Advice for a new RN about delegating to UAPs who have bad attitudes...

TypicalFish · Aug 9, 2005

Christine;

1) They are testing you; some, not all, UAP have issues with new nurses becuase they feel that they know more than the new nurses do. It sounds like you are being helpful; but also double check and learn exactly what are their duties, and stick with that. Every job usually has a written description, find it and know it. They do.

2) You are not there to be their friends; you are there for the patient. If something would of happened to the woman with the 358 blood sugar, it would of been YOUR FAULT for not checking. You need to remember that, saying "She didn't tell me" would never, ever fly in court. You need to say "Pt X has BS due q4 hours, I expect for you to report to me what the result is, high, low or normal, Thanks" You can be firm without being snotty. Who cares if they get annoyed at you for asking them to something thatthey should do-it's their job, for heaven's sake. You worked hard for your degree, respect it and yourself.

3)Stick with the above, and they will see that they can't push you around, and will lighten up eventually. Best of luck, blessings and good wishes

MedSurgeMess · Aug 9, 2005

I have the RNs that treat me like I am still an CNA, and then the CNAs tell me that I know how to do a particular job, so they just don't do it. I have no support from our unit manager-she says 'deal with it', so I am just documenting and biding my time until a better job posting comes my way.....

MandiBSN · Aug 9, 2005

Sucks I know! I too was a NA for a long time. Now I'm at a new hospital and this one NA is constantly trying to tell me how to do my job. I get so sick of her attitude. But Just bear with it. I know she is testing me. so i'll just kill her with kindenss and do my job. We have to remember we worked way to hard for our licenses to have someone else put it at risk.

christvs, DNP, RN, NP · Aug 9, 2005

Sucks I know! I too was a NA for a long time. Now I'm at a new hospital and this one NA is constantly trying to tell me how to do my job. I get so sick of her attitude. But Just bear with it. I know she is testing me. so i'll just kill her with kindenss and do my job. We have to remember we worked way to hard for our licenses to have someone else put it at risk.

You're right-(as are the others who posted here too)I need to remember the patients come first. I think most of the NAs I work with are great-I think we should all help each other out when we can. It's just that I hate it when someone is just plain rude or bossy or thinks they know more than the nurse! I mean, hello! We went through nursing school & graduated & passed boards-so we are the ones really responsible of taking care of our patients & we know more than those who did not go to school. I guess it will just take some time to get used to all of this.

NurseKristiina · Aug 9, 2005

We have to remember we worked way to hard for our licenses to have someone else put it at risk.

This quite is so true! I have similar problems at my first job as an RN. But now is getting worse! For one reason (and I really don't know why) one of practical nurses hates me. I have tried to be friendly and I help them alot. She is spreading romours about me which are not true. Now I have looked up what the law says about discrimination at work and I have given it to the managers on the ward. I live in Sweden so the system is little different than yours. But still we have similar problems. I just can't believe that adult people act like this. The most important is to do the job correctly, treat the patients and act like profesionals. I really hope that all of you will have it easier soon. Take care

pricklypear · Aug 9, 2005

Good luck Christine - just be very clear on what you expect do be done, and when. Follow up if something wasn't done or reported in a timely manner, and make sure to spread praise liberally when due! It is hard going from NA one day to RN the next, and all of a sudden being on the other end of the stick. Resist the urge to do everything yourself - bad habit to get into because you'll run yourself ragged without any help.

RaeT,RN · Aug 10, 2005

I think there is definately a happy medium between trying to do all of your NA tasks as an RN and being one of those nurses who spends more time finding the NA to do the task than it would take to do it herself. Do not preface your requests with an apology - the other poster is right - you're not sorry you're asking her to do her job. Rather, if you approach the NA still in a compassionate manner (more flies with honey than vinegar, right?) and say something like, "I am just so swamped, trying to get the hang of all of my new duties as a nurse, and I really need your help as my eyes and ears." As much as you hate it, you are in it together and do have to work together, and they respond much better to a plea for help than a "Do it because I said so and it's in your job description." Remember too that techs do not prioritize their care like we do - their role is simply for task-performing and they prioritize that way. Unless they are students, they're not really looking at the big picture. Maybe explain why some things are so important to be done at a certain time? Good luck!

Sagebutterfly · Aug 13, 2005

Hi! I'm a new RN in my third week of orientation. I think I'm doing pretty well overall, & really do like my unit & the nurses I work with. Now I feel like my biggest issue or thing I need to work on the most is delegation. It still feels so weird to me to delegate to nursing assistant (NAs) because I was one for 2.5 years & it feels so strange to be on the "other" side. I think my problem is this: since I know how difficult it can be to do the work NAs do, I tend to either not ask them to do something when I need it -cuz I feel bad asking them to do something-even when I'm busy(I usually do it myself)or I notice I seem to just about apologize as I'm asking them to do something. And I feel like because I'm a new nurse & not demanding in the least a few of them are skipping some things they should be doing-like not totaling up I & O, & one of them last week checked a patient's blood sugar at noon & didn't tell me it was 386!!! I was running around so busy that day that at 12:30 it dawned on me that she didn't tell me the patient's sugar, so I'm thinking to myself "Hmm..I bet it was a normal value if she didn't report it to me." Nope! When I looked in the flow sheet I saw she wrote it there but didn't tell me about it! When I saw her next time I said "Gee, that patient's blood sugar was high-I had to give her insulin." She just said "Yeah" & then said "Oh & I forgot to write down her weight too-it was 250 lbs." I feel like she was just making up that number! Then another NA today was being difficult too. I was very nice to her & helped her clean up & transport patients whenever I could, but then she gave me attitude later on for no reason. Our patient was on every four hour blood sugar checks. So the last sugar was checked at 8 AM today. Then at exactly 11:10 AM I see her just about to check his sugar again, so I went up to her & said "Oh, he is on every 4 hour checks. So his next sugar isn't due until noon." She just gave me such a dirty look! I'm sorry if it's not convenient for you, I felt like saying, but too bad-the doc didn't order every 3 hour checks, so deal! (I didn't say that of course but wished I did!) Then at noon I saw her with the machine, so I said to her "How is his sugar?" And she says to me "I'll tell you it when I know it." And she said it in the rudest voice you could imagine. It really upsets me when I try so hard to be nice to people (NAs) and they turn around and act like jerks. How would you guys handle this? I know I have to learn to be more assertive. I guess I am afraid to speak up in case I offend anyone. Thanks for listening!
-Christine

Being a CNA is ruff. So much to do in so little time and sometimes we forget. I find it help full to get out a report sheet and write down what needs to be done for each resident and at what time. Perhaps that would help your aides to remember and give them say 20-30 min after the time to ask "what was *'s bla bla?" Insted of "did you get that * done?" It makes a person feel like you trust them to do their jobs. And aides are there to assist you. You shouldn't feel like you can't ask for some help. And you'll get help before asked if you help when you can. Personally their are some nurses I work with that are so kind, they do all they can for me and because of their kindness I even ask them do you need help with anything? And they in turn when I am busy come and help me. We are a team. No one is any greater than the other. While she went to school for nursing to know meds and proceedures and such. I know my residents, when they are in need of PRN medicine, when they are ill, and a lot of stuff that isn't my responsiblity to know how to, or do. think that there are some CNA's that feel like new nurses are too inexperienced. And those are the aides that are typically lazy and think they are so much better. It's your job to make sure the aides to what they are supposed to be going. And it's on you if they mess up. You must protect the residents and yourself. You really don't have to be gruff to be in charge. Moniter the problem aides. If you catch them negleting their duties say " Did you get ^^^ done?" The answer is obviousely no it if they lie and make up a number or such say oh well it's not here or I didn't see you do, or the resident said you did not. If she/he lies report it, it's dangerous thing to lie in nursing. But if they forgot and really seemed busy perhaps you should write out a sheet of paper with all the info you need them to get the duties and such but if it is a constent issue talk to the higher ups maybe he/she needs a calmer unit. Caring for people is stressful and sometimes you have to let a little attitude run off your back, but ifbthe person is rude to residents than report the behavior and interfear in the situation. Like "hay so and so, you sit a bit frazzeled, do you need to take a short break? If time allows let the aides cool off for 5 minutes. We all get this way at times. And in the face of needy people, call lights duties to be done, it can be hard to be chipper. I have a hard time being assertive also, but it's not for us it's for the residents. I hate to work with nurses that aren't assertive. Even though your trying to be nice by not calling lazy people out, it makes the good aides work harder to cover what the bad egg isn't doing. It makes me so made when I am running around doing 100 things at once and there's an aide on the phone while her resident's are running me ragged! I wish more nurses would speak up to such aides. I work with a lot of new nurses who let the aides sit around and not check or turn or change attends on residents all night ! It is upsetting. I know it is hard but it must be done. I end up haveing to say "hay, it's time for rounds, wake up"! I hope I helped some. Good Luck!

Daytonite, BSN, RN · Aug 13, 2005

christine, you're just having a devil of a time, aren't you?

i've never worked in a nursing home where the aides do the finger stick blood sugars. if i were you i would be personally taking the blood sugar of any patient who is on sliding scale insulin coverage so you can be right there with your med cart to give the insulin. it's your license on the line, kiddo. why would you want your practice to depend on some aide who may be reporting false information (you mentioned a weight you thought an aide made up). to my way of thinking an incident report should have been made out about this 386 blood sugar that got forgotten about. that's a serious thing for her to have failed to report. you also have some responsibility in this because as you recognize, you should have checked on her sooner. note to yourself: keep track of your blood sugar and insulin people. they are kind of a high priority. put them on a list where you can see it to remind you each day. watch the clock and mentally note when you should be checking on the blood sugars. if it will help you, buy a small digital timer and set it to go off at the times blood sugars need to be checked. they used to have these little timers you could attach to a name badge just for this kind of reminder.

does the facility have an official policy that specifically says the aides are to do blood sugars along with a procedure they are to follow? if they do, you need to look at that policy and make a copy of it for your reference. then make the follow up of these blood sugars a priority since you will be the one who will take the heat for a medication error, not the aide. i, personally, would announce that i was taking on the responsibility of taking the blood sugars of the sliding scale people despite what the facility says. i would defend my decision by stating that i wanted any insulin i was giving to be based on a blood sugar that i personally performed.

now, to the aide. i would recommend that you talk with your supervisor and explain what happened and ask for her advice before you do any correction or discipline with this aide. make sure you know exactly what the aide's responsibility was supposed to be in obtaining and reporting this blood sugar. then, one thing you can say to her is "that was an abnormally high blood sugar and you should have hunted me down and let me know about it immediately? from now on i want you to report any blood sugars that are over 200 to me." at the beginning of the next couple of shifts i would remind her not to forget to report blood sugars over 200 to you immediately. then, write down on a piece of paper or a memo form: _____failed to report a blood sugar of 386 on patient, ________ in room ____ who was on sliding scale coverage. date. your signature. and make sure it goes to the don in a sealed envelope under her door.

as for the aide who gave you attitude after helping her clean up and transport patients. . .stop doing that. don't help her unless she asks or really looks like she needs help. use that time to take the blood sugars.

as to this other aide. . .do as you have been and ask them if they've done a blood sugar yet. then follow up their response with, "i want you to make that the next thing you do." just ignore the snottyness and rudeness for now and act like it didn't happen.

it's a hard reality when you realize that your cnas are not of the wonderful, efficient variety that you were. efficient, competent cnas are a treasure, but, unfortunately, they either quit or move on or they go to nursing school and move on to another career. welcome to ltc. :smiley_aa

Daytonite, BSN, RN · Aug 13, 2005

If she/he lies report it, it's dangerous thing to lie in nursing. . .It makes me so mad when I am running around doing 100 things at once and there's an aide on the phone while her resident's are running me ragged! I wish more nurses would speak up to such aides.

If an aide falsifies the record with made up blood pressures, etc. the worst that can happen is she gets fired. If a licensed nurse does it their license is gone with the wind.

With nurses who hang around on the phone while everyone else is busy and their resident's are needing help I go over and stand over them and tell them to get off the phone. I stand there until they hang up (an assertiveness technique). Then, I inform them that the time to make personal phone calls is during their breaks (like maybe they forgot that!). If I catch them at it a second time I do the same thing and also tell them that I am writing them up, and I do--a nice neatly word processed memo documenting their behavior for the DON. If I'm feeling particularly put out with them I'll ask them if they want a copy of it. They either follow the rules and get to work or they are going to go out the door.

BETSRN · Aug 14, 2005

Hi! I'm a new RN in my third week of orientation. I think I'm doing pretty well overall, & really do like my unit & the nurses I work with. Now I feel like my biggest issue or thing I need to work on the most is delegation. It still feels so weird to me to delegate to nursing assistant (NAs) because I was one for 2.5 years & it feels so strange to be on the "other" side. I think my problem is this: since I know how difficult it can be to do the work NAs do, I tend to either not ask them to do something when I need it -cuz I feel bad asking them to do something-even when I'm busy(I usually do it myself)or I notice I seem to just about apologize as I'm asking them to do something. And I feel like because I'm a new nurse & not demanding in the least a few of them are skipping some things they should be doing-like not totaling up I & O, & one of them last week checked a patient's blood sugar at noon & didn't tell me it was 386!!! I was running around so busy that day that at 12:30 it dawned on me that she didn't tell me the patient's sugar, so I'm thinking to myself "Hmm..I bet it was a normal value if she didn't report it to me." Nope! When I looked in the flow sheet I saw she wrote it there but didn't tell me about it! When I saw her next time I said "Gee, that patient's blood sugar was high-I had to give her insulin." She just said "Yeah" & then said "Oh & I forgot to write down her weight too-it was 250 lbs." I feel like she was just making up that number! Then another NA today was being difficult too. I was very nice to her & helped her clean up & transport patients whenever I could, but then she gave me attitude later on for no reason. Our patient was on every four hour blood sugar checks. So the last sugar was checked at 8 AM today. Then at exactly 11:10 AM I see her just about to check his sugar again, so I went up to her & said "Oh, he is on every 4 hour checks. So his next sugar isn't due until noon." She just gave me such a dirty look! I'm sorry if it's not convenient for you, I felt like saying, but too bad-the doc didn't order every 3 hour checks, so deal! (I didn't say that of course but wished I did!) Then at noon I saw her with the machine, so I said to her "How is his sugar?" And she says to me "I'll tell you it when I know it." And she said it in the rudest voice you could imagine. It really upsets me when I try so hard to be nice to people (NAs) and they turn around and act like jerks. How would you guys handle this? I know I have to learn to be more assertive. I guess I am afraid to speak up in case I offend anyone. Thanks for listening!
-Christine

The CNA's lack of reporting that blood sugar to you was UNACCEPTABLE. You are now an RN. It is YOUR license we are talking about here. It is your job to delegate and you probably have to a lot of the time. In fact, if anything, you have an advantage because you have been a CNA before and know what is expected of you in that capacity. Use this past to your advantage.

I would make sure that you keep a list of any CNA duties (like the blood sugar) on your cheat sheet and make sure that these CNA's are reporting to you in a timely manner. Go to them BEFORE the shift starts and let them know what you expect of them. Then, at the same time, be a team player and help them whenever you can. You've been there and you know how difficult it is to be in their shoes. They are probably also jealous. help them when you can: help with that bed making, empty the foley if you;re there, things like that. Let them know what youahve done for them as well. You have a new role now and you have worked hard to achieve this position. You deserve better. But you haev to make that for yourself. best of luck.