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

SonicnurseRN · Jul 19, 2007

Well, I am a CNA @ a cardiac step-down unit & a RN student. Maybe I could offer some insight ... what part of their jobs are you having trouble getting the CNA's to do? Personally, I run non-stop all day @ work, but my nurses are always respectful of this & if they ask for something specific I always try to help them out & understand from their point of view. Maybe I am different because I have first hand experience from both jobs. Elaborate on what the CNA's are not doing & perhaps I can give you some tips : )

snowfreeze, BSN, RN · Jul 19, 2007

I have found the units and facilities which offer autonomy to the nursing assistants also attract the better workers. How can you have pride in your job if you are constantly being TOLD what to do. How we perceive and speak to the nurse assistants and techs effects how they feel about their jobs. We are currently trying to work out the bugs on the unit I work on with simular issues. This same facility has nursing assistants working twice as hard without coaxing on other units and they are actually happy.

A standard written job description allowing for some modification on a daily basis based on acuity and staff availability is what nurses deal with, nursing assistants can be flexible too and they actually do work harder if they are included in report and know what the expectations acuities and goals are for the patients they are a part of the care for. We are a team, why don't we treat all the departments involved in that manner?

And yes, there are some people who are just plain lazy, they don't need to be working in the health care arena; for the 'bad fit' workers, complaints need to be in writing, signed and dated and given to the nursing supervisor, manager and/or charge nurse on the day of the problem issue.

mer_RN · Jul 19, 2007

personally the CNA's at my work who are going to LPN or RN school often make the comments when asked where they want to work when they graduate often say they do not want to work in postpartum where they are currently because all the nurses do is "change diapers, help breastfeed and and look at crotches." they never notice when you are getting their patients up to the BR, filling their water pitchers, doing their vital signs, and oh also a little busy giving O2 to a baby that is desatting and having resp distress while you wait for nicu, or while you are trying to keep your pt who is hemmorhaging conscious until the resident can get there.

i have no advice as to how to make them do their work more efficiently, i guess when they get to their dream job of working in cardiac or med-surg where they can do "real" nursing and suddenly realize they are the one with all the responsibilty on their shoulders they will wish they had done their vitals with a better attitude!

no advice, just a vent!

SonicnurseRN · Jul 19, 2007

Ditto SnowFreeze! That's how our floors treats the CNA's! I love my job & most of the aides have been on my floor for 10+ years and do excellent work.

kstec, LPN · Jul 19, 2007

I work in a LTC facility and initially wasn't sure how to even ask for a CNA to do something for me. Somehow I don't have any problems now. I always give compliments of a job well done and if something needs to be done I assist the CNA by either getting the supplies or going in and helping the turn someone. When I worked as a CNA I liked to be left alone to do my work and not harped on. Most of the CNA's that I work with do a great job and they to run their butts off, so I always help when I can. At the end of the shifts before I leave I always check my residents to make sure that I'm leaving them clean, dry and comfortable. I usually grab pad and wash clothes and then if I come across someone who is wet or dirty (face), I either do it or if I need help I grab a CNA. Also if in a rare case I see the CNA's holding up the nurses station I'm getting good at offering suggestions to reliever their boredom, so they usually just keep busy to avoid this.

Nursey Face · Jul 19, 2007

I am a CNA at a large Boston teaching hospital and also a student nurse who will be graduating in December. I started about 2 months ago as a CNA and generally like it. Like others have stated, I run my ass off all day doing VS, changing diapers/bed pans, feeding patients, doing EKGs, drawing blood for labs, repositioning patients, talking to patients, getting them ice cream, ginger ale, crackers and whatever else the nurses need. One thing I would love to stress to the the nurses the following: for the CNA doing a good job, tell them they do a good job, look them in the eye when you see them and say hello, don't save small talk and stuff just when you need us, etc. My morale is going downhill because half of the nurses barely acknowledge my presence when I'm around or can hardly pull off a smile unless they need to me do something for them. Maybe the nurses here can enlighten us as to why that may happen and how we can change that. Maybe it's just another case of nurses eating their young. It's really difficult to deal with especially when you bust your butt every shift.

can'twait2B1 · Jul 19, 2007

Okay, this is a very common problem where I work, I myself worked as a CNA for ten years before going on to LPN and later RN school. I have never seen such disrespect between nurses and aides anywhere I have ever worked prior. There are some nurses who expect the CNA to do the job they are assigned to do and anything else that particular nurse doesn't want to do. I have been there I have seen it and its plain ridiculous that a nurse will chase a CNA down halfway across the unit to have them help a patient put on a gown, something that nurse could have done herself. These nurses give all nurses bad names because then we get the lecture at our staff meetings that nurses are being mean to the CNAs. BUT, that is not always the case for instance, I don't mind helping a patient use the commode or cleaning up an incontient patient, I don't mind or feel that it is below me to help a patient put on a clean gown or give a bath, that is basic nursing. And When I have time, I do these tasks to help out. However nowadays the CNA's (where I work) have attitudes and when you ask them to do something they are insubordinate, state you are not their "boss" tell you flat out "no, why can't you do it yourself?" :angryfire Our CNA's are not patient focused and on more than one occasion I have heard that. Then I even had one aide/RN student pull me aside and tell me "I don't want to do anything you ask me to because I don't respect you, you are not my superior only the charge nurse is over me" :angryfire I politely told her that she should respect her job and the fact that these patients are our primary concern and whether or not she likes me she should do what she is being paid for. :nono: I don't know what has gotten into the work ethic anymore but it is bad, and the sad part is the patient is the one who ultimately pays for it. Personally I can't wait until that particular cna is a nurse working on the floor and finds out that nurses really do have more to do than sit around and write. :lol2: Maybe she will respect me then? :idea:

TruDivaRN, BSN, RN · Jul 19, 2007

Well, I have been a cna for 10 years, and will be a second level Rn student in Aug. From experience, I can tell you its all in your approach. If you politely ask a cna to do something you usually will not have any problems. Sometimes the aides get tied up in pt. care. There have been some nights when I have had 16 total care clients to do on my own because we where so short. On top of this I had an very rude RN come up to me and ask me at 1030pm "where are her vitals:angryfire." Needless to say, I told her if you had gotten your vitals during the past two hours you set and talked on your cell phone you would have them now:angryfire. So no I did not get her vitals, and I meant I was not going to get them. I had been on my feet for nearly 8 hrs straight no lunch break and she had the nerve to be rude and insensitive like that:bluecry1:. Sometimes a little meekness will go along way. All cna's do not have nasty attitudes, sometimes we are overlooked, and taken advantage of. Noone ever stops to think, that the job of the CNA is as important as that of the nurse:blushkiss. Just my :twocents: .

omni123 · Jul 20, 2007

Okay this is a very common problem where I work, I myself worked as a CNA for ten years before going on to LPN and later RN school. I have never seen such disrespect between nurses and aides anywhere I have ever worked prior. There are some nurses who expect the CNA to do the job they are assigned to do and anything else that particular nurse doesn't want to do. I have been there I have seen it and its plain ridiculous that a nurse will chase a CNA down halfway across the unit to have them help a patient put on a gown, something that nurse could have done herself. These nurses give all nurses bad names because then we get the lecture at our staff meetings that nurses are being mean to the CNAs. BUT, that is not always the case for instance, I don't mind helping a patient use the commode or cleaning up an incontient patient, I don't mind or feel that it is below me to help a patient put on a clean gown or give a bath, that is basic nursing. And [b']When I have time, I do these tasks to help out. However nowadays the CNA's (where I work) have attitudes and when you ask them to do something they are insubordinate, state you are not their "boss" tell you flat out "no, why can't you do it yourself?" :angryfire Our CNA's are not patient focused and on more than one occasion I have heard that. Then I even had one aide/RN student pull me aside and tell me "I don't want to do anything you ask me to because I don't respect you, you are not my superior only the charge nurse is over me" :angryfire I politely told her that she should respect her job and the fact that these patients are our primary concern and whether or not she likes me she should do what she is being paid for. I don't know what has gotten into the work ethic anymore but it is bad, and the sad part is the patient is the one who ultimately pays for it. Personally I can't wait until that particular cna is a nurse working on the floor and finds out that nurses really do have more to do than sit around and write. Maybe she will respect me then?

I know just what you mean. I was also a CNA for several years before graduating this past year. The CNAs on the floor I work show absolutely no respect. They think because I am orienting to the floor I hould also be doing their work, too. I realize I have a lighter patient load since I am on orientation, but that's just it - I am LEARNING still, so it takes me longer to do my OWN job. The thing is I am not even asking them to do anything that they do not normally do! This past week for example, I asked for ONE set of vitals out of all my patients because I was busy with a million other things. She had the nerve to ask someone ELSE to ask me if I would do it myself. She couldn't even come to me herself. It eems like they respect the older nurses there, but they have no respect for the new ones. People keep telling me to put my foot down now before it gets out of control, but I have so much trouble with assertiveness. I don't want anyone to think I am lazy because I don't mind helping out and when I'm not busy I go around answering call lights and doing whatever needs to be done to help my coworkers. It's just this CNA had been sitting down surfing the internet half the night while I was busy and I have had it! Sorry it's so long :)

tntrn, ASN, RN · Jul 20, 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.

tddowney · Aug 2, 2007

I have been a Rehab nurse for approx 4 yrs, and take care of mostly stroke pt's. As a primary nurse I have multiple responsibilites for the care of our pt's. I have found it to be verry difficult to get CNA/s to do their job. This in turn makes my job even more demanding. In our rehab facility, nurses provide direct pt care in addition to our other job requirments, including being charge nurse, primary nurse, and ensuring each pt has a FIM score for all 18 items, and all the other nusring care tasks. My delima is not new. I am frustrated and exhausted in the efforts I have made in the past to help resolve this. The expectations are so great and our goals are being met-but, the support staff needs to step up to the plate and do the job or leave! Please offer any suggestions..

Never forget the basics of any workplace. (I'm not saying you have, but it's hard to do when you're always swamped.)

Please and thank you, always. Express appreciation for how much they help you.
Praise even routine work well done, and do it in front of the boss.
Autonomy to the extent possible.
When you have to criticize, make sure to include what they did well in the discussion. A little sugar does help the medicine go down.