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Difficulty Delegating to Nurses Aides

I am a new nurse, July 31 08 new grad. Things are coming along. I am getting to the point that I am making sure all my ducks are in a row and nothing is left undone for the next shift. Well I am starting to catch things that the NA's are leaving undone and not informing me that they weren't able to do it (or they just flat out didn't do it). On my unit we have an aide sheet to fill out to let the aides know who needs FSBS, VS frequency, drains, foley's etc. I've started to noticed that my Q4HR VS are only getting done once a shift but only after the fact 8 hrs has past and shift change is happening and the next set of VS are being taken. This is only one example of what I am catching not being done.

Then I am having difficulty delegating, I am asking for VS to be done Q1hr x8 then Q2hr x24hr and I am writing it down and handing it to the NA. If the VS are being done they are not being documented which is a very clear responsibility of the NA.

There is a long list of things that I've asked of the NA's and too busy to follow up on only to find out later it was never done.

Tonight one patient was NPO for a procedure and asked me to save her tray till she came back which I did and told the NA that I was doing this that is was in the break room and that when she came back to reheat it. I am in the room administering meds when that patient asked me for her food tray - she had been back for about 30mins. Change of shift is happening and the NA who are staying take a break. (I was of the understanding that one NA to be on the floor while the other takes a break but whatever.) I asked which ever one gets back on the floor first to please reheat her tray I would greatly appreciate it. I get these looks of how dare you even ask me something while I am one break. Then I leave the break room and they are loudly laughing. 30 minutes later both NA on back on the floor, the patient's daughter is coming and asking why she doesn't have her tray yet.

I've heard a few of other new nurses talk about getting looks or getting ignored when the ask theirs aides to assist with them. Is there a technique in getting the NA to do their part in caring for the patients? I am SO over getting eyes rolled at me.

I am getting to the point where I look for another nurse when I need some assistance because I know we mutually have the same interest "the patient".

I thought about talking with the nurse manager but we have the chain of command thing going and I have to address the NA before going further. This is hard to do if you are only aware of their lack of patient care after they have left.

Any suggestions of how to communicate with NA to get them to do what is in their job description for them to do? Also how to approach them when you realize that things were left on done? Time Management tips of how to follow up with NA to verify patient care being done and how to talk with them when its not.


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47 Responses to “Difficulty Delegating to Nurses Aides”

  1. DIXIE Says:

    I HAVE HAD MY SHARE OF IRRESPONSIBLE CNA’S AND THE BUCK ALWAYS WILL STOP AT ME, THE NURSE, BEING THE ONE LEGALLY RESPONSIBLE. I’VE FOUND THAT I MUST BE COGNIZANT OF ALL THAT IS ENTAILED WITH MY PTS.
    1ST-I INFORM MY CNAS OF WHAT NEEDS TO BE DONE, 2ND- I ASK THE RESULT OF THAT ACTION AT THE TIME IT SHOULD HAVE BEEN ACCOMPLISHED, IF IT ISN’T, I REQUEST IT THEN TO BE DONE AND TO LET ME KNOW THE RESULT ALWAYS THANK THEM PUBLICLY AS WELL.

    IE. WHAT WAS THE BP OF MS JONES OR
    WHICH SIDE HAS MS JONES BEEN TURNED TO NOW OR
    HOW MUCH WAS OUT OF THE DRAIN

    YES I’M HAVING TO DO MORE OF THEIR WORK BY THINKING FOR THEM BUT I HAVE THE ANSWERS I NEED AT THE END OF THE SHIFT. AFTER AWHILE THEY WILL REALIZE YOU RUN A TIGHT SHIP/SHIFT AND WILL HAVE THE ANSWERS YOU ASK BEFORE YOU ASK, THEY DONT WANT TO LOOK BAD OR INEPT IN FRONT OF OTHERS. IT DOESN’T HURT TO ASK THEM IN FRONT OF THE CN. IT IS A SUBTLE WAY OF HOLDING THEM ACCOUNTABLE. I HOPE THIS HELPS. AND OF COURSE ALWAYS THANK THEM PUBICLY OR THAT WOULD BE PUBLICLY. HAHA, LOL

  2. Mr Ian Says:

    I agree with most of what Dixie shouted.

    Speak to your NAs at the start of the shift and tell them – because of the continuing failure to complete all tasks – you will be running things slightly different.

    Clarify that they fully understand the instructions that you are giving them and go through each patient briefly to tell them what you require completed during the course of the shift.

    Increase your check-ins with the NAs. Do it on an individual level to remove the option to collude and have them check in AFTER every break period and go through their written schedule. Anything overdue – or getting close – highlight it.

    I also agree that at the end of the shift offer gratitude for completion of their work.

    However, I would not interrupt their break time. Usually these are unpaid breaks and so you are not entitled to talk work with them and they are entitled to switch off for that period. Even if they’re getting paid, breaks are still important.

    If they’re coming back to you after every break then you can catch up with any new or incompleted chores at that time.

    It will increase your workload slightly – but it’s unlikely anyone else is going to put the effort in to solve your issues.

    If it doesn’t work – then at least you have something to take to your manager as having at least tried.

  3. Tara Says:

    Why is this a universal thing that nurses aids are irresponsible and lazy?

  4. ADedicatedCNA Says:

    Well I have a suggestion for you after reading your blog. Ive been a CNA for 3 yrs now & I’m also currently enrolled in nursing school & I have a comment on your problem. You write like every CNA is lazy, they they doesn’t complete patient care or even care about the patients. I take offense to that. I love my job & my patients & There’s a ton more out there who feel the same & would agree with the suggestion I’m about to give to you. And that is…MAYBE if you stopped being such a BITCH & acting like your too good to do “aide” work you’d get a little respect. Clearly from the information you’ve proved you’ve never been a CNA because if you’d had you would be a little more compassionate to your aides. & As far as interrupting their breaks, do you like it when they interrupt you?! Do they even get paid for their breaks?! How hard would it have been for you to take a dinner tray in the that resident. You complain that a half an hr later she still didn’t have her tray what was stopping you from “simply reheating it?!” Ill tell you what was stopping you not your med pass or treatments – your EGO! Nurses like you are the reason CNA’s dont want to complete “little tasks” Do you even thank your aides at the end of the night!? You might be new, but honey if you don’t lose the maniac ego, you’ll be eaten alive in the world of healthcare.

  5. Rachel Says:

    I am a CNA & nursing student as well & I agree 200% with a dedicated CNA. I can’t even add to that. What amazes me the most, is that 1/2 of the nurses do not even have a clue about what they are doing. I volunteered to work tonight (Christmas), why? because I love my patients & I love what I do. Do you remember your first semester of nursing school??? You are taught how to put a patient on a bed pan, do you all of a sudden forget what you learned once you pass the boards? Again, our (CNA & RN) job description both say, PATIENT CARE. If a patient wants there damn food heated up, that is considered patient care. By the time you went & rudely interrupted your CNA on break, you could have reheated the food 10 times. Get a grip, get off your high horse, work as a team!!!

    You said “If the VS are being done they are not being documented which is a very clear responsibility of the NA”. Do you even hear yourself, “cleary its the NA’s responsibility”??? who in the hell are you???? you are a perfect example of a person getting a nursing degree just for the $. ugh, I can’t even talk about this anymore. All I know is that be appreciative, stop thinking you are GOD & maybe, just maybe you will get off the RN “shit list”. You are the reason I schedule my hours according to what RN is working. Pathetic, but the more stress you envoke on your floor, the less positive care the pts receive.

  6. Brittany Says:

    I am a CNA as well and I agree with everything the other CNAs have said. When you are an aide you go into your job because you want to help.You want to make a difference in someones life. It is so hard sometimes to remember every little thing a nurse tells you to do. And I am sorry but when I am onmy break dont even come looking my directions. I am off the clock and I am not spending my time to relax and cleaning butts for hours to go do something that every nurseis trained to do. I am a nursing student as well and the 1st thing I was told when it comes to nursing and delegating responsibility,my instructor who has a masters in nursing I might add said, Even though you have bigger fish to fry other than taking people to the bathroom, dont forget that you are NOT too good to do it. I say that in regards to everything in patient care. I am not trying to knock nurses either. Ilove the nurses I work with. But you know what every night before they go home they say tome and my fellow employess, you did a great job. Thank you. Thats why I bustmy ass for those ladies. I also want to mention that laying down 32 people when they all want to goto bed at the same time is hard and maybe the VS doesnt get done when you want it. well pick up the freakin equiptment and do it yourself and document it too. My nurses do when they can see Im busy. When I have 6 call lights going off at the same time. And the person aboveme is right as well when I started I left 1st shift which is perfect hours for me just because of the nurses. I went to second shift where they appriciate the fact that ifourlittle job hadnt been created that you nurses would bestuck doing what u useto do in Nightengale times and wipe shit yourselfs.

  7. Jill Hennderson Says:

    You might talk to your manager about replacing CNAs with technicians or RN students

  8. Jazz, RN Says:

    Wow you CNA’s jump at every little thing that’s said. We new nurses (May 2008) try and do as much as we can by ourselves, but YOU GET PAID TOO! I was a CNA throughout nursing school and YES I’ve had my share of nurses sitting on their ass and a patient calls and instead of the RN doing the task, they send me to. Yes there are lazy nurses but there are also lazy NA/Techs. I think some nurses abuse the privilege of having a NT/NA but you techs also abuse what you have. It’s NOT that hard to heat up a tray and I’m certain Ms. New Nurse doesn’t have difficulty doing it. She most likely had other patients asking for things and you get paid too for PATIENT CARE. Just want to remind you. The reason we DELEGATE is because there are things YOU CAN’T DO like pass meds, so we ask you to HELP (assist-like Nursing Assistant) us out while we do things only licensed personnel can do. If she was sitting on her ass all day, I could understand your frustration, but sounds to me like she has a very busy day. So busy that she didn’t even realize vitals weren’t charted on til the end of her shift. You guys need to chill and realize that just as busy you are, nurses are as well.

  9. Mr Ian Says:

    I had a feeling this might turn into a bun-fight.

    With the greatest respect to the CNAs who have commented – I think you are being a little harsh.
    The article author is pretty new and mearning to be a leader of a team is not easy – and it’s not something that is always taught in nursing school.

    So, it is of little use to berate the newly qualified staff and simply demand they be ahead of the game when clearly they are still getting to learn the game. It would be useful if experienced and commited CNAs as you purport to be not only realised this but also remembered that you can contribute to the solution.

    Before you ask, I was never a CNA. My ex-wife was before she made RN. My current partner is. Some of my most trusted colleagues were and are CNAs. I valued them immensely when I worked with CNAs. I have also worked with some awful and useless ones and they are very difficult to manage.

    But I have worked with equally awful RNs and I sometimes just laugh at how the CNAs run rings around them – but never compromise patient care. They just toy with them.

    But, to the CNA commentors, remember that this is a site to support newly qualified nurses and sometimes it means gently leading and not booting them in the face, in order to make things better. You are also as limited in your information about what actually happens on this nurse’s shift/ward so please avoid those blanket statements that ‘she obviously isn’t doing her job’ when none of us can say we know anything.

    By attacking the author you are doing nothing more than supporting everything she has complained about – that she is not getting the response she expects from her CNAs – your stalwartly ignorant and blindly aggressive defense is exactly the attitude that she is afraid of meeting when she tries to address the issues with her CNAs.

    You have now proven her fears to be likely true.

    This is called ‘shooting yourself in the foot’.

    Rather than insult her – perhaps you could offer some tips or guidance on how she can still get all her little ducks in a row from the CNA perspective – AND keep the CNAs on her side?

  10. Katie Says:

    Im a tech, CNA, AUA, whatever you want to call me. sounds like youve got crappy techs to me. but if you want to be validated and respected, youre probably going to have to either sit down and try to talk to the techs (if theres time) or go above their head since youve already tried talking to them and explain to your boss the situation. the techs arent doing their job and although vs are easy to do, their important. ive been doing my job for a long time and im hopefully going to finish my nursing degree pretty soon. its hard to find good techs these days. thats why the nurses on the unit i work for are very appreciative of me 🙂

  11. Katie Says:

    yeah that too. about being to good to do aide work. ive been in this game for a while now. been a tech for 5 years and when new nurses come on the unit acting like their hot shit and too good to help or do tech work pisses me off. every nurse should work as a tech just to see how hard our job really is and how much we bust our asses. i work in a very fast paced, heavy floor. and a lot of times im the only tech. in the tie it takes a nurse to hunt down a tech to do a simple task for them, theyve had ample amount of time to do it 2 times themselves and theyre too damn lazy to do it.

  12. Johanna RN, OCN Says:

    Hmmm…. There are a lot of strong words going on, but I am hoping my two cents can help. I am actually an RN who was never a CNA/NT, but I get along with my CNA’s great. I have mostly found that in order to get respect, you have to give respect.

    We all have our own jobs to do, but it is an expectation of mine that everyone work as a team, and I made that known. People may razz you at first, but in the end it really pays off.

    This means, if I am caught up with my work, whomever is the busiest (RN OR CNA) gets my help first. You might just give your nurse tech a heart attack if you ask if there is anything that you can help them with. Make the first move. After all, it really is that patients that we are trying to help, right?

    Also, don’t favor any one person over the other. Your selection is based on who seems the busiest/ who asks you for help.

    In all fairness, if my nurse tech is caught up, and I am drowning, they ask me if there is anything they can do.

    If it sounds like your tech is going to have a busy night (3 different patients are on frequent vital signs, etc), acknowledge that the tech might have a busy night (hence communicating you will really need them tonight), and just yell if they start to drown.

    I have an inkling that probably one of the biggest pet peeves of the majority of techs is if we are in a room, the patient needs something in the room (even if it is changing a dirty bed), that we always leave it for the tech to do. Now, us RNs may not do it as good as the CNA’s can, so I usually call the tech in to help me if I need it, but try to take a good stab at it first.

    I know that there are times where you cannot stay in the room and have to pass the responsibility on to the tech, but the few times that you can help will really make a difference.

    Give yourself some credit too. Keep a good line of communication open by saying, Room xxx had a large bm, and I’ve already changed so and so’s sheets, so they don’t need a linen change today.

    Not having vitals/i&o’s/blood sugars done on time/at all is another large battle. Don’t ask 30 minutes early if the task is due at a certain time. However, at let’s say 900 a task is due, and it’s not done. Ask them if the blood pressure was done for room xxx. If not, ask them if they are behind. If they are behind, let them know you are super busy too (only if you really are!) but ask them if there is something quick/super quick (depending on how much time you have) that you can do to help.

    The bottom line is: keep the communication lines open at all costs, and use teamwork. It makes things faster, easier, and a lot more enjoyable.

    Hope this helps! I think I’ve said enough.

  13. Jared C Says:

    I am also a tech as well as in nursing school. I have the privelege to work with an awesome floor of nurses. The only nurse that could maybe be called lazy is the odd traveler here and there. From my experience and observation at work, more often than not, if the techs are super busy then the nurses are super busy as well. Further, if both are busy, and of course there are exceptions, the nurses will be somewhat more busy due to all the different things they are in charge of. I have worked many shifts when the staff is slammed, but after techs have done everything they are qualified to do, there is still a whole lot of additional activities that the RNs have to do that techs aren’t allowed to help with. I mean, tech work is definitely hard work, but after you learn the job it is relatively repetitive work. Techs also do not have to keep in mind nearly the amount of factors relating to the patients that the RNs do. Techs don’t have the training to even be cognizant of many factors that the RNs are in fact responsible for. I can say that with confidence, even if that statement ruffles some feathers, because I am in the middle of getting that training in nursing school right now. In my opinion, mentally speaking, tech work is child’s play relative to nurse work.
    Now, of course, if it is a situation where someone is actually being lazy, then call a spade a spade. However, I think techs should try to keep in mind that their role is actually that of the assistant to the nurses. If a nurse asks a tech to do something, it is ultimately to alleviate some aspect of the care of the patient that a tech is qualified to perform thus allowing the RN to concentrate on other aspects that a tech cannot perform.
    Of course, this is just my humble opinion.

  14. Sasha Says:

    I have been a CNA since I was 18, now 21, and currenlty going to LPN school. When I first started working at a Nursing Facility, other aids looked down on me because I was so young. But I knew my stuff and proved my place. I also had a LPN who started out as a CNA, and knew where I was coming from. She began to teach me new things, and we worked to HELP each other. A CNA is there to assist the nurse, but if the nurse is acting like Ms Queen Bitch, then I wouldn’t want to help either. If you take your aid’s under your wing, teach them, and work with them, I promise you will get better results. New grads, no matter the field, always have to show their butt first to make sure people take them seriously. All’s honesty, you can’t do the work for them, but if you respect them like you want to be respected, you will get a positive result. I know from my own experience, the one nurse that was lazy, left me to do everything, got the wake up of a life time, when I had all the patients call lights go off within a 10 min window, and while I was doing my vitals before shift change, she had to answer the calls. Work with us, and we will work with you.

  15. anon Says:

    WHY do these AIDS that posted think its the nurses job to help them? Seriously?!!! WTF. “NURSES” AID. You AID the nurse.
    I have been an aid for four years, and the longer I am an aid I realize that sometimes when the nurse is sitting there being “lazy” at the server she is charting assessments, the most important thing-
    or thinking about what could be going on with her patient, planning out how to finish up her shift etc, waiting for a doctor to call her back and getting organized. HOWEVER- if the aid is on on their break and someone needs to go to the bathroom- of course the nurse should do it or whatever else needs to be done. Some of you guys have major chip on your shoulder. Get over it! If you are at work, other than your break you should be busting your butt. The aid always gets her break did you notice that? And how often does your nurse not???

  16. Older than grit nurse Says:

    Here is the key to working with your NAs. First remember that they are people too. If you have never worked as a NA, then you do not understand what it feels like to be one. It is hard work and very unappreciated work (I worked as a NA for two years prior to college). Second if you have a moment then do not sit down in the break room ~ go do something for your NA. Like for instance get VS or help get VS or make a bed, give a bath, etc. It is all about teamwork and to be a good team player you have to act like one. To get others to assist you, then they have to be part of the team. Promote teamwork. Talk to your NAs. If you have two or three routine NAs that you work with, sit down and actually get to know them. Find out what they are about. Every one hates doing something on their job. Find out what they hate and see if you can either help them do it or do it for them (if you have time). Mostly you need to value what they say. Often the client talks to them even before a nurse as they are the ones on the front lines so to speak. It really is about respect. Be careful not to nag or point out flaws because this only makes the person defensive. If you notice that they are leaving stuff undone ask honestly if you can help, it may be as simple as being overloaded or perhaps they do not understand why it is important. I have learned many lessons over the years from my NAs. The most valuable of which was to listen not only to my client’s but my team-mates. There is no better environment in which to work than a happy team where everyone plays a significant part. That is my sage advice to you.

  17. Nurseferatu Says:

    I was a CNA before becoming an LVN and now I have become an RN. I have learned that by letting my CNA’s know what I am doing- such as I may say to my CNA ” Can you take Mr. Joe to the bathroom, room 3 is in terrible pain and I need to give her some Pain medication” When I let them know what I am doing I get less hostility. I even let them know when I will be at the desk charting assessments or calling an MD, so they know I am off the floor and they know where to find me. I constantly ask throughout the shift how they are doing, if they need a break and if they need any help, even if I can’t help them myself, I ask…My advice is if you are getting hostility, pull the person aside in private and ask what you can do to fix the situation, even if you feel that you are not to blame, it puts the person less on the defense. I always state ” I can’t fix things if I don’t know I am doing something wrong…Can you help me?”

  18. 20 yr seasoned CNA Says:

    I have read all of these blogs and have some advice. I have been a CNA for 20 YRS and I have worked with some nightmares you call RN`S as well as ignorant CNAS. The one thing I see alot of is no one knows their place and that`s where the hostility comes in. Here`s why:

    RNs will do some ignorant mess like letting the call bell ring and say that`s not their job, RNs will get a patient and the patient asks to go to the bathroom and the nurse will come out of the room and go hunting for the CNA, RNs will not clean a patient stating it is not their job to do that or make a patient bed if needed. It`s stuff like this that will make your CNA resent you because it`s unnecessary.

    We are not asking for you to do our job, that`s why we are there, But don`t abuse us just because you are an RN Your title means nothing when it comes down to genuine care and quality care. I personally treat patients the way I would want to be treated. There is no harm in delegating to your CNA, but it is how you are delegating to them that makes the difference.

    I work in a position that is unappreciative, thankless and very hard work. CNAs have more contact with the patients than the RNs do. I have had nurses refer to us as ass cleaners, pond scum or flunkies/gophers just because we are CNAs. How would you like for a Dr. to come on the floor and barked a bunch of orders and procedures down your throat and says I want them done right now and was very very untactful? Wouldn`t feel good would it? Well as being a CNA that`s how it feels when RNs treat us that way. Rns don`t want to help their CNAs and will say why are you here if you need my help, I have you here to help me, not the other way around.

    The bottom line is Rns need to learn HOW to TALK to your CNAS instead of barking orders and having a chip on their shoulder or having a napoleon complex just because they are RNS. The word for the year is TEAMWORK!!!! Here`s something to think about….One day you are going to be a patient and pray you don`t get CNAS or RNs who act like all of you are acting here….You`ll be D.O.A.

  19. anRN Says:

    Wow, so much anger and resentment. It can’t be good for anyone, espcially for the patient.
    I am an RN, for almost 2 years. Prior to that I was an NA. I both roles I have never considered a patient’s need to be an RN’s or NA’s job, I just consider who can get it done most efficiently, while considering all of our patients.
    “difficulty delegating” should take the NA’s aside and ask why assigned tasks aren’t getting done and how you can help. If you can’t help, tell them honestly, why you can’t. If you sense attitude from a coworker, take them aside, ask them how you can improve the situation.
    I treat everyone with the respect I want to be treated with. The NA’s are actually a tremendous resource for you, they spend more time with patients than anyone in the patient care team. Learn to respect the job they do and the time they have and you will be well rewarded and could be a better nurse.
    I carry with me ALWAYS the advice I learned from the crib: “DO UNTO OTHERS AS YOU WOULD HAVE DONE TO YOU” If you act lazy in your role your coworkers will to. If you work hard, so will they. In this situation the patient wins.

  20. Serena Says:

    I was an NA for 4 yrs, before that a candy striper or “volunteer”(to be PC)in the hospital since age 14. I was also a dialysis technician and finally my last 2yrs in college I spent as a student nurse. I have now been an RN for 5 years and feel it is absolutely necessary for every nurse to at least shadow a CNA for a minimum of a week during their training and VICE A VERSA. Both will find that it is all very hard work, regardless of your title.

    A good nurse, especially one who’s walked in the shoes of an NA, will both delegate and when needed or when time will take on ALL patient care responsibilities, as we are ultimitely resposible for the care of the patient. That’s why we delegate “OUR” duties. However, this is not reciprocal, no one helps us with passing meds, calling doctors, taking their orders, charting full system and admission assessments(18 pages at my current job.)

    We are all stressed, overworked, underpaid, and under-appreciated. I think the only way to survive is to have trust in yourself and in one another by following the golden rule as “anRN” mentioned above. We all deserve respect. “Bitch” this and “lazy” that, people, this is our career, we are professionals. When you feel disrespected or wronged, confront the source. Yes you should hold the NA accountable for missing vitals, and when they roll their eyes at you, let them know you have documented by email to the charge/manager (YES ALWAYS PUT THINGS IN WRITING) that there were several missing VS that day and that you spoke to the NA who seemed unreceptive. HOWEVER let me ask the blogger/new nurse this, if there are VS missing from the whole shift and it is now changeover, but you were “too busy” to follow up on them earlier, guess what? Legally, our fault. Guess why? We are supposed to actually be LOOKING at these VS, not just at the end of the shift making sure our “ducks are all in a row.” If your workload is so high that you can’t even look at your pt’s vitals throughout the shift, this is a bigger safety issue and is not soley based on delegation. Let your charge nurse/manager know you don’t have time to even look at VS, less likely follow up on if they were done.

    Last bit, all of us are in high demand, if professional communication fails and management is unwilling to support our needs, find a better team. Yes, team, b/c that’s what we are. Amen and goodnight.

  21. Mel Says:

    Interesting discussion:
    I was a new RN 2 years ago and ran into the problem of trying to prioritze things and get things done in a timely manner. I fell into the trap of thinking the techs were supposed to do the “grunt work.” I then received the cold shoulder and had to figure out a new way of approaching the issue, as the techs/care partners are essential and we all play an important role. I don’t like the idea of shadowing, because every nurse and tech are different and we should have an inherent understanding of what we each do, but we all have to deal with the fact that even though we may be the best nurse ever, you may have a co-worker who will always refuse to put a pt on a bedpan and give you a bad name as well.
    🙁
    But what I found that works:
    1) Your are care partners, don’t forget and if you know your tech is on break or busy, then step in when needed, nothing is beneath you (a nurse once told me, RN’s can do everything a tech does, then cannot in return do everything you do)
    2) When you see that they are busy, offer to help. They may be fine bathing the patient on their own, but having an extra set of hands doesn’t hurt–I do get turned down quite a bit, but they know I am there if needed.
    3) If you see a tech struggling with someone and the patient is not yours, help anyway!
    4) Thank them publicly–I always thank them before the end of day.
    5) If there are issues, then address them, don’t let them linger. I like the approach above, if something is not done, follow-up…
    Eventually I found that all my tasks were done, they new that if I wasn’t tied up I was there to help, whether the patient was mine or not, and we all got along well.
    The great thing is that I am able to get everything done during the day and don’t feel as stressed and I don’t have the reputation of being a “bad” nurse.

  22. janegalt Says:

    It is a “People thing.” Sometimes it works, but most of the time a RN must think – should i invest in this situation or just do it myself, along with the two admits, the cares, the discharges. I just document and usually say bye bye to the hassel. RN’s cannot do everything. NA delegation problems is a management call. The new medicare guidelines will make management look at how much NA’s work and they will have to finally address it.

  23. nicole Says:

    I am a cna . I think that the nurse could have heated the tray. To walk to the break room and ask was crazy. Why would you do that . I can imagine the family member was probably thinking whats wroung with you ? why cant you just get the tray instead of hunting the cnas? esspecially if you know they are on break.?

  24. Laura Says:

    Maybe get them in a meeting and talk to them about how things can change. Perhaps they can come up with a better strategy.

    You do need to check your vitals after they’ve done them. They might not necessarily know when to report a bad number to you — they don’t have training in that. As a NA when I was in school, I moved from one unit that treated me terribly (one night, 3 pt’s had hourly accuchecks and I had 10 other patients – no nurse offered to help, and I didn’t have the *alls to ask) to another unit where the nurses, AND doctors (!!), said thank you. And please. And good job. What a difference!!! I worked harder and I was happier with my patients. Nurses should appreciate NAs. On the other hand, NAs need to do their jobs. If things are getting missed, by either an NA, RN, or MD, patient care is compromised and bad things can happen. A patient can die. There is no excuse. Work together, talk with one another, find a better way to do it.

    Call a unit meeting! You’d probably get good ideas. Talk about mutual respect, too. One should never roll her eyes at a colleague. One should appreciate the other. I know you are task oriented, being new, but try to look at the overall patient care. If you can do a “tech” task in a few minutes, do it yourself. Good luck!

  25. rhon Says:

    I am a RN that had previous CNA experience. I can tell you that most positions I have held there is always that one CNA that will always give you attitude. Just as the CNAs above got attitude on here and saying ‘you must have never been a CNA’- well YOU have not had to be a RN either. So dont judge US either. A new nurse’s 1st year is INCREDIBLY stressful. Its not your job to ‘put that nurse in her place’ or ‘show her’- pt care is was is sacrificed. CNAs can brush the chip off their shoulder too and just do what is delegated. If you are truly too busy to do whats asked of you and you feel the RN is being all high and mighty, lazy whatever- let him/her know that you are too busy. Dont be passive-aggressive and just not do it. If I have tried to build rapport with CNAs and been clear in communicating and Im still on their ‘crap list’ and they are not doing the VS or glucose checks, I will obviously do it myself late but also WRITE THEM UP. Management needs to know where the break down in pt care is. There is that ONE CNA where I work that I dont even bother asking anything of. All the rest CNAs we get along GREAT. I think its pretty pathetic when management tolerates said individuals who pretty much refuse to do their job. I just chalk it up as a unfortunate situation and I have zero respect for such person.

  26. Pat U Says:

    Yes, delegating CNAs are very difficult especially in the nursing homes. Nurses’ aids are always very. They always transfer their frustrations to nurses making it team work almost impossible. I have done this job for many years. Sometimes being a nurse feels like being in a war front where the enemy is not defined. All we do is to cover our big behind, because the whistle blowers are always fixated on us waiting to cry wolf just to kiss up. Insecurity and enviousness is the problem. Nursing home environment attracts bad news. It spreads like wild fire especially when it about a nurse. One day a friend said to me, “In nursing environment, if you are an LPN you are dead and if you are a RN you are really dead” I must tell you guys that this hypothetical statement is true. Every nurse can attest to this. May God save us from CNA gang up, Amen,

  27. Pat U Says:

    Nurses aids are always very angry.

  28. Pat U Says:

    ……..Making team work almost impossible.

  29. CadetNurse Says:

    I agree with rhon. I read the first blog from the new nurse, and re-read it to make sure I understood her comment and question that followed. She did not in anyway imply that ALL CNA’s are lazy. She simply stated that she is having trouble working with the CNAs at the place that SHE works in. Also, calling her a “Bitch” and assuming you knew every detail about the events that took place at her work (such as the tray heating incident)just goes to show that there are SOME CNA’s out there who really do have attitude problems. Simply not doing the task because you dont like the RN or dont think you have to do it is completely irresponsible, even if the RN could have done it herself. In the military, incompitence gets people killed, and someone with attitude gets fired. We also have another motto “No excuses”. Basically if someone REALLY cares about their work, they will get over their own bias and do whatever it takes to help (such as giving real advise ! to the nurse who posted this article). Like rhon said earlier, if you have an issue with a nurse tell them. If you cant handle the stress/disrespect of CNA life, go to or finish up school. No matter what, if you don’t have that degree, your work will be ruff and in some way you will be less respected. It is unfortunate and also a fact of life, we can either be grown ups and cooperatively deal with the issue or be passive aggressive and complain. Fighting within the work environment does nothing but effect the big picture- patient care.

  30. Rosie, BSN/RN Says:

    I TOTALLY AGREE WITH anon…I was a CNA for approximately 5 years, and worked with many many lazy CNAs…as well as many lazy nurses. However, I have also worked with CNAs and RN’s that were worth their weight in gold. As a new nurse graduate, I have one thing to say to everyone: WE ARE A TEAM. Let’s not make this into a “he/she’s too good for this, so I’m not doing it”. If you don’t want to do your job, LEAVE. We are here for the patients…nurses have the right and responsibility to delegate tasks…it’s within our SCOPE. That’s why we go to 2/4 year universities (I HAVE MY BACHELOR’S) and spend all this money to put RN behind our names. I’d like to see the techs who think the nurse is just lazy sitting by the phone take phone orders, call the pharamcy, check for allergies, get the meds, meanwhile deal with other patients, an admit, a code, and all the while having to babysit a grown person who’s job it is to take care of patient ADL’s or assist? Com’on. Let’s take the chip off our shoulders and call it what it is. This is the reason why nursing is struggling to be considered a profession–this is NOT HOW PROFESSIONALS ACT.

  31. Rosie, BSN/RN Says:

    I mean, I agree with rhon…

  32. TOM Says:

    Hmm, I am a student nurse and I keep hearing that the CNA staff on the floor that I was just on is impossible. I have to agree with the respect aspect of this conversation. I really feel that if you respect the CNA’s (after all they are licensed too), they’ll really have respect for you. I always talk about my patients DX with them and make them feel like they are part of the care. The more they know, the more they know how to report. How hard is it to empty a full hamper when you walk by it or help a CNA clean an incontinent patient. I have seen nurses that refuse to help clean patients. I have also seen nurses call and rip pharmacy for not sending meds up fast enough. We are PATIENT ADVOCATES AND PROVIDE CARE. HOW HARD IS IT TO JUST DO THE RIGHT THING. Wouldn’t you want care provided to your family in an efficient timely process?

  33. tabby5 Med Student Says:

    After reading everything posted here it’s hard to comment. When I first read the original posting i was appalled because it is worded in a way that is demeaning and condescending in regards to CNA?techs. I have worked as an aide in a 20 bed ICU unit at a rather large hospital for over 2 years as an only aide and I can tell you from experience that you will find lazy worthless nurses just as much as you find lazy worthless CNA/techs. The tech that use to work with me would take 20min smoke breaks while i was left to bust my butt every night usually on my own b/c she was nowhere to be found. So I understand that its frustrating to work with ppl like that but in all honesty, the nurses had 2 pt’s each normally while i would have ALL OF THEM. I think it tends to slip nurse’s minds that us “lowly aides” sometimes are much busier than they are. Not to mention I was treated horribly by half of them until they found out I was a med student and had more education that 95 percent of them. I’m grateful for every moment of the rude remarks, being spoken down to and treated like i was mentally handicapped because it’s going to make me a better doctor. Unfortunately, I think nurse’s and CNA’s need to stop doing the “poor me” act and trying to point the finger at each other and instead show mutual respect. You never know, that CNA who you treated like shit for 2 years may be your boss someday….so just keep that in mind.

  34. CNA/Current Nursing Student Says:

    As a CNA, I can relate to much of what has been said from other CNA’s. CNA work is extremely difficult, as is the work of an RN. The key, however, is respect.
    I think it is absolutely ridiculous that you went to find a CNA on her break to ask her to heat up a tray. In the time you did that, you could have done it yourself. That is a perfect example as to why a CNA would give you attitude. I’d roll my eyes at you as well.
    I almost find it hard to believe that an RN that has not been a CNA previously could even be a good nurse at all.
    I suggest you sit down and think of a respectful way to suggest to your CNA’s that you’d like them communicate with you and let you know if they are having a hard time getting things done and ask if you can do anything to help if time allows.
    The last thing you want to do is appear as though you are better than them… which is what you seem to be doing, unintentionally or not.

  35. michelle ceo Says:

    I THINK THE KEY IS TO INCLUDE THE STNA, IN PT. CARE, HOLISTICLY. TEAM IS WHAT WE ALL WANT. I AM A NEW GRAD, OLDER THAN MOST, AND I KNOW THAT ANSWERING A CALL LIGHT OR HELPING WITH A BED PAN HELPS THE ATMOSPHERE, ON YOUR FLOOR. I WORKED AS AN AID AND I KNOW THAT A NURSE WHO FOLLOWS THE STNA AROUND AND IS BOSSY, IS IN TROUBLE. RESPECT THEIR OPINIONS, THEY ARE OUR EYES AND EARS.

  36. Jennifer Says:

    I’ve been a nurse’s aid for a few years, with hospital AND nursing home experience. I’m a little shocked at all the harsh words on here, because it says to me that whoever uses them seems to have a set opinion of the other person’s job. Anyone with any experience here will know that there are good and bad aids, nurses, and so forth. I’ve worked with aids who will leave patients waiting to be cleaned up to go to break or whatever, and I’ve cared for their patient in their absence. I’ve worked with wonderful RNs and LPNs, and ones who weren’t so good. My best RN treated everyone with respect. I’m currently finishing my prereqs for nursing school, and I learned so much from him before I even started some of my classes, because he would answer any question I asked him in a friendly, informative way. My RN low was a nurse who was doing her assessments and came all the way down the hall to tell me one of my patients was falling out of bed. She evidently didn’t feel the need to try and keep the patient from falling, but left them hanging halfway out of bed and came to get me. The bottom line is this: our first priority is patient care. It doesn’t matter how much education you have behind you. RNs should understand that especially in a nursing home environment, CNAs are always hopping. We never get down time. We barely got a chance to eat a quick meal at the facility where I worked. HOWEVER, CNAs need to understand that RNs have responsibilities too, and just because they aren’t in a patient’s room at that moment doesn’t mean they are not doing their job. Assessments have to be done, doctors have to be called for new orders, discharge plans have to be done, and so forth. The point is, EVERYONE has a job that is necessary for the best care we can give to the patients. Never assume that anyone’s job means less than another. A good CNA is priceless but so is a good LPN and RN. Hostility can be felt by our patients and we should never transfer any of that to them. They are already stressed enough. If you have a spare moment, no matter what initials are behind your name, please help someone else. LPNs and RNs, if you have a few spare minutes, help with vitals. CNAs, if you have free time, help other CNAs or ask an LPN or RN if anything else needs to be done. Respect for all is key. Sorry this was so long-winded but it’s a HUGE concept that everyone should understand.

  37. bowers68 Says:

    you all need to to understand that the nurse is the boss. you were under her liscense and she is the delegator. Im a cna going to nursing school and i work on a vent unit. the nurses argue about who will work with me that day. all you need is good time management skills because there is no reason that a nurse should come around and ask you for vitals or finger sticksl. a good cna can have all this done in a timely manner and have time to spare. and for all you nurse who think you dont have to clean shit, well work with me one time and your fuckin atitude will change i guarantee it. Im former Navy SEAL and you all havent been through shit because the only easy day was yesterday.

  38. Pat Says:

    I’ve been a CNA for 16 years. I’ve worked in nursing homes, CBRF’s and in private duty. Currently, I work in the nursing home I trained in to become a CNA, only it’s now under new management. What have I found? Same place, same lousy RN attitudes, with a new facility name. After reading all of the posts, it’s obvious that ‘we’ aren’t and never were, (possibly never will be) on the same page. I’ve worked with great RN’s and other aides that worked their butts off. I work my butt off because I love what I do. My residents mean the world to me. What I’ve been so sick to death about for all of these years is the RN who thinks ‘her’s’ doesn’t stink. I now have to work with with ‘THE ONE RN’ who is stressed out, burned out and upity about her ‘title’. She knows everything. It’s like pulling teeth just to inform her of how a diabetic resident refused to eat his supper – right after having an insulin injection. Her attitude towards me was accusatory. What was I suppose to do? Shove the food in his mouth and force him to eat? No, this issue isn’t only about who’s lazy, who doesn’t care or who should do what. It’s about STATUS. And I’ve had it with the RN’s who can turn a unit into the depths of hell-fire just to save their own reps when they do their documenting. The REAL bottom line here is that ALL nursing homes are understaffed. I’ll repeat that. ALL NURSING HOMES ARE UNDERSTAFFED! That’s leaves everyone stressed to the point of having the opinion that ‘it’s them against us’. Teamwork my butt. I’ve never witnessed that in a nursing home. I say, close them down!

  39. ericka Says:

    I am a nurse and the one thing I don’t do is kiss ass u know ur job if u want it do the work I didn’t ask u to become or stay a cna my job entails a lot of legality and responsibility yes I will get along but I’m not jumping thru hoops for anyone except my patient I’m the kind of nurse if u want ur job do the work don’t worry about what I’m doing its really none of the aides business I delegate to u not vice versa I do not play I have and will get an aide fired in the drop of a dime I don’t mind helping out if and when I have a chance most of the time I don’t I don’t believe in insubordination or cnas making a hostile work environment u will b gone n a nano second with me go to school pay ur dues and stop taking out on these hard working nurses what u wish u cud have obtained and yes I’m a good trusted nurse and a nurses advocate

  40. Cindy Says:

    I agree with Ericka….a lot of cna’s who has been in the jobs for years thinks they know everything when they see a new nurse come in the unit….the cna’s do not understand all the responsibilities we have….I say write them all up, and if that doesn’t work, tell the nurse manager, and if that doesn’t work go to the hospital administrator…Do not let them treat you with disregard, we worked too hard to become an RN, and if they only knew that we already get abuse by the doctors (lol). I worked in a facility that the cna’s run the place coz they have been there for years, let me tell you, I wrote all the ones that didn’t do their jobs, and gave it to my DON, gave a copy to the administrator, did it for several months, I made sure that I made copies of the write ups…when nothing was done, I called the corporate and made an anonymous complaint how the facility was being run, let me tell you, in a week, the trouble makers were gone…Do what you have to do….Keep your head up!!!!You worked too hard for thy license 🙂

  41. kristen Says:

    i do have respect for nurses , but at the same time, i dont think nurses should have cna’s. a nurse is caregiver not a paper pusher!!!

  42. Shirleigh Says:

    I am a CNA and have been for the last 3 years. I have to say there are just as many good CNA’s as there are bad ones. I work my tail off all the time, but that’s because I care about my patients! And I do try to help my nurses as much as I can and I respect them. They have hard jobs and we CNA’s do too. It takes a good team to get the job done. Sometimes my nurses will help me boost patients, some will empty urinals when they go in the room, some will help change patients. WHEN they can – sometimes they don’t have time and I’ll try to round up another CNA. Then there are others who won’t help you do squat even if they are sitting and chit chatting away!
    When you respect eachother, there is team work. There are always a few in every category that just aren’t worth a cent – even nurses who don’t care, and it shows. Our jobs are stressful enough without the bull crap that goes on – nurse to nurse, CNA to CNA and Nurse to CNA. We all need a little help in these stressful positions.

  43. 20 Yr RN Says:

    1. Nurse’s Aide- an aide is a non-professional position. The aide is delegated to by the RN, a professional position.
    2. CNA’s have NO idea what the RN does. Respectfully, they only think they do. Better boundaries are needed to protect the RN profession.
    3. One does not need to be a CNA to know what they do. The RN also functions in this aspect.
    4. CNA’s and RN’s are NOT the same. CNA disrespect toward RN’s is all too common. RN’s are reprimanded and fired if they treat a physician with disrespect, disregard, refusal, aggression, hiding during a shift, or telling a doctor to change a patient’s gown as long as s/he is in the room! CNA’s are coddled, lots of excuses made and rarely written up or fired.
    5. RN’s do NOT have to explain themselves to a CNA as to why they are being delegated to.
    6. Great CNA’s, are also stressed by their CNA co-workers who burden them with lack of proactivity, initiative, and team-playership because they end up doing more work.
    7. Finally, there is nothing more wonderful than enjoying one’s work because the CNA on the team has good work ethic and is not “at war” with RN’s.
    8. Being a CNA is a physically tough job.

  44. Debby Says:

    I am a CNA and I work in an ICU Unit. I work a 12 and one half hour shift and including my break I sit an average of only 45 minutes a day, which includes charting. I do most of my charting standing up. What really brothers me is I run constantly trying to help all the 7 nurses and 14 patients on my unit. Then a nurse comes in that doesn’t know me or the unit and she reports me because I didn’t drop everything to help her when she wanted. I explain that I am in the middle of rounds, or vitals signs or glucose testing, and I am behind because I just helped three other nurses and answered 4 call lights, because no one else does so. If, a nurse needs me, I expect them to walk up to me and ask me and explain the need, for example, the patient is lying in his feces and I need help to clean him up. I would immediately help but instead, however, the nurses yell at me across the unit and expect me to always drop what I am in the middle of doing to be at their beckon call. Perhaps what I am doing is more important, perhaps not, but yelling at me across the unit, to come do something is poor communication. I also feel that there should be a protocol, that if the nurse feels that I am not responsive to her needs, that she talks to me first instead of running to the nurse manager to complain. Then I hear about it later as the Nurse manager tells me she has to write it up and I am allowed very little to defend myself. I want to help and support the nurses on my unit, but this seems to occur at the most busiest times and usually after a few days when there has not been a CNA on the unit. I just feel it is so unfair. Nurses need to realize that they need to promote good morale and complaining to the Charge Nurse when she doesn’t get my immediate attention, of course I am running and doing other things she just thinks her need is most important, and she gets me in trouble. I am demoralized. I can see why so many CNAs leave their jobs. It is rather unfair that CNAs have to please the patients, all the nurses, the mangers, the Doctors, and everyone else. The CNA is low man in the ladder and the grunt! The CNA is never allowed to say she is busy doing something else, as the nurses thinks their situation is first priority, always! I want to help and I am in nursing school too, so I want this to be my career, but I will tell you that I will never bark out orders to a CNA across a unit and expect them to jump at the click of my fingers!

  45. Jesus M. Montero Hernandez Says:

    Clearly, bad apples exist on both sides. Depending on facility/location, sometimes the CNAs are the bad actor and sometimes the charge nurses/staff nurses are. Honestly, a change of the shift is all it takes. Demonizing either profession us unfair and completely unrealistic.

    Management needs to put forth greater effort to isolate the bad actors on both sides and take necessary actions to discipline or, if need be, terminate the individuals that are poisoning the cohesiveness of the work-place team/family.

    At least, this seems to be the problem at my job. Bad actors will always come, but they need to go. Continue interviews, continue putting people on the floor. The only way to weed out the bad actors is to try and find as many friendly individuals who want to join work-place family that cares for the weak. And, helping them to get healthier and back to their independence, an aspiration we all strive for.

  46. Technician Says:

    This is what happens when employees refuse to work as a team. Nurses need to give up the mindset of this is the aides job, this is the tech’s job, etc. so I’m not going to do it. All some nurses want to do is push meds and write care plans. Is that all you went in to nursing to do? Patients are the responsibility of all staff. As a nurse if you think you are too good to change a patient for example you don’t belong in the nursing field. Are the CNA/Aides sitting on their asses in the nursing station on their phones or the internet? Are they taking excessive smoke breaks? If the answer is no then they are probably working their balls off, working harder than you, doing all the dirty work, getting paid like crap. Work as team! Everyone is there to support patients. At the end of the day they are working under your license-if all you are going to do is complain about it rather than being proactive, you are the problem.

  47. sunshine nurse Says:

    First let me comment on the post of the CNA’s who have nothing to give but thrashing comments. You may be a fantastic CNA. I do not know you so I will not belittle you with harsh name calling. However, YOU have also NEVER been a nurse. Not only are we responsible for all of our/your patients and their care, we are also responsible for every action you take. You may think paper work is not important but do you know without that documentation you patient can lose coverage of benefit and have important medical diagnosis missed? In a nursing home setting it is expected usually that a CNA get vital signs. In the hospital with only 5-10 patients I would demand it. My CNA’s (all 4 of them) have 50 patients to tend to . Now this is on a skilled unit where a lot of the pts are continent, able to feed themselves and voice their needs. However they manage to get all the vitals and complete the rest of their patient care. With that said my first med pass takes me usually about 4 hours. (the first part of my shift) I delegate task out to each CNA and as I move through my med pass I help with patient care as I am able. If a need is greater than the time I have available during med pass I will call the CNA. If not I will complete the task myself. A CNA will absolutely not tell me they are not going to do something I ask of them. I would not ask anything out of their ability. I do not ask them to do any part of my job description as well. I will lend a hand when able but a CNA can not do my job. And believe me late meds can make for a very bad night for you CNA’s. So wrapping all of this together. Begin as a new nurse laying out your expectations. Even having a team meeting prior to each shift is a great tool. This is me, this is what I expect. Gain the trust of your CNA’s as well, they want to know you have their back, and believe me the good ones will have yours as well. Help your CNA’s whenever you can (not when you want to) I definitely would have heated the meal up myself and not hunted a CNA do it. 5 minutes of a patient waiting for warm food is too long. Please and thank you’s go a very long way. If your CNA tells you they are overwhelmed help them, if it becomes a ritual that your CNA never gets all of their work done try to assist them with time management. If it continues maybe you are looking at someone who does not want to do their job. In that case a write up may be in order. On another note. ALWAYS listen to your CNA’s when they say something is wrong with their patient. They usually have a different more personal relationship with them and they are usually right when they say so. Nursing is not an easy job. It is stressful, tiring, laboring, and never ending. Team work and delegation is imperative!!!! So set your ground rules, always smile, be a team player, and breath deep!!! Oh and I was a CNA for 8 years. I have now been an LPN for 6 and I will be an RN next year.

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