What would you do about this issue?

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Hi Ladies,

To make a long story short....I have a dilemma which involves a primary CNA on a dementia unit. Help me out please ! :) There has been an ongoing issue where she believes she is able to do just about anything she wants despite my delegation efforts. For example, constant smoke breaks, constant phonecalls with her family/children that take her off the floor, neglecting patient care and when finally done doing it half ass, taking unauthorized breaks sleeping in the break room and always having an excuse every time she is confronted. She always has an emergency and leaves early from work per my ADON and has multiple call outs. I've made my ADON and DON aware of the issue and asked that she be moved to a different unit....worked for maybe a day, then surprise surprise look who is back on my unit. My bosses just don't seem to care,they even had a full blown search for her during the work day because she could not be found for over 45 minutes. Yet no consequences....

I don't mean to sound "whiney"...but what is one to do when upper management is aware of the issue ,yet do nothing about it??? Not only that, but what would you do as a nurse when you don't want a full blown unprofessional confrontation because being professional just won't work in this situation. Write ups are as good as a piece of trash in my work place and hold little meaning. I'm getting frustrated because the care provided to my patients is a direct reflection on me. I'm tired of other CNAS complaining to me when i feel as though I've done all that I can. Any advice would help!!!

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Write her up. Every time. Create a paper trail for administration. And it will let her know that you are paying attention, and will hold her accountable.

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if this is a corporate situation, the compliance hot line might work

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Specializes in Psych, long term care..

Go up the chain - to HR.

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Specializes in Psych, HIV/AIDS.

What would happen if you gave her absolutely NO assignments? When she comes on duty tell her she has to sit in the station, out of the way, but visible...kind of a "time-out" chair. Let her know that she doesn't do jack anyway, so she can visibly sit, in front of EVERYONE, and watch the world go by, as everyone else does their fair-share. Perhaps if you humiliated her in front of her peers it might wake her up to do something.

This may backfire, be ready for that, but maybe a few (many?) shifts in the 'time-out chair' could make a difference, somehow. She doesn't do any thing any way, so you are not really short-staffed. When she is in her time-out chair attempt to put her in a place whereby she can't be social with others.

As far as being unable to find her for long periods, isn't this patient abandonment? How would your superiors respond to that accusation?

I feel your frustrations, hope you find a solution SOON!

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I kind of like the time-out chair idea but I think it would backfire on you!

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Order food where she wants to eat for the both of you and and down and have a come to Jesus moment with her. Tactfully, lay out your expectations of her that coincide with her job duties. Sometimes, ppl have expectations that others justify not having of themselves. They fall in to habits that sometimes they inherited from the poorly performing preceptors they had. I can't remember if you said you did or not, but if you do not say anything....if you are not direct in what you like and don't like (even though they should know better!) you can hold them accountable until you hold yourself accountable first. Do not go off assumptions that you're on the same pg but she she simply just wants to write her on page in a book that's not hers.

Tell her, the little old ppl she cares for DID NOTHING WRONG, BUT GET SICK. They saved up 50,000 to but because low end LTC is at least 5,000, that money is gone in 10 months. If I'm paying 5,000 a month I WANT QUALITY SERVICE, don't you?? Somebody tells them when to eat and go to bed and they wait on others to help them if they mess their pants. We shower when we want. It's Thursday. They may be told they have to wait to shower till Friday. They have cared for others all their lives and they are at our mercy most of the time to help them. One day she just might be in their position. Let her know she is not in this alone...she is their to aid you in caring for them and you appreciate her...you couldn't run the unit without her. (By the way, the best ran units are the ones that have CNAs/Techs who think they are running the show. Give her that if you haven't already.)

Do you two talk about your personal lives at all? What I'm getting at is maybe if you work to build more commeraderrie with her and other CNAs in the future it will also build in them that drive to at least want to help you and be around even if that drive isn't their bc of motivation to simply help pts/residents the best way they know how. Sorry for the poor analogy but it's almost like a mommy daddy relationship were the closeness of you two dictates how well you take care of the helpless ones under your care. You're a not a team but that doesn't mean you can't be tonight...or the next time you work. Encourage her by letting her know that a job well done may make her feel good even better herself....it will give her a sense of pride and dignity in a job well done. Be willing to compromise. Let her sleep on her freaking BREAK. It's her time off the clock and she is of no service to the job, awake or asleep. Maybe you already do, but I remeber when I was a CNA, when a nurse jumped right on in and offered to help with a few pts during a round (under the guise or sincere intention of just wanting to see how the pts/resident's backside was looking ) my respect for them sky rocketed. At the same time, I genuinely cared about the residents/pts I took care of. I'm sorry you're in this situation but it will not last for ever and you will get through this.

I'm just throwing out ideas....you can throw them back.

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I think you went about it wrong, even though I'm a nurse of three days, I will share my little insight. When dealing with this cna 1st I would have pulled her aside and told her in a professional and respectful manner on how her taking long breaks is unprofessional. Then i would have said you have to understannd these people depend on you. Then I would have told her this is a warning the next time i will have to write her up. Yeah, she might yell, curse you out, ect.. But do her like you do residents who are difficult, smile, politely say okay, and walk away. The 2nd tiime I would've written her up and made copies and showed the DON, telling how I feel. Also, letting them know that my job and professionalism is on the line, cause people look at me to be in charge of the unit. If nothing was still not being done I would go to corporate, your proof is your copies. I guarantee soomething will get done; because corporate is like the kryptonite for nursing homes. But let me warn you if you do this you won't have a problem with the CNA; but the DON will be up your ass.

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Go up the chain, all the way to the administrator if you have to. This CNA is putting the patients assigned to her at risk. Is a patient going to have to get injured before this person loses her job? I would do it nicely, but try framing your next complaint/write-up in the context of patient safety/liability; sometimes the brass don't respond to anything but the threat of angry family members and lawsuits. It also protects you, in that you have it on paper that you anticipated trouble and tried (repeatedly) to get something done about it, so they can't throw it in your lap when something does happen.

Good luck.

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