Published Apr 16, 2001
I've returned to nursing after an 8 year absence and don't know how to handle this one.
I'm an LPN in a long term care facility and one of the aides on my wing is a real thorn in my (and everybody eles's side)with, I feel, the potential for disaster.
She appears to be about 16 or 17 years old and it's her first NA job. She's defiant, uncooperative, will NOT take direction and interrupts instructions to explain precisely why she did what she should not have done, never admitting that she may be wrong, or just plain inexperienced.
Case in point: An severly dysphasic woman with a gastric tube, unable to assist herself at all but apparently able to understand what's being said, done around her, was left by this aide wearing a pt gown, a bed sheet to her waist, that's all, with the window open (northern zone, 45 degrees, windy, wind blowing directly in the window) and even I noticed the room was darn chilly. The aide entered the room as I was covering the cold, uncomfortable resident and I took her aside to explain how vulnerable the elderly are, etc, and she flatly interrupted me, told me she wasn't gone long, that she didn't need to listen to me and could speak whenever she wanted. She's right, of course, but not in the position she's working...
This is typical, but not the only incident that other nurses, aides, and I have had with her.
I've tried to approach her from the position that this job is an on-going learning experience and I'm trying to give her information, not criticizms, but it's not working for me or anybody else.
My concern is that if she is this insolent and rude to the staff, what's she like to the residents, considering that her job does required the muscles of an elephant and the patience of a saint? Of course, she's often alone with very fragile and vulberable people.
My inclination, after having discussed her work with a couple of other nurses who've worked with her, is to go directly to the DON and have a frank discussion of my concerns.
Of course, we're all overworked and understaffed as are ALL nurses but she's like having one more BIG problem person to look after and, to some degree, I am responsible for her actions.
I don't want to come across as a drill sargeant, esp. since I'm trying to wade through all kinds of new and only vaguely familiar rules, meds and equipment myself but something has got to give and I just don't think she's got the maturity to deal with this very important job, and the compassion and responibility that go along with it.
Anybody out there......and suggestions?
sharann, BSN, RN
As far as I am concerned,this "child" sounds like an immature moron who has no buisness in being around any patients,ESPECIALLY the elderly and defenseless.Go straight to the top on this one.Do it now,before you work again.Document for your own records that you complained and to who and why.Back it up with exactly what you wrote in your post.If no one wants to do anything...leave. You have a licence to protect as well as your pts wellbeing. You are not being a prudent patient advocate if you allow this to continue.You might even be liable legally if this ***** hurts someone.I would refuse to work w/her at the least. Good luck and sorry you are in this situation. What genius hired her?
Get rid of this loser before she causes real problems.
Please remember that you (and the other nurses)are responsible for supervising this aide. If you do not do anything about her substandard care (document, incident reports, speak with DON), you can be held responsible for HER actions. She wjorks under your direction and authority; don't hesitate to remind her that you ARE her supervisor when she works with your patients. Personally, I would refuse to work with her.
It is your responsibility to act as a patient advocate. You must document each incident that you have witnessed and encourage the rest of the staff to do the same. Your DON, as you know, needs the documentation in order to counsel or discipline any staff member. Nursing assistants are no less responsible for the quality of care the residents receive than the rest of the nursing team. This nursing assistant is a problem and you are responsible for her actions.
I recently read a statement "..... remember you cannot change people, but you can change how you react to them." As her superior, you are responsible for maintaining the highest level of care for those patients/residents you are assigned to. You are also expected to correct any situation that would "do harm" to others within your facility. A simple statement of fact such as "This fragile patient can not be left in a room that is this cold for even a short period of time." I would recommend some reading materials that would educate this nursing assistant on care of the elderly. I would also explain as a matter of fact that if this reoccurs, "I will have to document the incident".
Always keep in mind, your license is at stake as well. Any disaster, is your disa
Hi pooh. I agree that you and the other staff need to be more proactive on behalf of the patients and yourselves. Tolerating this aide's behavior will drag all of you down with a patient's care if it hasn't already. At age 16 or 17, you all would be especially doing her a favor and letting her know that she can't behave in the real world as she may at home.
As others have suggested, you want to be assertive with her and let her know that her behavior won't be tolerated. Document your encounters with her. Other staff should sign your incident report as active participants or witnesses to getting this aide's behavior in check. Present this to management, because she is all of the staff's liability.
Do make sure that you're all above board with your behavior towards her as another poster indicated. Even if it hurts, praise her for things that she may be doing right. Her self-esteem no doubt is low. You want to break her without breaking her spirit. Perhaps her work hours should be reduced if she's working full time. Or, maybe she should be put back on probation with an CNA preceptor if possible.
Ultimately this aide may need to find some other source of employment until she can get get a grip on her self esteem, work and people skills. Best wishes.
Leaving a resident the way she did is neglect, plain and simple. To her it may have only been a few minutes but to an elderly person whose circulation has slowed down, it must have seemed forever. Many of my residents have multiple covers on them all during the warmest Summer months. I cannot imagine leaving her in this state. How will she feel if this lady ends up sick or much worse, dead, from Pneumonia??? Please write everything up and keep copies. Voice your opinion and concerns to your DON and if after a sufficient amount of time nothing is done, I would seriously consider finding another job. Once your nursing license is gone, it's gone, and this girl is a BIG accident waiting to happen. Good luck, I know it's a tough situation to be in as I have been in similar ones.
I agree with Sharann, Topazstone, and cmggriff. You need to get this girl out of your facility, and out NOW. She is a liability and risk you don't need on your hands. Document her responses to you, VERBATIM, with dates, times, and nature of incident. You need some ammo to back you up to get this girl out of your facility, but something tells me it won't take long to get it. Good luck. Let us know what happens.
Well my question is ,why havent these other nurses done something by now??? Im thinking if you go directly to the DON she may say , no one has written her up, no one has told me about her, lets try to work with her and see what happens ,!! Before going to the DON have your ducks in a row, start writting her up , and start turning them in. If she is doing everything you say then it wont take long, and until then be on her like flies on s---- as best you can any way , out of your busy day. Remember if it wasnt documented it wasnt done..Same goes in this situation. Have the other nurses do the same believe me she wont be there long, and on the other hand she could wake up and take heed to the write ups. just a thought
I agree with the other posts. I'd like to add that while this person is keeping you occupied with the necessity of micromanaging her, other aides and patients are facing situations that could use your intervention, but you are not available because of your having to deal with "problem child."
Document Document Document..and be sure to have witnesses...this aide is what I like to call a Toxic person...negative,irresponsible,and more than likely creates the very stress the nurses are dealing with...but it must come from all sides and not just you. Take all licensed nurses aside..omit any who seem to be too friendly with the aide.(although I now this sounds James Bond-ish it will ensure success).and discuss ways to address her issues. direct confrontation in front of a patient is out. take her into a closed area with another nurse and then point out what you see to be the issue. allow no nonsense talk from her...have her sign a form that states she discussed the issue and ways to amend it..most facilities have this in form of counselling forms or incident reports. when you have enough of these incidents documented (usually 3-4 will do), go to the DON with fellow nurses at a pre-arranged time..that way the DON will have time to listen to you. I am sure she would rather deal with the one aide than a nurse walk out over the aide. Look in your Policy and Proceedures book, get the supervisors involved. do this now...she is definitely a loose cannon!!! Good Luck!!!
I agree with all of the above, Pooh. If this person has any aspirations of being a nurse, she's going to have to learn to listen follow directions. If she's arguing and defensive, she's not receptive to any new information. And, everyone else has pointed out, she is endangering your patients.
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