What am I doing wrong?

  1. I need some help please. I have been a RN on a med-surg floor for about 5 months and have been off orientation for about 2 months. I mainly work weekend nights with a patient load of 8-11 pts with one aide. There is usually 1 other RN who has the same workload that I do. The one aide requests that she does not take assignment with me but will constantly seek me out to tell me what is wrong with my pts. Usually its along the lines of "the pt in rm 42 needs more pain meds." Now I know I can't be everywhere at once, and I appreciate that she tells me these things, but if I don't stop what I am doing at that moment, she says I don't listen to her and cops an attitude. I've always repeated back what she has said so she knows I've heard and understand her and thank her for informing of a pts condition. but she has now accused me of not properly taking care of my pts and/or not having my priorities straight! I tried takling to her, but she walks away from me when I bring the subject up. Oddly, she has told other RN's that I answer more call lights than any of them and has beennnn very complimentary about me to the other aides. I was hoping to try to solve this problem on my own, but I overheard her asking a pt if they were in pain, and wonder out loud why "the nurse won't give you pain medicine" Obviously, I had to take this to my manager to cover my butt ( thept wasn't due for meds for another hour) I don't know how much of this is me feeling overwhelmed as a new nurse, her being a bully or maybe I have poor interpersonal skills. I feel she is trying to prove something and I really want to work this out! Any suggestions? Thanks for letting me get this off my chest! Sorry this si soo long!
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  2. 14 Comments

  3. by   Karina212
    I have had some similar experiences and to be honest, it seems like she may be jealous of you. In my experience, the CNA was older than me and I came along, half her age, and was working as a new RN. It gave her the perfect opportunity to feel superior and try to intimidate me. This also happened to some of my friends that were new nurses! Give it time. Unfortunately, you may have to "prove yourself" to her and hopefully she'll leave you alone. Definately tell your nurse manager if it continues. Stuff like this shouldn't be tolerated!
  4. by   RN-PA
    Originally posted by DARN MOM 128
    Idon't know how much of this is me feeling overwhelmed as a new nurse, her being a bully or maybe I have poor interpersonal skills. I feel she is trying to prove something and I really want to work this out!
    Hi DARN MOM 128! I quoted only this last part of your post because it's what I wanted to focus on most, since it's the crux of your dilemna, in my opinion.

    First I'll say that you have a lot on your plate with the 8-11 pts. on your own and being a new nurse on Med/Surg. You are trying your best to keep your head above water, and succeeding from what I can tell from your writing. It sounds like you *DO* have your priorities straight, whether your aide thinks so or not.

    I have found one of the hardest aspects of nursing to be the interpersonal relations, stemming from my own background of problems dealing with conflict and expressing assertiveness. I have run into a few aides (~AND~ unit clerks ~AND~ RN's ~AND~ IV nurses, ~AND~ LPN's, etc. etc. )in the past who had a need for power and abused others to get the power. In fact, there's a long-time aide on our Med/Surg floor who has had many run-ins with nurses because she thought she knew best and more than the nurses (and frankly, sometimes she DID!). An 11-7 RN told me of a conflict between him and this aide, and he finally told her, "When you go to nursing school and get your RN, then you can tell me what I should do!", and she backed off. You don't have to be mean about it, but you will probably have to take her aside before a shift begins and have a little talk with her about her attitude and what you need/expect. It's not easy, but it's easier than dealing with the stress and build-up of anger that comes from not dealing with it night after night. Believe me; I've been there. :stone Hopefully, they eventually will respect you for speaking up and you will have a good working relationship where the patients will benefit and you both will be able to focus on your work.
  5. by   gwenith
    IT IS NOT YOUR FAULT!!!!!

    She not only is a bully but she is a classical bully. People get the wrong impression of bullying and think that the person doind the bullying will be 100% against them - some are but they are usually brought up short early on as thier attitude is easier to pick by management but how much more effective to gain control over you (and never kid yourself bullying is always about overt or covert control) to show support of you to your colleagues while undermining your confidence. She is manipulating the situation so that it is almost impossible for you to complain about her. Acting in the way she does "hides"" her behaviour from the management and makes it harder for you to define your complaint.

    YOu have to do something about this situation NOW. From your post you are already feeling the loss of self confidence that this behaviour causes. It is difficult but here is what you do.

    1) Document every interaction at the end of every day. Don't worry about writng it in impersonal mode this is about how she makes you feel so you write that honestly.

    2) In particular write down incidences like you have here where you have heard her asking patients about pain meds.

    3) make sure you document that the patient problems she is reporting are not her patients
    4) Take it to your Nurse manager
    5) see if your facility has a "peer support" group/person you can talk this over with or failing that get a clinical mentor, someone who doesn't neccessarily work oon your floor to discuss issues with in a calm manner so you can valkidate your own practice.

    The biggest problem with bullying is the adverse impact upon you. and this is why I have suggested seeking peer support.

    At any time you can PM me or Email me for support.
    If you want to know more about bullying go to www.nurseadvocate.org
  6. by   Liddle Noodnik
    Funny this came up -- I started a new job Apr 7 and there is a newly trained CNA who is WAY too pushy! She will tell me an IV bag is running low (I KNEW that) or this lady needs suctioning (when DOESN"T she?) etc., and if I don't hop on it she starts pushing "It's almost EMPTY!" "She needs it NOW!" and many other incidents. She doesn't know I just left the suctioning patients room or have the IV bag on my plan.

    I am all for CNA's advocating for patients (they often know more than I do about patients) but to her every need is an emergency. It isn't even that she knows these patients well cuz she is as new as I am. It p'es me off! I have tried lighthearted admonitions such as "ha ha, gee are you pushy!" or "I heard you the FIRST time, I told you I would take care of it..." I also have 22 years experience and I feel like BLASTING her!

    Thing is she IS new and needs to BACK OFF! I have given her no reason not to trust me! My charge nurse noticed this trait the other nite thank God and I think he spoke to her... I do plan to sit her down if this continues, she is probably just anxious...
  7. by   sjoe
    "she is probably just anxious..."

    NO WAY!

    "I have found one of the hardest aspects of nursing to be the interpersonal relations, stemming from my own background of problems dealing with conflict and expressing assertiveness. I have run into a few aides (~AND~ unit clerks ~AND~ RN's ~AND~ IV nurses, ~AND~ LPN's, etc. etc. )in the past who had a need for power and abused others to get the power."


    "She not only is a bully but she is a classical bully."

    True enough and there are many threads here, as well as books in your local library, on these very topics.

    Always remember:
  8. by   Liddle Noodnik
    Originally posted by sjoe
    "she is probably just anxious..."

    NO WAY!

    By that I meant that she was afraid of things going wrong with her patients, perhaps terrified, and she wanted to make sure everything was being done right.

    But I also feel that she has probably always been a pushy gal and needs some "retraining", LOL!
  9. by   Rapheal
    Had almost the identical situation. Pain meds administered on
    time, CNA with issues. She waited till I took lunch then called the NURSING SUPERVISOR to come down. She did and interviewed the CNA, the patient and looked at my documentation. Everything on my part was good. She was "talked to". This CNA is trouble and has "psych issues."

    I am now very direct, and very short with this CNA. I never give her more information than she needs to know. I am not rude but let her know that our interactions are STRICTLY BUSINESS. The nursing supervisor told me to let her know "that you are the RN and she is not to interfere or question your judgement". If this lady was normal I would be happy to explain more to her but in her case this is not good.

    Gwenith gives excellent advice. And to quote SJoe "you will get as much c**p as you put up with". ESTABLISH FIRM BOUNDRIES. Hope things get better for you.
  10. by   nimbex
    I agree with Rapheal about FIRM BOUNDARIES, with the load you cary, you don't have the time to explain your actions, nor should you.

    The aid can't talk negatively about you, you need to trust each and have each other's "back", tell her this.

    On the flip side, she might be comming from needing to feel validated, and want her ideas about patient care to count too. So with those "firm boundaries" give her an opportunity, when it is OKAY, and praise her, just the same... let her know when it's not.

    let us know how it's going, it's going to take time for her to settle in and let go of this pushness, once she gets to know you, I hope she'll lighten up. If not, we'll have a new thread and I'll be the first one to administer pillow therapy on her !
  11. by   cna on her way
    As a CNA I can honestly say that this aid seems to have some control issues. I would point blank tell her that you don't appreciate this type of critisism from her. Yes a CNA is a very good patient advocate, sometimes we get to spend more time with most patients than the nurse and therefore we tend to seeand hear more about them. Its good to let your nurse know when there is something wrong or something different. But as an aid it is not our job to tell a patient "I don't know why she hasn't given you pain meds yet" because we don't know why! Maybe she is trying to make you feel inferior. And by talking good about you to other people she is further making herself look like the "good guy" in this situation. Just don't allow her to make you feel bad, this sounds like a personal problem of hers!
  12. by   RNPD
    All such good advice here.

    Food for thought-if you are told at any time by anyone (including an aide) that a pt needs pain meds, please stop what you are doing (if at all feasible) and either administer meds or if, not time for meds, check the patient yourself to see if other interventions are needed. As a patient in pain, waiting for relief is the worst feeling in the world. Even if the nurse comes to me and states that the med isn't due yet, but she will call the doc and let him know that the prescribed dose isn't holding, it is some relief to me. Please place pain at the very top of your priority list, just under codes. I have known nurses who are so set with their routines, that when told of a patient's pain, they say "I will get to it ASAP" and then go on to complete their chart checks because "that is what I do from 8AM to 8:30 AM". Please be a nurse who will stop what you are doing to evaluate and treat a patient's pain.

    Another thing to do is if you can't immediately go to the patient, tell the aide why. Say, "As soon as I finish pouring and passing this patient's meds, I will go to the other patient". Or "That pt was medicated 20 minutes ago, but I will check on her as soon as I finish here". (And make sure you do what you say!). Instead of merely acknowledging the aide's words, let her know you really heard her and value her as a team member by letting her in the your plan. It doesn't cost you any extra time, and will probably make her respect you more & save you a lot of grief. Not to mention the patient she is advocating for!
    Last edit by RNPD on May 14, '03
  13. by   blue280
    This is exactly why I just LOVE this board. Thanks to all who have given me such excellent advice. I will not work with this aide until the weekend and I do plan on sitting down and talking to her. I realize that I am new to her and its going to take time for her to trust me but I can not let this situation escalate any further. Who knows, this might be a win-win situation for all! If not, I know I gave it by best shot. I will keep you posted. Thanks again
  14. by   MandyInMS
    The part that caught my eye was when you said you tried to talk to her and she'd just walk away..what the heck??? Find a slower time during the shift and have a conference with her ..find a quiet room and shut the door...explain how you appreciate her advocation of pts and all that she does for them, and that you always want to know if a pt needs anything..any changes in condition, ect. Also explain that you have a large pt load and MUST prioritise (sp?) care, specifying that just because you don't just JUMP to her call doesn't mean that you aren't going to address it asap....I think a lot of times people think when you are reviewing a chart,checking meds,writing down critic info that you aren't 'doing anything'...example...family member walks by and you are sitting at the desk with a chart about to call a MD r/t problem and are rechecking all orders before the call, gathering vs,important info....what the family member SEES is " you just sitting at the desk" ....so many times at work there are misunderstandings r/t lack of knowledge and information...just explain this to the cna so she can understand...if that doesn't work..time for meeting with supervisor/DON.
    Wish ya the best of luckkkkkk

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