I am in the process of writing up a patent care associate.Through a computerized form the hosptal uses to report issues.
When asked what the nature of the incident is.. I had to choose a category. Insubordination does not quite cover the nature of the problem.
I am an R.N. with a very heavy assignment. My PCA is supposed to be working under MY direction. #1 on their job description is...
"Under the direction of a registered nurse.".. and so on and so forth. I am ultimately responsible for the care they deliver.
This PCA consistently refuses to collaborate with me regarding patient care. I asked for an EKG and a troponin to be drawn. I was "talking to the hand". She flat out refused. It is her JOB! She will Not take any direction, rather give it.
Patients note her rude, loud and hostile demeanor.. and share their observations/ concerns with Me!
As a tech and a RN student I understand both sides. I understand that you had a heavy load so most likely so did she. But If a b/p isnt taken she should be written up. Stress causes people to come off as rude on both sides. I do my job(tech) but I have had nurse wanting me to come out of my scope of practice per facility policy because they dont have time when they only have 4 pt and I have 15. I have had RNs ask me to take someone to the bathroom when one of my other 15 pts is in crisis( rapid response called/ code situation) when they are in the room of the pt that needs assistance (BRP, ice, warm blanket). And get mad because I didnt stop what I was doing to make it happen: CODE OR BRP, I decided that my code was MUCH more important. I understand that it is my job but RN doesnt mean that you can leave your pts in limbo because your a nurse and you feel like it is my job. It is but from what I have been taught it is your job also. HECK no she shouldnt tell you no. I think she may just have a problem with you. Especially since you noted that pts have made comments. I agree with an poster, that nursing students should be aides before being allowed to become a nurse. I think that many would have a different view of the jobs techs/aides really do. My RNs love me my PTS love me but respect goes both ways.
That's insubordination. You don't just write it up one time either but EVERY TIME this happens. Also, when patients complain send in your CN to hear it. It's important for them to know this surpasses the RN/CNA scenario. If is upsetting patients and taking time away from care. Patients shouldn't have to deal with that kind of crap. They have enough to worry about without being bothered being by rude and unprofessional behavior.
Oh, my gosh. I can't even stand to read through every reply! As an RN I have run into this so often. Usually, management seems to side with CNA's! Saying something like," you can not order the CNA to do anything, you have to ask"....CATCH 22! If I can not order my CNA to do a stat EKG, if all I can do is ask, and he/she can say NO and that be ALLRIGHT, than what the heck is stopping ME, the RN from telling the doc, "no, I don't wanna do that stat or at all, do it yourself!" Would THIS be acceptable!!! UGH. From my experience, I wish I would have done THIS....1st time: talk to the CNA and document on paper, make copy for you, and give other copy to manager
2nd time; write up CNA, give copy to manager and CNA
3rd time, write up CNA, copies, and ask manager when she is planning on disciplining this CNA as this care problem is causing a possibly unsafe environment for the patients
4th time; write up, copies, and asking manager if discipline has occured yet as behaviour is still being exhibited..if mamagement still is unresponsive....TAKE ALL THE COPIES TO HR.
Wish I would've went to HR. Because after a while, the manager decides the RN is the problem, not the CNA...and guess what....the RN can get disciplined and/or fired!!!!!!!!!
Start "ordering" CNA's to do things, and see what kind of response you get. I wouldn't say "Susie, would you please draw some labs for me?" But I would say, "Susie, please draw labs on patient Jones in 201. Thanks so much!" It's not asking, yet not necessarily "ordering."
Semantics, I guess, but sometimes those go a long way.
Good point. You aren't asking them to do something but telling them. It's not a question and shouldn't be phrased as such. Be polite yet firm.
Definitely semantics but I do the same as you without issue.
Write them up, OP. Be concise and clear as to why. You need a paper trail here. Keep us posted as I'm curious to how it plays out. Good luck.
So if the doctor says to the nurse, "can you please draw a cbc on my patient?", the nurse can say "no" because she was asked and not told?
lol
Ofcourse the nurse should not say no. When my manager told me the same thing I literally LOL. I couldn't believe that because I asked instead of told meant the CNA could do whatever. The point is that it will not hold up legally as insurbordination since the nurse asked. Well atleast that is how it works at the facility I work at.
That's insubordination. You don't just write it up one time either but EVERY TIME this happens. Also, when patients complain send in your CN to hear it. It's important for them to know this surpasses the RN/CNA scenario. If is upsetting patients and taking time away from care. Patients shouldn't have to deal with that kind of crap. They have enough to worry about without being bothered being by rude and unprofessional behavior.
Thanks, batman. However, there isn't a Cn available on afternoons. Also, if I were to send supervision in, to get the patient's perspective.. it would only give my patients more "crap" to deal with by describing the episode.
No can do. I simply apologize to my patient for having to see that .
That sucks that she is acting so rudely toward you and everyone else. She, obviously, doesn't realize what a good job she has. There are so many people out there, including myself, that would love to have her job - and perform it with respect.
Start "ordering" CNA's to do things, and see what kind of response you get. I wouldn't say "Susie, would you please draw some labs for me?" But I would say, "Susie, please draw labs on patient Jones in 201. Thanks so much!" It's not asking, yet not necessarily "ordering."
Semantics, I guess, but sometimes those go a long way.
Thanks ,Horseshoe. I think I have the semantics thing covered. I said... The patient in room xxx has a troponin ordered for 2100. In a cool, calm, professional manner. I was making sure she saw the order. She has the same electronic record I have. Most PCA"S are on top of it, draw it before I see it. Again, her response was.. talk to the hand, I ain't doin' it.
I always make my "requests" in a direct manner. But adding the nice factor isn't working. Nothing works to direct this PCA.
Specializes in Trauma Surgery, Nursing Management.
I must chime in here. Although it is proper form to say, "CNA X, can you please take a BP in room 203?", what I am getting from NurseLoveJoy's post is that her NM advised her that if you put your delegating task in the form of a question, it is illegal. What is this, Nursing Jeopardy?
Me: "CNA X, empty the foley in room 388."
CNA: "What is recording I&O's?"
Me: "YES! That's $500 more for you!"
We "ask" for CNAs to complete tasks because it is polite. I don't think that it is necessarily an issue that we must tip toe around; as Batman stated, it is semantics.
OP, I can empathize with you. I have had CNAs completely refuse to do something which is totally in their job description. The thought process of a particularly nasty CNA was that since she hadn't been held to the standard as outlined in her job description after 10 years of working on the unit, she sure as heck wasn't going to start NOW! So you must document.
NENE RN
142 Posts
As a tech and a RN student I understand both sides. I understand that you had a heavy load so most likely so did she. But If a b/p isnt taken she should be written up. Stress causes people to come off as rude on both sides. I do my job(tech) but I have had nurse wanting me to come out of my scope of practice per facility policy because they dont have time when they only have 4 pt and I have 15. I have had RNs ask me to take someone to the bathroom when one of my other 15 pts is in crisis( rapid response called/ code situation) when they are in the room of the pt that needs assistance (BRP, ice, warm blanket). And get mad because I didnt stop what I was doing to make it happen: CODE OR BRP, I decided that my code was MUCH more important. I understand that it is my job but RN doesnt mean that you can leave your pts in limbo because your a nurse and you feel like it is my job. It is but from what I have been taught it is your job also. HECK no she shouldnt tell you no. I think she may just have a problem with you. Especially since you noted that pts have made comments. I agree with an poster, that nursing students should be aides before being allowed to become a nurse. I think that many would have a different view of the jobs techs/aides really do. My RNs love me my PTS love me but respect goes both ways.