- 0Sep 6, '01 by P_RN Senior ModeratorOver on the nursing issues/patient safety forum there is a good post from a new nurse. This needs more comments. OK?
Registered: Sep 2001
Location: Louisville, KY
attitude adjustment needed?
I'm a new grad, currently on day #14 in the ICU....and I have a huge problem! Maybe some of you guys with a little more experience can help me out here--is this really a major deal, or am I just over-reacting?
On my unit we have nursing assistants, generally one to a unit, and every morning we nurses fill out a detailed sheet telling them what our patients need to have done. The responsibilities listed on the page are such things as hygeine, accuchecks, temps, I&O's, and turning. Every morning, I spend five or so minutes filling this out. Every morning, I fully expect that these things will be done as per the instruction sheet....AND EVERY DAY, THE ONLY THINGS THAT GET DONE ARE TEMPS/ I&O'S (IF I'M LUCKY!)
Now, I'm not an unreasonable person, but this drives me NUTS! I understand that often the assistants are as busy as we are, and I am always willing to help them out if I can....but, I DO have the expectation that they will at least TRY to do what they're supposed to do! I've asked nicely, that doesn't work. I've yelled and ordered, that doesn't work either. I don't know what to do. When I voiced concern about this to my preceptor, I was warned not to alienate the nursing assistants because they can be so much help to me. When I replied "Really? When?"--he just looked at me like I was stupid. So is it just me? Am I over-reacting because I'm new and don't yet understand how things work? Or is this a situation like the Emperor's new clothes, where everyone sees the reality and are afraid to acknowledge it for fear of reprisal?
I need help here, folks, because I've got to go back in there tomorrow and deal with these people--and, quite frankly, it's going to take all the self-control I have not to "alienate" them further for not doing their jobs...
Any advice you can offer would be appreciated!
Mod Squad Senior
Registered: May 2000
Can we say "Passive Aggression" boys and girls?
Asking nicely with a pretty please, if you would, if you can, when you have time........guess what.... doesn't work.
Ordering sounds a little harsh, but a constant expectation such as what were the 12:00 vitals on Mr/Mrs ____? When did you finish the bath....so etc.....works a little better. How does Mr J's elbows look......?
People tend to let WORK EXPAND to the time allotted to it.....so if you have 8 hours you stretch the work out to....8 hours.....So who can blame them if it ALL doesn't get done....Awwwwww.
You need to be constantly vigilent....reminding.....expecting. Threats hardly ever work......PROMISES do.
You then need to follow up on promises...even if it makes the preceptor antsy. He may have been one of the enablers who got the staff the way they are.
- 0Sep 6, '01 by CardioloGreat advice P_RN
not-nancy-nurse...breath in...breath out...now relax I agree, be constantly vigilent, remind remind and remind, and expect, and I must add, professional. When you ask the who, what, when, where, and how's in a professional manner, you may see things done like you want, or even before you get the chance to ask. This brings to mind the other "P" word here too...patience.
Please be patient with yourself. Your unit, patients, and your colleagues are very fortunate to have such a dedicated nurse amongst them. Get to know the unit and the way things are done around there...be patient and professional, breath in, breath out, and relax.
- 0Sep 6, '01 by michelle999what a nightmare!! why not try to make a competition out of this e.g " sue has managed to fill in her charts". If you play the game it will all work out, but don't get too upset. If they don't do them then tell them they will have to on the ward round and explain to the consultant why these weren't done.
Also try explaining why we do this and the implications for each patient if we don't.
I know this will take some time but be patient, they're not all dunces but they don't always engage their brains
- 0Sep 6, '01 by catladyI disagree that a lazy aide is better than no aide at all. Same for a lazy nurse. I don't want to be around them. If I know I have a heavy workload, I'd just as soon do it than have administration think that I have "help," in the form of a lazy so-and-so who isn't carrying her own weight. Better to have fewer people, but all working hard as a team, than more people, but some dragging everyone else down. Lazy staff not only don't do their work and create more work for others, they're horrible for morale and usually the biggest complainers.
- 0Sep 6, '01 by bedpanmanI remember being fresh out of nursing school (4 years ago) and having to work with a really lazy group of NA's. The main problem was, that they were all older and didn't like taking orders from somebody young enough to be their son. I was really frustrated and I tried everything from being nice to being mean. At a later job I found something that occassionally works. If you say things like "lets go bath Mr. So and So" or "can you help me turn so and so, I need to assess his posterior breath sounds and do back care" it helps build report and makes you look like a hard worker. Don't look for help from your co-workers. They have found a way to deal (or not deal) with the problem. As a last resort talk to your supervisor and try to get the problem resolved. Harsh reality is that NA's are alot easier to replace than a dedicated RN. However the bottom line is that you are ultimately responsible for all their tasks. The patient's family isn't going to go looking for the NA if their dear dad is covered in feces. An NA's name isn't going to appear on an incident report for a new decub on a patient that wasn't turned, and an NA is never going to get in trouble for not getting blood cultures on a patient that was fibrile and nobody knew it. The responsibility is ultimately yours. If you feel that you've tried everything and there is still no change, suck it up for long enough to build your resume a bit an get a good letter of rec. and then leave. Hey you got a pulse, you got a liscense, you got a job somewhere. In the mean time take some yoga classes and mellow out.
- 0Sep 6, '01 by Dave123I really agree with most of what "bedpanman" had to say. I believe in the three types of leadership styles and in the end thats what it boils down to, getting someone to what you want them to do.
1. Authoritative - demands (they are tough to work with in most situatations, good for emergencies) people usually hate being "ordered" to do something.
2. Delegative - everyone has to delegate somethings but not all of the scut work. People thinK that people who delegate all the time are lazy and who likes to work for or with someone lazy.
3. Participative - I think this works best and its the one I use. "can you help me" "will you help me" "lets go do this real quick before something else comes up". "While I get his meds and get these orders taken off can you help me by doing this". I try to show I will do anything they do and will not dump on them. This works for me.
I also usually tell them I have been where they are from aid, emt, LPN, and now Rn, so I know how hard it is to do thier job because I've been there. (trying to find common ground) Plus sometimes I use the "reward" thing for the good workers by buying a pizza or something. A pizza is cheap, working hard for 12 hours with lazy people is the worst.
I will also say that sometimes you get an "Oxygen Thief" working with you (both aid & nurse) and nothing short of saying "Look, I have plenty of my own work to do without doing your job also." If that still doesn't work I just tell to stay away from me and I do all my own stuff.
Forgive, if I mispelled something, english wasn't my major :-)
- 0Sep 6, '01 by Mitonot-nancy
You have what is commonly refered to as new grad itis. This is characterized by the authoratarian and less than diplomatic attitude you have for co-workers. In my 7 years as a NA I personally frustrated many new grads much like yourself, for the simple reason you can't treat people like trained dogs and expect them to like it.
My advice to you is as follows:
Tone down your ego and get over yourself.
You have a great deal to be proud of by finishing nursing school but it is showing itself in a less than helpful way.
Catch on to the way of thinking the NA's work with and not FOR you and this will go along way to getting their co-operation.
- 0Sep 6, '01 by tigerOUR CNAS CAN GET AN ATTITUDE TOO. YOU HAVE TO REMEMBER THOUGH THAT THEY HAVE BEEN TAKEN ADVANTAGE OF BY SOME NURSES. I ALWAYS HELP WITH MY PT. CARE, BEDMAKING, PASSING H2O, ETC., UNLESS I'M REALLY BUSY. I WORK IN REHAB AND ONE TIME I REMEMBER I HAD 6 PTS AND THERE WERE TWO CNAS TO ASSIST US . ONLY ONE FEEDER ON THE FLOOR AND I KNEW THAT THE CNA ON MY SIDE DOESN'T LIKE QUADS/FEEDERS. PLUS THE PT. WAS YOUNG MALE WITH ATTITUDE OF HIS OWN. I DON'T LIKE TO DEMAND SO I TRIED THE SUBTLE APPROACH--"OH, BY THE WAY, THIS PT WANTS TO EAT IN HIS ROOM SO YOU CAN BRING HIS TRAY DOWN HERE." SHE SAYS "I KNOW HES A QUAD AND WHAT MY JOB IS. I KNOW I HAVE TO FEED HIM. WHY DO YOU HAVE TO TELL ME?" I JUST LET IT GO. THE VERY NEXT DAY HE HAD AN APPT. AT 9 A.M. AND BREAKFAST WAS AT 8. I DIDN'T SAY A WORD. WELL THE PT HAD NOT BEEN FED ON TIME FOR HIS APPT AND WHEN HE COMPLAINED AND THE UNIT MANAGER ASKED ME I JUST RELAYED THE CONVERSATION FROM BEFORE AND IT WAS THE CNA WHO GOT CONFERENCED. ANOTHER THING THEY DO ON OUR UNIT IS IGNORE PT. CALL LIGHTS WHEN THEY ARE MAKING BEDS OR PASSING WATER. THEY THINK THAT IF YOU ARE AT THE DESK CHARTING THAT YOU ARE DOING NOTHING. ONE DAY I HAD DONE MY OWN SHOWERS AND GETTING PEOPLE UP-WITH NO HELP FROM THE CNA. THEN I MADE ALL MY BEDS AND PASSED MY WATER BEFORE I WENT TO BREAK. AS I'M ON MY BREAK THE THERAPIST CAME IN AND SAID A PT. WANTED TO GO POTTY. I SAID PLAESE GET THE CNA OR SOMEONE ELSE I'M ON MY BREAK. THE THERAPIST SAID SHE HAD ASKED THE CNA (WHO WAS JUST MAKING BEDS) AND WAS TOLD TO GET THE NURSE. I WAS STEAMED. I COULD HAVE LEFT ALL MY BEDS A ND H2O FOR HER IF I WAS LAZY AND I WAS THE LAST ONE AT BREAK INCLUDING HER. ANYWAY, I TOLD THE THERAPIST TO TELL HER SHE HAD TO DO IT AND I HEARD LATER FROM ONE OF THE OTHER NURSES ABOUT HER GRUMBLING AS SHE WENT.
- 0Sep 6, '01 by RNforLongTimeWell, I too have worked with some EXTREMELY lazy Nursing assistants at the facility where I am now employed. I sometimes think that it would be a lot easier to just do it myself. And sometimes , I do.
I have no problem assisting the NA's with their duties, like turning or cleaning an incontinent patient. I have never felt that I was ABOVE empting a bedpan.
Mito, honey, YOU are the one who needs an attitude adjustment! Let me tell you that you are in for a rude awakening when you graduate from nursing school. I, too, worked as a CNA through my final year of college and I know first hand what a tough job it is! But, I worked in a LTC facility and if I as an aide talked to ANY of the nurses, LPN or RN with any disrespect then I was written up and/or fired for insubordination. That never happened to me but it did happen to another CNA at that facility.
Like someone earlier said, it's best to say to the NA "can you help me lift so and so up in bed?" than tell them to do it. I find that a lot of times the aides KNOW what their job is and still grumble and moan about it the whole shift. I do not have time to babysit the nurisng assistants and have told that to the nursing supervisor on more than one occasion.
I think one of the biggest problems that some NA's have is that they fail to realize that Nurses can do their jobs but they CANNOT do ours!