Unruly CNAs, how to get them moving?

brownbook · Oct 4, 2019

I don't know where you work. Acute care hospitals are very different from skilled nursing facilities.

Very, VERY, generally speaking your CNAs were working, doing their job competently, before you were hired. Maybe before you even started nursing school. They know what to do, when to do it. They don't really need much overseeing from a new grad LPN.

Of course there will always be one or two who cause problems.

Give us specific examples of the "bad apples" behavior and we may have some tricks that work.

Your new unit manager is an example of an idiot, a "bad apple". She gave you no guidance and her comments about directing and controlling your CNAs is a very humiliating and degrading way to refer to co-workers. They are not cattle!

Guest219794 · Oct 4, 2019

Read your post, then noticed your credentials.

With 4 years as a CNA, it seems like you probably know as much about the subject as anybody.

People are motivated internally or externally. Some people are just wired to do a good job regardless of the circumstances. Many need motivation- some combination of positive consequences for high performance, negative consequences for poor performance.

I work in an environment in which there are no rewards for excellence, or consequences for mediocrity. As a result, there is a wide spectrum of performance, and we are all paid based on years of experience.

old&improved · Oct 5, 2019

I wish I knew the answer. I have similar problems with a CNA who will graduate nursing school in 1 more semester. She has to be told constantly to do things she should already know (she has been working at the hospital for more than a year). And this girl hopes to work at this hospital as an RN after she graduates! She is the least productive or proactive person I've ever seen. She has been reported to the bosses (by several RNs) and I think she has been spoken to because she improved ever so slightly (she now asks once or twice a shift if there's anything I need for her to do). I can only look forward to her graduation and moving on to another place.

I realize I could report her further, but it seems pointless since she will be moving on in about 7 months. If I am asked by the bosses I will tell them what I think, but I don't think her problem is fixable because it's not a lack of knowledge, but laziness and attitude.

brownbook · Oct 5, 2019

I've read here, from other respondents on similar issues, that often management is fully aware of these "bad apples" and eventually they are terminated. It sometimes takes a while to "properly" fire an employee .

EDNURSE20, BSN · Oct 5, 2019

Calling them “your” CNAs for a start is not good and is probably shows how you treat them. They are there to do a job, not just run after you. Treat them with respect, thank them, and most importantly work as a team.

Editorial Team / Moderator · Oct 5, 2019

Atilla the Hun said "take one head." ?

JKL33 · Oct 5, 2019

On 10/3/2019 at 9:48 PM, Nurse Pure-Spring said:
New nurse here, and of course we have not yet grown our big boy pants! However, when work needs done it needs done. I think I do a decent job at assigning tasks and requesting a reasonable amount of work for my CNAs to perform. Most of my aides are good and know what to do, others are not so. My question is, how - as a new nurse - can I get my CNAs working better and more efficient without sounding like a jerk or the “mean nurse”? ALSO let me not neglect to mention one of our new Unit Managers called me “green” for not being able to direct my CNAs and control them.
Yours truly,
Nurse Pure-Spring

I see it this way: They were doing the job before you got there. That is to say, this isn't much of an emergency and things aren't going to happen overnight. I doubt that, as a new grad, you were brought in to correct whatever CNA-related problems may exist. Sooo...

The best thing you can do is get up to speed on your end of things. Concentrate on learning to perform the RN role well. That is best for the patients and best for you personally/professionally. There is a close-to-0% chance that you are going to improve the performance of the CNAs (if that is indeed necessary) when you don't have your own feet underneath you just yet. I mean this in a friendly way: You need to improve your own performance (Right? That is the goal of all of us when we are new at something ?).

Begin to develop a rapport with the CNAs.

If there are truly unacceptable things going on, don't condone these; report them. Don't make the mistake of making big compromises in attempt to ingratiate yourself. But other than those (important) points, you aren't in a position to get into the finer details just yet.

Generally speaking, people's cooperation is gained through basic kindness and treating them with dignity the way most all people want to be treated.

Good luck!

Tron8622 · Oct 6, 2019

Since you are new Im gonna give it to you straight . Nursing and politics are a synonym. Nowadays you are considered a great worker 1. in that you work well , very rare in this age of nursing . 2. are friends with the boss very high in this age of nursing . Chances are your problem CNAs might be lazy , cant keep up the work , or are friends with the boss and know a paycheck will be there regardless of who you are . I would just delegate the tasks to the CNAs and allow them to choose who is doing what and right down who chooses to do wat . Divide and conquer. I have seen my problem CNAs get eaten by the wolves once the hard working cna got to choose their own tasks once delegated to them as a group . Also Id becareful of your boss your problem cnas might already be putting you on the chopping block

RN_atlast · Oct 7, 2019

Work together with them. Show them you are not above doing something, that goes a long way. As a new grad you are pressed for time, making it hard to help out.

Nurse_Mike, ADN, RN · Oct 7, 2019

Working in different facilities, I, (as no doubt most others) have seen different variables and mindsets. I have saw large facilities that were perpetually short-staffed, where everyone worked as a team, and worked well together and it was in this environment that the lazy or political would not survive long. Then comes the rinky dink, mickey mouse facilities with not much going on except for politics and laziness. Most employers in all fields have openings, and I had read in a book recently how the underlings really can have the power over their bosses because they really control the quantity and quality of work. Years ago, there were times when jobs were hard to find, and when someone found one they did their best, as they were raised to do. I agree that a hard work ethic can be an innate quality, and I have also seen well run units that would not tolerate nothing less than the best efforts on the part of all staff. Hiring like minded-personalities based on myers-briggs/keirsey has proven beneficial as well--as opposed to a crew that does not understand each other ect...

TheMoonisMyLantern, ADN, LPN, RN · Oct 7, 2019

I think managing CNA's is different in LTC than it is in Acute care. In acute setting most of the care is delivered by the nurse as the CNA usually will have 1/2 the floor or the whole floor. In LTC most of the care is given by the CNA's because the nurse has 1/2 the floor or the whole floor. LTC management typically has the assigned nurse working as the immediate supervisor of the CNA's and holds the nurse responsible for any lack of care or mistakes that the CNA's may make. Because of this when you have a CNA that is unmotivated it can and does come back on the supervising nurse (been there done that). And while getting in the trenches to do the dirty work is good for morale and important for nurses to do, when you have 30-60 patients AND you're a new grad it is very difficult to manage one's time well enough to be able to do that.

Please know I'm not trying to be diminutive to acute care folks, just having worked both there is a different mindset in LTC when it comes to working with CNA's.