The relationship between nurses and nursing assistants is key to good patient outcomes. Compared to other healthcare providers, nurses and nursing assistants spend significantly more time with patients at the bedside. As frontline health providers, good communication, teamwork, and professionalism are crucial to building strong working relationships between these two roles.
Yet, inconsistency, lack of support, and poor communication can sometimes break down these relationships, which can hurt the staff and their patients.
Find out what causes the breakdown of relationships between nurses and nursing assistants, how it can affect staff and patients, and what certified nursing assistants (CNAs) and their supervisors can do about it.
Causes of Breakdown in Nurse-Nursing Assistant Relationships
Nursing Staff’s Role
Communication between nurses and nursing assistants can make or break relationships. In Miller’s thesis and a paper by Beynon et al., both nursing assistants and nurses expressed the need for effective communication with CNAs to not only to correct mistakes, but also when they do well.
Nursing assistants expressed multiple times that they’re more likely to ask for help from a nurse they know will listen and offer help. Without sufficient positive feedback, nursing assistants can feel unappreciated and may even leave the field.
By providing positive feedback, nurses and CNAs can help to achieve a more positive work environment.
Positive feedback goes both ways. Just as nursing assistants appreciate and value positive feedback, nurses in these studies also expressed their appreciation for CNAs who give valuable feedback or additional perspectives on patient care.
Nurses in an article by Campbell et al. said they appreciate nursing assistants who provide feedback, offer ideas on how to handle changes in the patients, and perform their responsibilities well. It makes their jobs easier.
Nursing assistants also appreciated nurses who helped them with two-person tasks, such as turning patients. Nursing assistants in Miller’s study and Pickering et al. said they had hurt themselves or heard of other nursing assistants getting hurt when they did not receive help from a second person to lift or move patients. One study group in Campbell et al. even set up turns with a nurse and nursing assistant every two hours.
One of the responsibilities of CNAs is to report changes in the patient to the nurse. Nursing assistants in Pickering et al., Campbell et al., and Beynon et al. said they choose which nurses to ask for help and report changes to based on the nurse’s attitude and previous responses.
As a result, some nursing assistants said they stopped reporting changes to the nurse or asking the nurse for help because they did not receive adequate help. The lack of help can leave CNAs feeling unsupported and can ultimately have a negative effect on patients.
To prevent the breakdown of working relationships between nurses and CNAs, nurses should:
- Help nursing assistants when they need support with a patient or are running behind
- Communicate with them about changes in patients’ conditions or care plans
- Listen when nursing assistants come to them with changes in their patients
- Offer nursing assistants appreciation when they provide feedback, share insights, and work hard
Learn more about the solutions nursing staff can use to better communicate with each other later in the article.
Registered nurses spend the most time delegating to nursing assistants. Yet, they’re not the only ones who contribute to the breakdown of relationships between nurses and nursing assistants. The policies management makes can affect the relationship as well.
Some nursing assistants may find the leaders at their workplace prioritize speed over safety and quality care. They may have to make do with the resources and time they have rather than using best practices.
Nursing assistants may follow best practices, but their supervisors might reprimand them for taking too long or running behind.
Workplace leaders may also prioritize some tasks over others because those tasks have to be documented every day. For example, some nursing assistants say they have ignored patients who needed to go to the bathroom because they had to shower other patients and document that they did so on the shower schedule.
Management should prioritize best practices and safe, high-quality care over cost and speed. They should make sure their nursing staff has the supplies they need to provide the best care for patients.
They should also prioritize care based on patients’ needs rather than what needs to be documented. Nursing staff should never be reprimanded or punished for “taking too long” when they only took as long as they needed to provide the best, safest, and most complete care.
When management prioritizes best practices, safety, and high-quality care, nursing assistants do not injure themselves or their patients. According to Miller, CNAs are three times more likely to be injured on the job than any other profession.
As a result of these policies, some nursing assistants may not have time for regular breaks or practicing self-care for nurses. The impacts of the nursing shortage can be felt at all levels of a healthcare organization and, as a result, nursing assistants can often bear the weight of these stressors.
Instead, it is critical that management encourage nursing staff to work cooperatively. Nurses can help by encouraging nursing assistants to take breaks and respecting their break times.
Effects of Strong Relationships Between Nurses and Nursing Assistants
Relationship breakdown between nurses and nursing assistants can negatively affect the nursing staff and patients. Yet, when healthcare teams communicate and work together, according to their scope of practice and abilities, nursing staff and patients all benefit.
Effects on the Nursing Staff
- Effective team communication so everyone is on the same page and feels supported
- Higher patient survey scores
- Decreased nurse burnout and stress
- Work divided reasonably, according to scope of practice, abilities, and schedule
- Decreased turnover
Effects on the Patients
- Best practices followed to provide safe, effective care
- Positive care outcomes
- No missed care
- Fewer accidents and falls
- Increased satisfaction
Solutions to the Breakdown of Nurse-Nursing Assistant Relationships
The breakdown of relationships between nurses and nursing assistants calls for nursing assistants and their supervisors, whether they be nurses or healthcare leadership, to help build better relationships with each other.
Nursing assistants and their supervisors contribute differently to better relationships. Yet, Ellen Munday, CNA, offers one solution that can apply to everyone on the healthcare team.
“Stay patient-focused. The best comment I heard about patient care is to make sure the patient has the best day they can,” she says.
What Nursing Assistants Can Do
Conflict between nursing assistants and other healthcare staff can lead to employees quitting or leaving for another field or job with a better environment. According to Health Affairs data from July 2016, nursing home staff had a median annual turnover rate of 94%. This high turnover rate, which only increased after the pandemic, can create negative outcomes for patients and the healthcare team.
Marie Davis, CNA, suggests nursing assistants should work with their supervisors to prevent turnover.
“The problem must be resolved in order for you to be able to continue conducting yourself in a positive manner at work,” Davis says. “If you’re unable to solve the problem, a transfer to another department, another floor, or another supervisor should be suggested to prevent you from being terminated or quitting.
For nursing assistants who stay in their job, Davis and Munday offer healthier solutions that deal with conflict. These solutions aim to serve both the patients and healthcare team:
- Focus on the patients’ needs
- Keep your behavior professional
- Inform your supervisor of any breakdown in communication or teamwork
- Recognize personality differences do not reflect job performance
- Find team members who value nursing assistants
The literature suggests that how nursing assistants might choose to deal with conflict do not serve the patients well or keep with best practices. Nursing assistants may:
- Skip care
- Not report incidents or changes in their patients
- Do two-person tasks by themselves
- Ignore best practices or safety procedures
- Disengage from patients’ emotional needs
What Supervisors of Nursing Assistants Can Do
Nurses, other healthcare team members, and supervisors can help build relationships between nurses and nursing assistants by supporting good communication. “When other healthcare team members are interacting with CNAs, they should make sure everyone is on the same page,” Davis says.
Nurses and nurse supervisors can take several steps to build better relationships with nursing assistants:
- Discipline or remove healthcare team members who bully other nurses, nursing assistants, and team members
- Show the nursing staff that the facility has a zero-tolerance policy for bullying behaviors
- Listen to nursing assistants’ patient observations
- Encourage nursing staff to take breaks for self-care
- Prioritize care based on patients’ needs rather than what needs to be documented
- Step in and help nursing assistants who are running behind or busy
- Meet with nursing assistants individually or collectively to address their concerns
- Remember nursing assistants work under the nurses’ licenses and any accidents, falls, or missed care will put the nurses’ licenses at risk
“They should check to see if there are any conflicts or any other problems amongst the CNAs by meeting with them individually or addressing questions during workshops,” Davis says.
Nursing assistants value when supervisors appreciate their opinions. Miller found that change has to be made based on the concerns they brought forward for them to feel heard.
“As a CNA, we have direct, hands-on observation of a patient. We see the patient in a wide variety of settings during the day,” Munday says. According to Beynon et al., nursing assistants provide 80-90% of direct care, so they may see things that the patient did not report or have changed since the nurse’s last visit.
According to the same study, observations by nursing assistants can provide valuable insight to nurses into changes in a patient or patterns of uncooperation and workplace violence.
Nurses should remember nursing assistants work under the license of a registered nurse, so any accidents that happen because of missed or unsafe care might cause the nurse’s license to also be at risk.
Meet Our Contributors
Marie Davis, CNA
Marie Davis has been employed as a CNA in the healthcare field for over 14 years. She is also the founder/CEO of Ria’s Beauty Collection, founder of Ria’s Crafts and Things, and author of “A Burden Has Been Lifted.”
Ria’s Beauty Collection specializes in skin care and hair care products for those that may be experiencing difficulties with skin and hair issues. Ria’s Beauty Collection launched in 2015, due to Davis’ skin condition with eczema. Ria’s Beauty Collection gives back to the community through donating, gifting, giveaways, vending, collaborating, volunteering, and more.
Ellen E. Munday, CNA
Ellen E. Munday has been a certified nursing assistant for seven years and is the mother of NurseJournal writer Rebecca Munday. She earned her CNA license from Wor-Wic Community College in Maryland. Later moving to Georgia and then to South Carolina, she continues to demonstrate a commitment to assisting patients with activities of daily living. She brings compassion and knowledge in a variety of healthcare settings supporting the nursing team.
Page last reviewed November 2, 2022