What to do about CNA disputes?

estrogen · Aug 19, 2005

Oh yeah... and I would like to add. When I started three weeks ago, I thaugh that the pace was way slower here than in a hospital. Now, that I found out how much double and tripple charting I have to do, how many different checklists, and report sheets etc. I can promise that I will NEVER EVER say again, that the pace is slower and more laid back in LTC. I wish that instead of all the charting and checking off boxes I had more time to do assessments and checking on the residents and making sure that they are safe and comfortable.... :uhoh3:

DusktilDawn · Aug 19, 2005

This morning after my night shift the am shift CNA came to me and complained about my night shift CNA on her hall. This is the second time (yet two different CNA's) in a row that she complained about a couple (I think three) of the residents laying on their bed sheets instead of underneath them, two of them having the bed alarm not attached to them and one having the call light out of reach and one commode being full of BM and not emptied. This girl was livid. She interrupted me and the am nurse during narc count (big no-no, I think) and was nearly screaming at me, infront of other nurses, residents and who knows who else was standing around. I asked her to slow down and use the residen't last names instead of their first, so I can actually find out who she's talking about (I have only been there for three weeks and don't know them all by first name yet), which she didn't. She just kept on ranting.
She complianed yesterday too, but the CNA was a different person than tonight. As a matter of fact I have to admit I was under the impression that both of them were doing OK (they both were guys), because they seem pretty active, eager to help me with whatever I asked, had everything done on time, brought me the VS early etc. I even praised them which I feel horrible about now, because I feel like I might have been manipulated. ....But I'm not sure if this girl (am CNA) is not just going over board either. A very uncomfortable feeling.
Now I'm not per se disputing what this am CNA was saying, but I can honestly say, I visually checked on all 60 residents during my shift and I didn't observe them to be laying ON their bed spreads, I'm pretty positive, I wouldn't have missed such an obvious thing. However, I don't think that it is possible for me to know at all times that all the bed alarms are on the resident's, all commodes are empty and all call lights within reach on 60 residents.
So I really don't know what to do about this and am quite distraught. I had never had to deal with these kinds of CNA issues in the hospital, as they allways knew their job well, there were so many of them and so many nurses (concidering a 6:1 pt-nurse ratio and 10:1 CNA ratio as opposed to 60 pt:1 nurse and 3 CNA's) that it was pretty impossible for them not do their job. I don't enjoy confrontation at all and have a great respect for CNA's and for everyone for that matter... I mean we're all adults and on top of that, most of them are quite a bit older than me, a lot of them in this facility are men (I know, that shouldn't make a difference, but I will admit that I feel perhaps even more awkward if I have to supervise someone who could be my dad and is a military vet and has three honorable discharges) . So I really feel very uncomfortable at the thaught that I had to reprimand someone or baby-sit them and boss them around...
Yet to cover myself, I'll have to do something I guess... So I was thinking I'll call the DNS today and try to explain the situation and how I feel about it as best as I can, without disregarding anyone or taking anyone's side. I will say though that I think it wasn't appropriate to yell at me in the hallway, as the morning shift CNA did. I am pretty sure that the complaining CNA will talk to her too, so I don't want it to look like I'm ignoring the issue... Oh how uncomfortable this is! The most uncomfortable think I have encounter in nursing yet, I think
:imbar
I'd appreciate your thaughts. I'd love to hear from CNAs too.

Estrogen, take a deep breath.

You said you had an uncomfortable feeling about this situation. Did anyone verify at the time the CNA made her complaints whether they were valid? If on both nights the night shift CNAs left things as she claimed, did she offer to show anyone what she was talking about? I understand people being upset, but really, screaming sounds like overreaction to me. You also stated that you did not see any residents laying on their spreads.

I would document what you know happened when you were working with both night CNAs, and what you observed. Also I would try to document what happened as objectively as possible about what occurred with the am CNA, remember you have the other nurse you were counting with there. If the am CNA wants to write up her findings, suggest she do so. It seems odd that 2 nights in a row she has the same complaints. There may be other things going on with this person you do not know about, or an existing situation you may be unaware of. You should talk to your DNS after you have taken the time to write down what happened, that way it can be easier to relay what order events took place in, and it also gives you the opportunity to give a clear account from your perspective.

If this am CNA has complaints in the future, have her show you exactly what she is talking about, ie: full commode, call bell out of reach, etc. Eventually the truth in these types of situations come out. For now don't openly take any sides. Just deal with facts that can be proven.

It's not easy being put in the middle. I do wish you the best. :wink2:

estrogen · Aug 19, 2005

Estrogen, take a deep breath.
You said you had an uncomfortable feeling about this situation. Did anyone verify at the time the CNA made her complaints whether they were valid? If on both nights the night shift CNAs left things as she claimed, did she offer to show anyone what she was talking about? I understand people being upset, but really, screaming sounds like overreaction to me. You also stated that you did not see any residents laying on their spreads.
I would document what you know happened when you were working with both night CNAs, and what you observed. Also I would try to document what happened as objectively as possible about what occurred with the am CNA, remember you have the other nurse you were counting with there. If the am CNA wants to write up her findings, suggest she do so. It seems odd that 2 nights in a row she has the same complaints. There may be other things going on with this person you do not know about, or an existing situation you may be unaware of. You should talk to your DNS after you have taken the time to write down what happened, that way it can be easier to relay what order events took place in, and it also gives you the opportunity to give a clear account from your perspective.
If this am CNA has complaints in the future, have her show you exactly what she is talking about, ie: full commode, call bell out of reach, etc. Eventually the truth in these types of situations come out. For now don't openly take any sides. Just deal with facts that can be proven.
It's not easy being put in the middle. I do wish you the best. :wink2:

You're right, I should have had her show me right then and there what she was talking about. I also should have told her to lower her tone immediately as she is not acting appropriately and residents and staff can hear her. ...She got me so flustered! I wish I was a more assertive person.

DianeMyra · Aug 19, 2005

Yelling/screaming at you, by her, can never be OK. I'm not sure if it's within your power, but she should be warned in no uncertain terms of the dire (or should I write fire ) consequences that would befall her if it were to ever happen again. No one, especially the residents, benefits from that kind of immature drama. ~ Diane

Daytonite, BSN, RN · Aug 20, 2005

I'd appreciate your thoughts.

I see a couple of practical ways to approach the immediate problems.

One way is to take a quick check of your assigned patients just before report. Anything you observed your aides doing 7 hours before this dayshift aide came in the door don't count with regard to her complaints. Better yet, is to have each nightshift aide make rounds with you. This may be difficult for the aides to do because they are most likely busy getting people up for breakfast. However, if you make it a regular thing that you do, remind them during the night that you're going to make a final round and check their work, and then try to be consistent about doing it (although there will be times that you just won't be able to get it done). This is going to do two things for you: (1) give you first hand information of things being left undone or done incorrectly by your aides, and (2) put you in a position of possessing some facts already if one of the day aides comes to you with a complaint which gives you control over the situation. Now, this suggestion is time-consuming, for any charge nurse, so the next paragraph is, I think, a better solution.

Another way to approach this is to insist that the off-going aides and the oncoming aides make a quick round of their patients together so that any problems are nipped in the bud right then and there and face to face between the two parties involved. They should check that beds of incontinent patients are dry, commodes emptied, and have them check the bathroom for dirty bedpans and other surprises like piles of dirty linen or BM where it doesn't belong. This gives the aides a little more autonomy. It also gives you more time to complete what you have to do with the oncoming nurse. Make this something they are expected to do. When the day aide comes to you with a complaint the first thing you ask is, "Did you make rounds with (my aide, ______)?" If the answer is "yes" then you have to ask why this wasn't noticed on rounds. If the answer is "no" then tell the aide that you're busy with the narcotic count and that as soon as you finish you will go with her to the rooms so she can show you what she's found, but you expect her in the future to make rounds with your aides before they leave. Now, it's not fair to spring this kind of thing on the aides or the other charge nurses without giving them a heads up on what you are planning to do. There can also be glitches with this when you have an aide that has to leave early or a day aide comes in late.

These kind of complaints between the shifts got so bad in one home where I worked that the DON and all the charge nurses came up with a similar approach. The complaints between the shifts had been getting to be a really serious problem with a lot of animosity and hatred developing between the aides. What was happening was that the really good aides were feeling that no one was listening or doing anything to help them so they went right to the boss, the DON. She informed all the aides that it was their responsibility to make rounds with the off-going aides AND they were each to sign a little half sheet form she had developed where they listed the room numbers they had checked and both aides signed the form. Those forms were then supposed to be turned in to the oncoming charge nurse and forwarded to the DON. I know that sounds like a lot of work, but after a couple of weeks the massive numbers of complaints that the charge nurses and the DON were getting stopped. It also gave the DON irrefutable proof of whether or not a particular patient had been checked. Whenever an aide came to an off-going charge nurse with complaints, the charge nurse merely had to say, "Did you check this patient when you made rounds with ____?" which encouraged the aides to have some accountability in solving the problem. If the answer was "no" we would reinforce the policy with them by saying, "You need to make rounds with ____ so this kind of thing doesn't happen." In a case like that I would always go to the rooms of the patients the aide was complaining about in order to get first hand information to back up what I was going to say to the aide who left the mess the next time I worked with them.

Aides act out like this one did this morning because of their feeling of powerlessness. Think about it. If you are trying to get someone's attention you start out calling their name. Your voice gets louder and louder if you are ignored until you finally start shouting. You do that because you first assume they can't hear you. Then, getting no response, you begin to think that they are ignoring you and now anger enters into the situation. I'd be willing to guess that this aide has complained to other charge nurses (and all her co-workers as well) about these kinds of things before and is feeling that no one is listening to her. So, she did the one thing that has probably gotten action in her own life, she escalates to screaming. By coming to you, she actually did a very brave thing and handed you a golden opportunity to show her and the other CNAs what kind of a leader you are. This aide has not had the benefit of the training you have had, but the things she was complaining about were the most important things in her world at that moment. Recognize that, do something successful about it, and you will be a hero in her eyes.

While she absolutely behaved the wrong way, I would assume her complaints were legitimate, stop what I was doing and address her immediately. What I would do is stop the narcotic count, face her to let her know she had my full attention, ask her to calm down, and listen right then and there to her complaints without interrupting her because she needs to vent. Then I would tell her that I need to finish the narcotic count, but as soon as I am done I will go with her so she can show me these things. After rounding with her I would thank her for bringing the problems she found to my attention, apologize for her day starting off on a bad note and let her know that I am going to do something about this and discuss it with my aide. I would follow-up with her a few days later and inquire if things had gotten better and encourage her to come to me if this happened again. I can almost guarantee that her screaming tirades will stop if her problem gets attention and is resolved. I would talk with the night shift aide on our next shift together. I want to hear his side of the story. Sometimes there is a legitimate reason an aide can't complete their last round. If something like this were the case, I would let my aide know that he needs to let the oncoming aide know this. I would also advise him something like this, "Well, Joe, I think you ought to have the day shift aide make quick rounds with you before you leave. That way you have a defense if she comes to me after you've gone home and starts blaming you for leaving your people in a mess." Or, you might ask, "You've been doing this kind of work for awhile, what do you think we can do about this?" I wouldn't second-guess the praise you gave him earlier. It sounds like he genuinely earned it. You won't know if he manipulated you until you do some investigation over his next few shifts and have more information to work with.

Now, let me explain the reason I said that I would stop my narcotic count in this situation. This would be a time when I would step back from my position of authority in order to gain the respect of the aide. My co-worker, the dayshift nurse, needs to give me some latitude here and understand that I need to deal with this problem now. The narcotic count can wait a few minutes. She's not going anywhere for the next 8 hours. The oncoming charge nurse has some responsibility here as well as me. So, I want the dayshift charge nurse to hear the complaints as well. She has an obligation as a supervisor of the dayshift aide to help her deal with this problem as well as me. And, I have, in an assertive way, taken control and guided the course to be taken in this situation. (Just a side note here. . .I would be interested to know how many times any of the day shift nurses might have heard these complaints and what they each, personally, did about them.)

I hope you consider these suggestions and try them. If they are successful they will give you tremendous influence and respect with the aides and, believe me, that's a good thing to have. The aides will begin to look at you with great esteem and know you to be fair-minded. It also contributes to their feeling of pride in having done a good thing for the patients. These things are reasons good employees will stay at their employment. One of the biggest complaints I heard from LTC aides over the years is that no one listens to them. They feel so helpless. I think that this is where the dayshift aide was coming from. I always assume that an aide's complaints are legitimate unless they prove to be otherwise. In this way I'm giving them respect and recognition and demonstrating that I can be open-minded. Through our actions we can demonstrate an aide's importance and worth to the patients and our employers. Actions almost always speak louder than words.

Let me add one caveat. Nothing is full proof. A lot of CNAs will bust their butts to do what is right and only ask for recognition and approval. Even when mistakes are called to their attention, you can tell when they are struggling to do things the correct way. There is always an employee out there that just doesn't respond well to supervision. Some are just belligerent or bent on causing trouble. That is when disciplinary action must be taken: (1) a confrontation where you state the wrongdoing, (2) clear instruction given on how the behavior must change, (3) the consequences of repeating the wrongdoing, and (4) a formal write-up or documentation. That is for a different discussion and I don't think it applies to the situation you experienced today as you described it.

I know our opinions have clashed on other posts. I am offering these suggestions with the sincere hope that you will find them helpful. Nurse to nurse. In the end, you were the one who lived the situation and know all that actually went on. Good luck, Estrogen. I have faith you have it in you to step up and solve this problem so everyone comes away satisfied. Dealing with people and their feelings is one of the hardest roles of a charge nurse and supervisor; one that school really can't give us real, actual situations to practice on. It can't be learned in just a few weeks and some of these kinds of problems take longer than a few minutes to resolve because there may be much bigger issues underneath it all. Dealing fairly with subordinates is an ongoing endeavor and one that often causes us more angst than doing nursing procedures. Good luck.

caroladybelle, BSN, RN · Aug 20, 2005

Give them weapons and have them fight to the death. Just no guns...the stray bullets might cause a ruckus.

(my regrets, I thought only mature adults worked in hospitals and snippy little children stayed home with mommy and daddy)

DusktilDawn · Aug 20, 2005

Give them weapons and have them fight to the death. Just no guns...the stray bullets might cause a ruckus.
(my regrets, I thought only mature adults worked in hospitals and snippy little children stayed home with mommy and daddy)

:rotfl: :rotfl: :rotfl: :rotfl: :rotfl: :rotfl:

Estrogen, I used to cry :crying2: when people yelled at me or even if I though they were angry with me. I still have that urge when it happens, but through the years I've adapted. We all get flustered at times. Sometimes re-evaluating a situation and coming up with solutions for similiar situations in the future helps me alot.

I hope this situation improves at work. Avoid taking sides in any work place conflicts, just try to deal with the facts objectively.

Best of luck

mandrews · Aug 20, 2005

Interrupting a med count!!!! :nono: :nono:

GO TO WORK TONIGHT AND WRITE HER UP. IF WHAT YOU SAID IS ACCURATE WRITE HER UP. It is a learning experience not a punishment.

I tell my cna that during the lull when most are sleeping and they are taking their 4 o'clock vitals to make sure the trash is picked up, etc. I also check these things when I do my rounds and we are able to double check each other. It only takes a minute to assess the room condition. Some patients get used to hearing I need to see your BM or I need to know if you have a bm that they save it for you. Especially the older residents. I would explain this to her when I also discussed her lack of professionalism and the correct procedure for reporting a problem.

I PERSONALLY SLEEP ON TOP OF MY SHEETS. MY KIDS DO NOT ALWAYS FLUSH THE TOILET. :chuckle

melissa

Mandylpn · Sep 3, 2005

Give them weapons and have them fight to the death. Just no guns...the stray bullets might cause a ruckus.
(my regrets, I thought only mature adults worked in hospitals and snippy little children stayed home with mommy and daddy)

:roll :roll :roll I agree! but just try to have (I mean help) someone get fired, good luck, it takes lots and lots of documentation, even if they are on probation. Some days I feel like a babysitter. :banghead: