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

NotFlo · Apr 15, 2012

The worst thing for them to see is someone sitting behind the desk giving orders..

I get your point but honestly...when the end of shift rolls around the CNAs will be history, while I'll still be sitting there hours later trying to finish my charting. If I get a few minutes here and there during my shift to sit and chart you bet I'm going to do it. I'm sorry if it upsets the CNAs to see me sitting there charting (or sitting at the desk getting info from charts to place a call to the doctor, or scheduling an appt, or calling for a stat lab or chest x ray, or any of the other things I have to do at the desk each day) or if they resent me for it but charting on 20 or more medicare pts on first shift is no joke.

I do help them whenever I can with whatever I can but if I help them every moment I'm not actively giving meds or doing treatments or completing assessments I'll be there 24/7...I can help them but there's no one available to help me with the tasks I can't complete because I spent that time helping the CNAs.

NY RN 1 · May 5, 2012

You sound like the person I want to work for... Someone who holds people accountable for their actions or inaction. I trained as a CNA and received my certificate at age 17 and worked in a nursing home for the summer before I started my senior year. I did home care for a year (mostly quadriplegics) and worked in a hospital as a nurse's aide and secretary (at times) for 3 years before getting my RN, and have continued to work there for the last 15 years. And most of these years, it has been relatively good place to work. Until, of course, I took a job on a unit where some of the aides and secretaries are not only downright disrespectful, but insubordinate and verbally abusive as well.

As a nurse's aide, I never asked the RN's to help me with a bath or to help me to toilet people. We had 2 aides for 20 patients and if I needed help, I would get the other nurse's aide.. When a nurse asked me to do something, I considered her to be my boss and I did what she said without hesitation and I certainly never talked to her disrespectfully or refused to do something. And, I never worried about how much work the nurse was doing... whether she was sitting at the desk or in a patient's room. I did my job, so the nurse could do the work she was required to do.

Being that I have done both CNA, secretary, and RN work, I know that I have a better understanding of the physically and emotionally demanding job that all of the jobs require. I enjoy working as nurse... But... and this is a big one.

I can't tolerate working with such disrespectful (to both staff and patients) and insubordinate people. An example of one incident was when I had finished going over discharge paperwork with a patient and asked the aide chatting and drinking coffee with the secretary at the nurse's station if either one of them could do vital signs on the discharged patient and take them out to their ride. The nurse's aide, in a very sarcastic tone, said to me "you know, nurse's can do vital signs, too." I replied to her, that "I know they, but can nurse's aides check a blood glucose and change the rate of the insulin drip?" At that point she walked away. And I, turned to the case manager (whom I was the nurse's aide for over 10 years prior to this incident) and asked her... "did I ever talk to you like that when I was your nurse's aide?" She looked at me disgusted and said no.

I even had a nurse's aide yelling at me when I asked her if she entered a heart rate of 32 on patient was correct or a typo (i had already checked on the patient by this time). Not only did she enter a critical heart rate on a patient and not inform me immediately, but she couldn't remember if it was correct or not. I told her, if she wasn't sure, then she needed to go into the computer and "unchart" it. She said she couldn't because she was already on overtime and had to leave and she would do it tomorrow. During this, she is screaming at me in the hall and I told her she needed to stop yelling and she yelled right back and said "No, I'm not going to." And, when I told the manager about this and we met with her, along with the director present, I was the one that got yelled at for not communicating with her.

It's unbelievable how some of the support staff are so busy watching to see if we are working (because some don't believe we are working if we are at a computer charting or preparing medications). One nurse's aide, even went to a manager to get it so she did not have to leave a patient's room while doing her bath (which supposedly took over an hour) because it would be too hard to leave an isolation room. I asked the nurse's aide if it would be safer for me to be interrupted while I am passing medications in another patient's room to answer a call light. I don't mind helping patients with their ADL's, but when it jeopardizes patient safety because I can't perform critical tasks for my patients, like getting a blood transfusion started and doing a tap water enema on the same patient in order to get them to the GI lab to be scoped (all within a half an hour) to stop the bleeding, ADL's become last on my list of priorities.

In detention centers, the residents are not even allowed to speak at all while the nurse is passing medications. If they do, they have privileges taken away. The nurse's aide and secretary feel it is okay to interrupt us during med pass.

I am currently looking for another position, but in the mean time, I pray I can make it through each day without patient's being harmed from the flat out refusal of some people to answer call lights.

rgroyer1RNBSN, BSN, RN · May 5, 2012

My aides are awesome even if it is at the hospital, I am er and sicu nurse manager, and I will get out and do aide work even if I am a Bsn, and Msn, I started out as a Cna in ltc, then bacame an lpn ans worked at both the hospital and ltc as an lpn, then I got my ASN, BSN, then MSN, I went through the ladder as it was instilled in me by my mom as she went through the same thing, my grandmother her mom did, and my great grandma my grams mom didnt though she was an Lpn, then a good old.diploma Rn and a very renowned head nurse at the TB hospital in her time, I always try to encourage my CNA's to go back to school, and like I said my cna staff is excellent and we could never do without them, and my little sister is going through the same clinical ladder and I raised this girl as we are several years apart, and she works in my er as a cna right now I am so proud of her and she graduates from lpn school in three weeks, and back on topic the only thing some of my cna's do that really aggrevates me is when a light is going off and they have a saying that is famous among some of my cna's and nurses, and this is my biggest pet peeve that I am trying to put a stop to is when a light is going off and it never fails I have a few nurses and cna's that likw to use the all to famous saying and phrase "That is'nt my patient", I am trying to put a stop to it, if any one knows how please let me know. I mean I am the nurse manager and I answer lights and work the floor quite a bit right along my nurses and cna's, and I have never said that when a light is going off and I am the manager, this is really my only problem with my staff, and.I could care less about their smoke breaks as long as their work is done, as I am guilty, I smoke too, I started in lpn school and havent been able to break the habit. Lol

rgroyer1RNBSN, BSN, RN · May 5, 2012

And btw why we are on this topic, none of my Cna's or Pct's would'nt dare to act this way torward any of my Rn's or Lpn's, because they know how I am as their nurse manager and supervisor, and if they acted this way they know their @sse$ would be written up so fast and disciplined so fast their heads would spin and I make this very clear to them all the time, so I feel for all of you all the time, also I feel that if an aide of mine was as disrespectfull and yelling at any of my nurses like some of the aides talked about in this post , I think in very blatant terms I would either dismiss/suspend-without-pay/terminate them immediately, I am serious as cancer if I found out one of my aides acted like this torwards any of my nurses, be it Rn or Lpn, as nurse manager I would feel obligated to terminate them immediately. Best wishes.Rod Rn, Bsn, Msn, Ed/Sicu Nurse manager

sauconyrunner · May 5, 2012

Its a tough thing to motivate CNA's. They are not paid well, have sometimes very heavy assignments (in so many ways, people are fat these days!), there is very little respect given to their job, etc.

3 things that I have done that are painless, and generally easy and seem to have helped is to

1. Thank you aide for whatever they have actually done. Tell them you really appreciate that they took Pt A to the bathroom

or whatever. People like to be thanked.

2. Ask the aide's advice on something. "I noticed Mr. J's appetite has really gone down. what do you think is going on?" The Aide may know that his family has not been visiting as often, or that he hates the last 3 meals with broccoli. THe Aide may not contribute anything of value, but you gave them an opportunity to share information and show them that you value their ideas. You don't have to act on any of this, but you can say "Oh thanks...I appreciate you sharing that idea with me"

3. I try as much as possible to learn a little bit about the Aide's lives at home. This way I can ask, "How is your Dad doing? How are the kids....Did you see Dancing w/the stars? I just think so and so should have been thrown off- what do you think?

But if this stuff does not produce results, YES...write their behinds up. You would not put up with a nurse doing that...why an aide?