What to do???

Dalla · Mar 16, 2011

I thought it was law that a LTC facility HAD to have a RN at all times? As for the CNAs, it is their job to get report from their nurse. I would write them up and see that they are all disciplined by management.

ocean waves · Mar 16, 2011

Hello. Sorry that you are experiencing difficulty regarding giving important patient care reports to the CNA's at your facility! One idea is to arrange a talk with your nursing director about constructive ways to solve this problem. For example, maybe you could volunteer to prepare and provide a required inservice education program for the CNA's about patient care reports. Hard stuff! Best wishes.

DizzyLizzyNurse · Mar 16, 2011

I thought it was law that a LTC facility HAD to have a RN at all times? As for the CNAs, it is their job to get report from their nurse. I would write them up and see that they are all disciplined by management.

At least in NY state there only has to be an RN in the building so many hours as long as someone is on call the rest of the time.

Forever Sunshine, ASN, RN · Mar 16, 2011

When giving CNAs report, I say it once. I don't have time to repeat myself. Its their job to get report, they usually listen in, if not.. then that's their problem.

I tell them things pertinent to their job. For instance if we have a new resident... history.. transfer status.. diet info.. assessment etc. If its an existing resident I tell them if they are on antibiotics, change in diet/transfer status, any new wounds, or things to look for.

TheCareerStudent · Mar 16, 2011

I have seen situations like this in other fields, so sorry you have to deal with this. From my personal experiences both as a general team member and manager I have found situations like this can be difficult to deal with. I have noticed that when a manager comes in who is young, many of the older folks on the team have trouble being Indians to a young Chief. Then the youngsters on the team think that it is okay to disrespect the Chief and follow the Lead Indian. Hope this makes sense.....

If you are a young newer nurse I can only tell you to be cautious as to how you handle this. You want it to be resolved and there must be some level of discipline involved.

I have also, very unfortunately, seen this in situations regarding race. I have seen one race as the Chief and a majority of one race as the Indians. This can be a disaster if you have just one bad apple in the bunch on team Indian. It only takes one bad mentality to pollute the group mentality.

Again this must also be handled very carefully, especially due to legal consequences of actions or even words.

I would advise that you go to your manager for insight and to discuss ways to solve the problem. Good luck!

mentalhealthRN · Mar 16, 2011

Yeah in NY its 8 hours minimum of every 24 hours, with an RN available by phone.

First of all the way the CNAs are treating you is totally unacceptable and needs to be brought to the DONs attention.

The second thing that comes to mind is wondering what info you are giving them. One poster mentioned telling them if the resident is on ABX. Not sure why the CNA would need to know that unless it was resulting in diarrhea all day or something. Maybe you are telling them more then they really need to know.

Be sure what you are passing along is really the essential stuff they need to know to do the residents ADLs and anything that needs special attention that shift. Like if a resident has not eaten all day and you need to have the aide be sure to encourage and report back what was eaten or not. If a pt maybe fell that day and so mobility status has changed, or if a resident has had diarrhea all day--if you need a sample. If a pt refused to get out of bed and maybe there is a CNA who does well with that pt and maybe could convince him to get out of bed. Diet/consistency changes. New on precautions. Anyone who was sent out to the hospital. Died. Keep it to the really need to know stuff.

The DON needs to make it clear that they are expected to listen to report as it is the only way for them to safely do their job. That they LEGALLY work under YOUR direction and if someone is injured or a mistake is made that could have been avoided/prevented if they had listened to report that they could lose their job and possibly be liable for a neglect charge with the state. Maybe if they knew that they would get serious. But definately make sure you keep it CNA stuff only.

brownbook · Mar 16, 2011

The whole situation sounds horrible, too many things "wrong" with the picture to right them.

But you could ask the CNA's for their advice. Ask them what they want you to report on.

MouseMichelle · Mar 16, 2011

I would write them up and talk to your DOn about this

Chin up · Mar 16, 2011

Sorry dear, but that is insubordination. You can write them up. Me, I would tell them to punch out and go home. I have no use for disrespect, and will not, put up with it. At my age we don't take that garbage anymore. Bad days, yes...bad moods, yes...disrespect, never. Nip this in the bud now, or it will become a trend. Good luck! Peace!

NamasteNurse, BSN, RN · Mar 17, 2011

When giving CNAs report, I say it once. I don't have time to repeat myself. Its their job to get report, they usually listen in, if not.. then that's their problem"
Actually, everything the CNA's do or don't do can become YOUR problem. They don't transfer properly and the pt gets hurt, your problem. They feed someone who is on thickened liquids regular food and they aspirate; YOUR problem again. If you are the charge nurse everything that happens on that floor, you are ultimately responsible for.
True, many CNA;s have HUGE attitudes and just don't listen or do the things they are supposed to do. I feel like I am constantly telling them the little things they know. They want to get away with doing as little as possible. Some are like that, not all.
Just remember you are the nurse and the pass or fail of your floor is your responsibility.

MommaRN86 · Mar 17, 2011

Thanks for all the feedback! Feel extremely frustrated that the information I was giving CNA's is very pertinent to their care of the pt's and I was completely unheard. I should not have to assert my position as the RN, that's a given. The DON will have to handle it from here.