attitude adjustment needed?

  1. 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!
    Thanks,
    not-nancy
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  2. 12 Comments

  3. by   P_RN
    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.
  4. by   P_RN
    http://allnurses.com/forums/showthre...?threadid=9774

    Not-Nancy, I reposted this over on the General Nursing Discussion forum. There are more answers there.

    P
  5. by   PhantomRN
    Let me get this straight you have ONE aid for HOW many potentially VERY HEAVY FULL care patients? And you are wondering why she dont have things done?

    How many patients do you have? I am hoping that you get in there and help. Actually in the unit I work in the aid is not allowed to go in and turn someone by herself the RN must be in there as well, just in case the patient gets into trouble. Also the RN, NOT the aid is responsible for the care.

    You were warned by your preceptor to not offend the aids? Hmmmmmm.

    """"When I replied "Really? When?"--he just looked at me like I was stupid.""" Oh boy that speaks volumes.
  6. by   tiger
    PHANTOM RN--THAT IS THE CRAZIEST THING I'VE EVER HEARD. YOU ACTUALLY HAVE TO BE THERE TO TURN EACH PT. ???????DO YOU HAVE TO SUPERVISE A$$ WIPINGS TOO???????
  7. by   KellyandtheBoys
    If someone, a Dr. for instance, yells and orders you around are you eager to help out? My guess would be probably not. I've always utilized my assistants as exactly that, assistants. And, I've gotten every bit of help I've needed.
    I have no idea how big your unit is, but, I'd guess about 10 beds. So each and every morning this aide becomes responsible for 10 sets of vitals, 10 baths with beds, turning and repositioning half a dozen patients along with 1&0's, passing water, trays, answering call lights and on and on. No wonder she can't finish all the work.
    My suggestion is you ask your preceptor what he sees as fair things to pass on to the aide. Personally, I believe that the R.N., and not the aide, should be responsible for vitals and I&O's. As far as hygeine goes, split the baths. And as far as turns goes, ask the aide to help you with turns. Your patients that need to be turned probably should have 2 people to turn them anyway.
    Treat the aides how you would want to be treated and you'll get you will be able to accomplish a lot more!
  8. by   lovingnursing_r
    Originally posted by not-nancy-nurse
    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!
    Thanks,
    not-nancy
  9. by   lovingnursing_r
    Originally posted by lovingnursing_r
    I WORK IN A CCU WERE WE USUALLY DONT HAVE CNAS. I USUALLY HAVE 2-3 PTS. BE THANKFUL YOU HAVE ONE. ALWAYS TREAT YOUR CNAS WITH RESPECT B/C 1 DAY YOU ARE GOING TO NEED THEM AND THEY WILL NOT HELP YOU. AN EXPERIENCED RN ONCE SAID........... CNAS CAN MAKE YOU DAY BETTER OR WORSE.
  10. by   donmurray
    Talking of attitude adjustment, Does "not nancy" mean what it appears to, this side of the pond?
  11. by   Sylvia
    Hi Nancy,

    Try to find out why things aren't getting done. Is the aide too busy or too lazy? It may take some creativity to find out but I'm guessing you'll probably find he/she is too busy.

    It's hard to be a new nurse. You definately do not want to alienate the aides but don't let them push you around either, or get away with not doing their jobs.

    Welcome to the profession. There's a heck of a lot they don't cover in nursing school.

    Hang in there.

    Sylvia
  12. by   P_RN
    donmurray...if you mean as in Nancy-boy? I think that here it means not "Nancy Nurse" a fictional idea of the perfect well bred nurse in her starched white uniform and her little clipboard......

    Here a Nancy Boy would more likely be "sweet."
  13. by   RachetRN
    Hi Nancy,
    I have worked on both sides of the fence...CNA in high school/technical school, then to LPN, and now to RN...Remember the old saying? You catch more flies with honey than you do with salt?

    When I statred out as an LPN after working there as a CNA some resentment was felt by everyone involved, because I was suddenly 'one of them'.
    I agree with the above mentioned stuff, esp. the case load stuff...how many patient's does the CNA have? If the no. is around 7 or more than it may be that she truly is too busy to get it all done.

    Also, do you KNOW that she is comfortable doing some of this work? She may have had a patient Vagel down during a turn and is now afraid to do turns, etc. So, take a step back, look at the big picture...is it ALWAYS the Glucose test she does not do? (fear of blood borne infc's) or ALWAYS the bath's/bed's (bad back)...If you cannot find a pattern AND it isn't patient overload then and only then would I just confront her. However, do it in a kind manner -- ask her to lunch, or carry a cake to work and establish a CNA appreciation day. It may be as simple as the CNA just doesn't feel appreciated. This may be the case if it is a universal problem and not just a particular CNA.

    If so, many times the CNA's feel like they do all the work. Our Hospital has RAD days where everyone gets dropped down a notch -- RN's do LPN work or CNA work depending on the rotation, LPN's do CNA work, CNA's do some housekeeping and some CNA's shadow RN/LPN's. It really increased teammember playing and it is not uncommon to have EVERYBODY say at any given time..."boy that CNA/LPN/RN work is tough...I'm glad I have my job and not hers"

    You could try this too...have the CNA shadow you all day and the both of ya'll team work all patient care together. Maybe an appreciation of what you really do will make her more receptive to what you have to say.
    Last edit by RachetRN on Sep 23, '01
  14. by   canna42
    I have been an LPN for 25yrs..have seen many new nurses drown themselves in what we called new nurseitis. Sounds like the line has been drawn...nursing assistants can make or break you in many situations. The usual base of the problem is communication. In our hospital we work alongside the nurse assistant most of the time. I find to learn your priorities...let the assistant know what is most important for you...let her know that if she is tied up and needs help you are available but to please keep you informed. If you have put yourself up on the pedestal.. you will alienate not only the assistants but eventually the nurses too. The situation you describe is the assistants way of getting you back for attitude..may be her "job" but ......! Try pitching in an helping her in her "job" when she is busy. Don't expect immediate results.Trust takes awhile to build. Maybe after walkiing in her shoes you will see situation in different light.

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