Role of CNA

[gpmedsec]

I am a new LPN working on a dementia unit at a long-term care facility. I was not a CNA before nursing school and my school didn't provide a lot of training for basic nursing care, other than bed baths and transfers. I am in charge of the CNAs on my floor during my shift. I been here three weeks and feel the CNAs are not doing their job and are taking advantage of me. I've walked into a patient's room and seeing two CNAs looking at a cell phone which is against policy. I also have difficulty finding out which CNA is scheduled on a patient when that patient needs toilet it.

I am not sure of their duties and feel uncomfortable reprimanding them. Can someone give me any advice in this situation? I don't want to start this job being taken advantage of by the CNAs.

[bugya90, ASN, BSN, LVN, RN]

I was the same as you. My first job as a new LVN was the local LTC. Many of the CNAs were actually people I went to high school with which made it doubly hard to enforce the rules. What you have to realize is if the CNA screws up, it's your license on the line. My number one thing was no cell phones until the work is done and no phones where residents can see you (I worked nights a lot so the cell phone policy wasn't very strictly enforced). They are probably testing you because you are new and they want to see what they can get away with. Once you reprimand and write up 1-2 people, they will stop testing you.

If you need to know their schedule, ask you DON for it. Our CNAs had to report to the nurse at the beginning of each shift and we gave them their assignments. If you want a list of their specific job duties or job description, your DON can get that for you too. You should also discuss with your DON what type of disciplinary action you are aloud to take and what needs to be reported up the chain of command for management to deal with.

[LPNtoRNin2016OH, LPN]

The problem is you have "rules", this is very hard for nurses who didn't not work as CNAs to understand. Your not creating a co worker environment that encourages cohesiveness, your demanding a totalitarian one. If you find a cna on their phone (as long as they aren't taking pics etc) let it go and say "hey do you mind getting Jane's call light while I get Bob some ice?". Your reinforcing that they are there to work without making them feel they are being watched. If its a chronic issue, go up the chain of command, usually you remain anonymous. Doing what above poster said to do will result in very angry and resentful aides. Start encouraging, complimenting, and jumping in where you can to help. I have been an lpn for 8 years so I get LTC is busy but you will be surprised with what positive uplifting actions can do vs making them feel like your itching to write them up. Depending on your state, the aide isn't even working under your license technically because only the RN can technically delegate nursing tasks. I realize this isn't always the case because LTC is mostly lpns but if an aide does some sort of neglectful care, like lets say not having two sides spot the Hoyer and pt falls, you would not have action brought against your license for that unless someone told you and then you did nothing to ensure the pt was ok. And stnas are at the bottom of the totem pool (which they shouldn't be) and are paid crap, those factors combined with authority happy nurses makes for bad environments. Bottom line, treat them like co workers. If people aren't being showered etc, ask them why before you start in with the disciplinary action. And as I said if it becomes chronic, take it to command. Your sides will become your lifeline if you can become a effective leader.

[quiltynurse56, LPN, LVN]

What is your facility's policy towards cell phones? If they have a policy of no phones on the floor, you start there. Remind them of this and have them put their phones in their bags or lockers.

One evening, I had a CNA not exactly complying so I ended up taking hers and locking it in the med room until the end of shift. Ask management what you are suppose to do if they don't comply with keeping them off of the floor.

[princesscoronado]

Seems like you need to take the time to study the scope of practice of an NA. How are you suppose to delegate task and enforce proper ways to do tasks when you say yourself you don't have much if any experience

[vintagemother, BSN, CNA, LVN, RN]

Honestly....LPNtoRNin2016 made a good point in my opinion, regarding not addressing the phone usage while asking the CNA to complete a task.

I employed tactics like this when working in an LTC/SNF.

The CNAs working with my residents weren't near as hostile toward me as the other nurses.

And when CNAs unite in solidarity, in order to do less tasks... That's awful. I observed CNAs tattle on nurses and refuse to do basic duties when it came to the other nurses. [emoji45]

At the end of the day...I don't care if you're on your phone. It doesn't affect me, as long as they do their jobs. But if I ask you to turn, feed or toilet someone, you better come running.

And I'll gladly assist. After all, we're all a part of the "team"!

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