Unsupportive 'team' members

[Chixie]

Im a new staff nurse, been in post for 5 weeks on a very busy hectic orthopedic surgical ward with mainly post op patients and i have 14 patients under my care. I have been working the morning shift 7-3pm with two supports (CNA/CSW) for the past three days. I have run into problems with one of these CSW's, i shall call her CSW J.

1.on day one i was discussing a problem with the unit secretary regarding a discharge that i had done the previous day as pieces of paper were missing and she was unable to file his notes due to this missing so i was trying to sort this issue out when a patient rang his bell, i continued to deal with the problem regarding the patients discharge as the unit sec was due to go home in a few minutes for the weekend and it needed sorting. CSW J decided to bellow up the hall from where she was sat at a desk playing on her phone for me to answer the call bell ' Staff nurse there is a bell going behind you ya know!' in a really nasty tone. i explained that i was busy trying to sort a discharge out, that i didnt appreciate being interrupted and could she please get the bell as she was not busy. She huffed and puffed and muttered under her breath about lazy nurses.

2. day two, i asked the two CSW's to pair up and sit the patients up whilst i started the medication round, i get half way round to discover that the patients are not sat up so unable to take their tablets or ready for breakfast. I had to hunt for the CSW's to ask them to help me sit the patients up. i found them in the kitchen doing nothing.

3.whilst i finished the medication round i asked the CSW's to pair up to do the double washes and i highlighted which patients were singles,doubles and who was independent.i then had the dr's round to do and prep three patients for theatre and escort two of them down to theatre as well as wounds to dress,etc. I come back from theatre after the 2nd patient to find a dr wanting to talk to me about a patient and whilst i was discussing the issue with him CSW J started moaning about how i havent had done any washes and that im lazy and not doing anything. She then went on to say that as i was sitting there doing 'nothing' (i was charting and on the phone to a dr) then i could do the care plans-its a rule here that if you do the wash then you do the care plan (as you saw the pressure areas/skin condition)

4. I had a patient on hourly urine measurements and after handover that morning i highlighted the key things to the CSW's which were the hourly obs/urine measurements and who they were on and i asked them if there was a problem to please let me know or if they were unable to do the hourly because they were busy to let me know so that i could do it. Well it got to midday and i was checking the patients drain site and i went to document the drainage when i noticed that the hourly had not been done since we started shift! the patient had passed next to no urine in this time.

Im sick of her attitude and having to check that she has done her job. She refuses to communicate with me and tell me how the patient is doing ie did the patient assist with their wash, refuses to listen to anything i say,for instance this one gentleman is self caring-he just needs a bowl given to him and he washes himself-but she went in there and washed him.

What can i do? How do i go about solving this problem? i cant do everything myself, i was the only nurse down this end of the ward and i had a whole list of things that had to be done and because im new to nursing i often have to find another nurse to raise a query or to clarify a question (as well as having to hang my fluids for me)

[Chixie]

why don't you try being nice to them one day, even if you don't want to, and see what happens.

Nice? Where have i been not nice? or unreasonable? Should i allow them to sit on their rears all day and do nothing in case i offend them by asking them to do some work?

let them take their break first

erm..... i didnt get a break namely because im rushed off my feet and dont have time to take a break other than getting the float to hold my end whilst i go to the toilet. These CSWs' get their 45 minute break (and more) without fail, they also dont tell me when they are going and they both go together leaving me alone on the floor,which is a no no to start with.

bring breakfast, do vitals or I&Os on a few patients...whatever it is. you can say "that's their job" or you can do it and reap the reward of an awesome environment with aides who are eager to help you. i've been there, done that, and i know what i'm talking about.

I expect that if an aide is too busy to do I&O then they can say as they pass me in the hall 'hey sorry i havent had chance to do the hourly for the lady in 2:4' that way i can add it to my list and do it. I dont think that is too much to ask for.

This is why it was so funny that nurses who asked for "help" would put EVERYTHING off on the CNA's that they could possibly get away with. Not only would they do that, but they would take 2-3 breaks before the CNAs would be able to take ONE break and THEN if a patient needed something while the CNA was on break the nurse still wouldn't tend to them. They would ignore the patient and just hope that the call bell would disappear or the CNA would come away from break to help them while they sat around texting on the blackberry.

This isnt me, this has nothing to do with my situation as i have stated, i am not sitting around do nothing, i am doing the things that a qualified nurse has to do, a CSW cannot pass meds, do ECGs, remove drains or chart.

[tokmom, BSN, RN]

Doesn't matter if you were CNA of the freaking year. Taking care of that many patients is almost impossible as an RN, if the complexity is high. If they are doing hourly UOP, these are not easy patients to care for. To the yelling poster (can't remember the name...sorry) I can bet my last dollar that a nurse, you mentioned with 10 patients and doing CNA work on top of her own load, either has LOW acuity patients, or isn't doing her own job well at all.

Sorry, I have to side with the OP on this one. She is the RN and has the right to delegate appropriately, which she is doing so. She is working with two tough CNA's/CSW, who are testing her to the harm of the patients.

And for history, before the yelling one flames me, I have worked as a CNA, and was a damn good one. Now I'm a damn good RN, but there is a point where I delegate because nobody is going to do my job for me. I have no problem getting up to my elbows in poop and bodily fluids, but in the end, that paperwork is still going to be sitting at my desk, expecting to be signed, sealed and delivered by the days end.

I totally respect CNA's, and I think the OP does too. She just doesn't like lazy ones.

OP, I think I would try to talk to them in a non confrontational way near earshot of others. I wouldn't trust these two people to not say something else to your NM. If that doesn't work, just simply write them up and talk to your NM about them.

[tokmom, BSN, RN]

How is it going for you? :hug:

[TheOracle]

At the end of the day the only thing that matters is the care of the patient. In the nursing hierarchy the RN supervises the CNAs end of story. CNA's assist patients part of that job assisting is supporting the RNs.

I too was a CNA and it wasn't always the most pleasant job, but it was what it was. I had responsibilities and keeping a running tally of who had done what and how many breaks everyone had had was not among them. To be completely honest, I didn't go to work to take breaks and lunches. I went there to care for patients and earn my pay.

JSlovex2, doing any and everything that you are capable of doing is within the job description of a CNA. Sure an RN can do what a CNA can do, but a CNA can't legally do what an RN does, so it doesn't exactly follow to expect RNs and CNAs to switch duties as dictated.

It'd be the same as getting ticked off at a doctor for not administering a med he rx'd because the RN had been working since 6 and he only showed up at 11.

Rules of polite society dictate that it is nice and polite to help one another even if it isn't one's responsibility technically. As long as there's a CNA on the clock and they are not tied up the RN shouldn't have to worry with things like bed changes because he/she has other responsibilities. In all technicality it IS the CNA's job to help out the nurse if even in an indirect way.

As for the lazy comment - the OP never said you called her lazy. She said one of her CNAs did in her original post.

I'm sorry you got stuck with poor nurses, but all you can do now is not be like them and try and have empathy for someone who's job is being made harder by unprofessional people.

OP - I agree with the advice already given about keeping a record of the CNA's unprofessional behavior then having a sit down with them separately and attempt to work it out between the two of you. I'd also keep management abreast of the situation. Should the behavior persist take further action ie. writing them up/reporting them to appropriate management.

And ditto - how is it going?

[Chixie]

Oh its awful, i hate going into work. It seems that every shift that im on duty,so is she!

Today was a classic example of her laziness and attempted bullying of a 'float' csw. On the weekends we have to serve dinners and the rule is that one csw from each of the teams(a+b) does breakfast and then the other two do lunch, to share the load. well i had a 'float' csw who started breakfasts and i couldnt see the csw from the other end. i popped my head round the corner and asked if one of them could give my csw a hand. i was met with a barrage of abuse including 'well ive got washes to do, turns and obs, we are supposed to be a team ya know'

I explained that it wasnt fair to make one csw do all the meals and the trolley would be waiting at the end of her bay for her to do breakfast for her patients.

She then spent the rest of the shift moaning and complaining and making as many sarky comments as she could.

Ive given up and i am actively searching for a new staff nurse post as i am sick of her. Management wont do anything as, and i quote 'that is just her' and to make matters worse her buddies are now joining in with her little games including extended breaks, leaving me alone on the ward whilst they go for breaks, taking twice as long to do anything/everything and making comments.

And the ward manager wonders why they are short staffed, why float nurses/csws refuse to come to us (they would rather go home 'sick' without pay than work here) and why staff never last more than a year or so

[Chixie]

I am actively hunting for a new job, cant deal with this mess anymore. Its hard enough as it is being a newly qualified nurse without having to deal with all this childish crap, im outta here.

[Nursula_rn]

Hi.

I do not know if your employer conducts "exit interviews" with HR when you leave. One of my old employers did. It was conducted with an HR person, and went up the chain to be discussed regarding staffing, recruitment and retention to ensure that all was done to make the ward safe and well staffed. I know- sounds too good to be true. But that would be your chance to make a statement. The questions we were asked were the same for everyone, did not name names, and did not become part of your file. After that, I would have the urge to write a letter of truth when I was well into my next, better job. Anonymous to save my own name. Then name away. Then tell it like it is. And fire it at whomever is above those managers who did absolutely nothing for you. You can always clip a copy of the posting for the same job you are leaving with a copy of your complaint each time you think of it. (Hi Big Boss! I see that you have an opening in that crap hole again. I know why...) Oh- I know, petty. So this is half suggestion and half fantasy suggestion. Use your good judgement.

[Chixie]

Well she is leaving for a new job very soon. I feel as though a huge weight has been lifted from my shoulders.