Problems with CNAs

TopazLover, BSN, RN · Mar 12, 2012

Have you done any progressive discipline? Unfortunately sometimes nothing succeeds like excess paperwork.

If you have shown the expectations and not getting positive responses it may be time to lay down the law of acceptable.

The issue of smoke breaks amazes me. That is an easy one to document and discipline as necessary.

If they are really just out of class then who is allowing these bad habits to be formed if not you? Management is holding you accountable. You are now the boss not the friend of the CNA. Put your big person pants on and wade in.

winnowill · Mar 12, 2012

Out of 8 CNAs 6 are new. One of the older ones busts her hump. The other you have to track down. 2 of the new ones follow her. Out of the other 4, 1 wants to help everyone else at the cost of her assignment, 1 wants to socialize with the residents to much, and the other 2 I believe are trying but seem to have issues with either speed or time management.

I have done some disiplinary action in the last week because I have run out of ideas. The nurse over the CNAs came up to me Thursday and accused me of trying to run all of "her girls" off. "You are going to have to learn that you need those CNAs because they will make or break you." And my DON told me that I need to "get creative on how to deal with this issue."

I'm about ready to try to find another job. I feel like I'm setting up for failure here.

TopazLover, BSN, RN · Mar 12, 2012

Do they have any ideas on these creative solutions? So one of the "older" CNAs is teaching the bad habits while the other old CNA is covering for all? The newbies will need guidelines as to when and how to socialize with residents. The two that are trying; what happens with their assignment?

My bet is that the one "old" CNA has chased other nurses away and is being protected because of age/longevity. If the CNAs are really under another nurse then the ball is in her court. IF she supervises these folks she will be doing your work when you leave. And eventually you will if you are getting this kind of support. Eventually you begin to worry about your lic. You recognize that you cannot keep your residents safe when you are being intimidated not to do what needs to be done.

They are clueless that they have set you up for failure. They do not know how to manage and are expecting you to supervise when your hands are tied.

gymrat33, LPN · Mar 13, 2012

I work the evening shift and when I come in, I make out the assignment sheet immediately. On top of the assign. sheet is a cover sheet that lists in very to the point expectations what needs to be done in general to make our unit run smoothly. At the bottom in bold lettering is a statement that if failure to follow these expectations, dicinplinary action will be taken. Even the new ones know what to expect. I also take the newer ones down the hall and explain with the care cards in hand how to care for each resident from transfers to peri care. That way they cannot go back and say the nurse never told me. I have one cna that has been there for 30+ years and I still remind her of certain things.

Then if they don't do what is expected, the first time I talk with them privately. That is step one of the dicinplinary action. then step 2 is a warning that the next time is a write up. If it's time management, I help them manage. If it's just blatant disregard for authority and our residents then I make it clear that their behavior won't be tolerated and we go from there.

That is our license on the line and all of us has worked extremely hard to get it and I'm not losing it over someone who doesn't want to do the job and be accountable.

I wish you luck

NoahscoopsRN · Mar 17, 2012

I'm experiencing a sort of similar situation as you are. I'm 28 yo and a new nurse, some of the aides I work with (i'm 11-7) are, and I'm trying to be polite as possible, LAZY. I myself worked as an aide for 6 1/2 years prior to becoming a nurse (the 3-11 shift) and I know first hand how hard and demanding it can be, however, they chose their job and they just have to manage! (or leave). I do not view myself as any better than anyone else on my units, degree or not, I try to be as fair as possible...to an extent. You can't allow people to walk all over you, that being said, you can be firm with the aides without seeming as though you are going through a power trip. Make it be known at the beginning of your shift what your expectations are of each one of them and make sure they follow through with their assignments. Yes their license is on the line, however, so is yours, and your supervisors will be on your butt a lot quicker than theirs because technically we are supposed to oversee what they do (or don't do). I remember when I first started at this job, I had a pt who was actively passing, family was not with her (which is fine) so I had told each aide (there are 3 per unit for 11-7 at this facility) after your first rounds, I want each of you to take turns sitting with her, I don't care if you rotate 20-30 min per person, it is unacceptable (in my opinion) for a pt to pass alone if I can help it. They didn't really respond when I told them that, no, "ok fine" nothing. So, I gave them the benefit of the doubt went about my business, and noticed after their rounds they were all sitting around doing nothing while I ran around like a fool. So I said to one of them, "Are you done with rounds?" she replied (rather b*tchy), "of course I'm done with rounds." So I responded (rather b*itchy), "well I asked you to go sit with that woman and you're not, you're just sitting around." She got annoyed and ended up slowly walking to the pt's room. She probably stayed there no longer than 15 min. Another aide asked to go on break (I said not yet) etc..the point is they did not care. I said, "What would you do if that was your mother in there? or grandmother?" They didn't see the comparison. So I being the better person went and sat with the pt and she passed peacefully about 15 min later. Those aides were later reported and reprimanded for not doing what I had asked them to do. I wasn't asking for the world, I was asking for compassion for a dying woman, something that they just did not have. I'm not sure if it is because I'm young or new, but they just don't listen to me. I'm not there to be friends with them, I'm there to do my job and make sure each pt is cared for properly. Just stand your ground! It's not worth losing your license over! Good luck.

edgarmatthews · Apr 11, 2012

Here is what I would recommend for any new RN becoming a LTC supervisor: Be 100% professional and make a good first impression. Dress the part of a supervisor, if allowed. Don't be anyone's pal. Come in with a take charge attitude. Don't let anyone push you around. You are not their friend, you are their boss. If possible, don't let anyone know how inexperienced you are. Fake it till you make it. You will eventually make it. Whatever you do, never let anyone question your authority. Your LPN's and CNA's will know much more than you, even a year into your job. Treat them with respect. Get your ass dirty and get into the trenches with them once in a while. Make it a point to glove up and wipe some asses once in a while. Buy your staff pizza and gifts on occassion. Back up your nurses. Don't let them tell you your job. Ask them for advice when you have to, but if you can figure out the answer another way, find it that way. You don't want to look totally ignorant. Youtube and Google are your friends when you don't know something. Don't take any crap from CNA's that have been there since Moses was baby. Never let anyone doubt that you are in charge, by your actions and how you carry yourself. Don't be afraid to write people up, but pick your battles. Learn some time management techniques; you will need them. Never cut corners with nursing or safety. You are the example and you have to lead by example. Be fair and consistant with everyone. When you have to make a quick decision, make it. Don't hesitate. Be decisive. If you are in charge of the house, you are really in charge. Hopefully, you have a DON who will always have your back. If not, get out of there. You should always have your LPNs' back too. When you interview, they will tell you that you have lots of time to orient. They are lying to you. They want you ready to work on your own like yesterday. They will throw you the keys to the house, so catch them and be ready to take charge. Don't call the DON over every decision. She is hiring you to be in charge and handle things, not to run to her everytime someone complains. Handle it yourself! This is as much, if not more, a leadership/management position than nursing. If you are young, grow up now and be ready to lead. And, always remember that the residents come first. You can do it, but you have to have faith in yourself. CNA issues are your issues. Get a handle on them, and your job will be easier (but never easy.)