Polite way to deal with AWOL CNA’s?

[Beepbeepbeep]

FYI I am a VERY new nurse.  When signing up there wasn’t an option for starting my nursing career in 2020.  I would appreciate input on an issue that is impacting my ability to function as a nurse.

For context I used to be a CNA and I understand how hard the job is.  I was regularly told by nursing staff that I was very good at my job, and other shifts would try to poach me to their shift (haha).  I know you have to move fast and efficiently, and that it can be very draining.

I am now a nurse.  Training was brief and inconsistent and I feel like I am still getting my bearings. I have up to 20 patients a shift.  Very needy.  Lots of behaviors.  VERY heavy medication passes.  The CNA’s I am paired with are always nowhere to be found.  I genuinely feel like I am doing total patient care for all of my patients.  I ask for vitals (when I am stupid busy and CAN’T do them myself) from the CNA’s, I never get them and do them myself.  I am constantly having to go find the CNA’s (on their phones, chatting, in the kitchen, etc) and let them know they have call lights on, so-and-so needs to go to bed, etcetera.  I am answering 80% of the call lights.  Toileting, putting people to bed, etcetera.  I just CANNOT FOR THE LIFE OF ME ever find the CNA’s paired with me.  I know these are all things that are within my scope of practice, but they significantly impact my ability to act as a nurse.  I can do a CNA’s job but they can’t do mine.  

I’ve talked to them about this and feel like I receive a lot of attitude and push back.  I explain that I really need to focus on getting my “nursing flow” down, and constantly doing “their job” (sorry!), really impacts that.  If I don’t get a flow down then I can’t expand and help where needed, and my shift will be chaos.  I just get “so?”, “ugh, well I’m busy too!” , and other dismissive snide comments.  I lost an hour of my med pass once because I did a patient’s entire bedtime routine because they said they didn’t like their CNA, and when I asked another CNA for assistance with this persons cares they gave me a snide “OK? So what?”  And didn’t assist at all.  Soooo I did it all on my own.

I don’t want to be overbearing or rude to the CNA’s I work with.  But I am genuinely lost as how to motivate them to do their jobs (?)
 

[Been there,done that, ASN, RN]

"I don’t want to be overbearing or rude to the CNA"  You are not being rude... you are directing them to do their jobs. They are a lazy bunch, that will surely let you do their work. You have already  let them know.. they can get away with it. 

You cannot motivate them, they like it just the way it is.  Your only possible hope is to write them up each and every time you cannot find them.. or they refuse your direction.  

Discuss this with your immediate supervisor , get direction there.

Starting your career in such a toxic environment does not bode well.  Continue your job search.

[Davey Do]

My heart goes out to you, Beepbeepbeep! Coworkers have the potentiality to make our work rewarding or be a constant uphill struggle.

As a new Nurse who's worked as a CNA, you can see both sides of the coin. And being an obviously caring and competent caregiver, it's frustrating to have to deal with those who work hard at avoiding work.

The old saying, "with these oxen we must plow" comes to mind, so we must continue to fulfill our duties despite these stumbling blocks.

I learned that I did not work as a Nurse to gain popularity but to provide a service. I have been confrontive with others and randomly unpopular in my career, but could sleep well with myself.

Early in my career, I once avoided one of my responsibilities and was confronted by my Supervisor. He said some things to me that I carried with me. One thing he said was, "My job is no more important than yours- we just have different responsibilities. One of my responsibilities is to tell you to do your job, so do it!"

And finally, he said, "You don't have to like it. You only have to do it".

I could get behind that.

Good luck and the best to you Beepbeepbeep!

[DyerRN, LPN, RN]

Davey, that is great and funny advice from your past manager! I agree though that transition is difficult to make. I was an STNA, Lpn then RN manager and getting that respect from both the aids and nurses was Not easy!

I did what you have done by offering to jump in and help when they got behind, which gained the respect from maybe half of them. The other half abused it. This lead to me having the pull "The Card" and tell them this is a warning, the next time I catch you out smoking when there are call lights going off you will get a write up. 

They still did not listen to my empty statement or so they thought. The next time a resident had a fall while 3 of my 4 aids were smoking. I was definitely not pleased and those 3 aids got write ups. I believe strongly in if you do you job well and efficient then you deserve an extra break (rather it being going to get a snack or out to smoke). However, having 75% of the crew out was not efficient.

End of the day after this point in time my crew ran well and efficient with the occasional hiccup. 

[caliotter3]

I have to agree with what was previously stated by BTDT, write them up each and every time you cannot find them or they refuse your direction. Give a copy of the write ups to your manager when you have that talk. It may take a long, long time for any action, but give the offenders plenty to think about as they muse when or if the ax will strike.

[Davey Do]

On 11/12/2020 at 8:58 AM, DyerRN said:

Davey, that is great and funny advice from your past manager!

On 11/12/2020 at 8:37 AM, Davey Do said:

Early in my career, I once avoided one of my responsibilities and was confronted by my Supervisor.

It's interesting that you should note this, DyerRN!

I just responded to your thread about favorite nursing positions. I cited CD treatment as one, and lo & behold, this situation occurred with that Supervisor!

Ha!

[macawake, MSN]

On 11/12/2020 at 4:57 AM, Beepbeepbeep said:

I am constantly having to go find the CNA’s (on their phones, chatting, in the kitchen, etc) and let them know they have call lights on, so-and-so needs to go to bed, etcetera.  I am answering 80% of the call lights.  Toileting, putting people to bed, etcetera.  I just CANNOT FOR THE LIFE OF ME ever find the CNA’s paired with me.  

On 11/12/2020 at 4:57 AM, Beepbeepbeep said:

I’ve talked to them about this and feel like I receive a lot of attitude and push back.

I just get “so?”, “ugh, well I’m busy too!” , and other dismissive snide comments.  

...and when I asked another CNA for assistance with this persons cares they gave me a snide “OK? So what?”  And didn’t assist at all.  Soooo I did it all on my own.
 

On 11/12/2020 at 4:57 AM, Beepbeepbeep said:

I don’t want to be overbearing or rude to the CNA’s I work with.  But I am genuinely lost as how to motivate them to do their jobs (?)

Well they clearly have no qualms about being rude to you, so I wouldn’t lose any sleep over how they perceive you if you decide to put your foot down. I don’t mean to imply that expressing the expectation that they actually start doing the job they’re paid to do is rude. It’s not. Just remain professional and communicate your expectations clearly and firmly.

Even though most of us probably prefer to be liked and get along with others, these people sound like they’ll only keep on taking advantage of you for as long as you allow them to. Work isn’t a popularity contest.

I realize that it can be difficult as a new nurse who already has her plate full with gaining proficiency in a new role to also have to deal with coworkers who aren’t pulling their own weight. 

I agree with previous posters. Unless the CNAs you work with start doing their jobs, they need to be written up. I sincerely hope that your employer/manager will give you his or her full support. If they didn’t and I was in your situation I’d start searching for a new job if at all possible.

One thing I was wondering when I read your post is it you were previously a CNA in the same facility you’re now working in? If that’s the case, it can be very difficult to change roles and be in charge of people you’ve worked with in your previous role. 

Best wishes OP! I think it sounds like you’re doing a good job. I hope that your work situation  improves! 
 

[Beepbeepbeep]

Macawake,

No, it’s a new facility.  So I have the added frustration of learning the new space and the new patients.  And I’m learning how to work with new staff, new aides, and what their flow and routine is like.  I just know from working as an aide at my old facility that the work ethic and flow I’m seeing could be improved.  I shouldn’t be looking for the aides, finding them sitting and chatting and relaxing while not answering lights, and having to remind and pester them to do their jobs constantly. 

[JKL33]

Agree you will need to write them up. Keep trying to develop a rapport with each of them, but even that needs to be done within the boundaries of the understanding that we are all going to do our part, here, and I appreciate you doing yours.

Be prepared with a plan for what you will do if your endeavors are not supported. You can't practice like this.

[Kooky Korky, BSN, RN]

You have to toughen up.

Stop doing their work, even if patients have to wait.  

Go out and get them from the smoke area or wherever they are.  Tell them there are patients crying and falling and wetting/messing themselves because you have only 2 hands and no help from them.

Talk privately with each one of them.  Tell them how needed they are by helpless, sick patients.  Tell them your expectations - 1 unpaid lunch break and how long it is and that only 1 of them can go at a time so the floor will still be tended to by 3 aides and a nurse, not just by a nurse.  Let them know that their breaks are exactly 10 or 15 or however many minutes the law says for your state.  (Look it up on a Dept. of Labor website to be sure).  

Tell them they are forcing you to do something you don't want to do, which is write-up's, if they don't stop breaking the rules and torturing and abandoning their patients.  Ask if they would behave the same toward people they love - their Mom, their Aunt, their Grandma, their child. 

Ask if they would want an aide like them taking care of them personally?  An aide who spends (name the amount of breaks and time that you have observed on several shifts) being absent from the ward - would they feel comfortable with that person?  Would they like being helpless, dependent, alone (especially now during COVID with no or few family visits)? You might get some lip but the message will have likely hit home.

About paid breaks - the law where I live is 1 15 minute break after 4 hours of work IF there is time, based on the work flow.  I have seen places that a break is taken much sooner than 4 hours, seen the 15 minutes put together with the unpaid lunch, making it 45 minutes, seen people take a 2nd break before the end of an 8 hour shift, thus stealing that break, as it did not come after 4 hours of work. 

(I have also seen the whole thing go for more than 45 minutes.  People seem not to count the travel time to the cafeteria or the smoking area or the restaurant.  )

The paid break is not guaranteed in my state.  If taken, it is meant to be for a very quick potty break, a very brief call to a babysitter or something like that - that really can't wait - like to the mechanic if your car is in the shop that day, or to the child's school.  It is not meant to stretch into anything past 15 minutes. 

Obviously, emergencies, true emergencies can arise but they should be rarer than rare.  I know some people have more troubles than others, especially if they have kids or are taking care of someone who is ill or infirm at home or dealing with an evil ex, but even these matters should be infrequent.

Your main weapon will be writing people up, I am guessing.  It is pretty unusual to get true repentance from ne'er-do-well, surly persons, which I assume, perhaps wrongly, is who you are working with.

Be nice and talk privately first to each aide.  But be firm and tell them your expectations.  You could even write down your rules (not guidelines, not requests) and give them a copy.  

1.  Be ready to work at 0700 (or shift start time), not first arriving or hanging up the coat, or using the bathroom but ready to work.

2.  They must ask you if it's OK to go on Break/Lunch.  You have final authority to grant breaks and meals because you have final responsibility for the wellbeing of the patients.  No leaving the floor is permitted without your approval.

3.  Breaks and meals are secondary to patient care.  

4.  VS will be taken and given to you in writing by 0800 or whatever time you need.

5.  "Susie, I expect you to do your job of taking care of the patients, not sitting in the kitchen talking on your phone ".  Learn to word things like a boss.  Put a little fear in them if they don't respond to the "do the right thing" approach. 

[YOU ARE THE BOSS.  YOU MUST BEHAVE ACCORDINGLY.  YOU DON'T SEE YOUR BOSSES RESCUING YOU, DO YOU?  WHY THE DEVIL DO YOU THINK YOU SHOULD MAKE LIFE EASY FOR THE AIDES BY ANSWERING ALL THE LIGHTS, DOING VS YOU HAVE PROPERLY DELEGATED TO THEM, ETC?  SORRY FOR CAPS BUT I WANT YOU TO HEAR ME.]

5.  1 person at a time may take a break or meal.  1

And so on...

Make a WRITTEN assignment at the start of the shift and keep a copy.  Designate VS, Break and Meal times, etc.  Post the state law re: breaks on the assignment sheet.  

 

If that talk doesn't work - and you could even have a 2nd talk to be totally fair - then you have to go to writing up each person every time there is a violation.

I disagree with the sentiment on the board here that you should frequently bring in food for them and be complimenting them all the time.  They are adults and they should be coming to work to work, not eat your food, torture patients, and take advantage of you.  Yes, an occasional compliment or expression of gratitude is fine.  We all need affirmation, appreciation.  But they must be self-motivated to not be more trouble than they are worth.

Nurses must follow ethical and legal rules.  Other people who hold lives in their hands must do the same or must be terminated. 

Nurses are not meant to be Mama to everyone,  begging and pleading with people to do their jobs.  You are their boss, not a supplicant.  You don't need their permission to hold them accountable for their behavior.

If people don't like their jobs, they can go get some other job.  You are not responsible for their lives, their opportunities, their well-being, their income, and so on.  You are responsible for the patients.  You can't continue to do the work of the aides.  As you already see, that will burn you out quickly.   You are expected to do your job?  Why are you not also expecting them to do theirs?

So - what will you do?  

Also - have you spoken to the DON and other supervisors to try to enlist their help?  What responses have you gotten?  This is very important.  Will your DON perhaps also talk to, counsel these aides?

There needs to be a rule that all cell phones be left in the DON's office during work.  No exceptions.  See if you can get this enacted and enforced.

I guess you could always file an ANONYMOUS complaint with CMS, your local newspaper and radio stations, your local government, your state representatives, your federal reps.  I can't stress too much the ANONYMOUS aspect.  You don't want to be fired, blackballed, hurt by whoever would be embarrassed by your going public.

I do like the team-building approach, such as was employed by the boss of a poster above (Davey Do's boss?).  Try to incorporate some of that, too.  Let them know how important they are.  They are not essential but replacing them is kind of a pain.  So perhaps you can meld them into a good team.

Best wishes.

[SarHat17, ASN, RN]

9 minutes ago, Kooky Korky said:

I disagree with the sentiment on the board here that you should frequently bring in food for them and be complimenting them all the time.  They are adults and they should be coming to work to work, not eat your food, torture patients, take advantage of you.  Yes, an occasional compliment or expression of gratitude is fine.  We all need affirmation, gratitude.  But they must be self-motivated to not be more trouble than they are worth.

Nurses must follow all sorts of ethical and legal rules.  Other people who hold lives in their hands must do the same or must be terminated.  Nurses are just too busy, these days especially, to be Mama to everyone, to be begging and pleading with people to do their jobs.  If people don't like their jobs, they can get some other job.  

Yes! There is a time and place for potlucks and celebratory gatherings for birthdays with food, Secret Santa gift exchanges, etc. Essentially "bribing" people to do a job they are paid to do is NOT your responsibility, nor is it appropriate or necessary in the environment/situation. Doing that actually could set a somewhat dangerous or at the least, uncomfortable, precedent.

Others have made really good suggestions on how to address the situation kindly and with a focus on teamwork and the big picture.

I may have missed some information, but you are the RN on the floor, not the DON or manager of this facility, correct? It may be helpful to look at the situation as if you all (you and the CNAs) are all cogs in the machine, and if some cogs aren't working, then the whole machine breaks down. Ultimately, if they aren't doing their job, they need to be held accountable. If that isn't the way management sees it, then I strongly encourage you to consider moving on from this facility.

[Jedrnurse, BSN, RN]

I think that the words "polite way" in your title don't apply here. Firm but fair, no-nonsense but not disrespectful, maybe, but you're past the "polite" stage with these behaviors.