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Relationships with CNAs

How to Build Relationships with the Certified Nurse’s Aides and Why It’s So Important

-Melissa N., M.A., CCC-SLP

Recently it was brought to my attention how well I know the staff at my facility, despite their discipline. In response, I explained that it is vital that each employee is aware of the role that the other plays in the lives of the residents for whom we are working. The information about the patients we can share that eases the burden of care can be great, and working together to complete the everyday tasks involved with the care of the residents can alleviate friction between disciplines that is not only unnecessary, but unwanted. I have found that the Certified Nurse’s Assistants (CNAs) often have knowledge of a patient’s behaviors, personality, family dynamics, and actions that other disciplines don’t, due to the nature of their profession. The CNAs are frequently the ones who know whether or not a resident is following modified diet/ fluid consistency guidelines. They can tell me if family or friends are bringing the resident food that is not consistent with diet orders. They notice when a resident has a change in language and/or cognitive functioning. The CNAs know residents’ preferences, hobbies, and activities in which they engage.

When I first begin a contract with a facility, I have a mandatory in service scheduled for the CNAs as conveniently as possible, typically along with another mandatory in service. During the in service, I address the general aspects of the scope of practice for Speech Pathology, and when a referral should be made. The in service not only reminds them to watch for symptoms that indicate a need for ST to become involved, it also serves as an introduction to who I am, and the role I play at the facility. During the work day, I am conscious of the stress upon, and the workload of the CNAs, and assist them with transfers, toileting, passing trays, delivering items to other departments, fetching needed items from other departments, and the general care of the residents. My philosophy is, if I am capable of doing it, then why ask someone else to? Small actions can speak loudly when it comes to establishing a mutual respect in the workplace.

Occasionally, I post a fact sheet regarding a topic that needs to be re-visited, such as what “mixed-consistencies” are, or the difference between aphasia and cognitive deficits. Sometimes I will just post it for signatures, other times I will hand out a quick true/false quiz that upon return to me, the CNAs receive a candy bar or other kind of small treat. This makes providing education and/or refresher fun and easy for the CNAs and for me. This is also true of being involved with new employee orientation, which helps to familiarize me with the new CNAs personally, while ensuring that they are aware of my role and signs/symptoms that they should be looking for that indicate a need for ST involvement.

I strive to be an active team member who is courteous, respectful, and willing to complete task beyond my “scope of practice,” in order to establish a solid relationship with the CNAs. They are the team members who are involved in EVERY area of the residents’ lives, from their diets to their taste in music. It is by maintaining a fluid exchange of relevant information with team members about the residents that ensures that not only are their needs being met, but that they feel safe, cared for, and enjoyed. Truly, that’s what being in the health care profession is about, and the real “scope of practice” guidelines that should be followed.