I am such an avoider of confrontation. I would rather stick a needle in my eye than write someone up, but I have a problem with delegating. I hate to do it, but when I must, I do. I was charge of a unit today, with two LPNs and seven aids, one went home because our census had dropped a little and she asked to go after am care. I was very busy all day with coumadin orders, Pshychiatrist came in, IV's beeping all day, problem solving with lpns, ADON, new DON and administrator. Had a 20 min lunch, no breaks. Toileted a few in the am, rounded and put the glasses on residents eating breakfast (I have repeatedly asked them to do this), turned on heaters, got sweaters for residents, etc.
When I came back from lunch had chronic faller ask to go to BR, another resident trying to get out of W/C with IV, stated had to go to the BR and I ask the first aid I see to attend to her. About ten minutes later, while walking by and attending to my work ,I double checked to see if she took her because I was concerned she would try to get up again and geez; she had to go. The CNA's were just starting to make rounds,a nd heaven forbid they go out of order. I then asked another CNA , "who is on the floor", as opposed to potty line. She said "We know, you already told us three times Mrs X has to go to the BR." She was very smart and rude. I was going to ask if someone could toilet Mr. W who is the fall risk. I told her that I was speaking of another resident who I was afraid would fall and she stated rudely that "nurses could take residents to the BR too."
I am so tired of being talked to this way and it was the 3rd or 4th time she has talked to me this way, dripping with tone and attitude. I wrote her up and she refused to sign it. This is the only the 2nd time I have written someone up; the first time was on another unit for verbal abuse to a resident, and not permitting the resident out of bed and discussing the resident behavior to another resident.
Any way, this CNA works doubles, is very young and is good with the resident. But she seems to hold a grudge toward me as when I ask her why a certain resident is not getting out of bed that day-actually she blows a gasket. I work part time and do not have day to day knowledge of residents and any change that may have taken place days before and get skipped in report. One other time I was ready to begin report to the next shift when a family member told me his father needed changed. I was standing near the resident and boy did he need changed-there was no way he did this recently- so I did a look up and down the hall and couldn't see the CNA and I paged her, something I rarely do. She screamed from the BR- "I know Mr. A needs changed- I'll get to it" It was emabarassing in front of the family members that were near the BR. I did not write her up. But today I could no longer ignore her lack of respect and I gave her a written warning as per ADON. But the CNA tried to turn it around on me- once again pulling the nurses should take them- on and on. Let me say I think I am more hands on than the other charges and I try to help the aids out as much as I can until my work backs up. I stayed an hour over as it was, and I rarely take breaks, etc.
I need assertiveness training and delegation skills. It seems if I try to communicate or follow up on a residents needs they flip like I'm not permitted to communicate. The same CNA was informed that a resident in her section had died and while she was heading for the room, I stated "Cindy, her family is with her. would you ask them if they would like you to come back?" and once again her retort was an attitudal "I know how to do this!". I feel that I am asking a decent question, but I get flipped on.
Sorry for the long post- please help.
But let me say one thing, toileting is my big peeve, although I very rarely ask them to do it, sometimes I just don't think they
realize the importance of the dignity issue and the ramifications of prioritizing, the safety issues, etc. I have heard the "go in your brief" statement by another CNA who backtalks me too.