What if CNA won't work?

PeachPie · Apr 28, 2006

Oohhhh gotcha. I profusely apologize. I know what you mean. Some of these same people had no problem referring to me as "the chinky-eyed girl" even though they were hypersensitive to anything that could be remotely interpreted as racism.

chadash · Apr 28, 2006

I really really need to resist this compulsive urge to post! I keep on saying, I am going to quit, but like an alcoholic with an apartment above a bar…

There IS a real problem of some CNAs not caring for their patients, disappearing without notice, and just plain being lazy.

There IS also a problem with CNAs being abused, overworked and disrespected.

It is really not either/or, it is both. Unfortunately, some managers deal with NAs in such a way that they discourage the ones who want to give quality care, and retain the ones who don’t give a rat’s a@@.

I approached a shift manager in LTC once about the NA to pt ratio being such that I didn’t feel I could give the level of care my pts deserved. She replied that if they made the ratio more reasonable, the other NAs would just sit more, and I would be the only one still working and giving more detailed care. I left her office scratching my head; I guess I succumbed to the “baffle them with absurdity” method of management. I do think she was sincere, but pt care did not improve.

If I were in management, I would make pt ratio such that all essential task could be performed in a dignified and timely manner, and any one who did not do their job would be fired. Plain and simple. Give your employees task that you can reasonably expect them to perform, and require that they perform.

anniev · Apr 28, 2006

I am an LPN in LTC for 12 years now. Do on to others ... I like to be told I do a good job, I tell people when they do a good job, I thank them . I like to be listened to when I speak, I listen when others speaks . I like to use my talents without having to ask permission, I adore an STNA who comes with and assessment or their own " Mr X felt warm I took his temp it was 101! he's breathing kind of fast too.I laid him down put a cool cloth on him and told him I'd get the nurse.' Thank you so much for your observations I'll check him right now. and I like to follow up with " Mr X had a UTI with + nitrates your excellant observations prevented him from becoming septic! Great Job! I truley try to keep every thing with a positive note . I love when there is time to teach my STNA's by letting them listen to lung sounds explaining what it means and what can be done then when I am not around they may hear moist cough or respers and ;)think there is a connection , I feel they and I come off more professional this way .

st4wb3rr33sh0rtc4k3 · May 3, 2006

Oh this was just the forum I was looking for. :banghead:

I am a New Grad, Staff Nurse RN, been on my own for a week now. Was a CNA for 5 years before that. I work different shifts and what makes it hard is managers don't agree on things. So when I try to delegate tasks it makes me look stupid or like I don't know anything. This has happened twice. First, I was calling for some residents to come back from Activities for the podiatrist and finger sticks. I was bumrushed by the a Nurse Manager and Activities Director for getting the times wrong and the rules. They did it in front of CNA's and Residents. Then, I was told by one Manager to pass something on and then another Manager in front of a CNA that I delegated to, told me someothing different. This particular CNA she said that in front of I have a hard time delegating with. I feel it is because I am doing tasks "on my butt" writing nursing notes, orders, etc. that she is taking advantage of me. The CNA's during the day and evening are great! They do everything they are suppose to. Well, I guess I will have to be alot firm now and ask my Staff Administrator on some "delagating" skills.

GLORIAmunchkin72 · May 3, 2006

No nurse should be put down in front of his or her subordinates or publicly. It totally undermines authority. I would like to extend that to any employee. Discipline should be done privately.

Oh this was just the forum I was looking for.
I am a New Grad, Staff Nurse RN, been on my own for a week now. Was a CNA for 5 years before that. I work different shifts and what makes it hard is managers don't agree on things. So when I try to delegate tasks it makes me look stupid or like I don't know anything. This has happened twice. First, I was calling for some residents to come back from Activities for the podiatrist and finger sticks. I was bumrushed by the a Nurse Manager and Activities Director for getting the times wrong and the rules. They did it in front of CNA's and Residents. Then, I was told by one Manager to pass something on and then another Manager in front of a CNA that I delegated to, told me someothing different. This particular CNA she said that in front of I have a hard time delegating with. I feel it is because I am doing tasks "on my butt" writing nursing notes, orders, etc. that she is taking advantage of me. The CNA's during the day and evening are great! They do everything they are suppose to. Well, I guess I will have to be alot firm now and ask my Staff Administrator on some "delagating" skills.

AMINI'SNURSE · May 3, 2006

i would have change the women myself.. and not let her sit there until shift change then i would have reported him/her to the don...when i was a cna i remember one time this women was asking for a sweater and 3 nurse were at the desk taking not passing meds or everything like that just talking about the one nurses vacation and they did'nt get this women her sweater but that they did do is wait for the cna to get off her lunch break and get the sweater for the women...that sicken me you have some nurse who think they're to good to do anything else but pass meds..well im a lpn now and when i done passing meds i don't spend time at the desk talking i spending helping my pts anyway i can if it's a pain pill or bed pan...

romie · May 6, 2006

I am a department head and manager in my facility. Even though I am not a nurse and not the department head of the nursing/ CNA department, I am empowered to supervise the CNA's, just as every department head has that responsibility, whether they are th Social Worker, MDS coordinator or Activity Director. The biggest problem in our facility is that the department heads dont enforce rules consistently, so the CNAs look at us like freaks from another planet when we question them about their patient care or call them on their slacking or bad attitude. To make matters even worse, alot of the nurses act less like nurses with a license and patient to protect and more like medication aides who couldn't care less what the CNAs were up to. So there is inconsistent enforcement or backing up of the department heads or other managers who attempt to supervise the CNAs. If I were a nurse working in long term care, one of the first things I would do is sit the CNAs down and say "I am not laying my license on the line so that you can sit around and talk about last week's party while Jane Doe marinates in her excrement and developes sore and infections." It may seem a little harsh, but I am fairly passionate about the care that my residents recieve. I am very encouraged by this thread, seeing that there are nurses that care and supervise the CNAs.

st4wb3rr33sh0rtc4k3 · May 6, 2006

I like the fact that you mention others manager us that are not nurses. Working together as a team is important. That is what we are there for. Although, I pass medications sometimes I have to stop in my tracks to help out. Some say I need to stop it for time management, but it is my responsibility not only theres. Luckily most of the nurses I work with are that way. Especially during rounds or dinner time. You have to keep an eye on everybody.

I am a department head and manager in my facility. Even though I am not a nurse and not the department head of the nursing/ CNA department, I am empowered to supervise the CNA's, just as every department head has that responsibility, whether they are th Social Worker, MDS coordinator or Activity Director. The biggest problem in our facility is that the department heads dont enforce rules consistently, so the CNAs look at us like freaks from another planet when we question them about their patient care or call them on their slacking or bad attitude. To make matters even worse, alot of the nurses act less like nurses with a license and patient to protect and more like medication aides who couldn't care less what the CNAs were up to. So there is inconsistent enforcement or backing up of the department heads or other managers who attempt to supervise the CNAs. If I were a nurse working in long term care, one of the first things I would do is sit the CNAs down and say "I am not laying my license on the line so that you can sit around and talk about last week's party while Jane Doe marinates in her excrement and developes sore and infections." It may seem a little harsh, but I am fairly passionate about the care that my residents recieve. I am very encouraged by this thread, seeing that there are nurses that care and supervise the CNAs.

emeraldjay · May 6, 2006

As an aide that has to deal with the occasional co-worker that won't work, I can completely empathize. What I don't get is when someone says that so and so is a fantastic aide, when all I ever see so and so do is find ways to get in everyone else's way, check up on the other aides, and basically wait for someone else to do the job they could have done alot sooner if they hadn't been checking up on everyone else. This same aide came in for her regular 7-3 shift while I was finishing my 11-7 assignment and at first acted like she was going to help me finish my final am care, all she did was stand around asking me if I knew how to do this and do that but not really helping. I really wanted to go off but bit my tongue because the resident was right there.

Next episode when I finally blew, I had been told at 6 that I had to stay late, she pulled the same stunt. Since we are allowed a between shift break when our 11-7 assignment is finished I was about to leave to take it, and this aide screamed in front of the nurses station to one of the nurses, "I thought they were staying through breakfast." My response, "None of your people are even out here and I am taking my between shift break." then out the door I went.

This aide has also been known to say that we should answer some bells because the sound was getting to her. Sorry but while I'm am washing the last bit of poo and urine from a demented Mrs X's behind at 0630 just so she doesn't have to hear call bells.

Being told by our head nurse that the 11-7 crew has to get 10 people out of bed washed and dressed, of which 2 are self-care with the rest requiring both aides to be in the room because they're too time consuming for day shift really gets to me, especially when I see the some of oncoming crew sitting down for their own breakfast as soon as they punch in. This isn't a slam against the day shift, just those chosen few that do decide that it's night's fault that their job doesn't get done.

Daytonite, BSN, RN · May 6, 2006

ntcomplt8265. . .i'm sorry you're having a rough go of it. i've been in nursing for 30 years, worked in both the acute hospitals and nursing homes as a staff nurse and in supervision and management. one thing i can tell you that i have observed is that many nurses get their first opportunity to get into supervision and management in nursing homes. they want those positions, but it doesn't necessarily mean that they are trained or competent in them. a big problem i saw with hospital nurses who came into nursing homes to work was that many just did not understand just what kind of power and authority a charge nurse has or how to use it, or just the reverse, they let the power go to their head and were like bulls in china shops running rampant over everyone's toes. nursing homes expect their charge nurses to be authoritive and to manage both staff and patient problems. handling staff problems, particularly when you have to deal with insubordinate or sassy nursing assistants, is a total enigma for many charge nurses. i learned how to handle these things the old fashioned way--through trial and error. i made plenty of mistakes along the way. and, believe me, i am very sympathetic to what you are going through. i don't think that delegation is your problem. are you sure your problem is with delegation and not with getting up the nerve to speak the words to the cnas--that's more in the line of assertiveness and it just takes practice and courage on your part.

first of all, if you haven't had a course in assertiveness techniques look for one offered by continuing education companies. an 8 hour seminar in assertiveness or on how to deal with difficult people in the workplace is also a good investment of your time and money.

second, the first problem you need to tackle is your nurse manager and other ancillary workers (activities director, you mentioned). they are undermining your authority in front of your subordinates. you need to stop that. they are either doing it because they are truly ignorant of the proper way to correct someone's behavior or they are competitive and actually trying to make themselves look better by making you look bad in front of your subordinates. you have to speak to them individually and tell them that you would appreciate it if they would correct you in private rather than in front of the people who you are supposed to be supervising as it undermines your respect and authority with them. if you find it too difficult to do that, not a problem. the next time they do something like that, stop them in their tracks and say, "hold on a minute. let's speak in here." and direct them to a private area. think about what you will say and practice it in your mind so you'll be prepared to say it if the time ever comes. this way you control the situation in a respectful, assertive, professional way.

i didn't quite understand what the problem with your cna was. however, i've had plenty of experience dealing with cna problems as well. i wonder if the original op ever got her problems solved. i know what i would have done, but that's long past now. one of the reference books i keep at hand is managing difficult people: a survival guide for handling any employee by marilyn pincus. it very positive in it's approach. sometimes when you're dealing with nasty cnas you have to be more hard-handed.

GLORIAmunchkin72 · May 6, 2006

Medication Aides do not have the authority to supervise CNAs. As a matter of fact one tried to and got in trouble.

I am a department head and manager in my facility. Even though I am not a nurse and not the department head of the nursing/ CNA department, I am empowered to supervise the CNA's, just as every department head has that responsibility, whether they are th Social Worker, MDS coordinator or Activity Director. The biggest problem in our facility is that the department heads dont enforce rules consistently, so the CNAs look at us like freaks from another planet when we question them about their patient care or call them on their slacking or bad attitude. To make matters even worse, alot of the nurses act less like nurses with a license and patient to protect and more like medication aides who couldn't care less what the CNAs were up to. So there is inconsistent enforcement or backing up of the department heads or other managers who attempt to supervise the CNAs. If I were a nurse working in long term care, one of the first things I would do is sit the CNAs down and say "I am not laying my license on the line so that you can sit around and talk about last week's party while Jane Doe marinates in her excrement and developes sore and infections." It may seem a little harsh, but I am fairly passionate about the care that my residents recieve. I am very encouraged by this thread, seeing that there are nurses that care and supervise the CNAs.

st4wb3rr33sh0rtc4k3 · May 11, 2006

thanks so much for the tips... i am definately going to look into it... :thankya:

ntcomplt8265. . .i'm sorry you're having a rough go of it. i've been in nursing for 30 years, worked in both the acute hospitals and nursing homes as a staff nurse and in supervision and management. one thing i can tell you that i have observed is that many nurses get their first opportunity to get into supervision and management in nursing homes. they want those positions, but it doesn't necessarily mean that they are trained or competent in them. a big problem i saw with hospital nurses who came into nursing homes to work was that many just did not understand just what kind of power and authority a charge nurse has or how to use it, or just the reverse, they let the power go to their head and were like bulls in china shops running rampant over everyone's toes. nursing homes expect their charge nurses to be authoritive and to manage both staff and patient problems. handling staff problems, particularly when you have to deal with insubordinate or sassy nursing assistants, is a total enigma for many charge nurses. i learned how to handle these things the old fashioned way--through trial and error. i made plenty of mistakes along the way. and, believe me, i am very sympathetic to what you are going through. i don't think that delegation is your problem. are you sure your problem is with delegation and not with getting up the nerve to speak the words to the cnas--that's more in the line of assertiveness and it just takes practice and courage on your part.
first of all, if you haven't had a course in assertiveness techniques look for one offered by continuing education companies. an 8 hour seminar in assertiveness or on how to deal with difficult people in the workplace is also a good investment of your time and money.
second, the first problem you need to tackle is your nurse manager and other ancillary workers (activities director, you mentioned). they are undermining your authority in front of your subordinates. you need to stop that. they are either doing it because they are truly ignorant of the proper way to correct someone's behavior or they are competitive and actually trying to make themselves look better by making you look bad in front of your subordinates. you have to speak to them individually and tell them that you would appreciate it if they would correct you in private rather than in front of the people who you are supposed to be supervising as it undermines your respect and authority with them. if you find it too difficult to do that, not a problem. the next time they do something like that, stop them in their tracks and say, "hold on a minute. let's speak in here." and direct them to a private area. think about what you will say and practice it in your mind so you'll be prepared to say it if the time ever comes. this way you control the situation in a respectful, assertive, professional way.
i didn't quite understand what the problem with your cna was. however, i've had plenty of experience dealing with cna problems as well. i wonder if the original op ever got her problems solved. i know what i would have done, but that's long past now. one of the reference books i keep at hand is managing difficult people: a survival guide for handling any employee by marilyn pincus. it very positive in it's approach. sometimes when you're dealing with nasty cnas you have to be more hard-handed.