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Advice, what would you have done in this situation?

During shift change I had a pt ask for pain meds, I was pulling Dilaudid, wasting, and doing my med checks in the med room when a oncoming nurse frantically comes in the med room and says pt in room __ needs a bedpan NOW! Her family was at the nurses station beeyotching that their mom needed a bedpan and no one was moving fast enough.

Everyone could see I was pulling a narcotic. I was busy. The lazy nurse aids were sitting in the station watching the clock! No one told them a damn thing. The other RNs/LVNs in the station, gossiping, didn't lift a finger.

So I, with Dilaudid in hand (meant for another pt) went to go put the pt on her bed pan. The next day I find out the oncoming CN wrote all the nurse aids up. My directer talks to me about this later and says "You need to learn how to delegate, we all work together on this floor..." I should have told her everything that truly went on, but I just left it alone. I'm a recent grad, I don't want to stir the pot...

But I just have to say, I despise (some) of the aids on my floor. They are lazy, and they get paid for it.

***********

Did I mention when I got in the pt's room I got an ear full of YELLING, that their mom had been waiting for 10 mins. And her IV was beeping, and "whats your name, who's your boss...I'm reporting this... yadda yadda yadda"

(I know this seems like a rant...but, I just had to get it out)

Edited by squatmunkie_RN

JennRN65

Specializes in ICU, Cardiac.

1. The nurse who came to tell you that the patient needed the bedpan started the cascade by not putting the patient on the bedpan herself. You don't need report to put someone on a bedpan.

2. If the oncoming CN heard and saw was going on (enough to write up the aids) why did she/he not intervene initially?

3. Sorry you have to work with people who cannot do something simple like put a patient on the bedpan.

Chin up, you did nothing wrong.

nurse2033, MSN, RN

Specializes in ER, ICU.

Next time ask the aides to get the bed pan. I know they might complain or give you **** but that's their problem not yours. I have no problem taking care of things myself but when you have multiple tasks you must stick to the RN-only tasks. Your boss is right, you must be assertive to get the work done in the face of apathy and laziness. Don't worry, they are not your friends. Be professional and hold them to their job even if they don't have the same level of professionalism.

it is a hard situation to be in. as a new employee, you are on probation, if you upset the balance, you are blamed as the "problem child". it comes across as if things were great before you got here, and the only thing that is new, is "you". in nursing school one quote i remember "nurses eat their young". try to get through probation, dot all your i's and cross all of your t's. try and approach the aids and say could you get mrs. x's bedpan? at times you feel like mangement thinks "it is eassier to get rid of one new employee, than to hire all new staff.

coolpeach

Specializes in ER/Ortho.

Last week I went into a patients room to give meds. After we finished she said I really need to go to the bathroom. This is an ortho floor and getting someone up, and to the bathroom takes a lot of time. I still had several meds to pass, 3 nurse lab draws to do, and finger temps to take. So I go to the nurses station, and 3 techs including the one for this patient are standing there talking, laughing, and one of them is having a phone conversation. I tell the tech to please take the patient to the bathroom. He then gets snotty with "Why didn't you just do it when you were in there." I then replied back "When you start doing my job then I will start doing yours."

Yes, you need to learn how to delegate otherwise you will get stuck doing double work. You were busy, you should have walked to your aide and asked her/him to go help Ms. XYZ while you give pain meds to Mr. ABC. Don't be afraid to ask your aides to do their job. I know sometimes it's easier to just do it yourself but CLEARLY you were busy. It's hard but I had to learn.

Good for the CN for writing the CNAs up. She was right to do so here andmust have been good and ticked to do it. Hopefully this was the start of getting them in line. If they don't do as told you and the other nurses need to write them up and continue the paper trail so they can be let go if need be.

You do need to learn to delegate. She was spot on here as well. As a new grad you might be trying to keep the peace and not make waves but part of your job is delegating to others. If you don't then patients will suffer. You can do it in a polite yet firm way. If they don't comply you write them up.

Burnt Out, ASN, RN

Specializes in Med-surg; OB/Well baby; pulmonology; RTS.

It is very hard as a new grad to learn to delegate but it is necessary. You will burn out quickly if you do your job along with everyone else. I'm not saying we as RNs can't put a patient on the bedpan, get ice water, etc but if we have jobs that only we as licensed professionals can do, then we have to ask for assistance from our techs, CNAs, etc.

carolmaccas66, BSN, RN

Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

Hey we have all been in this situation.

Your NM was partially right - you do need to take a more authoritative role. I would have locked all the narcotics away till I could get back to them, then I would have gone out to the nurses' station and started saying in a loud voice why was everyone just sitting there? as the shift hasn't finished? I would have given them tasks to do there & then (if that is part of your job). If not report it to your shift coordinator or whoever is in charge of your shift. It always truly amazes me when the carers/ENs I have worked with as Charge Nurse think they can sit down for 45 minutes before their shift ends, and do nothing when they should be checking patients, re-checking notes/meds, whatever and there are buzzers going off everywhere. You work the full 8-10 hours, whatever it is -that is what you're getting paid for - THEN you can go home & sit on your butt. I get really annoyed with that attitude, because I don't sit down at work unless I'm giving or getting handover, or doing notes.

I NEVER let people interrupt me doing narcotics. I tell them they have to wait no matter what. Dealing with medication is very serious, you need to have all your attention on what drug you are dealing with at the time. It's too easy to make mistakes when people are yammering on in your ear.

And something else - you said you had the narcotic in your hand meant for another patient when you took the bedpan in? Don't ever do this again; if you give it to the wrong patient, lose it, etc it will look like you're trying to hide narcs - it's too easy to get them mixed up. Do not get into the habit of wandering around with medications - ANY medications - for different patients, or putting them into your pocket. Do the narc first, then deal with everything else, or lock the meds up until you can get back to them. Try to get into good, safe habits with medications.

If you don't act authoritative no-one will do anything and they will just ignore you, and YOU will be the one running around like a headless chicken doing everything. Get tough on lazy people, and I would also write them up myself then complain to the NM or CN, whoever takes complaints when they refuse to work.

And you said you are a new grad? So? If you don't speak up, no-one will listen. Sure you will get flack, but that's also part of being authoritative and delegating - making a complaint to a senior nurse is part of delegating. If you don't stand up for yourself and your rights, everyone will just use you, ESPECIALLY in a job like nursing where you get your slackers (as in all jobs).

carolmaccas66, BSN, RN

Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

I meant to add, rant away. That is what we all do at some time or another! You're normal trust me!!

We don't really have place to "lock up meds" there is a med room in the nurses station, thats it. And, everyone uses it, including respiratory therapist. So, I don't feel right just leaving Dilaudid on the counter in the med room.

All the aids knew the situation. They were sitting at the nurses station listening to everything. They were waiting on the next shift of aids. It gets to a point where they no longer work during shift change....

I should have said I am busy. I have narcotics in my hand and I can't do it now....ugh, that was an awful day.

Thanks for the answers.

Ella Halligan RN

Specializes in Pediatrics, Rural, L&D, Postpartum.

It's not easy being the new one on the floor... no matter how long you've been a nurse! That being said... there are jobs anyone can do, and there are jobs only RNs can do. Anyone can put a patient on a bedpan. Only you can give pain meds.

When I was a CNA I frequently told the nurses I work with (who were wonderful) that it was my job to do the things either of us could do so that they could do the things only they could do. And I expect that attitude of the CNAs I work with. (Luckily, I usually get it!)

I had one young CNA I worked with some years ago who disappeared on me while I was trying to clean up a peds patient who had vomited all over his bed... and IV site. She got the linens, but despite my clearly outlining exactly what I needed done, she just disappeared on me. I pulled her aside after I got everything changed by myself (which took five times longer than it would have taken us to do together) and told her that when I need her there, I expect her to be there... and if she is needed elsewhere she needs to inform me, not just disappear.

She pulled a HUGE eye-rolling, finger-waving act on me, "You don't have ANY idea how hard our job is, blah blah blah"... well she picked the wrong RN to try that one on, because I worked my way up through every single level from NA to RN (even stopping at LPN along the way). I looked at her and said, "I know exactly how hard your job is because I used to HAVE your job... and I did it a lot better than you just did." And I reiterated my statements: if you are helping me, you are helping me, not disappearing... and if you are needed by another RN you are to tell me, not just disappear.

We ended up being good friends. Firm... authoritative, but not yelling or aggressive will get you a long way in time.

You had meds, especially narcs, to deliver. That should have been your priority.

Maybe taking the particular aide by the arm to the needed room might have gotten the message across, along with 'You have time to assist Ms X while I medicate Ms Y. If help is still needed, I will stop here on my way back.'

Although 'please' and 'thank you' may go a long way, you should not have to beg people to do their own job.

You can be assertive without being aggressive and objectionable.

While they are still on the clock they are getting paid. And don't have nearly as much charting as YOU do!

Best wishes!

P.S. People are aides, things are aids. There is an 'e' at the end of people and aide; no 'e' in thing!!!!

Edited by merlee
added something

GoodNP

Specializes in Cardiology, Research, Family Practice.

You did nothing wrong; however, your NM is right. It's time for you to dig deep and assert yourself. Your workday will be less hectic, and if you can balance being assertive without being ******, your co-workers will have more respect for you.

It took me about 7 years of being a nurse to finally develop the assertiveness that is required when dealing with lazy people. At this point in my career, if I were in this situation, I would look to whichever aide was assigned to help with that patient - or even any random aide for that matter - and, politely but with confidance, say "Please go assist the patient onto the bedpan." Then, I would simply turn my back and continue doing whatever it was I was doing.

Of course, this is very difficult for many of us b/c we are intimidated by some of our co-workers. I was for a long time. Especially when I was a 21 y/o new grad and the aids were often much older than me. Now, however, I couldn't care less if a lazy gets put out when there is work to be done. If they want to complain to the NM, they will also have to justify why they didn't volunteer to pull themselves away from their gossip hour to help the patient in the first place.

Good luck to you and practice being assertive.

Edited by GoodNP

sugarloaf98

Specializes in Med/Surg, Orthopaedics,.

By the time the nurse told you about the bedpan he/she could have dealt with it obviously.

Interrupting the narcotic administration only puts you at risk of making an error, all for a bedpan!:nurse:

I believe when you are backed into the wall, new nurse or not you have to delegate. I am a new nurse and have for the most part left my aides alone as long as they are doing their job.

Recently they have changed the schedule for aides so my shift aides leave an hour before my shift ends, and the new aides come on at that time. I have learned my shift aides basicly stop working at the one hour before clockout point...the new aides won't start working until after being on shift for an hour..leaving this huge 2 hour hole where it seems like I have no aides on the floor during my largest med pass for the AM.

Horrible situation but the good news is I have taken another job so with the time I had left at my current job I decided to push my delegation skills. Yea I've had a few snide remarks cast at me, had one aide go on lunch and not tell me and when her call lights went off, came back to tell me I had to get them for her. I did get them, and then talked to her about how she needs to let me know if she is leaving the floor or taking a break for continuity for care.

Even with more delegation my aides still have told other nurses I am a fair nurse and that I leave them alone as long as their work gets done and mine gets done. With the exception of one or two and the above 2 hour shift hole my aides are very hardworking and I dont mind telling them. They work hard, I compliment them like crazy, they slack or disapear from the floor to jawjack, I remind them that ultimately they dont answer to me but the patients.

I believe in the whole team effort concept but it only works if all members are into it. I try to lead by example, I answer call lights when I can but not to the point where my aides think I will get all their call lights, I rarely sit (even to chart), and I always tell my aides if i am leaving the area so they know exactly where to find me (normaly to do Tx's on a patient that take some time like trach care+gtube+skin care and dressings). It has rubbed off and some of my aides have started to emulate.

I am hoping the confidence I have gained will carry over into my new job with a new group of aides.

You may also want to put a sign on your Med Room Door " Please do not ENTER this room if Nurse is Preparing Medications" or Please do Not Interupt Nurse in Medication Room"

Orange Tree

Specializes in Medical Surgical Orthopedic.

I would have told the nurse that it would be a while before I could get to that patient's room. Then I would have asked her to let "Jill CNA" know that the patient needed assistance. If that failed, I would approach the group of CNAs and let "Jill" know that the patient in room 123 needed assistance with a bedban. I would have also reminded the group of CNAs to keep an eye on the call lights.

Our shift change is a 7AM. When I was very new and requested vitals on a patient at 6:15, I was actually told, "We don't do vitals after 6AM. That's the next shift's job." It was such a ridiculous thing to say that it was actually kind of funny.

JenniferSews

Specializes in Professional Development Specialist.

I agree with everyone. It's hard to do but you need to delegate, especially in a situation like this. I have found that being direct works best. Addressing a group of CNAs with "can someone please help Ms X?" meant that everyone looked blankly at the floor, the walls, the ceiling, and no one actually got up to help. But a direct "Jill please help Ms X on the bedpan" works better. Then if they ignore you, it's easier to take disciplinary action. Hang in there, it gets easier!

Riseupandnurse

Specializes in Medical Surgical.

JCAHO has identified being disturbed while passing meds as a serious cause of med errors. Therefore any hospital that wants their accreditation has to be making efforts to deal with it. Putting patients on the bedpan while in the middle of drawing up a narcotic for another patient is dangerous. I would have told the nurse to find a CNA and I was NOT going to stop administering the narcotic because of the rules. Did my CNAs like and understand me? No. Was I ever reprimanded or disciplined for delegating appropriately? No! You can't please everyone all the time. Put your patients and your license first and hang the popularity contests. That said, I know it's a hard lesson to learn and hugs to you.

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