I have a problem with my management skills

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    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.
    Please advise!
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  4. 27 Comments so far...

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    I know exactly how you feel. I don't have much advice. I was like that when I started doing charge about nine years ago. It got so bad, I was working like a fiend, staying late, while everyone else was relaxed and leaving me behingdwhen it was time to clock out.

    I recommend nipping it in the bud right now. Bottom line is you are concerned about the patients safety, and not there to make friends.

    Is there someone above, as in manager/DON that can support you here. Perhaps you can have a meeting with the one's causing the problems. Let them know in no uncertain terms that you are in charge, and you expect to be listened to.

    I hate when I have to throw my weight around like that. Why can't people just do their job, and work together. I can't stand when people go so regimented in what they have to do that they get all huffy when the charge nurse asks them to do something.

    But nip it in the bud right now. I got in the habit of "doing it myself" rather than fuss with the staff.

    The other night a CNA had eight patients, I asked him to set up some traction on our sister unit next door. He said "you aren't doing anything, you need to chart my vital signs while I set up the traction". I immediately snapped "you don't know what I'm doing, and you ARE setting up the traction and you ARE charting your own vital signs. No negotation!"

    Hopefully sooner or later you can develop a positive relationship with the staff. Good luck.
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    You are right not to tolerate that type of attitude, the patients must come first and if you tell her to bring a patient to the BR then she needs to do it right then, I would counsel her and let her know that next time she disobeys a order she will be fired. Do not apologize or make any excuses, you are in charge and what you say goes, you do not have to explain your rationale to her. If she doesn't like your decision then let her quit, you will be better off without her, after that I would have a staff meeting and inform all aides that they are to do their jobs that are asked of them by the charge nurse or floor nurse, they are there to assist and if they do not want to do that job then suggest they look elsewhere. Once all employees know the rules they will either follow or leave, if you are fair and consistent then hopefully all will work out and those slackers that don't will be gone.
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    I agree with 3rdShiftGuy and BadBird. It's obvious that the "younger" employees are there to get paid for doing as little as possible. The bad thing is, they get by with it!! We all worked hard to get through school so we can provide the best quality of care possible, and for the most part we do a GREAT job. We are in this field because we care. Don't ever appologize for wanting what is best for your patients! They are the reasons we're here. It has been my experience that issues should be dealt with immediately. Tell one of the other CNAs to take care of the deceased resident and inform the "know it all" where she stands in the grand scheme of things. It's obvious the things you have tried have yet to work. In my opinion, little miss CNA needs to be put in her place or put out the door.
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    OMG, thanks guys. BTW, I found this CNA sitting in a resident's room this am eating a bowl of cereal from someones tray, and talking to a CNA who was "feeding" a resident, except the resident wasn't eating. I don't think the full time charge rounds like I do, and the CNA's resent me for doing it. They can skate through breakfast if no one rounds. I didn't say a word about the cereal- I thought- she is working a double, she can sit and no one was going to eat it anyway. Thats what I get for my kindness! I guess they instintively found my achille's heel and take advantage of it. I also feel that the "feeders" in their rooms don't get fed enough, they are hurried and the tray is taken away.
    I feel their behavior has been unchecked by the outgoing DON and administrator for so long that they are unable to adjust to someone who values resident's rights and dignity and safety issues. The administrator just cares about census and resident care has gone by the wayside unless the state comes in.

    Again, thanks for being here allnurses sibs,
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    There are literally hundreds of good sources, but may I suggest that initially at least, the thorough reading of "Management for Dummies." It also includes a lot of references and suggestions for further reading.
  10. 0
    You say:
    "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'm curious what you mean by 'is good with the residents' when what you describe is certainly not good.

    I would respond to your question in different ways depending on what this means. please clarify.

    I have found that if you start a conversation with someone who isn't doing what you want, with mentioning something that you like first it works better. For instance, that you appreciate that she works extra to help out, because we always need the help, but that you're concerned that when she does so many hours she might not know how she is coming across to residents and famiies. That you know she doesn't intend to speak in that manner, because you know that we have the resident's best interests in mind, but that maybe it is her fatigue which makes her come across as less than caring.

    It sounds like you have had several encounters with this individual and need to speak with her to nip it in the bud before she reacts in a negative fashion again. I would suggest before she does something else, and not in reaction to the next altercation. Try to think of the good things that she does for residents and highlight them. And compare that good behavior with the bad. Explain that you don't understand why sometimes she seems great and others just miserable. I have found that a conversation started in that manner usually allows the other person to open up and express their frustrations as opposed to being hostile. Once you can discuss the situation, as opposed o arguing it you will find it easier to come up with solutions.
  11. 0
    In the facility that I work in, eating off a tray is grounds for INSTANT dismissal, no matter WHO it is.

    I think you should definitely go to a higher up and let them know that either she gets the word or you are sending her home.

    No negotiations. You don't need that stress on top of all the rest you have.

    M
  12. 0
    Originally posted by MRed94
    In the facility that I work in, eating off a tray is grounds for INSTANT dismissal, no matter WHO it is.

    I think you should definitely go to a higher up and let them know that either she gets the word or you are sending her home.

    No negotiations. You don't need that stress on top of all the rest you have.

    M
    Yes, you are right. Thanks for your reply.



    Blessings,
  13. 0
    OMG, Carrie--
    I'm with MRed94 all the way on this one. No way would that type of attitude and behavior been tolerated by me or any other supervisor/ charge nurse--in my day we didn't need to call up a DON for problems like you describe- the offender would have been written up and sent home and we would have made do with who we had left. If I had been in your spot, the DON would have been called up right away and it would have been: 'either that girl goes now or I do. You choose.'

    Her 'mouth' would have been grounds for discipline/dismissal regards the the deceased patient's family ; and for certain, she would have been fired on the spot for eating off of a patient's tray.

    I am so sorry that this has happened to you, but you know what? You are going to be the better for it. Bless your heart.

    Peace,
    Lois Jean


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