I started out working at my facility I work at now as a CNA almost 3 years ago. I have worked alongside many of the people who I am now supervising. I have been a nurse 3 months, so that in itself makes it hard for me to be assertive and feel comfortable about it. There have been a few instances where I need the CNAs to do something and I tell them.. they say "OK" , but it doesn't get done. For instance, for Neuro checks : They are done Q 15 minutes for the first hour, every hour for the next 3 hours and then every 2 hours for the next 24 .. etc.. Well we were getting them every hour at this point and the CNAs do the vitals anyways, so they are asked to get neuro check vitals as well, and they know that. We needed these vitals at 4, 5, and 6 pm. I marked it on their paper and notified them every hour when they were due. End of the shift comes around and the 5:00 vitals are missing.. even AFTER reminding them exactly at 5:00 that their vitals are needed. I try my best to keep on them until i know it done, but in LTC its sooooo busy you just cant possibly remember everything as a nurse and especially a new nurse in the middle of med pass. I need advice on ways to let them know im serious, but still maintain their respect? What do you find works the best for you?
Nov 15, '07
Wow, its nice to hear people have similar problems! This sounds exactly like me when I was a brand new 20-year-old RN in LTC. CNAs would never get my vitals on time and it used to make me crazy. Shift after shift I would remind them that they needed to check vitals at the beginning of the shift, not the end. Nothing worked. They never got them when I wanted them. Finally a light bulb went on above my head and I realized that just like I need a rational for doing something so did the CNAs. So, I sat them down and told them that I needed the vitals at the beginning of the shift so that I could make decisions about care, treatment, medications, further assessment, and monitoring. I explained that I didn't want to find out the vitals at the end of shift (2200) only to realize that I was going to need to call a doc about a BP or temp. Problem solved--got my vitals done on time. Furthermore, I gained their respect by having that kind of a conversation with them and they felt respected and valued by me.
Nov 15, '07
Thats great advise dolche, yet I still fear that they wont take it to heart because I was their coworker at one time and they were at one time teaching me.. and not to mention im younger than all of them
Nov 15, '07
Well, I was 20, so I know what you mean. Most of them were 2-3 x my age. You have the degree--they are just waiting to see whether or not you can "prove yourself." They want to see what you are made of and whether or not they can rely on you to pull through for them. I would focus on building relationships with them that establishes you as a member of the team. Do whatever you can to help them and then expect the same in return. Be sure that you phrase your delegation properly as well. For example, don't say, "Mary, can you get the vitals signs on Mr. Jones?" Instead say, "Mary, here is the vital sign sheet for Mr. Jones. I need to have the vitals recorded by x time. Thank you very much." Then, follow up at x time and ensure that the vitals were indeed taken. Don't ask her 2 hours later if the vitals were taken at x time. She needs to know that you are serious when you delegate. Remember, delegation does not remove your responsibility. Ultimately you need to ensure that the tasks you have delegated were indeed accomplished in a timely manner.
I know you are going to do great! Keep up the good work.
Nov 15, '07
I have been a nursing home nurse for years now and the best thing I have found is talking to them, giving them the reasons I need the to do something, and what the outcome would be if they don't do them.
I have always stressed to them that while I don't like writing someone up, I will do it if they can't do their jobs.
Nov 15, '07
and I JUST went through this not long ago with the whole vital situation myself...
my regular aides are really good about getting my vitals down by 4pm, but the temp girls I have had here lately...OMG...don't even get me started!!! lol
Nov 14, '08
I agree about showing them how serious you are. At first I was the weak young nurse and I was afraid of a fight so I just ended up doing things myself and then one day I had enough and I did write up a few people and then everyone started to take me seriously. I earned their respect by demanding that we all do our jobs in a timely fashion to the best of their abilities. I practice what I preach and ended up having a wonderful team.
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