Adequate preparation, communication of expectations and ongoing monitoring is certainly essential for our certified nursing assistants. Holding them accountable for their assignments, proper technique and interpersonal skills should be a given, yet many times nurses and managers will complain that over the years we have gone from the “nurse is in charge” to the “tail wagging the dog.” 

Fear of CNA turnover and recruitment of qualified staff will sometimes prevent managers from holding employees accountable for ongoing concerns. After all, even a poor CNA may pick up an additional weekend shift!

I often ask nurse managers the question, “Do you think that the fast food establishment down the street would allow an employee to give out the wrong change multiple times each week without some type of intervention?”  What about if they forgot those fries with the burger and there were complaints multiple times per week?

How long would the restaurant allow that to go on? Then I ask, “is resident care more important than fries?”

I also ask nurse managers if problems with Activities of Daily Living tracking relates to their CNAS, and if that’s causing more than pocket change to be left on the table.

I firmly believe that most CNAs could be nurses if given the opportunity. They are smart enough and have insights into resident care.

It’s not just about more education, or re-education. Facilities must have a good monitoring and system for oversight, mentoring, coaching and holding staff accountable. This needs to start at the charge nurse level.  Nurses need to be consistent! If one nurse doesn’t follow through it makes it hard for the nurses who are holding the CNAs accountable.

Teaching charge nurses and CNAs professional respect and courtesy, setting expectations, and then backing it up with kind, firm and consistent follow-through is essential! By having high standards for CNAs and managers, resident care will improve.

Susan LaGrange, RN, BSN, NHA, is the national education coordinator at Pathway Health Services.