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

Morainey, BSN, RN · Mar 23, 2012

I have this same problem at my work right now. Some, definitely not all, but some NA's are lazy and have a crappy work ethic. I feel like I nag people, like, all the time. I don't feel like I should have to be a babysitter for a lazy aide when I have my own patients to worry about. Unfortunately, sometimes it's easier to do whatever it is rather than go ask them politely, wait half an hour, ask again if they did it, and then finally do it myself. I feel powerless and resentful, because it's only reinforcing bad behavior ("why bother, she'll do it anyway if the call light rings long enough" and it takes time away that I need to do my job. I don't understand why some people are the way they are. End rant.

lumbarpain, ADN, RN · Mar 23, 2012

I have a story that will knock everyones socks off and its TRUE!!!!!!!!!!!!! I had a Cna who came from the Islands, and she was very defiant and upstanding to the nurses. Had a bad attitude, no matter how nice you were. Anyway....she had blantantly TOLD ME OUTWARDLY she had 2 social security numbers she uses in the US and then smiles and walks away!!! Strike number one...........on top of that.....she had asked to go back to her home Island of Jamaica and was informed that if she wants time off (outside of her usual time off) that she has to find another co worker to take her shift while she is gone. This was fair because it was NOT HER TIME TO TAKE HER VACATION and she was leaving the facility in a situation. She downright refused.!!!!!....LEFT THE JOB AND WENT TO JAMACIA anyway and now hold on to your seats..this is the clincher all.......the reason was for her return to Jamacia was....TO HAVE SEX WITH HER HUSBAND!!!!! AND THEY HIRE THESE PEOPLE?????.....HAVE YOU EVER HEARD ANYTHING LIKE THIS IN YOUR LIFE????>....this resulted in her being brought up up charges of abandoning her job and she was to show up in front of a council which I had to attend because I had trouble with this incredible piece of trash. She was fired THANK GOD!!!!!! So, if anyone can top that story I would love to hear it.....this was incredible...no words can describe the insensitiy of these people that shouldnt be in the healthcare industry at all . VERY SAD.

lumbarpain, ADN, RN · Mar 23, 2012

Halfmarathoner.......dont fret, Patience is a virtue......Nurses have an abundance. Only thing wrong is if you work in a Long Term care facility most times the CNAS have a union, so they know they got you by the corndogs and the nurses have nothing but their stethoscopes......Its a darn shame that many nurses in this industy complain about the downright laziness of their aides and the aides have NO GUILT about it at all. If they have no guilt or no concern....then they should be fired, done deal. Who needs that in a stressful job as it is. If you write them up and they are on probation for a few days or whatever the facilities protocol is THE NURSE ON THAT SHIFT IS Screwed for she has to find someone to replace that aide if the higher ups dont do it. But I am sure they will.

jadelpn, LPN, EMT-B · Mar 23, 2012

I think it starts with having a staff meeting, with a laid out job description on what CNA duties entail. Trial a sitution where CNA's are partnered up--sometimes to have 2 to do the work, it is more helpful and goes quicker. Another choice is at the begining of your shift, go with the CNA and do rounds. CNA takes vitals, while you do the rest of your assessment, give meds, then you both can do incontinence care or trip to bathroom, turn and repo. One CNA group can man phones and call bells. After rounds, then you can do some paperwork. In 2 hours, go on rounds again to turn and repo, put your eyes on your patients, whatever needs to be done. Rotate job responsibilites between the CNA pairings. Spell out in your policies a clear path of discipline should CNA's be non-compliant. I think it is important for a nurse to see patients and be mindful of what is being done or not done, because ultimately, as the licensed professional we are responsible if a patient is not turned all night or falls. Sometimes the culture of the unit is such that "this is what has always been done", a huge part of culture change is clear expectations. And yes, I was a CNA for 14 years before going on for my LPN. And for the CNA's who love what they do and do it with a smile....YOU ROCK!!!!

brandy1017, ASN, RN · Mar 24, 2012

Some CNA's are wonderful, kind and hardworking, others do the bare minimum, mouth off, are insubordinate and then throw a tantrum when you have the nerve to call them on not doing their job and the lame excuses they give! Work is supposed to be a party with my buddies, how dare you expect me to actually work and with people I don't like! No one's going to tell me what to do attitude. You have to kiss up with the mother may I, would you please do this, when that's ignored did you forget, would you please do that? Give me a break. I only wish they could be the RN and find themselves doing our work and their work and dealing with a mouthy, childish tantrum thrower so they could get a look in the mirror. All I can say to that is grow up already!

caliotter3 · Mar 24, 2012

There was a CNA who had been fired two or three times in the past at the same facility that I found myself working with one time. Lazy, smoked pot on the job, disappeared for hours at a time. I got fed up to the point that I told the charge nurse not to team me with him at all, since I ended up working alone anyway. You have a harder time dealing with problem employees when the employer insists on calling them a warm body and keeps them on the payroll. I told the nurse what a bad effect it had on me to know that he was getting paid the same as me and I was the only one doing any work.

Merlyn · Mar 24, 2012

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..

Don't ask them to do anything that you wouldn't do yourself if you had the time. Help them once in a while to show them you can do what you are asking of them. The worst thing for them to see is someone sitting behind the desk giving orders. Tell them some of what you have to do, say If I didn't have to do this I could help you more. Don't leave them out of the loop. Include them in discussions of patient care. I have found that the CNA's know more about the patient then anybody does because they see the patients for eight hours or more. This may not work but it is worth a try.

shellycochran · Mar 25, 2012

I was a CNA at 18 years of age, an LVN at 27 and Finished my RN when I turned 40, And I never needed anyone to tell me I did a good job to do a good job. I am so tired of being told they don't feel appreciated. We have a whole generation of techs and nurses that don't even know how to work. They are getting paid for 12 hours of work, their thank you is the paycheck they get. I appreciate it when someone tells me good job. but when I get a Good job, from someone it's because that is all I do, and I don't need a pat on the back to get it. suck it up and do the job you are getting paid for, if you don't like it get another job. The patients don't care if you are feeling unappreciated.

shannic99 · Apr 15, 2012

DON here, looking for a few good nurses.... and I can promise one thing: I do not tolerate this behavior AT ALL!!!! LumbarPain I bow to you, as you said all of the things that needed to be said! I actually ended up on this thread doing a little research on the relationship between graduate nurses and CNAs, for a final paper in the final week of my final course in the MSN program. But it was not that long ago (or so it seems) that I myself was in many of your situations. I put up with it myself as a new grad, but it did not take long and I had enough. Every CNA that worked with me from that point on knew that they would have to do their job or they might as well stay home. If they were making their rounds and a light went off, I answered it. If they were sitting at the nurses' station chatting on whathaveyou, and a light went off- they answered it even if I was filing my nails behind the desk (which I never did was just an example... between the hand washing and sliding my hand in between too tightly packed rows of bubble packed meds I had no nails to file! :) ) My point is, we each had jobs to do as part of a team. I respected them and commanded respect as well (note: command, not demand). Just like a football team: the quarter back calls the shots but without the rest of the team he is useless. On the other hand, without the quarterback the rest of the team wouldn't have a job!

I developed a way to communicate with a touch of humor that gets my point across without making the person feel a need to be defensive. For example: one morning early in my career as an LPN, I was fed up with the CNAs who DAILY stood at the nurses' station and whined and complained about assignments. They were doing so SO loudly that I could not hear the nurse giving me report. SO I grabbed the MAR and threw it to the ground. Then I think I tossed my stethoscope (by this time I had their attention) I told the other nurse loudly as I stomped my foot "I am TIRED of taking care of these same 30 people every day. I am TIRED of giving meds. I just don't feel like doing it today and I am not going to sit here and count these meds with you (BTW- she had caught on to what I was doing, no harm done there). I had 7 aides staring at me open mouthed. The other nurse asked "well who is going to do it?" As soon as I heard one of the aides say "but that's her job" and another agree, I looked up at them and smiled. They all laughed, because they understood my point. I never had that problem again. I've never thrown anything again either, but in the eight years since then have developed a personality that they respond well to. When I went back to school, my aides were my biggest cheerleaders....When I went back again after that for my BSN, the cheering continued....When I became DON, they brought me balloons...and When I commented last week that I was almost done with my MSN, they told me they said "We are proud of you..." But don't think that I am a pushover... Last week I also fired a nurse and three CNAs for absences, insubordination, and lack of teamwork. When I hired a nurse Friday, I told her teamwork is a requirement. I warned her that the CNAs might try her, but once she lets them know that SHE knows she is their supervisor, then she should have no problems. If however she does have problems, I expect her to speak to the aide, and write it up. If an aide refuses to sign there is to be no yelling or confrontation, just a "witness" signature stating the refusal to sign (can be another nurse or even another aide). From that point forward, I will handle the situation. I also back up my nurses; however, I do not put up with bullying. As I mentioned before, there must be teamwork. I stress this to the CNAs as well, upon hire and as often as needed. And while I do make certain all staff are properly oriented, I HAVE to be able to assume that during the course of their training they were taught their scope of practice (this in response to a previous comment about needing to be told on hire to assist the nurse). Just as LPNs are taught in school to supervise assistants and RNs are taught to supervise LPNs, I am 100% certain that if the aide is certified and attended a training course that was addressed in some form or fashion. And if an aide comes into my facility and tries for a second to think it doesn't apply to them, I will gladly wave to them as they leave the parking lot. Not one person, not one discipline can do it alone.... It takes the entire team!

shannic99 · Apr 15, 2012

In my research on graduate nurses I came across this cutsie poem, thought I'd share the laugh!

A Graduate Nurse throws up when the patient does.

An experienced nurse calls housekeeping when a patient throws up.

A Graduate Nurse wears so many pins on their name badge you can't read it.

An experienced nurse doesn't wear a name badge for liability reasons.

A Graduate Nurse charts too much.

An experienced nurse doesn't chart enough.

A Graduate Nurse loves to run to codes.

An experienced nurse makes graduate nurses run to codes.

A Graduate Nurse wants everyone to know they are a nurse.

An experienced nurse doesn't want anyone to know they are a nurse.

A Graduate Nurse keeps detailed notes on a pad.

An experienced nurse writes on the back of their hand, paper scraps, napkins, etc.

A Graduate Nurse will spend all day trying to reorient a patient.

An experienced nurse will chart the patient is disoriented and restrain them.

A Graduate Nurse can hear a beeping I-med at 50 yards.

An experienced nurse can't hear any alarms at any distance.

A Graduate Nurse loves to hear abnormal heart and breath sounds.

An experienced nurse doesn't want to know about them unless the patient is symptomatic.

A Graduate Nurse spends 2 hours giving a patient a bath.

An experienced nurse lets the CNA give the patient a bath.

A Graduate Nurse thinks people respect Nurses.

An experienced nurse knows everybody blames everything on the nurse.

A Graduate Nurse looks for blood on a bandage hoping they will get to change it.

An experienced nurse knows a little blood never hurt anybody.

A Graduate Nurse looks for a chance "to work with the family".

An experienced nurse avoids the family.

A Graduate Nurse expects meds and supplies to be delivered on time.

An experienced nurse expects them to never be delivered at all.

A Graduate Nurse will spend days bladder training an incontinent patient.

An experienced nurse will insert a Foley catheter.

A Graduate Nurse always answers their phone.

An experienced nurse checks their caller ID before answering the phone.

A Graduate Nurse thinks psych patients are interesting.

An experienced nurse thinks psych patients are crazy.

A Graduate Nurse carries reference books in their bag.

An experienced nurse carries magazines, lunch, and some "cough syrup" in their bag.

A Graduate Nurse doesn't find this funny.

An experienced nurse does.

lumbarpain, ADN, RN · Apr 15, 2012

Working 17 years in LTC/Sub acute has given me a BIG Red Bullet light on top of my head. (like the police cars used to have) when it comes to aides, questionable Nursing Homes, and just general staff behavior when I go on my interviews. However, most times I dont see the Aides as I am taking a TOUR of the home. At this one home I just recently went to there was an aide sitting outside having a smoke.......right away I labeled her......I shouldnt have.....I thought to myself.....does she come out here often, will she be a problem child for me on the unit where I wont be able to find her when I need her? I dismissed this immediately out of my head and continued on.

I find that the Aides will TEST you, will annoy you at first and put you on trial to see how far you will tolerate things. Its a CNA hazing. I dont think its fair, but you are absolutely correct when mentioning that its a connection you must establish with them because you work as ONE, Making a job easier with teamwork is a high priority. Having CNAS run to callbells as soon as they ring is wishful thinking but if all work together and find that working together without spending useless time complaining and working on the problem together will make everyones lives much easier. This makes the job more pleasant, simple and less physical and stressful, all will be happy campers. I have worked with nurses that WOULDNT get their hands dirty to help change a patient, or do ANY CNA work.....They would respond with..." I AM A NURSE, I DONT DO AIDE WORK, I DIDNT GET MY DEGREE TO DO AIDES WORK. I wasnt a big fan of these types of nurses. The work is not pleasant at all, not easy, not a bowl of cherries most days. Its depressing, upsetting, aggravating, stressful with little or no REAL GOOD DAYS where nothing happens at all. Then you wait.......like an asteroid coming, you wait for a code, a major fall, or a family that is super upset because something is not being done. And unfortunately it usually happens. This is the job we chose. But some are not true to the job, its just a job, I find that these are the people that should search for something else besides caring for people, cause their hearts arent really into it.

Merlyn · Apr 15, 2012

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..

Maybe if they were compensated for the bad backs,the abuse, the physical exhaustion they get things would be different. I worked in Rehab. When I took an assignment, the work was hard and brutal. In the eyes of my fellow nurses, I was just a strong back. They didn't even treat me the same way. The next day I work as a nurse. I was back in the 'family of healers'. Scores what are they? It's the patient in the bed that matters, not some score on a sheet that will be filed away at the end of the day. But as a LPN I was trained differently