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 (?)
 

[PollywogNP, ADN, BSN, MSN, LPN, NP]

Agree with laying down the law firmly. I once found my CNA in empty pt room near the window bed, sitting in the pt recliner chair with her feet up on the chair & the curtain pulled. If you walked by you would not see her feet, I was looking for a rolling IV pole. Yeah wrote her up. I’ve had to tell a CNA to get off her phone as dinner cart had arrived & yes it’s your job to pass & collect dinner trays. She actually told me she was applying to nursing school & someday she would be telling me what to do. Never happened, last saw her when she completed her RN to BSN where I was nursing faculty & had received my MSN/FNP.With vital signs be wary when everyone has temp 98.6 pulse is 80 & resp 20, nope. Don’t do their job for them. Be firm, be kind, but do not let them tell you when they are going on breaks, write down break times & mealtimes on assignment sheet.  They don’t leave the unit without talking to you first. I once worked with an RN hat would’ve sit in break room reading Harlequin novels (he would) and expected others to come get him if his patients needed anything. I put a stop to that, the charge nurse was afraid of him.

[Jeckrn1, ADN, BSN]

You are doing the one thing that drives me nuts about nursing.  That is putting band-aids on problems to get the job done no matter what.  This keeps senior leaders are in the dark about problems and they can go around and say everything is fine.  

Before I would write the CNA's up I would talk with them and explain to them that you will not tolerate their neglect of the patients along with informing your direct supervisor of the issues. Once you have this talk with them and the next time they neglect the patients write them up so they understand that you will hold them accountable.  If you have to write them up be very specific about what they were doing or not doing and how it caused neglection care to the patient.  The word neglect in the write up will cause the senior leaders to take it more seriously since they are now aware of issues which can be consider neglect and just not say it is a personnel problem.  

Remember when you do not hold the CNA's accountable for the care they are to give you are also neglecting the patients in your care.  

If your senior leaders do not want to do anything about the issue its time to look for another job.  The reason for this is if something happens to a patient they will throw you under the bus to cover their own butts.

[Kooky Korky, BSN, RN]

I hate it more than I can express that some of you are recommending OP quit if she can't get this trouble corrected.

We are always telling nurses to quit, go somewhere else.  Haven't we learned by now that the grass is not really going to necessarily be greener somewhere else?

 

Besides, with hospitals and other facilities being owned more and more by large corporations, no longer by individual owners, it could be very easy to find one's self blackballed and unemployable by a lot of facilities.

[Stillcrazyafteralltheseyears]

I couldn't find one of my CNA's for over an hour one day. When I did find her she said her car broke down when she left the facility to take someone home from a previous shift. As she was speaking to me she became sob and diaphoretic and started to complain of chest pain. Had to call an ambulance on her and she was admitted to the ICU for a MI. When I talked to her co-worker about this. (She was covering this aides room while she was missing)she said that the aide in question, was out smoking crack with her boyfriend. So when your in charge, not only do u have to watch for deterioration of health from your patients but also  from the staff that return from lunch.  I spoke with the nurse manager concerning this issue and had a staff meeting going over policy and proceedure with everyone. Lastily I locked the smoking room door. So when it was time for the smoke break I knew exactly how long they were in there.

[Jeckrn1, ADN, BSN]

10 hours ago, Kooky Korky said:

I hate it more than I can express that some of you are recommending OP quit if she can't get this trouble corrected.

We are always telling nurses to quit, go somewhere else.  Haven't we learned by now that the grass is not really going to necessarily be greener somewhere else?

 

Besides, with hospitals and other facilities being owned more and more by large corporations, no longer by individual owners, it could be very easy to find one's self blackballed and unemployable by a lot of facilities.

Sometimes you have no choice but to look for new employment if you want to stay happy in your life. If you are extremely unhappy and tired at work it will affect your home life. Sometimes radical steps are needed to make management see the problems. 
 

It is true that the grass is not always greener but if you are all ready working at a facility where the grass will never be green you have to make a choice. 

[JKL33]

11 hours ago, Kooky Korky said:

I hate it more than I can express that some of you are recommending OP quit if she can't get this trouble corrected.

We are always telling nurses to quit, go somewhere else.  Haven't we learned by now that the grass is not really going to necessarily be greener somewhere else?

That's very true but trying to manage incorrigible nursing assistants without support is something that will turn ugly very fast. Really ugly.

 

11 hours ago, Kooky Korky said:

Besides, with hospitals and other facilities being owned more and more by large corporations, no longer by individual owners, it could be very easy to find one's self blackballed and unemployable by a lot of facilities.

Well, one way or another the answer to that isn't for me to compromise myself by having people who have nothing to lose sabotage my work and neglect patients on my watch and whatever other nasty shenanigans this can devolve into.

If those are the choices then I personally would not need to work in this profession at all.

[Sabah S.]

I wish you worked at my facility ? theres a  tracker on our badges so if your nurse cant find you, she can atleast see that you’re in room 112 or 115 or if you’re hanging out in the break room. 

[9kidsmomRN]

7 hours ago, Sabah RB said:

theres a  tracker on our badges so if your nurse cant find you, she can atleast see that you’re in room 112 or 115 or if you’re hanging out in the break room. 

Mine, too. There are some CNAs who Say they are going to be a nurse.... that make me cringe. I  hope that they change their mind. The trackers really are great...they turn off the call light when you walk into the room, too, and it time stamps how often you are in the room as well as how long you spent with each patient. Can be a “life saver” when pt complains that no one has been in the room for hours...and distinguishes between RN, CNA, etc. 

[Kooky Korky, BSN, RN]

On 11/15/2020 at 10:35 AM, JKL33 said:

That's very true but trying to manage incorrigible nursing assistants without support is something that will turn ugly very fast. Really ugly.

 

Well, one way or another the answer to that isn't for me to compromise myself by having people who have nothing to lose sabotage my work and neglect patients on my watch and whatever other nasty shenanigans this can devolve into.

If those are the choices then I personally would not need to work in this profession at all.

I see your points.  But sometimes a nurse has some time in on the job, some seniority.  Or he/she needs the insurance and can't just up and exit.

I know that it is vital for Management to back the nurse and that bosses might turn on us, despite the good job we have done for decades.  We are totally expendable.  I know.

I just hate that nurses, generally speaking, won't stand up for themselves or for the profession, let aides trample us and ignore and abuse patients.  Schools do a horrible job of preparing us for the real world of dealing with the type of workers we so frequently encounter - aides who have so little respect for others or for themselves that they smoke crack on duty, lie, disappear, etc.  

[sevensonnets]

My hospital had a hospital-based training program which, after a 4 week training class, hired several graduates of that program into the CC units on a provisional basis to do basics such as baths, recording foley outputs, blood sugars, etc. We got burned big time: blood sugars that were recorded and treated but never done, aides that flatly refused to assist nurses when asked to do so, unprofessional attitudes, extra long lunches, patients not being turned, etc. I am management and I did and have always stood up for nurses. I will not hire aides into CVICU. We carry on like we always did before there was any such thing as a CNA. If that ruffles some feathers, well, I don't care; the proper and safe care of critical care patients will always come first on our unit.

 

 

 

 

 

 

 

 

 

[Bluefamily, MSN]

Beep beepbeep...like Kooky Korky advised...the key to this problem is creating a facility policy based paper trail about the lack of rule adherence by the CNAs. The key is to make it administration's problem. 

Obviously administration is in the dark  either by choice or by truth. However, they deal well with paper. If you show them, based on the facilty's own policy the CNAs behavior, (show them without emotion or the he said/she said).then you've educated them and it's in their hands.

If administration still does nothing, then report it to the corporate office and Joint commission. 

It takes some preparation on your part (and I know it's tough being new)...but make out the scheduled break sheets, and CNA assignments. Keep notes of the CNAs. Then grit your teeth and don't do their job. Only do yours. If you have to go fund them...write down how long it takes you to find them and where you find them. This level of detail is important if you are seeking lasting change in a new facility.

[Guest219794]

Some good advice here.  As you get more experience and earn more confidence, this may improve a bit.

But- It sounds like you work in a place with low standards, and that won't change.