What if CNA won't work?

Specialties Geriatric

Published

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.

Specializes in Gerontology, Med surg, Home Health.

Amen, Sister!! Charge Nurses are supposed to be in charge of their units, their CNAs and their residents. Too many nurses look to someone else to get things done. I have nurses call me to tell me that the CNA needs to be written up for being insubordinate or not doing their job and when was I going to do it...yikes! I politely tell them that THEY are the charge nurse and I would be happy to sit with them when THEY write THEIR CNA up. If you give the responsibility of discipline to another, you will never get respect from your co-workers. It's not easy to counsel someone, but it is certainly more effective coming immediately and from your direct supervisor.

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Specializes in geriatrics, telemetry, ICU, admin.

A lot of stuff you brought up! I was a CNA for 3 years and have now been an RN for six. It is true that you should teach. I follow my new CNAs (I don't get very many, I don't have a lot of turnover) as they do their rounds. I saw one go into a room for a few minutes and then leave. My first clue was the light never went on!! I went up to her and asked if the resident had been changed and she said that she had. I replied "Well, we need to check." Wet, of course. I changed the resident with the CNA's assistance. This CNA decided that the night shift wasn't for her, after all. It takes a lot of time and spot checks, but being a team with individual autonomy and trust is great! Hope this helps.

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Amen, Sister!! Charge Nurses are supposed to be in charge of their units, their CNAs and their residents. Too many nurses look to someone else to get things done. I have nurses call me to tell me that the CNA needs to be written up for being insubordinate or not doing their job and when was I going to do it...yikes! I politely tell them that THEY are the charge nurse and I would be happy to sit with them when THEY write THEIR CNA up. If you give the responsibility of discipline to another, you will never get respect from your co-workers. It's not easy to counsel someone, but it is certainly more effective coming immediately and from your direct supervisor.

Capecod - that's great if the nurse is allowed the TIME to supervise! In our facility, the day RN has the largest med passes, the most treatments, plus dealing with doctors, families, and whatever else the DON decides to dump on her for the day. There have been major problems on that shift with the CNA's and the nurse is ready to quit. I wouldn't have her job for anything!

More and more, I'm seeing a lot of the problems in our facility caused by ineffective management. I've had good ones over the years and I know what they look like, and this gal isn't one of them.

I've also listened to you and some of the other supervisory people here, and you guys GET IT, but this one is just sad.

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I'm a cna and dislike cna's that don't do their jobs. If your in charge don't put up with lazy cna's. Your residents come first. Follow your company policy on discipline. Let's get rid of those that don't care. Just like with me when I go to work I do what my nurse's ask me to do. They help me and I help them. I worked in a facility where the NA's ran the 3 -11 shift and it was sickening. So if there are any NA's reading this post get off your butts and do your job and most of all respect your nurse's and residents and to those who do their jobs Hats off to you.

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CNA's are responsible to do their jobs, just as we nurses are.BUT I do have to say here that a CNA has a VERY demanding ,physically grueling job that is underpaid and under appreciated. If LTC facilities were forced to put the needs of the patient first and properly staff their facilities things just may improve. BUT if wishes were pennies Id be rich, the only way to get LTC owners to do the right thing is to FORCE them to do it legally, UNIONIZE, step number one, better laws protecting patients and staff, and MOST IMPORTANT, decent OVERSIGHT by the regulating bodies.

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I sent out a memo to all my CNA's. VS must be done by such and such time, I & O must be properly recorded, etc and that I would be making rounds at such and such time, about an hr before end of shift to make sure all rsd were reasonably dry and clean and if things weren't done on time (unless there is an emergency) then they would be written up before at end of shift. It is working great! All the CNA's support me and understand I just want the rsd taken care of and that I depend on them to be able to do my own job. I cleared the memo w/ the DON ahead of time. I never spoke to the admin about it but he came to find me the day I handed out the memo and thanked me. He said this was the leadership he had been looking for and that it could mushroom "into bigger things". I have never been in a leadership position before so this was a scary step for me. But w/ 3-7 women working in one hall someone has to lead and it is our job as charge nurses on the unit to lead.

I am a nursing student and an aide and I take a lot of pride in caring for my patients. Some, as we all know, do not and this makes your policy important. The only problem I have is regarding vs and I&O's. My floor's policy is that all qshift vs are to be charted with in 1 hour after your shift begins so the docs don't have to look for them. This makes sense unless you have a heavy load of patients. Making one round to do vitals can take longer than an hour if you have multiple incontinent pts, some needing two aides to change the linens, pts who need assistance to the bathroom, as well as pts in pain (which needs to be reported to the nurse ASAP in my opinion) and confused and agitated pts. I see normal vs being charted "on time" as very low priority in comparison to pt care. I have been criticized by nurses before because a doc asked them for the vs on a stable pt while I'm busy cleaning up the pt with c diff. I understand it's frustrating, but surely ppwk is secondary to the physical needs of the pt.

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First, try not to work in the same facility in which you were a CNA. Its a very difficult transition to get them to accpet your authority. And YES it falls on you for any poor care being given. Long term care is known for these problems. Just pray they dont have a union, then its really impossible.

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Specializes in Gerontology, Med surg, Home Health.
CNA's are responsible to do their jobs, just as we nurses are.BUT I do have to say here that a CNA has a VERY demanding ,physically grueling job that is underpaid and under appreciated. If LTC facilities were forced to put the needs of the patient first and properly staff their facilities things just may improve. BUT if wishes were pennies Id be rich, the only way to get LTC owners to do the right thing is to FORCE them to do it legally, UNIONIZE, step number one, better laws protecting patients and staff, and MOST IMPORTANT, decent OVERSIGHT by the regulating bodies.

Ingelein-If I posted a question on here about a good pie recipe, I think you would yell to the apples to unionize. It is not the answer to every problem...and you obviously have never been involved in a survey in the state of Massachusetts....oversight?!?!? cripes there is a regulation for everything in this state!

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Dear Cape Cod Mermaid,any good pie recipies?That actually was funny, I practised my union song on the pumpkin pie last night! But seriously, having alot of regulations , does not mean they are enforced.Last year here in Wisconsin ,the head of the SE branch of the BQA was fired because of lack of follow through.There was a huge shake up in a few nursing homes, FBI rolling out boxes and boxes of records, plastered all over the TV for days.The nursing homes in question had so many violations that were just allowed to slide from year to year, until the families got together and got the DOJ involved.There is an expose written by a former Wisconsin State Examiner, Mary Richards Rollins,called "Patients, Pain and Politics", talks about the coruption of the BQA here in Wisconsin.Have you ever talked to any of the nursing home reform advocates? They have alot of evidence that there has been a pathetic lack of enforcement of all those nice regulations.Do some research, maybe even you will be surprised.You know I am not even in nursing anymore, was for 27 years.I want SO much to help you nurses who are still in the field, as well as my own daughter ,an RN in the Navy.I have NO connections to any union, but I do have another daughter who is a employment/labor attorney and oh boy , the stories I have heard!Until you personally are in the position of needing protection and find yourself facing 4 people from management with no one allowed in the room with you, you will understand what I am trying to do here.

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Specializes in psych, geriatric, foot care.

Of the union talk for a moment.

If your CNA's won't work ie...change a brief when asked. Tell them you are writting them up, change the brief yourself if you can (ie..have time) or delegate it to someone else and document the incident, then follow-up with the DON.

In your example of the brief, if I were the one in charge I would have said, "I realize it may be _____'s resident but I asked you because they are not here" I would also be very nice saying this but I would follow through with the above if they didn't comply.

If you appear weak then they will walk all over you, be fair but not easy.

I also agree with some of the others that it can be difficult taking charge over people you have worked side by side with. I tend to ignore the way others treat me and focus on the way they treat the residents because they don't have to care for me...but they do need to care for the residents - its their job. I also tend to stay out of squabbles b/w staff unless it affects client care.

I find managing co-workers like middle mangagement and everyone knows middle management sucks.

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Specializes in Geriatrics.

Wow! Great! Terrific! What A Glorious World You Livein, But Believe Me They Remember More The People That Walk By And Do Nothing......its Your License!

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:nurse: I have a question for you guys. I work with this one CNA who is very rude, selfish, cold, neglectful and lazy. She is sloppy too. Well, we work second shift and when we clock in and get our lists and reports, she'll start to to PM care on all her residents. I'm not talking about the ones who go back to bed for dinner/bedridden, comatose patients. She'll take the ones who eat supper in the dining room and do pm care and put johnnnies on them and then wheel them back to the dining room.

So after supper, she'll just put them back to bed w/o changing them or washing thier faces and she''ll leave the bedridden patients unchanged and not turned. She'll hide in the dayroom watching TV with her feet up on a chair (like her living room) while the other aides and I bust our asses answering lights and putting residents to bed. One night I worked with her short of one aide; and she pulled the same stunt, finishing her pm care before supper and hiding in the dayroom. I had 3 hoyer lift patients on my list and she refused to help me stating she was on her break; which lasted until 10:00 rounds. I had to call a fellow aide on the other wing to help me since the nurse was busy with meds.

:trout: She doesn't understand the concept of teamwork; despite being an aide for about 8 years. She's fresh and has a big temper. She doesn't take corrective, gentle criticism at all. She started working last fall; on her first day orientating with another aide on the floor, she kept snapping at her that she's not a retard and been a CNA for 8 years. The orienting CNA was just introducing her to the residents and talking about routines and showing her the linen carts and stuff. But she took it the wrong way. So she ended up with a list on her own. She obviosly didn't want to work with her orientator to help get residents up and hoyered; she said to the charge nurse, "I'm not a child, I work alone.":(

I asked her why her patients were in gowns in the dining rooms and she snapped that her list is hard and she wants to finish early and to mind my own business. But one of the residents she had in a gown always had her son come over to feed her supper every night and he would be upset if he found her not properly dressed. I addressed it to the charge nurse and all she said was that I have to work it out with her and she was not a cna babysitter.

Well, I try to set a good example with that aide by helping her out with patients and telling her that we work together as a team and not against each other. Teamwork actually gets work done more effectively and quickly. But she cops an attitude and calls me bossy and I'm not her charge nurse.

She was written up last month for not putting on a tab alarm on a resident and refusing to check on him during rounds. The administrator is keeping an eye on her attitude and bad behavior after she yelled and screamed at another CNA and nurse.:uhoh21:

She yelled at me a few times in front of patients and visitors for being bossy, interrupting her while she was on her socalled break, and for taking too long in the shower room. She hoyers pateints by herself but will tattle on other cnas who do the same. One day she was wheeling the hoyer lift to a residents room and I nicely asked her if she needed help, and she snapped, "What? Do I have the right to use the hoyer lift? Do you need it right now?" I was like, "Whoa, calm down. I'm just offering to help you. We're a team and hoyering patients takes 2 aides to do." She started cussing me out in French. (She's Haitian.) and told the administrator that I tried to snatch the hoyer lift from her. :madface:

Now she's supposed to be watched by them, but they are afraid of her since it was rumored that she threatened to sue them and turn them into the state for discriminating her for her being Haitian. The charge nurse started to get tough and write her up for her bad attitude, but administration does nothing. I went to the DNS about the aide putting gowns on her patients before dinner but she told me to discuss it with the aide and I should worry about my own list and my work.:nono:

I'm so F@CKIN fed up with everything!! I hate being one of the only aides that care and not being appreciated by the administration. Most of the other aides aren't much better than Miss Attitude. I work with only 3 good aides now. Most of the other aides I used to work with quit or went on night shift, or got fired for closing thier eyes for a second. Do you have any suggestions or comments about Miss Attitude's early pm care and bad attitude? :trout:

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