What is the Problem?

[rkumiwcc]

I worked hard to get my license, and even harder to find a job. I actually found one really close to my house! Who would've thought right? Some of the staff were really calm and patient with me, especially since I'm a brand new nurse.

However...the hostility and disrespect doesn't come from any of the nurses...its from the CNA's! Even when listening to a conversation between some of the CNA's and the LPN's or RN's, they are very disrespectful. When asked to complete a task, there is constant eye rolling, sucking teeth, and sarcastic responses. If you pass a CNA in the hall and ask a question, they'll keep walking and act as if they didn't hear you. I didn't realize I'd be working with so many unprofessional people. I'm very kind to all of the CNA's because as far as I'm concerned, they work hard. To have to clean 10-15 people, feed them, toileting them, and documenting on time? Their jobs aren't easy. But come on...quit being so rude.

However since I've been here I've heard many mumblings about how some CNA's are upset because the new LPN's are young and inexperienced, and they don't appreciate someone younger than them telling them how or when to do things. I think with some, its a cultural thing which is understandable but there isn't any excuse for the disrespect. At the end of the day, its the patient that suffers as a result of the poor work ethic existing in my facility. The supervisors have been aware of the disrespect for some time, but are slow moving to handle it because its such a touchy topic. Anyone else out there, new and experienced, know what I'm going through? Any advice on how to deal?

[calivianya, BSN, RN]

I saw the same problems with CNAs in the hospital I worked in as a CNA. I just don't get it. Some of the people with the worst attitudes were also those that had been there for years. Yes, the job sucks - but guess what? There are plenty of other occupations that pay more than CNAs at entry level if they resent where they are so much. CNAs make $10 an hour here, the hotel I worked at as entry level customer service paid $10.50, for example, and there are a lot more grunt work hotel jobs than CNA jobs around here because there are a heck of a lot more hotels than hospitals and nursing homes put together. They could also go back to school if they're so unhappy with people younger than them telling them what to do so they could be the RN/LPN giving orders instead. So what's the deal? I just wonder if some people like to be miserable and like to treat others badly. It's not like anyone is forcing them to be CNAs forever. We get to pick our own occupations.

/soapbox.

[RNGriffin]

We have pcts in our hospital, and I can totally understand where they are coming from when they suck their teeth at some of the nurse( especially the newer licensed nurses). Many new grads believe their job is solely to administer medication and start iv lines and all other work is the responsibility of the tech( cna in your case). We have many nurses who will enter a patients room leave with the room destroyed or press the call light for a tech to assist the patient to the restroom, change the television, grab a bag of ice, or even in the middle of a transfusion assess the vitals.

While I am by no means the perfect nurse, I believe in the word teamwork and assistant. They're there to assist me with task that I am unable to perform. I will not send a tech running the entire floor of 15-22 patients at a time to do my assessment gathering.

[Nurse2long]

I think it would be helpful in this situation to involve the CNAs in the decision making and planning of care for the patients and see them as valuable team members. I find CNAs can share great information related to their observations and relationship with the patients. I have had great working relationships with the vast majority of CNAs in a variety of settings. It is important to be a leader and offer respect to all members of the healthcare team. Sometime you have to give first to receive mutual respect in return....and I am not saying you are not doing this already...just persist :-) They really do have a tough job and so do the nurses. It can be a stressful work environment and I think sometimes they may feel like they are the low man on the totem pole and have no input. Sometimes we, as nurses, are stressed ourselves and may interpret someone's behavior as rude when they may just be overwhelmed or overworked. Communication is the key...Just ask them if everything is ok and get a conversation going. Don't wait on management to fix it because it probably won't happen. On the other hand, I am sure management would welcome any ideas or solutions that would improve teamwork and co-worker relations. You could score points with management if you are innovative and solution oriented. Better to just communicate I think....Best of luck.

[TheCommuter, BSN, RN]

The CNAs' attitudes might be the result of them not wanting to at work there in the first place. A huge number of the CNAs in my city (and many other cities across the US) are part of a "forced workforce" due to welfare-to-workfare regulations.

Many of these mostly single mothers would much rather stay at home and raise their children, but they are being forced into accepting certain jobs in order to keep certain public assistance benefits such as food stamps, section 8 housing and welfare payments. The welfare-to-work programs tend to track women into jobs that entail quick training and little formal education such as nursing assistants (CNAs), dietary aides, childcare workers, etc.

When we've got a literally forced workforce of caregivers in America's nursing homes, bad attitudes happen because many of these single moms simply do not want to do backbreaking CNA work.

[xoemmylouox, ASN, RN]

The CNAs may also feel disrespected. Perhaps some of the nurses at your facility do tend to treat them poorly?? I have worked with many nurses who act superior and completely disrespectful. Granted being passive aggressive and rude is not the adult way of handling this either. I think the issue is the huge amount of stress that is involved. We are taking care of more patients, that are sicker, with less time. Staff get upset at each other and things breakdown making work even harder. Continue to show them the kind of nurse you are, while letting them know you won't tolerate their behavior.

[LadyFree28, BSN, LPN, RN]

I think it would be helpful in this situation to involve the CNAs in the decision making and planning of care for the patients and see them as valuable team members. I find CNAs can share great information related to their observations and relationship with the patients. I have had great working relationships with the vast majority of CNAs in a variety of settings. It is important to be a leader and offer respect to all members of the healthcare team. Sometime you have to give first to receive mutual respect in return....and I am not saying you are not doing this already...just persist :-) They really do have a tough job and so do the nurses. It can be a stressful work environment and I think sometimes they may feel like they are the low man on the totem pole and have no input. Sometimes we as nurses, are stressed ourselves and may interpret someone's behavior as rude when they may just be overwhelmed or overworked. Communication is the key...Just ask them if everything is ok and get a conversation going. Don't wait on management to fix it because it probably won't happen. On the other hand, I am sure management would welcome any ideas or solutions that would improve teamwork and co-worker relations. You could score points with management if you are innovative and solution oriented. Better to just communicate I think....Best of luck.[/quote']

^ THIS....from a former CNA....LPN...now RN.

Most of my conversations, choice of words and tone and delivery have made my relationship and transitions less contentious and more of a team-based approach. I make sure I know who I am working with on my shift; what the plan is; what challenges may happen during the shift, then get to work. Takes about less than a minute to do a quick elevator speech on both sides to compare notes on assignments and give heads up.

People have personalities and tones that are in respect of who they are. I've learned to look at people from that respect, and make it about our business; providing holistic care.

I've been handling team members this way when I was a CNA, then a nurse, the same way...and I have been in this business for a while...it's worked pretty well.

[KelRN215, BSN, RN]

When I worked in the hospital, I remember during our orientation the staff development people talked about this kind of problem with the "career CNAs". Sad to say it was very true.

I remember once getting report on a quadriplegic teenager with an exceedingly rare autoimmune condition. Despite being quadriplegic, she was continent and used the restroom. Being a teenager in a double room, using the commode was not something she wished to do. I believe we had a hoyer lift to get her up but it was still a two person job. Anyway, at the beginning of the day I told the CNA who was assigned to her with me "this patient is quadriplegic, so I'll need help getting her up." Her response? "I'm not lifting anyone today, my back hurts."

When I had total care patients, I usually bathed them myself or with another nurse because finding the CNA and arguing with her about helping me do it just wasn't worth it. I did my own vitals because it was the only way I could guarantee they would get done. I know that because so many of us did these things we were essentially reinforcing bad behavior but with everything we have to do as nurses, do we really have time to police the CNAs too? My manager once started asking us why we were always running off the floor to tests and whatnot and why the CNAs weren't doing it? By and large the answer was "because by the time I find a CNA (more often than not hiding in the locker room talking on her phone) and fight with her about doing it, I could have been there and back."

[Amnesty]

Jesus, why do facilities let things get this bad?? I think everybody in health care has heard of chronic CNA issues, but you always kind of hope that those are just horror stories and that isn't the norm. At the hospital where I do CNA work, we have expectations. You have your 10 patients, you do vitals on them q4h and you bathe them in the morning or early afternoon. The only time nurses ever have to do vitals or give baths is in special situations, such as where there's only one overnight CNA and that patient is going to early-morning surgery, or post-op where the nurses are required to do vitals q15mins.

It's really a breeze working in the hospital doing it this way, and more often than not, it's the aides who have time to sit around while the nurses are scurrying about busy as bees! I know that even in my town, the nursing homes have a lot of problems with CNAs like what you all are describing. My younger sister is the med cart tech in a nursing home, and she told me she'd never work there as a nurse and entrust her license to those CNAs. I remember when the CNAs found out that she makes more than they do, and she was very worried that they would start giving her attitude instead of helping her out when she asked, literally like, "Well you make $10 an hour, go do it yourself!" (Their pay is probably around $8.50-9.00)

It's just an authority problem. Whether they were "raised with it" or not, it isn't something that should be allowable in the workforce. There will always be situations in any job you take where somebody younger than you has to give you orders. Ageism goes both ways, and it's really rather ridiculous.

[mclennan, BSN, RN]

I think the root of the problem lies in the lack of education given to CNAs. I've long pondered this - why are people who have the most frequent and intimate contact with patients given the least amount of training? In my home state CNA training was 3 weeks. 3 weeks of daytime class 9-5, a few days of clinical, a written exam and a skills test. Boom. Here's your state certificate, go take care of patients.

I happened to have a very thorough and compassionate, old-school CNA instructor back in those days (15 years ago!) who pummeled into our heads an element of customer service and stewardship toward our patients. We didn't just learn to wipe butts & make beds; she was adamant in lecturing us about respecting the humanity of people, normalizing their experience, treating them with courtesy and old fashioned manners.

I could tell even then, this teacher was fighting an uphill battle. The majority of students were a) totally disinterested in learning about the meaningful elements of this work and just wanted to get their certificates, scram and get a job - many were on court ordered programs, welfare to work etc. b) from foreign countries where the cultural practices are so different than ours, especially in a western medical setting, with a language barrier, that many could not grasp the theory. (I asked.) The test was mostly about skills.

So we are left with a workforce of CNAs who are largely undereducated, uninterested, and from vastly different cultures who struggle to adapt & communicate effectively.

Before anyone gets their panties in a twist, I'm not generalizing. I've been very careful not to use blanket terminology. There are some AMAZING CNAs out there who are dedicated, hardworking, respectful and skilled. Most of them are on their way to nursing school.

It's so typically American to wait for a crisis, then try and treat the symptoms/problems rather than analyzing the root of the problem and changing systems to prevent the crisis. Nursing homes have been and will continue to be places of low quality care and workplace conflict until we figure out how to modify and improve CNA education & raise the pay. Patients, technology, pharmacology, and health care laws are getting more and more complicated. 3 weeks of training doesn't cut it any more. We need to stop churning out such poorly prepared direct care workers and stop tolerating low quality employees. CNAs are the backbone of any facility and as long as they remain undereducated and underpaid, this is how it will continue to be.

[Nurse2long]

Well no, I wasn't a CNA or LVN/LPN... Started as an RN, then BSN and now working on DNP. I think starting as a CNA then working your way up is the best way however...you would gain valuable experience! I wish I would have done it that way.

[Nurse2long]

Yes! more education!