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!
I am the author of a continuing education module for the Wisconsin Nurse Residency Program regarding delegation. Although delegation can vary from state to state, there are a couple factors that remain the same.
1. The CNA cannot perform any tasks without an RN order or direction. So if she is not doing what you ask of her, what is she exactly doing? If she cannot complete the task you assigned, then it is her responsibility to tell you why.
2. If you want to go farther and help your manager out and show her you are serious, I would suggest she review the latest National Council of State Board of Nursing website regarding delegation. If she does not have access to it, I would be happy to forward you the information. The NCSBN did an extensive class and video on delegation based on a true case in which the CNA did not do her job and a patient died. It was unbelievable and it was my catalyst for writing the module.
This CNA is responsible to complete her assigned tasks and she can't tell you no without reason. I would arm yourself with as much info as possible before you go to your NM. When I was in management, I really appreciated when my staff took the initiative to find out information before they came to me with a complaint and expected me to do all the follow-up work. If you need any info, just email me. I cannot post the info on this site because it is copy written.
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!
"why is she tallking to you that way?"
Any insight will be greatly appreciated.
My understanding is that refusal to carry out direct orders and or instructions given by a superior is insurbordination. Being aggressively hostile and or belligerent is truculent behaviour.
Either way you are correct in writing this person up. Challenges to one's authority cannot go unchecked,and should be dealt with promptly and in the proper manner. Formal written notes on record leave a clear paper trail so everyone knows where things stand.
I just typed a long response and my connection failed....urg....The summary: I have not read all of the replies here so please forgive me if I repeat. Three things:
1. Not only is she insubordinate, she is negligent and patient's safety is not being addressed. You ask things of her for a reason.
2. Maybe she is looking for a lawsuit or a way to "settle" a personal rift between the two of you by getting you fired/written up for asking her to do too much or outside her scope. Please be cautious.
3. Her extreme hostility...have you considered she is under the influence on the job.
Good luck to you. No one should have to work in these conditions.
Specializes in LTC, assisted living, med-surg, psych.
I'm going to play devil's advocate here for a moment.
It may be old-fashioned, but my grandmother (a nurse during WW I) had a strict philosophy that has served me well over the course of my own lifetime: You catch more flies with honey than with vinegar.
IOW, it's not what you say to someone that matters, but the manner in which you say it. No one---CNAs included---likes to be ordered around as if they are servants or young children who don't know their place. It doesn't take a Miss Manners to figure out that a polite "Mary, would you take Mrs. Smith's vitals now? Thanks" gets quicker results than barking "I want those vitals now!" or "Maybe you could give up one of your smoke breaks and go get Mrs. Smith's vitals, ya think?"
Respect for our co-workers and yes, even our subordinates should always be the default position when assigning duties and asking other members of the team to carry their part of the workload. Almost everyone responds well to being treated decently and spoken to as an adult; CNAs are no exception, and I guarantee that the vast majority will perform better if nurses and other supervisors would do more working WITH them and less sniping AT them.
Just my two pence worth.. I've managed CNAs and caregivers for years, and I can count on the fingers of one hand the number I couldn't get along with simply by treating them with respect.
OP, i totally understand what you mean. i avoid confrontation likes its the plague. on the other hand, she clearly doesnt have any respect for you as it is, so what do you have to lose? as you said, being nice to her isnt getting you anywhere. especially if this issue is brought to your nurse manager's attention, then the NM can't get upset at you when the PCA plays the victim card of "but she came and discussed this with me or told me that....". i totally get that this is much easier said than done, just trying to be that little voice in your ear "you can do this! you can do this!"
Had to respond again. Everyone has given wonderful advice!
This is always one of my challenges. I have a serious face when I'm serious, and it can come off aggressive..(of course if a man were having 'the face', it would be considered NORMAL).....so I just wanna know....after you have asked the PCT to do something three times, asked why it isn't being done, stated the rationale for the task, been as nice as pie....how is it possible to NOT MAKE THE FACE....when you finally have to say..."I need you to do this right now...I've asked for two hours, and I need you to do this right this minute unless somone is bleeding or coding!".......ugh. What has the world come to when incompetent people keep their jobs, while others who are serious about their work are at risk of making a workplace seem "hostile" just by enforcing the rules when things have gotten out of hand???.....ugh......sorry, a little vent..: )
I am really tired of doing my work, AND the PCT's work while I see them slowly meandering, raising their eyeballs, and humphing all over the hallways. I am also tired of my license being at risk unless I do all the work myself.
By the way, I am ABSOLUTLEY thrilled when I get to work with the 3 out of 5 PCTs who respond accordingly, do not humph when asked to do something, who understand the rationale of what they are doing, who I do not have to monitor every 30 minutes to make sure they are doing what is expected........I love working with these people, and am very thankful and appreciative when I can.......I make it a priority to comment well on all their good teamwork and organization to them, and to management. I have even tried to give compliments when a lousy PCT does something right...even if it is just recording the vitals....you think that might make them want to be part of the team.......that hardly ever works.........thanks for the rant space..........
OP, let us know what happens-this is a problem in many areas.
Much as it pains me to say this, and as a former nursing assistant/home health aide it really does; the "problem" has come about from letting the inmates run the aslyum.
Between reading stories posted here, and seeing what goes on in hospitals/facilities today one cannot help by wonder what is up with this? I mean back in my day if a nurse said jump, your only response as a NA was "how high"? If you had an attitude problem the head nurse or another supervisor sat you down. If that didn't work then written warnings came. Should all this fail that was the end of your career at that place. If a head nurse or supervisor couldn't get you out of the hospital, they at least got shot of you on their floor/unit. Move the problem along and sooner or later the powers that be realised the initial complaints were correct and usually that was the end of that.
It breaks my heart to see grown nurses practically begging on bended knee to get someone to do a job they are being PAID to do. I've seen one to one NAs simply get up and leave their patient because their shift was over without word to anyone. I've also seen NAs (CNAs PCTs etc) flat out tell nursing staff everything from "no, I'm not doing this", to "No, I'm not doing this and am late for my lunch/dinner/cigarette/coffeebreak" so you (the nurse) deal with it". And on it goes. Here you have a nurse that probably doesn't even get a pee break and whose only meals maybe whatever is stuffed in a drawer or pocket being told "talk to the hand" by someone hired to assist her and works under HER licence.
This is an over generalised statement, but youget the picture. IMHO much of the problem stems from places simply not paying enough to attract quality people who not only want to do the job, but are willing to make it a career. This means places have to rely on whatever or whomever they can get and that often means the bad apples have them by the short and curlies. It does not help matters much either that often nurses and UAP staff have separate unions, or in some cases the former has no representation at all while the later does.
There are some really great UAPs out there,and am willing to bet while no one may say "thank you" every other minute, they know how much they are loved/valued.
How about if the nurse is after the end of her shift? And it is time to go home? She can well refuse an order because her day is over. How can you address something like that if you were written up for insubordination at the END of thei shift?
I've managed CNAs and caregivers for years, and I can count on the fingers of one hand the number I couldn't get along with simply by treating them with respect.
msn10
560 Posts
Hey OP,
A couple more thoughts.
I am the author of a continuing education module for the Wisconsin Nurse Residency Program regarding delegation. Although delegation can vary from state to state, there are a couple factors that remain the same.
1. The CNA cannot perform any tasks without an RN order or direction. So if she is not doing what you ask of her, what is she exactly doing? If she cannot complete the task you assigned, then it is her responsibility to tell you why.
2. If you want to go farther and help your manager out and show her you are serious, I would suggest she review the latest National Council of State Board of Nursing website regarding delegation. If she does not have access to it, I would be happy to forward you the information. The NCSBN did an extensive class and video on delegation based on a true case in which the CNA did not do her job and a patient died. It was unbelievable and it was my catalyst for writing the module.
This CNA is responsible to complete her assigned tasks and she can't tell you no without reason. I would arm yourself with as much info as possible before you go to your NM. When I was in management, I really appreciated when my staff took the initiative to find out information before they came to me with a complaint and expected me to do all the follow-up work. If you need any info, just email me. I cannot post the info on this site because it is copy written.
Good luck