't get a response you hope for, but you do get two CNAs talking to each other about how they know of someone they would love to kick up and beat around in the parking lot?

Go to your immediate supervisor?

How about you go tell supervisor you can't get your charting done and now are afraid to leave the building due to possible work place violence?

Supervisor goes to talk with the aides and returns ALSO THREATENED AND AFRAID TO LEAVE THE FACILITY?

I finished my charting by hauling them to the end of the DARK corridor. LTAC charts are heavy.

Do you think administration would fire them?........WRONG

Who do you think was fired............................................................................

....................................................

This hospital has been shut down by someone else.

Her name is Katrina.

aap987 · Sep 15, 2007

The floor of the hospital where I work has the reputation of being HELL. Reason? The attitudes of so many workers. The day shift CNAs report with frowns and attitude. The night shift CNAs sleep and smoke.

The RNs or LPNs who are bossy and rude to the CNAs get the most work out of them. But I consider this abuse and uncalled for, but it is the way it has worked on the floor for years and years.

I am actually nice to them, and they talk disrespectfully to me and relunctantly do what I ask them to do. :madface:

The overall disrespect and condescending hierachy stems from the supervisor from hell.

Supervisors should promote harmony and work ethic.

This is why so many people get BURNED OUT. As an RN, I cannot do my job plus the job of the CNA while dealing with the supervisor from hell and smart-mouth CNAs.

:angryfire

momthenRN · Sep 15, 2007

I have seen nurses treat the cna's very poorly. I am not saying there is an occassional bad apple in the bunch but please and thank you's go a long way. I have seen some of my coworkers sitting down socializing while the aide is busting his/her heiny to get many things done on many patients. When I worked as an ICU tech and unit secretary pre nursing, I really appreciated being appreciated. It kept me moving, working hard and striving to do my best. I try to relay my thanks to every team member because with out them, patient care suffers....

nurseangel47 · Sep 16, 2007

I, sorrowfully, disagree to some degree, with the comment made stating that cna's job or job description, however you want to phrase it, is just as important as the nurses's. Now, having said that. Let me explain just exactly what I mean. We, as RNs, charge nurses, whatever term you might want to address us as, or refer to us as, have sole responsibility for absolutely everything that happens on our particular unit. To the patients or residents (if it's a SNF or rehab unit), the family members and others who are physically present while visiting said patients or residents, to the staff in our ordination, not SUB-ordination, I note.

We have usually five to eight, sometimes more in acute care settings such as hospitals. Usually around 28 to 30 (!) in rehab and / or skilled nursing facilities previously labeled as "nursing homes"....and this is an extraordinary amount of heads to be liable for, in and of itself.

Perhaps when the student nurses who have been cnas have not only graduated, but have become seasoned health care workers in actual nurses' roles, they will find themselves venting regarding poor patient care/delivery from the point of physical care delegated, as is the charge nurse's duty.

Time and time again, I have in my 20 plus years of working as a registered nurse (insert charge nurse here in the case of the concentration of recent nursing care I have practiced in the setting of skilled nursing facilities) found most of the cnas under my supervision, and direct ordination, either a) talking on THEIR cell phones while supposedly on duty, not on breaks b) avoiding staff directly and obviously by hiding in vacant shower rooms, backporch areas to smoke endlessly and incessantly on another "break", c) hiding behind pt's doors in their rooms eating which is a whole 'nother thread in and of itself regarding cleanliness, basic hygiene, not to mention poor health care delivery contamination, c) backtalking ME disrespectfully seeing as how they feel that I am not their "boss", d) the list continues, for those willing to listen! It has not to do with HOW I approach them, nor what I say, ask or delegate to them in regards to their job description and the task at hand that I have no time to complete myself, read certified NURSING assistant, here, not hired hand perhaps willing or not to do what is in their job description, upon hire, for their perusal if they would only take the time to carefully ponder the true meaning of the word nurse, delegate, supervision, etc.

I have a hard time swallowing the fact that we, as a body of nurses, per se, are too hard on them, or ask them too many times to do such and such a task, which is blatantly obviously in dire need to be done anyway, and then for them to have the audacity to either backtalk, refuse, report to management that we are the rude ones, etc.

It is a generational thing to some degree. My kids, their friends, the younger generation behind me, as a general rule, are afraid to perspire, get their fingernails dirty or otherwise be offended with good ol' fashioned hard manual labor. Which is, in their job description.

Just as I sweat bullets getting four hours worth of meds in my pts. within two hours if I'm lucky enough, twice per an eight hour shift, so should they just go ahead and do their job, not wincing, backtalking or reporting me for doing MY job, by asking/telling/repeating myself for delegated tasks that are within their job descriptions anyway. Oh yeah, the vital signs. Try doing all that we as registered nurses do in a compressed timely manner for 28 to 30 residents and see if asking your cnas for their once per shift vs on maybe 4 of their residents, and see if it doesn't make YOU see red, once you've graduated, and become seasoned, responsible, and in charge of legal and ethical issues such as pt care, delegating duties to ancillary staff, following up with results of stated ancillary staff's duties outcomes, and see if you feel the same way you do now, about these issues.

I'm willing to bet the farm,....you won't.

It's not about respect, give or take, it's not about rudely or nicely asking a cna to do something or help with a task such as turning, cleaning, taking simple vital signs....it's about just doing a job. Period.

The one you as a cna signed on to do upon hire.

missfreda · Jan 24, 2011

Very well said! We need more of your kind of nursing views! :yeah:

erinofanubis · Mar 18, 2012

I also get a lack of respect from most of my CNA's. I am tough. I expect that the CNA's do the CNA job and not whine about it. I am the nurse from hell that wears white and the cap. I have a couple CNA's that with gentle prodding will do their job. I have had about 6 others go by in this workplace that badmouth, watch inappropriate television shows (Jersey shore) on an Alzhiemer's unit ect. Today I went to give an "inservice" to a CNA who screamed that she was not going to help another CNA on another part of the facility and that she was not going to work with me. The other end of the facility heard this rant at 5 AM. I took another charge nurse and tried to get her into a vacant room to talk. She again raised her voice very loudly and verbalized that she was not going to talk to me. Myself and the other charge nurse explained that this was not optional. She continued her rant that she was not going to do it. She would not sign anything ect. We tried to get her into a room and out of the resident lobby where several residents were gathered. She left the facility stating that I was making this the worst job ever. I called my ADON (DON on vacation) and informed her that the CNA was informed not to return until she talked to the ADON. The ADON sounded "inconvienced" by this action. She said that she would try and talk to her tonight and to have the other charge nurse remind her tonight to call the CNA. That an "inservice" on insubordination and one counseling from today were "all that we could do" Unfortunately I was not impressed. I am a nurse and I have the right not to be spoken to in this manner. I called the director of the facility and told him. At least I think I can trust him. He still has the attitude that nurses are to be respected. This younger generation thinks they can do whatever they want and they control the work environment. You should not have to coddle your CNA's They should do the work they are assigned to do This concept of total autonomy for CNA's is bad. If I let the CNA's decide how to appropriate care and to who why did I go to RN school. Why have any training at all just let the CNA's decide everything.

Not_A_Hat_Person, RN · Mar 18, 2012

This younger generation thinks they can do whatever they want and they control the work environment. .

I work in home health, so I haven't worked with CNAs for a while, but I had plenty of older CNAs who were problem CNAs, because they'd been allowed to get away with poor care, laziness, and insubordination for so long.

lumbarpain, ADN, RN · Mar 18, 2012

Its sad to say I was exactly the way you were, in the very beginning I EXPECTED the aides to adhere to my call for help with a patient or to Just DO THEIR JOB the way they were supposed to do......It didnt happen. YOu were a babysitter for them also.

I had virtually ran out of the facility LOOKING FOR THE AIDE who was On her cellphone in the parking lot, I had no idea where she went. She had gotten fired afterward, but most likely for something else. I didnt miss her. I had aides who blantantly asked ME WHY I was walking around at 10pm( near my shifts end) checking on patients!!!!! DO YOU BELIEVE THIS???/ She stood at the end of the long hall watching me go in and out of the patients rooms, I was doing rounds, making sure everyone was ok.

She yelled down the hall....WHAT ARE YOU DOING? I stopped, looked at her and said, I am doing my rounds, why? She declared that I was checking to see if her work was done. I walked casually up to her and right in her face said to her......"Well, If you did your work, I would think you have nothing to worry about then"

She stood there awed at my answer.....But it worked.....she had never attempted to make my life miserable again. We became close after that and we worked very well together. They test you, they really do, to see how far you will go and what lengths your authority will lead to. They are afraid of you in the beginning because of the uncertainty of losing their job. I dont think that is right but in a way its a good way to find out who the trouble makers are and who are the real workers are. They get insulted thinking you are finding things wrong that will have to be changed resulting in more work for them. I had one CNA actually name me "Hitler" HITLER!!!!!! needless to say the name flowed throughout the facility like wildfire....I was devastated because all I wanted was for my Cnas to do their work without me hounding over them and have some discipline within themselves. So, I found that the best way to interact with your aides is to come down to their workload, their grips, their wants and needs, and give a helping hand often when they need it....I also found that buying them dinner once a month was a nice thank you from me for their hard work. I never had difficulty again.

lilliben1 · Mar 18, 2012

I don't know why some CNA's act like that. I am a CNA on a med/surg floor right now and I can't even conceive of aides talking to the nurses like that. I think that would be an immediate write up if not termination. We're all supposed to be on the same team, helping the patients get better and be the most comfortable while they're in the hospital. If it's such an inconvenience for the aide to do their job, I don't know why they are even in that line of work. I think that upon hire, the managers need to explain the role of the CNA better, as in helping the nurses and doing what is asked for them. Not just the basics of their job description.

When I worked in a LTC facility, we did see a lot of this. I think it's different in LTC's than in hospitals, but why, I couldn't tell you. I for one, don't mind helping the nurse. But I also realize the nurse has a million things to do and she or he is only one person. I like helping the nurses, and we get along great. If there's something I can't do at that minute, I call one of the other aides to ask if they can help.

lumbarpain, ADN, RN · Mar 20, 2012

Sadly some people go into the job just for the money.