Im a new staff nurse, been in post for 5 weeks on a very busy hectic orthopedic surgical ward with mainly post op patients and i have 14 patients under my care. I have been working the morning shift 7-3pm with two supports (CNA/CSW) for the past three days. I have run into problems with one of these CSW's, i shall call her CSW J.
1.on day one i was discussing a problem with the unit secretary regarding a discharge that i had done the previous day as pieces of paper were missing and she was unable to file his notes due to this missing so i was trying to sort this issue out when a patient rang his bell, i continued to deal with the problem regarding the patients discharge as the unit sec was due to go home in a few minutes for the weekend and it needed sorting. CSW J decided to bellow up the hall from where she was sat at a desk playing on her phone for me to answer the call bell ' Staff nurse there is a bell going behind you ya know!' in a really nasty tone. i explained that i was busy trying to sort a discharge out, that i didnt appreciate being interrupted and could she please get the bell as she was not busy. She huffed and puffed and muttered under her breath about lazy nurses.
2. day two, i asked the two CSW's to pair up and sit the patients up whilst i started the medication round, i get half way round to discover that the patients are not sat up so unable to take their tablets or ready for breakfast. I had to hunt for the CSW's to ask them to help me sit the patients up. i found them in the kitchen doing nothing.
3.whilst i finished the medication round i asked the CSW's to pair up to do the double washes and i highlighted which patients were singles,doubles and who was independent.i then had the dr's round to do and prep three patients for theatre and escort two of them down to theatre as well as wounds to dress,etc. I come back from theatre after the 2nd patient to find a dr wanting to talk to me about a patient and whilst i was discussing the issue with him CSW J started moaning about how i havent had done any washes and that im lazy and not doing anything. She then went on to say that as i was sitting there doing 'nothing' (i was charting and on the phone to a dr) then i could do the care plans-its a rule here that if you do the wash then you do the care plan (as you saw the pressure areas/skin condition)
4. I had a patient on hourly urine measurements and after handover that morning i highlighted the key things to the CSW's which were the hourly obs/urine measurements and who they were on and i asked them if there was a problem to please let me know or if they were unable to do the hourly because they were busy to let me know so that i could do it. Well it got to midday and i was checking the patients drain site and i went to document the drainage when i noticed that the hourly had not been done since we started shift! the patient had passed next to no urine in this time.
Im sick of her attitude and having to check that she has done her job. She refuses to communicate with me and tell me how the patient is doing ie did the patient assist with their wash, refuses to listen to anything i say,for instance this one gentleman is self caring-he just needs a bowl given to him and he washes himself-but she went in there and washed him.
What can i do? How do i go about solving this problem? i cant do everything myself, i was the only nurse down this end of the ward and i had a whole list of things that had to be done and because im new to nursing i often have to find another nurse to raise a query or to clarify a question (as well as having to hang my fluids for me)
I really don't think sending them home is going to solve the OP's problem. What happens the next they work together? You think all of a sudden the CNA is going to start working because she got sent home? Wrong. The CNA/CWJ is going to make the new grads life even harder!
Be professional, and have the guts to speak the CNA and discuss the problems. Sending him/her home is only adding fuel to the fire.
Getting sent home a few times without pay may change her attitude and start to build a nice file against the person. Taking away money from someone can be motivation. True it may things worse but keep sending them home. Talking to these type of people will do nothing. You are not going to change their work ethic by talking to them.
I am a CNA and sometimes I wish the CN would have sent some fellow CNA's home. Why? Because it's obvious that the person does not want to be there. I am already picking up their slack so might as well make it official and tell 'em to take a hike.
So no, I do not think that sending the slacker(s) home is extreme at all
This is further validation of my theory that nursing schools who require applicants to first be CNAs are spot on. Not to worry, I think doctors should be nurses too.
Specializes in Peds, OB-GYN, CCU, ER, Corrections.
You definitely need to do something about this problem ASAP before some serious patient harm comes down. Nobody likes to have to write up a fellow employee especially when you're new. You can try talking to them, but these sound like some rough broads, I would want every encounter to be a witnessed one so nothing comes back to haunt you. Good luck. And btw while you're having this heart-to-heart with your manager I would bring up this 1:14 nurse to patient ratio, that's too much even for an experienced nurse. Wish you the best!
i work at the same facility where i served as a CNA. i don't recall a nurse ever writing up a CNA and i'm pretty sure all hell would've broken loose if they did. nurses did go to the supervisor and complain, and CNAs went to her to complain about nurses. maybe it was just my unit, i don't know, but my supervisor wouldn't have trusted the nurses to have that kind of authority over CNAs. just as there are "bad/lazy CNAs" there are "bad/lazy" nurses and at least on our unit it's almost impossible to keep CNAs employed. a GOOD CNA is rare. that's without nurses being able to write them up. anyway, as i said, i think it would be awesome if nurses seved as CNAs first. i truly think it would make a huge difference in the dynamic. my favorite nurses when i was a CNA were veteran nurses (who actually enjoy taking care of their patients and don't DEPEND on CNAs) and nurses who were CNAs before they were RNs. now that i'm a RN i've had CNAs ask me if i was a CNA (if i didn't tell them) and tell me that they could tell. they actually go back and forth arguing over which part of the wing they're going to work on because they always want to work with those of us who have been CNAs and tend to do more for our patients than the nurses who weren't.
Ive worked as a CSW/CNA before i got my nursing post, i did many shifts on the ward where i eventually got my job-the fact that i worked hard and got on with my jobs was one of the reasons i was hired despite not having the surgical experience.
I fail to see how me working as a CSW before i got my nursing post makes any difference to someone who is lazy and wants to collect their paycheck without actually doing any of the work involved?I have a list a mile long of nursing tasks that need to be accomplished, CSWs' cannot do any of these tasks (dressing changes,med rounds, dr rounds, drain removals, collecting from theatres,etc) Ive had a word with one of my fellow staff nurses who has had the same problems with this particular CSW. She feels that the CSWs' have no idea how much a nurse actually has to do.
If this particular CSW wants to do my job then she needs to go back to school and get her qualifications and then go to uni for three years and battle to get a job.
And i certainly do not appreciate being called lazy
my favorite nurses when i was a CNA were veteran nurses (who actually enjoy taking care of their patients and don't DEPEND on CNAs)
Hell,i could do the washes all day long but who is gonna pass the meds? ring the dr?
Ive worked as a CSW/CNA before i got my nursing post, i did many shifts on the ward where i eventually got my job-the fact that i worked hard and got on with my jobs was one of the reasons i was hired despite not having the surgical experience.
I fail to see how me working as a CSW before i got my nursing post makes any difference to someone who is lazy and wants to collect their paycheck without actually doing any of the work involved?I have a list a mile long of nursing tasks that need to be accomplished, CSWs' cannot do any of these tasks (dressing changes,med rounds, dr rounds, drain removals, collecting from theatres,etc) Ive had a word with one of my fellow staff nurses who has had the same problems with this particular CSW. She feels that the CSWs' have no idea how much a nurse actually has to do.
If this particular CSW wants to do my job then she needs to go back to school and get her qualifications and then go to uni for three years and battle to get a job.
And i certainly do not appreciate being called lazy Hell,i could do the washes all day long but who is gonna pass the meds? ring the dr?
who called you lazy? i definitely did not so that's a little suspicious that you point that out. you're right, if a "CSW" wants to do your job then she should go back to school. that's exactly what i've always said to CNAs (even when I was one) and LPNs who complained about RN pay, but we're not talking about the "CSW" wanting your job, are we? I simply said that I personally feel (as in I have a personal opinion) that it would be a good idea for nurses to be CNAs first because I don't think anyone (even if it's a pizza man) should be delegating task that they haven't done/won't do/don't want to do to other people. It's the same concept you mention that "CSW's" have no idea how much nurses actually have to do. I have to say though, I was much more frustrated with nurses when I was a CNA than I am frustrated with CNAs now that I'm a nurse. Maybe that has to do with the fact that I was a CNA (which I think is a huge part of it) or maybe it's because our facilities operate totally differently. There's no way to know.
And i certainly do not appreciate being called lazy Hell,i could do the washes all day long but who is gonna pass the meds? ring the dr?
for the record, CNA's can say the same. "hell, I can pass the meds and stay on the phone all day long, but who i going to take care of the patients?" just saying.
The point is that she has her jobs to do and she is refusing to do them. I am doing what i am required to do
You said
my favorite nurses when i was a CNA were veteran nurses (who actually enjoy taking care of their patients and don't DEPEND on CNAs)
i love taking care of my patients but i cannot do this alone, hence why there are CSWs' there to do the tasks that i have not got time to fulfill. If there is a choice between collecting a patient from theatre (which only a qualified can do) and getting a wash done then i have to go to theatre and leave that wash for the CSW.
The point is that she has her jobs to do and she is refusing to do them. I am doing what i am required to do
You said i love taking care of my patients but i cannot do this alone, hence why there are CSWs' there to do the tasks that i have not got time to fulfill. If there is a choice between collecting a patient from theatre (which only a qualified can do) and getting a wash done then i have to go to theatre and leave that wash for the CSW.
I don't doubt that if you have 14 patients that you need help which is why you have two "CSW's." This is just a touchy subject for me which is why I say (and firmly believe) that nurses should be CNAs or "CSWs" before they are nurses. The reason being - I was a CNA before becoming a nurse and actually I became a CNA to make sure nuring is something I wanted to do before I left my other profession (which I held a degree and had debt toward). I learned during that time that I absolutely LOVED working with patients, but MOST (not all, but MOST) of the nurses were LAZY and would have me do ANY and EVERYTHING I was capable of doing. Not just what they couldn't do or didn't have time to do, but EVERYTHING i was legally allowed to and some would even ask me to do things I wasn't supposed to do which I refused. It was a normal day when they took a break to eat breakfast, a break for the hell of it, and another break for lunch - all while I'd stll be getting the patients cleaned up and ready for the day and hadn't had my FIRST break. THEN there was the flip side....there were the nurses (like the veteran nurse I mentioned) who took care of her own patients and had me do things when I wasn't busy helping the lazy nurses. See, this particular "veteran nurse" I have in mind cared for TEN patients with NO HELP when she started out. The "lazy nurses" I refer to had 4-5 patients WITH help. The veteran nurse could take care of her 4-5 patients easily without needing help because she took care of 10 patients in the past with NO help so 4-5 was a piece of CAKE for her! This is why it was so funny that nurses who asked for "help" would put EVERYTHING off on the CNA's that they could possibly get away with. Not only would they do that, but they would take 2-3 breaks before the CNAs would be able to take ONE break and THEN if a patient needed something while the CNA was on break the nurse still wouldn't tend to them. They would ignore the patient and just hope that the call bell would disappear or the CNA would come away from break to help them while they sat around texting on the blackberry.
THIS IS WHY I SAY NURSES SHOULD BE CNA's FIRST! THIS IS THE CRAP THAT HAPPENED WHEN I WAS A CNA. THIS IS THE CRAP THAT MAKES ME A BETTER NURSE TODAY AND UNDERSTANDING WHAT CNA'S REALLY DO ENABLES ME TO DO NICE, HELPFUL THINGS FOR THEM AND THEY ALL LOVE ME WHICH IN TURN MAKES THEM GO OUT OF THEIR WAY TO HELP ME OUT ANY TIME THEY ARE FREE. I WENT OUT OF MY WAY TO HELP THE "VETERAN NURSE" I MENTIONED BECAUSE SHE WOULD NEVER CALL ON ME TO DO STUPID THINGS THAT SHE COULD DO HERSELF AND SHE WAS AN OLD LADY! THE NURSES WHO RAN ME TO DEATH WERE YOUNG AND AS A MATTER OF FACT MOST OF THEM HAVE NOOO IDEA HOW TO EVEN CHANGE A BED OR DO THE MOST BASIC THINGS THAT SHOULD BE REQUIRED BEFORE ENTRANCE TO NURSING SCHOOL! HALF OF THEM WOULD ASK ME TO DO SOMETHING SO THEY COULD TAKE BREAK #3 OR SO THEY COULD SIT AT THE DESK AND TALK ON THEIR BLACKBERRY. I SAW IT THEN AND I SEE IT AND ACKNOWLEDGE IT NOW! I DO NOT TAKE A BREAK BEFORE MY HELP. I DO NOT ASK MY HELP TO DO SOMETHING WHILE THEY ARE ON BREAK. I DO CERTAIN DUTIES THAT ARE "THEIR JOBS" JUST TO BE NICE! NOBODY DOES THINGS JUST TO BE NICE ANYMORE! I DON'T CARE HOW SIMPLE IT IS. DO YOU KNOW WHAT I LOVED FOR THE NURSES TO DO WHEN I WAS A CNA AND THIS IS SOMETHING I DO NOW FOR MINE? INPUT AND OUTPUT. IT'S NOTHING HARD. IT'S SIMPLE. WHEN YOU DO LITTLE THINGS LIKE THAT FOR THEM YOU BEST BELIEVE THEY WILL BE MORE WILLING AND EVEN ENTHUSIASTIC TO DO THINGS FOR YOU. MY FELLOW NURSES GRIPE ABOUT HOW I GET THE "GOOD CNA'S" TO HELP ME. YOU KNOW WHY? BECAUSE THE CNA'S GET TO CHOOSE AMONGST EACH OTHER WHICH WING THEY TAKE AND THE "GOOD ONES" WANT TO WORK WITH ME.
believe me, if your "aides" are BOTH (not one, but BOTH) frustrated with you then you are doing (or NOT doing) something! you'll disagree and tell me i'm wrong, but i know better. if for no other reason than to prove me wrong why don't you try being nice to them one day, even if you don't want to, and see what happens. let them take their break first, bring breakfast, do vitals or I&Os on a few patients...whatever it is. you can say "that's their job" or you can do it and reap the reward of an awesome environment with aides who are eager to help you. i've been there, done that, and i know what i'm talking about.
I don't doubt that if you have 14 patients that you need help which is why you have two "CSW's." This is just a touchy subject for me which is why I say (and firmly believe) that nurses should be CNAs or "CSWs" before they are nurses. The reason being - I was a CNA before becoming a nurse and actually I became a CNA to make sure nuring is something I wanted to do before I left my other profession (which I held a degree and had debt toward). I learned during that time that I absolutely LOVED working with patients, but MOST (not all, but MOST) of the nurses were LAZY and would have me do ANY and EVERYTHING I was capable of doing. Not just what they couldn't do or didn't have time to do, but EVERYTHING i was legally allowed to and some would even ask me to do things I wasn't supposed to do which I refused. It was a normal day when they took a break to eat breakfast, a break for the hell of it, and another break for lunch - all while I'd stll be getting the patients cleaned up and ready for the day and hadn't had my FIRST break. THEN there was the flip side....there were the nurses (like the veteran nurse I mentioned) who took care of her own patients and had me do things when I wasn't busy helping the lazy nurses. See, this particular "veteran nurse" I have in mind cared for TEN patients with NO HELP when she started out. The "lazy nurses" I refer to had 4-5 patients WITH help. The veteran nurse could take care of her 4-5 patients easily without needing help because she took care of 10 patients in the past with NO help so 4-5 was a piece of CAKE for her! This is why it was so funny that nurses who asked for "help" would put EVERYTHING off on the CNA's that they could possibly get away with. Not only would they do that, but they would take 2-3 breaks before the CNAs would be able to take ONE break and THEN if a patient needed something while the CNA was on break the nurse still wouldn't tend to them. They would ignore the patient and just hope that the call bell would disappear or the CNA would come away from break to help them while they sat around texting on the blackberry.
THIS IS WHY I SAY NURSES SHOULD BE CNA's FIRST! THIS IS THE CRAP THAT HAPPENED WHEN I WAS A CNA. THIS IS THE CRAP THAT MAKES ME A BETTER NURSE TODAY AND UNDERSTANDING WHAT CNA'S REALLY DO ENABLES ME TO DO NICE, HELPFUL THINGS FOR THEM AND THEY ALL LOVE ME WHICH IN TURN MAKES THEM GO OUT OF THEIR WAY TO HELP ME OUT ANY TIME THEY ARE FREE. I WENT OUT OF MY WAY TO HELP THE "VETERAN NURSE" I MENTIONED BECAUSE SHE WOULD NEVER CALL ON ME TO DO STUPID THINGS THAT SHE COULD DO HERSELF AND SHE WAS AN OLD LADY! THE NURSES WHO RAN ME TO DEATH WERE YOUNG AND AS A MATTER OF FACT MOST OF THEM HAVE NOOO IDEA HOW TO EVEN CHANGE A BED OR DO THE MOST BASIC THINGS THAT SHOULD BE REQUIRED BEFORE ENTRANCE TO NURSING SCHOOL! HALF OF THEM WOULD ASK ME TO DO SOMETHING SO THEY COULD TAKE BREAK #3 OR SO THEY COULD SIT AT THE DESK AND TALK ON THEIR BLACKBERRY. I SAW IT THEN AND I SEE IT AND ACKNOWLEDGE IT NOW! I DO NOT TAKE A BREAK BEFORE MY HELP. I DO NOT ASK MY HELP TO DO SOMETHING WHILE THEY ARE ON BREAK. I DO CERTAIN DUTIES THAT ARE "THEIR JOBS" JUST TO BE NICE! NOBODY DOES THINGS JUST TO BE NICE ANYMORE! I DON'T CARE HOW SIMPLE IT IS. DO YOU KNOW WHAT I LOVED FOR THE NURSES TO DO WHEN I WAS A CNA AND THIS IS SOMETHING I DO NOW FOR MINE? INPUT AND OUTPUT. IT'S NOTHING HARD. IT'S SIMPLE. WHEN YOU DO LITTLE THINGS LIKE THAT FOR THEM YOU BEST BELIEVE THEY WILL BE MORE WILLING AND EVEN ENTHUSIASTIC TO DO THINGS FOR YOU. MY FELLOW NURSES GRIPE ABOUT HOW I GET THE "GOOD CNA'S" TO HELP ME. YOU KNOW WHY? BECAUSE THE CNA'S GET TO CHOOSE AMONGST EACH OTHER WHICH WING THEY TAKE AND THE "GOOD ONES" WANT TO WORK WITH ME.
believe me, if your "aides" are BOTH (not one, but BOTH) frustrated with you then you are doing (or NOT doing) something! you'll disagree and tell me i'm wrong, but i know better. if for no other reason than to prove me wrong why don't you try being nice to them one day, even if you don't want to, and see what happens. let them take their break first, bring breakfast, do vitals or I&Os on a few patients...whatever it is. you can say "that's their job" or you can do it and reap the reward of an awesome environment with aides who are eager to help you. i've been there, done that, and i know what i'm talking about.
Specializes in Trauma Surgery, Nursing Management.
Easy, JSlovex!
"why don't you try being nice to them one day, even if you don't want to, and see what happens."
The OP never said she was being unkind to them. She is asking them to do their required work. She outlines and states her expectations at the beginning of the shift (very professional, OP). When she realizes that her pts were not sitting up (one of the tasks that she asked the CNAs to do) prior to administration of meds, she searches for the CNAs and found them in the kitchen. That's pretty blatant disrespect, not to mention puts the OP way behind now because she has to sit her pts up THEN administer her meds. She had a well thought out plan to increase efficiency (again, very nice job on your part OP) but the plan went south because her team mates didn't complete their part. With 14 patients to tend to, you have to use every trick in the book to increase and streamline efficiency, and the OP is trying to do just that.
The worrisome part of your dilemma, OP, is that your CNAs are putting your pts at risk. I can't believe they didn't chart the hourly UOP. A doc does not order hourly UOP for the fun of it. It scares me to think that this pt hadn't passed much urine since the beginning of the shift when you found this out at midday.
I was a CNA as well. I worked 2 nights a week, every weekend and every holiday while I was in nursing school. I chose this route so that I could transition well into the nursing workforce. You can bet your bottom dollar that I busted my butt the whole shift. I didn't care what the assignment was, I didn't care if the nurses were taking a break, or if they were chit chatting. I had MY duties to attend to, and didn't worry about what the nurses were doing. My job was to complete my tasks on time, and do so without them having to ask me.
OP, talk to your NUM. See what she can do to help you delegate. Are other nurses on your ward having this same issue?
ckh23, BSN, RN
1,446 Posts
Getting sent home a few times without pay may change her attitude and start to build a nice file against the person. Taking away money from someone can be motivation. True it may things worse but keep sending them home. Talking to these type of people will do nothing. You are not going to change their work ethic by talking to them.