Leadership in Nursing

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    I work in a nursing home where I am the person in charge when I come into work- I work under my bosses license and essentially do an LPNs job. Something I've has trouble with is how to stand up for myself when I see something happen that shouldn't and how to go about taking action without making enemies. I know I'm there to work and I'm not shy, but I tend to get either railroaded over, disrespected, or ignored by the aides when I do try and take a matter in hand. Any advice?

    In particular this time, I caught one of the aides (who I've reported before) answer and talk on her cell while walking a resident to the bathroom without a gait belt. She doesn't know I saw her. I know I'm supposed to report this to my boss but I also know there's a decent chance she'll deny it since she doesn't know I saw here. Again, any advice? I'm sick of feeling guilty for just doing my job but I don't want to get a rep for being the boss' pet.
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    I've never been in a nursing leadership role, but I would have addressed the aide and reinforced client safety with her.
    Last edit by mangopeach on Jul 1, '12
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    I thought about it but I'm so nervous. Anytime I've ever tried to address an aide with an issue, i always end up feeling like some kind of anal retentive person. I know it sounds silly but I have a lot of anxiety over dealing with people in these situations. And this is the first job I've ever had where I'm not on the bottom rung.
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    Be careful if you are a nursing student working in a role that is normally in the scope of practice for an LPN. You might want to reconsider a leadership position if you don't feel comfortable confronting other staff members regarding rule/policy infractions. If you are having a lot of anxiety dealing with personnel issues perhaps you need to gain more experience, take some management theory courses, or speak with your supervisor. There are ways of addressing infractions that are more effective than others. Such as beginning with a positive statement, stating the negative concern and ending with a positive statement/compliment.

    I'm confused how you work under your boss's license? Even a CNA works under the direction of a licensed nurse but not "under the license of another". An LPN works under their own license under the supervision of a licensed RN, MD, DO, APN, DDS.
    KelRN215 likes this.
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    I'm not sure how it works. My boss is an RN and myself and other women who pass meds are "RPs"- responsible person. We're technically a level four rest home (that really should be a nursing home given the residents we have), so we don't do any skilled care here.

    I am comfortable in my position; I've been in it for a year and it's given me a good foundation for nursing school. I just know that something I need to work on is addressing infractions without overstepping my bounds.
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    So your working as a medication aide then? Check with your state bon to determine the exact scope of practice, assuming there is a medication aide certification. In some states there are specific rules about medication aides in nursing homes and assisted living.

    Since you are a student, do you have room for electives? If not, when you are on a semester break look into some of the continuing education courses offered in adult education or continuing professional education in a county college. There are often some classes regarding leadership, delegation, human resources and the like that may give you some tools to use as your progress in your career and advance your role. Check your facility policy & procedure and perhaps your job description, there may be specific guidelines for dealing with infractions. Your role may ultimately simply be to write up the situation for management to address and confront only if egregious or a safety issue. You can also check with management or HR for tips on how to address the issue. Fortunately I've had some great superiors that are more than willing to offer suggestions to combat tough situations.

    Knowing your weakness is a major step in overcoming it. If you are conscious of where you have difficulty you then have the capability to improve or accommodate your personal limitations. Good luck.


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