Posted in another forum... no response...please answer

Ah, crb613. . .this is one of my favorite subjects to talk with other nurses about. I spent a good 10 years of my career fighting stupid CNAs like that before learning how to deal with them. I was pretty much forced to learn how to deal with it because I found myself in supervision and managment and we couldn't have them being insubordinate with the bosses, otherwise the animals start running the zoo.

First of all, let me clarify with you that they were being insubordinate and disrespectful with you. The first problem most nurses have dealing with this is what to say back to these nincompoops. It hits you like a slap in the face because you don't expect people to behave like this. This is the unseemly side of the profession--those who are negative thinkers that are never going to make it past the role of a CNA--very sad. The other part of the problem is that a whole bunch of other nurses have let them get away with this smart mouthiness. So, I'm going to suggest that going to their manager is probably not going to help one bit because the manager is probably part of the problem, has been unable to confront them herself, or she doesn't know how. I'm real big on RN being autonomous. We're problem solvers!

You have to practice what to say first. Confronting these people is a skill just like any other nursing skill (catheterizing someone or putting an IV in). The more you do it, the better you get at it. The first few times you are a little shaky at it. Well, you know that now, don't you? You've got to try to keep your voice as calm and even as possible even though you are screaming inside. You've gotta be nice and respectful even though they're trashing all over you.

Next, here are a couple of things you can say. They range from addressing their behavior to correcting them to giving them direction. All are OK. I used to actually keep a couple of statements written on the back of my poop sheet so I'd get the language exactly the way I wanted it at just the right time (OK, I'm very anal that way).

"Stop talking to me in that tone."

"I just gave you a direction and I didn't ask for your comment."

"Just do as I asked."

Simply ignore their comments and repeat the direction you gave them.

You don't, however, want to get into a shouting match or a discussion with them because now you've been sucked into their manipulative little game. It's always a good choice to just repeat what you've said and stand your ground. The hard part is keeping your mouth shut and not talking back to them! Remember that talking back and arguing with them is only giving them attention.

A lot of times you don't know what to say and end up walking away thinking they got the best of you. Later you think, "Oh, I should have said this to them." If it can be done, you merely take them aside and address it with them as soon as you realize that. It is never too late. What I found over many years of doing this is that it is always better if you and I, the nurse, address these deadbeats ourselves. If we turf it off to someone else, it makes us look weak to these CNAs. Even when I was a head nurse and had staff RN come to me with a problem like this I would give the RN instruction on how to handle it much as I'm doing here with you now and encourage her to confront the aide herself in order for the RN to retain her authority and whatever power she had over an insubordinate. Also, once you confront them, you keep confronting them every time they act up. It really gets easier each time. You can say things like, "I've told you before not to talk to me in that tone of voice." "I told you earlier to get this patient water and you still haven't done it? Do it now." You become a burr under their saddle. They either start complying and do what they're supposed to while you are on duty with them or they leave. Either way, your work day is going to be a lot easier. It helps to bone up on assertiveness techniques and if you ever see a one or two day seminar on handling difficult people come along--take it. Never thought you were going to have to almost be like to parent to a bunch of adults acting like children, did you?

I hope I've given you some things to think about. I often used a little book called Managing Difficult People: A Survival Guide for Handling Any Employee by Marilyn Pincus to help define and explain the behavior of problem people. I worked in a lot of nursing homes which seems to be a place where a lot of these kinds of CNAs tend to collect. However, now that hospitals are using CNAs again, some of these deadbeats are creeping back into the acute hospitals. They develop behavior like this because it is allowed to go unchecked. That you are already taking an interest in how to deal with it makes me think that you might be headed toward a career in managment and supervision you courageous person you. Good luck with your next encounter.

crb613. . .if you do decide to take the job offer from this place be aware that if these aides are not already gone you are probably going to have to address their behavior. It is doable, but as a new grad there are a lot of other things you have to learn as well that will consume your time. From time to time people post about problems with CNAs and when I see them I will also respond since it seems like I've had to deal with this all throughout my career. You generally don't see licensed people treating each other this way, so nursing schools don't usually spend much time addressing difficult employee behavior. However, it is definitely within the RN's realm as we are supervisors of the care givers. Just keep in mind that part of our responsiblity as RNs is that some of the buck does stop with us. As you become a stronger and more confident RN you will learn more strategies to deal with these kinds of people, but to be an effective leader you must learn to deal with it eventually. The old RNs of years ago would have stood their ground and thoroughly knocked these people down a peg or two. Those old nurses were battleships to behold when they were in action! We have to revive some of that within ourselves for situations like you have found. I noticed that you have also been following another thread where an RN has been having to deal with a nasty CNA. This is not unusual to happen in a nursing home, but the way it is handled is what is important. Don't let it scare you off to a job. CNAs like that 9.9 times out of 10 are nothing more than a dog and pony show. They usually know their fate is pretty much sealed. They are just going to make as big a show as they can as they go out the door. It has to do with protecting what little self-esteem they have. They know who holds the real power. Don't relinquish your power if you can help it. You don't necessarily need words to reinforce it. You have it by legitimate means of a license and job title. One of your tasks as a new RN will be to learn to use it wisely. The fact that you are looking for answers to a problem indicate that this is already on your mind. If nurses who want to bring quality into nursing facilities keep leaving them because of CNAs who intimidate them, then what kind of nurses are our schools turning out? When things got depressing I used to think of myself as a kind of nursing gunfighter who came into town to clean it up. I know it makes me sound like a real egomaniac, but it helped me justify why I was staying on while others were heading out the door and running away. I've got plenty of scars from the wounds I got from the mistakes I made in the process. I always liked a good challenge.