Nurses - Leading your subordinates (Nurse Aides, Nurse Techs, Med Aides) - page 4

by brotherbear

10,115 Views | 37 Comments

With the stressful nature of the field it would be no surprise that nurse subordinates feel the pinch too. Nurse subordinates (those who work under you) are usually Nurse Aides, Nurse Techs, or Medication Aides. Some nurses are... Read More


  1. 0
    I generally don't like the term 'subordinate', it sounds condecending.
  2. 1
    Quote from mom4jesus
    This may be the rules of the facility, but licensed nurses are supervisers of unlicensed nursing staff. Unlicensed nursing staff such as Cna are working under the LPN's or Rn's license and the LPN has to work under an RN. Licensed staff are to delegate either directly or indirectly to other unlicensed nursing staff but the licensed nurse is responsible for the patient care.
    "Are you aware that indirect delegation (such as the performance of tasks listed in a nurse aide job description) does not alter the responsibility of the nurse for appropriately assigning and supervising the unlicensed persons performing the tasks? "(KBN)
    At our facility, the ONLY people that can delegate to CNA's are charge nurses and management. Nurses are not our supervisors, and are not allowed to delegate to us at all. This is said up front to everyone in general orientation, directly from the mouths of high management.
    ChristineN likes this.
  3. 2
    Quote from ShyGecko
    At our facility, the ONLY people that can delegate to CNA's are charge nurses and management. Nurses are not our supervisors, and are not allowed to delegate to us at all. This is said up front to everyone in general orientation, directly from the mouths of high management.
    Then everything I've been learning in nursing school is a lie?

    As was previously mentioned, RNs butts are on the line if a CNA makes a mistake.

    I am a tech (an equivilant of a NA) and OF COURSE we are all playing for the same team. We all have important duties with the common goal in mind: the pt's well being. I would never work at a place where nurses were not "allowed" to ask their CNA to do something while they draw up a med. I also have a great working relationship with the nurses I help, and don't feel like they are a dictator to my day.

    As far as what nurses can or can't do, the ultimate authority that rides over everything else is the Nursing Practice Act for the state you reside in. This is a legal "what nurses can do" guide. Like it or not, nurses CAN and SHOULD delegate if possible- not to pass the buck, but to accomplish the most things for the patient. I don't know nurses on my unit that are "above" wiping a butt. They can and do if I'm not there. This isn't a battle for egos or a "you're not the boss of me" arguement. If you have awesome CNAs who already know the routine (for example, go get suction equipment in anticipation for a patient to be suctioned by a nurse), then obviously, there isn't much guidance needed. The team will work like well oiled machinery.

    I don't understand why everyone gets so upset over "authority." Nurses have their butts on the line for medication errors, even if a physician writes it the way the nurse gave it, and they are also responsible for the errors of their NA's. It's a "when in doubt, blame the nurse" scenario (appealing, isn't it?)

    We all know we are ALL important for the patient's well being and input a lot to the outcome of a patient. I am going to graduate nursing school in two months, and I anticipate that I WILL delegate something if I must do something that the CNA cannot do to accomplish more for the patient. The patient is who we serve.
    bollweevil and leslie :-D like this.
  4. 1
    Quote from vamedic4
    perhaps it's just me, but referring to people as "subordinates" is a good way to alienate yourself. i realize this is good for the heading of the post, but i've seen nurses do this and use that specific terminology when talking to others --that's a huge no no.
    i'm not trying to start a fight- quite the contrary. but whether you're a nurse or an aide, your goal is the same...to provide the best care for your patient. and just because the nurse is the only one with the legal responsibility for the care doesn't mean she's the only one who deserves the credit for it.
    rule number one: if you need something done...ask. "can you get a stat cbc on 436 and then take him down to xray? sure, i'm all over it. not: you need to do a stat cbc on 436 before taking him to x ray. that will automatically have your aide headed for a long trip to the bathroom. respect goes a long way, and remember...we can't read your minds.

    rule ii: remember, as others have pointed out, that while you may have 5 patients (or more depending on your facility), the aide may have 2-3 times that many. and having all that responsibility is a lot, that's a lot of manual labor that you're not having to attend to, so patience is a must.



    your recommendations ring true - especially the one about sharing credit. make sure you thank those who help you - you never know when you'll truly need their help again. and believe me when i tell you - if you just "expect" people to show up when you get in the habit of not thanking others for help - you're going to be left alone, doing whatever it is - by yourself.

    vamedic4
    going to nap soon
    if you ask somebody to do something, are you willing to have them tell you "no"?

    and if someone is expected to do a certain job, why do we have to bend over backwards to not ruffle their feathers so they won't hide in the toilet or leave us alone? they need to do their jobs.

    nothing wrong with being nice, although people often interpret it as weakness and try to take advantage of you. good to give credit where it is truly due, and the like. but i work for the pay and so does almost everyone else. no one has to be extra nice to me, they never share credit with me and sometimes have stolen it from me but i have learned to speak up when that happens, and i think others should do their jobs and not expect me to thank them all the time. i do thank them and praise them but their good work should not depend on me doing that. they should work because it's their job.

    aides are our subordinates. we tell them what to do, like our bosses tell us. we are responsible for their behavior to a large degree, thus we have to have the authority to assign them, teach them, monitor them, and correct them.
    Virgo_RN likes this.
  5. 0
    Quote from ShyGecko
    At our facility, the ONLY people that can delegate to CNA's are charge nurses and management. Nurses are not our supervisors, and are not allowed to delegate to us at all. This is said up front to everyone in general orientation, directly from the mouths of high management.
    A Charge Nurse is the direct supervisor, although there could be a supervisor over her.

    And delegating work to you is certainly a function of a supervisor.

    So I'm not sure which nurses are not your supervisors.

    What exactly did high Management say to you in Orientation?
  6. 0
    Quote from jlsRN
    I generally don't like the term 'subordinate', it sounds condecending.
    We are subordinates, too. We are subordinate to doctors, managers, etc. Life is full of ranks. Why is it so distasteful?

    That, as I see it, is a major problem with nursing today. The aides don't know we are their bosses and we are afraid to let them know becaue se want them to like us and sometimes because Management won't back us up.
  7. 1
    Quote from vamedic4
    But whether you're a nurse or an aide, your goal is the same...to provide the best care for your patient.

    snip

    Rule number one: if you need something done...ASK. "Can you get a stat CBC on 436 and then take him down to Xray? Sure, I'm all over it. NOT: You need to do a stat CBC on 436 before taking him to X Ray. That will automatically have your aide headed for a long trip to the bathroom. Respect goes a long way, and remember...we can't read your minds.
    I know this post is almost a year old, but I am really bothered by this. You mean to tell me that you would walk away from a patient who needs care because you didn't like the way the nurse asked you to do your job?

    And you want respect?

    Any nurse who walked away from a patient because they didn't like the way the doctor spoke to them would get slapped with a charge of abandonment. If you want to be treated like you are on equal footing, then act like it. Understand that your obligation to the patient supersedes your ego.
    Last edit by Virgo_RN on May 1, '08
    hotmama2be likes this.
  8. 0
    I understand what you mean NancyNurse but I have seen many NA's do just that, the nurse tells them that they have to do something and they will walk away and do it whenever. It truly is a shame but it does happen.

    I myself just clench my teeth and grab the blood draw kit when a nurse talks to be in a demanding voice. but the patient is first so in I go with a lavender top.

    BTW our BOH says we cannot have blood draw kits anylonger... what a bummer.


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