What if CNA won't work?

[Josifek]

Hello. I've had something on my mind for a while and I was wondering if anyone here could give me some input. I will be (God willing) an LPN in three months. I intend to work in long term care upon graduation. I have been working as a CNA for some time now and have come across other CNAs who couldn't care less about their work and are guilty of flat out neglect and abuse. Y'all certainly know what I'm talking about so I don't need to list examples (a CNA working 11-7 who makes his first round at 0530 would be a good one). I know this doesn't apply to all or even to most CNAs but I've seen enough of these types to make me worried about how to handle it when (if) I become an LPN. Is it possible for an LPN to get into legal trouble and even be barred from nursing if neglect by an aid on his/her shift is proven? How can you possibly keep up with 30 something residents being clean, dry, repositioned, etc. as well as pass meds, do treatments, and chart? Today I worked with an aid who sat and watched basketball while her resident's brief was falling to her knees. The nurse mentioned it to the aid and her response was that the resident belonged to another aid (not true) so the poor woman just stayed like that till shift change. If you had been this nurse what would you have done? How do y'all handle this type of thing? I dont want to be a hard a** but I more than that dont want to loose my liscense! Thanks for any responses.

[Town & Country]

What you would do if you see an aide leaving a resident in wet briefs or something like that is to tell them to get the resident cleaned up.

Period.

If they refuse, put it on a level they can understand:

"Clean them or clock out and go home."

Then follow through.

Of course you have to have your DON's backing, which is where the problems come in.

I've actually worked in LTCs where the aides run things. You have, too, evidently, to even be asking.

Have a meeting with the DON before you are hired or start work and go over things with her to make certain you have their cooperation.

Then go from there.....

[lovingtheunloved, ASN, RN]

You're in charge, it's your rear on the line, the resident's care is the priority, and if the aide doesn't like it, too bad. Send them home.

[chadash]

Fire them, doggonit! I am soooo sick of this!

[JKDON]

you know the posts you are getting are all correct. as a cna who became and lpn and then rn then don in the same facility, this is the hardest way to grow up in nursing. people don't always forget your mistakes, and the "since when do we have to listen to you" mentality can be so hard. if you choose not to stay in the same facililty, follow the advice you saw here. ask the don how she want this kind of thing handled, make sure she is in sync with you. ask what kind of authority you have and how she wants you to follow up. give examples of how you think you would handle it. nursing school does not prepare us for this, i'm sorry. keep notes on what you did say to your aides and fellow nurses. keep your don informed and try to start with any aide by taking a teaching approach. assume they need training which may keep you from coming across too strongly. as much as you want to rip them out, it is not appropriate. at your nursing meetings express your concerns and see if your coworkers are on the same page. if the other nurses are letting things slide, you may have the loneliest job in the building. no matter where you go to work, walk in assuming it will be done the way it should be, then teach, teach teach, and if that doesn't work you have to take direct action. the worst is to say nothing. and last, you cannot expect things to change, or be done the way you want if you are sitting at a desk. let your staff see you out there. your example is vital. eventually, they will perform better just because you are there. who knows what happens when you are not, hopefully you find a few who care, who can motivate the others. keep your staff in on the successes and outcomes, praise them for that. good luck.

[southern_rn_brat]

I learned a big lesson just a few years ago and I've been a nurse 10 years. I had to learn to ASK the CNAs and nurses to do something instead of TELLING them. JKDON is so right. Get out there on the floor and be seen. Someone else had some good advice when they said to follow thru with what you said you will do (ex "do it or clock out and go home"). If the staff thinks you are a pushover they will push you to the limits but if they respect you, they will work together with you. Nothing beats team work!

[chadash]

One thing I learned is you don't always know the whole story. On my first nursing home job as a CNA I was working nightshift in an altzheimers unit. I was behind security doors with about 25 pts, (half were mine) and also had another 6 outside the doors. We were never to leave the secure area unattended, but unfortunately the one nurse and NA working with me that night would disappear for long periods of time, and I would get in a real fix trying to tend to my pts outside the secure area. One of them was on restraints and would try to slip out of them at her own peril. I was constantly concerned she would strangle herself, the old sweety. Well, I ended up tending to the whole 25 behind the doors most of the night, running to do the other 6 best I could. That night, the nurse cleaned up a urine spill in one of the pts rooms, and left the cleaner behind. I caught old Ted about to take a drink. She also left the chemical cabinet unlocked. I locked it and made no fuss. Should have known. I would be the one in trouble by morning.

Well, morning shift came in , and I did not have one of my patients dressed. I begged my nurse to please explain, but no, I was not to leave till I did it. My kids would be late for school. It hit me, I could cover everyones bummies all night, but that did not mean I would get an inch in the morning. Oh well. Things are not often what they seem. At least by Gods grace the pts made it through the night without incident despite the fact I was all they had. It is hard to be on both sides of a door at the same time!

[JKDON]

You know this is true also chadash. Sometimes there is an underlying cause for the work not getting done. It is the 1 hr break at teh desk with lights going off that our poor charge nurses are fighting with. I"m lucky to work where I do but I have heard horror stories and as an NA I've seen it as well. A good charge will ask first shoot later.

No?

[chadash]

Oh, I would still fire her. I don't care whose patient it is, no briefs go unchanged if it is within my power to do so.

I can't bear to think how uncomfortable a wet dangling brief could be! That is just mean.

[chadash]

It just hit me, to be a good nursing assistant, you don't have to be a rocket scientist. It just takes empathy.

[smiley22]

AHH yes, I remeber my first 2 months and still (since I've only been an LPN for 8 months) that was one of the hardest things about my job...i was respected greatly by family memebers and they always came to me to make sure the job got done...but you can't keep going behind the same aides and med aides to make sure they are doing there job...you know who works and who doesn't...you will always have your problem workers...have to stand up for your residents...because that's why you have a job!!

[Noryn]

Unfortunately most LPNs and even RNs in nursing facilities cannot just "fire" a worker. There is usually a chain of command and a discliplinary process to follow. Usually you have to document the disclipline process such as the first warning being a verbal, the second being a written, the third being suspension and the final being termination. Most facilities also offer a plan of correction which may include teaching.

Most CNAs are really good, they have a calling and do something most people wouldnt dream of doing. Their pay is lousy and the actual work is very hard on them and their bodies. So when you have CNAs that provide good care you have to encourage them, compliment them often and help them whenever you can. Nursing homes along with hospitals are horribly understaffed.

Now that being said there are also an unacceptable number of aides who do not perform their job as they should. When you see one that is not, it is your duty to talk to them and explain to them that their job is to take care of the residents. This wont always be popular and you will make people mad. You need to talk to the charge nurse and the DON in these cases and explain the problem.

If I would have been the nurse that saw the aide watch tv while a residents brief was down I would have stated to the aid, "Lets take care of this patient, I need you to help me." If they would have said it was not their patient, I would have responded to them, "No but it is someone's wife, father, (whatever the case may be) and you need to help me." Usually this works. If I was busy giving medication or assessing a patient I would have just told them that I was busy but since they were watching tv they could help.

You just need to be prepared for whatever excuses or statements they come up with. One time an aide told me in front of a family, "Well nurses just dont give us any respect and we are not important to nurses." I was then able to respond truthfully, "Really, well I disagree with you and as a matter of fact I married a CNA."

You are professionally and morally responsible for the care your patients recieve. We dont live in a perfect world. Sometimes you can get in trouble for doing the right thing. When you see a patient, think of them as one of your family members (dont call them mom though!) and do everything in your limited ability (limited because of understaffing) to make sure they get the best care possible.

I will leave you with this little piece of advice. As a new grad you are going to have a lot to learn. Some of these aides and situations will be intimidating. You do have a trump card that most people dont realize. Call the state board of nursing to report a situation you think is harmful or neglectful to the patient (if it is involved with nursing care). Despite some places that are claimed to be "run by the aides" once the regulatory agency becomes involved (some boards may refer you there) they will take true control of the situation. But you should only do this when all other options fail. I have never had to resort to calling the state board over CNA issues as I was always able to work them out with the staff or DON. I have had families report a CNA to their regulatory board and I will tell you first hand it is not a pleasant experience.