New Grad RN- Being "Charge Nurse" over seasoned LVNs and CNAs

[lifelearningrn, BSN, RN]

Hi everyone! I'm a new nurse, I've been working about 5 weeks now in a SNF, the first couple of weeks I was on a sub-acute floor and for the past few weeks I've been on the ortho-rehab floor. Because I often work with LVNs and am the only RN on the floor, I'm the "charge nurse", even though often, the LVNs I work with have been nurses for years, some decades. I am having a hard time feeling like I'm the 'charge' when I barely know what I'm doing! As far as the CNAs go, I am trying to figure out a way to get them to respect me enough not to argue with me when I ask them to do something.. for example, the other day I had a patient who I had given a suppository and I knew within 10 minutes he would be ringing the bell to get to the toilet. The CNA knew too, but decided she wanted to go on break. I asked her to wait until after this patient had been attended to, and she got ***** and said, "If I wait until he is ready, I might as well just wait until everyone has gone to the bathroom, and by then it'll be time to go home anyway"... Annoyed I told her to just go, I'd take care of the patient. I often get arguments when I try to manage the CNAs- they know I'm new, and the ones I get the most trouble from have worked for the company for years...

There is an LVN I work with that honestly drives me nuts. She's nice enough, and has been a nurse for quite a long time, but can't seem to get any work done during her shift. I often stay late to make sure there is NOTHING extra for her to do outside of meds and treatments, and more often than not, the treatments don't get done. When I ask her to make something a priority, she argues with me about why what she is doing at that moment is more important. (Sorry, that pt's iron pill can wait five minutes so the pt with 8/10 pain can get their PRN narc). My boss tells me I need to start writing people up when they don't do what I ask, but I don't know if that is the right approach right off the bat.

Any ideas?

[lifelearningrn, BSN, RN]

Any thoughts?

[BoyNamedSue]

Everything that you've written I have experienced in some way. I too am a new nurse, and have been in situations where I might have to tell a CNA what to do who does not agree with my decision. They might have been in the field for much longer than me, which makes it awkward, or use to feel awkward, when I asked them to do something. I ended up talking with my DON who backed me up. It got better, but there are still very territorial nurses who I still have to avoid. I think the key is showing assertiveness, but not being rude back. Take advice from the CNAs and other nurses because they do have experience. Reaffirm their concerns to let them know that you understand where they're coming from, but reenforce what needs to be done.

Also, taking a 15 minute meeting that addresses everyone's concerns in a sincere manner might bring issues out in the open, rather than letting them fester under a facade of teamwork.

[misstrinad]

do my best to include my CNAs under me in my plans.... Like giving supps or mom I ask them "when will be a good time for you before breakfast? I need to make sure you will be available to assist the pt to the br as I will be dealing with xyz " when I request they do something specific I include my reasoning "i need you to get pt x oob for breakfast this morning because I need to have a chance to monitor his response & vs before therapy comes at 830"

I've found that going beyond just telling the more experienced staff under me what to do has helped

Make sure that you are acting as a team player as well, try to get to know your staff, bring some treats in once or twice a week for them. In other words try to bond. And make sure you compliment good work, but make sure it is sincere and deserved or they will be able to sniff out that you are purposely dropping compliments.

If your discipline policy allows for it perhaps you can pull them into a verbal coaching meeting with you and your immediate supervisor before doing an actual write up. Help them to see you mean business and your supervisor is backing you. If that's not possible or if it was more than a minor issue then you will have to suck it up and do that write up.

You don't want to be seen as a pushover but you also don't want them to fall into the 'its us against her' mentality.

[NamasteN]

I tried that route, charge nurse right out of school and was quickly moved to floor nurse after about two weeks. Respect in LTC comes from moving up the ranks and if the CNA's and LPN's feel that you don't 'get' their jobs you will not earn their respect. Be ready to help out when needed, ie being available at meal times, toileting if need be, wound care etc. Ask a CNA or LPN to come with you on rounds. Hold daily meetings and ask their opinions about how to handle something. Once they know that YOU respect THEM, then they will respect you :)

[lifelearningrn, BSN, RN]

Thank you all for the advice. I'm going to incorporate all your ideas in my daily plans. :)

[workinmomRN2012, BSN]

include my CNAs under me in my plans.... Like giving supps or mom I ask them "when will be a good time for you before breakfast? I need to make sure you will be available to assist the pt to the br as I will be dealing with xyz " when I request they do something specific I include my reasoning "i need you to get pt x oob for breakfast this morning because I need to have a chance to monitor his response & vs before therapy comes at 830"

I've found that going beyond just telling the more experienced staff under me what to do has helped

make sure you compliment good work, but make sure it is sincere and deserved or they will be able to sniff out that you are purposely dropping compliments.

You don't want to be seen as a pushover but you also don't want them to fall into the 'its us against her' mentality.

When I was a CNA, I worked with some awesome nurses that knew exactly how to do this. They would ask- when is the best time for Mr ABC to get his suppository, inotherwords- when is it good for you. Also, every night when we were leaving all the nurses would stop report and thank the aides as we were walking out!

[workinmomRN2012, BSN]

I also tell the aides- if you need help with a patient ie boosting, 2 assist toileting, extra set of eyes for lift transfer, if I am outside of the room doing meds- ask me to help, don't wait for another aid- I'm here and I can help. It's a win:win situation, they don't have to wait for another aide which could take awhile and it shows that I am not above doing aide work again and that you do want to help them. It also shows that you are a team player. I think that I got a lot of respect this way. When I left that job- all the CNA's signed the card that they gave me and I still go back to visit them.

[Blackcat99]

WRITE-UPS-That's the one and only thing that works at my facility. The CNA's will constantly argue and fight with the nurses over every little thing that the nurses ask them to do.

[bluegeegoo2, LPN]

I favor educating and giving a general "heads up" about what's going on for my CNA's. I have found that a great majority of CNA's that I have worked with really appreciate me taking a little bit of time to explain my rationale for what I need done or what I'm seeing in an assessment. When they understand why, they tend to be much more compliant with my requests than the "because I said so" type of approach. If I need a specimen of any type, I will let them know as soon as I know so they can prepare. They have a pretty tight schedule as well so that they can complete any given tasks by the usual deadlines i.e. meals, therapy, family coming in, etc. If we fail to keep them in the loop about what's going on with their residents, they get just as frustrated as we do when we get "ninja admits" and other lovely surprises that management "forgot" to tell us about. If I see that any given CNA just likes to throw 'tude at any and everything I ask of them, I will write them. I save that for the last resort. I really don't like to write people unless I have exhausted all other avenues of communicating.