Subordinates

[bollweevil]

This is in reference to a thread called "Re: Nurses - Leading your subordinates"

I just wanted to discuss the idea expressed there by several members that we should not view aides as our subordinates. Rather, we should look upon them as our coworkers and team members. Several people thought it was demeaning and disrespectful to view aides or LPN's as somehow not our equals.

I know we are all on the same team and have the same goal, at least we should.

However, someone leads a team. In Nursing, that is the RN. Legally, LPN's and aides are subordinate to the RN. The Charge RN leads staff RN's, too. And a Manager or Clinical Supervisor or House Supervisor or Shift Supervisor leads the Charge Nurses. In a very real sense, there is a definite pecking order. When my shift supervisor tells me what to do, as a Charge RN, I do it. She's my boss. So is my manager. So are the doctors, even though they're not nurses. So are administrators, directors of the service we're on, and probably other people. Some of our bosses are younger and less experienced. Doesn't matter. They are in charge and outrank us and that's how it is. They might be nice, they might less us know they value us, they might be nasty and unappreciative. Doesn't matter. If they're over us, they're over us. Yes, it would be nice if work were always pleasant but the bottom line is, it is work, our job, not the place to look for kudos and confirmation of our worth. Yes, I want that as much as anyone else but I've learned to confirm my own worth or get it from family and friends. At work, I do my work.

We need, IMO, to realize that we nurses are in charge. By virtue of our responsibility, by virtue of being licensed and the laws governing that licensure, by virtue of our great liability for the acts of our team members, we are in charge. Like it or not. And lots of us do not like it. Lots of us would prefer to just do our own work and give total care, not need aides to help us or LPN's to do whatever for our patients. But it doesn't work that way.

I am not saying to be ugly or imperious or rude, arrogant, or otherwise lord it over anyone. But we need, I think, to accept that we are truly in charge and that some staff members are truly subordinate to us. I think a lack of this acceptance is largely responsible for the troubles in our profession.

Other lines of work have bosses. Grocery stores, car repair shops, schools, you name it, their are bosses and subordinates everywhere. In families, this is true. When we forget it, there is trouble.

Yes, every member of a team in any line of work is important and should be treated with dignity. But, bottom line, somebody calls the shots.

OK, flame away.

[sailordave]

In some cases the only thing that truly separates a nuses assistant from an LPN or RN is money to attain the degree. My ex-wife attended college to become an RN and was working as a CNA. She had to drop out of college to take care of her newborne son and her mother suffering from cancer. You can learn something from even the dumbest person no matter how smart you are. Just because you're paid more than others doesn't mean you are a better person than they are. Every job in a hospital is important

[Okami_CCRN, BSN, RN]

I understand where you are coming from but I do not like being pinned down as a subordinate, I am a nursing assistant and my job is to assist the RN. I know that because it was what I was trained to do and I will keep doing it until I remove myself from my position.

The problem I believe comes from the older nursing assistants who have not been able to keep up with the changes in the nursing world. Back in the day NA's only worrired about performing patient care, but now we have more and more responsibilities that keep us from performing our basic duty, Patient Care.

I continually find myself caught between these two worlds, do I help the RN or do I finish vitals. Do I help the RN do wound care or finish the blood glucose. It is challenging because I have a window of time to finish my duties but I have to balance that with helping the RN.

Hospital Administrators need to realize 1 or 2 Na's for 30 patients is not enough... it is not even safe. I believe as an NA I should have 10 patients top and even then things can get bad.

All of us (RN's, LPN's, NA's) need to band together and complain to administrators about the type of treatment we recieve because I believe until we all stand up for eachother nothing will get down and the perpetual place the blame will continue to happen.... and that is why I have given up on becoming an RN and I will do what I know I am capable of... MED SCHOOL HERE I COME!!!

[ok2bme]

Not to nit pick, but I HATE the term "subordinates"

It has such condescending implications

It reminds me of a situation at my current job, a man walked in and asked me "Where is your superior?" I said, "I don't have a superior, but my boss is out to lunch"

[sailordave]

From the movie "Down Periscope"

General: You're addressing a superior officer.

kelsey grammer: No sir, just a higher ranking one.

In the Navy, us enlistedmen use to have a saying for officers we didn't like. The Navy says I must respect the rank but that doesn't mean I have to respect the person who wears the rank. I was an E-5 and so I eventually learned that a soft touch (voice commands) gets more accomplished than a hard touch (screaming, yelling, cursing, etc). As a supervisor you may already have a clean clear plan in your head but perhaps you should sit down your crew and explain why it is you want things done this way. They may surprise you with why it would be wrong and may provide a better method. You're not lowering yourself by doing this. You're still the one who must make the decision. But you are gaining input from your crew as well as discovering which mind is the one most open for development and possible advancement.

[JBudd, MSN]

Encarta:

subordinate: 1. of lesser rank: lower than somebody in rank or status

I get a little tired of politically correct speech, because somebody's self esteem might be damaged. I am the nurse, you are the aide. In a court of law, I am held to a much higher standard than you are; based on education, responsibility, job description. I am held accountable for knowing you were able to perform the duties I delegated to you, and being sure that they were done..

I thoroughly appreciate my techs in the ER, and the CNAs on the floor. Yes you are part of the team and an important part. I would rather work with aides than not. But I am still the licensed professional. Certification does not equal professional licensing.

My manager had a tech in her office over refusing to do certain tasks that are in her job description (as assigned by the charge nurse), and had gotten sent home. The blunt warning was that further insubordination would be taken very seriously.

The word is not condescending, nor insulting. It simply describes the relationship that exists.

[Okami_CCRN, BSN, RN]

JBudd I understand that it is the "correct" word to be used but it is condescending especially when an RN goes up to you and asks you if you are her aide and then you over hear call you her subordinate. It has happened to me and it literally made me feel like crap.

So I am part of the nursing team and I am a co-worker... on my hospital ID it says Nursing Services just as it says on the RN and LPN Badge.

[mc3, ASN, RN]

Oh no - here we go again!!!:chair:

mc3:nurse:

a proud "subordinate" LPN

[Shenanigans, RN]

I started working as a caregiver about 6 months into my nursing training, and already at that point I had more "knowledge" then the caregivers I found myself working along side.

Over time I started to see that a lot of CGs (esp where I worked) liked to boss me and other students around - even though we answered to the RN. The RNs gave students more responsibilyt - like wound dressing, IM injections, insulin administration, taking vitals, and when I saw the CGs respond the way they did to such "treatment" I was none to impressed.

I noticed other things too, when a CG screwed up it was the RN who took the blame. A RN rushing to an emergency left four pottles of medications on the desk in the room of a bed ridden, immobile pt, the pt was no where near the drugs, and the medicatiosn were doses for four different people - not the pt in the bed. A CG came in, noticed the four pottles and proceeded to give the pt all the drugs. And there were at least 50 pills that the pt ended up having.

Now who took the blame? THe RN, even though she had left the meds safely out of the way of the pt she was the one who responsibiliy landed on. I really had to wonder about the common sense of the CG - I mean, she actually beleived all four pottles were for that one patient? WTH?? I dont' think so!

amazinging, all the drugs sort of neutralised each other and the pt survived.

The CG didn't even get a "dont' do that again" speech from the boss. The RN was officially repromanded.

I will view CGs as subordinates when I'm a RN (in a few months eeeep) because I am legally their superiour, and if the poop hits the fan because a CG mucked up, I'm the one who will be taking the blame. The pt's life and wellness is paramount to me and waaaaaaaaaaaaaaaaaaaay more important then some CG's feelings and self esteem. I do not want pts or my career harmed because of a CG or anyone else under my leadership! With that said, I treat everyone with respect, whether they be a cleaner or a CG or the Neruo specalist.

But at the end of the day, its about legal responsibily and if CGs want that responsibily or they want that "power" then go to nursing school, its not that hard.

[sailordave]

jbudd, I see your point. I think part of the problem isn't so much the word used as how some nurses see or treat those they are in charge of. I saw this problem all the time in the military. Some officers were cool and still managed to maintain reasonable control over their division. They were respectful towards those who had to follow their orders and did not have to throw rank around until one of them got out of line. Those were the officers we enjoyed working for. Then you had other officers who used their rank like a bullwhip. Right or wrong they expected you to blindly obey them and almost anything you said that was contrary to their ideas or orders was seen as insubordination. When I was in the military, we had ways of dealing with those types of officers. One thing we did was study the UCMJ (military law) and discovered there were times we could legally disobey an officer's command but we had to be sure of our case and disobey in a respectful manner. Just because you have rank and responsibility doesn't mean you should flog your subordinates with it. Just because you have the license and responsibility doesn't mean the subordinates need to worship the ground you walk on nor does it make you a better human being than they are. Think of the doctor the nursing staff hates the most and that's how some RN's treat their subordinates.

[realnursealso/LPN, LPN]

all i have to say is GRRRRRRRRRRRRRRRRRRRRRRRR:banghead:.

[jjjoy, LPN]

Encarta:

subordinate: 1. of lesser rank: lower than somebody in rank or status

The word is not condescending, nor insulting. It simply describes the relationship that exists.

I agree. Some people may have some negative feelings associated with the word, but that doesn't mean it's an inaccurate description of one's position in relation to another in a working environment.

Some people may abuse their authority or be poor leaders but the reality is that if one is in a hierarchically lower position that they must ultimately concede to their 'higher up''s authority or else go above that person to the next level.