Aides giving the "new nurse" problems

grinnurse, RN · Jul 2, 2005

Debbie - there is another thread around here just started recently by someone with a problem very similar to yours. Lots of good advice there. I'll just say (like everybody else has) that you need to make it clear right now what you expect from the CNAs. They may be "testing" you to see how much they can get away with, or have just always been allowed to do whatever they want without being questioned. You're just out of school, so all your "therapeutic communication" skills should still be fresh - use them. It's tough being put into a supervisory role so soon, but don't forget you're the one who went to nursing school.
I wouldn't advise you to go at this with all your guns firing...that will only make them resent you - then they'll try to make you miserable. If you find out they are not really taking temps, ask them why. If there's truly a problem, work with them to fix it. If they have no excuse, you'll know right away, and they'll know they've been cornered. If it continues, you may need to sit them down and let them know the steps you will have to take if the problem is not resolved between you and them - involvement of YOUR supervisor. It might be helpful for you to keep some discrete notes on what's being done, what's not being done, and what you have done about it.
Also, try some positive reinforcement - it's amazing what people will do for you when you notice and show recognition of their efforts. They probably won't be expecting it! You DO catch more flies with honey than vinegar!
Good Luck..

Great Advice. I have been using positive reinforcement as well as when I am caught up (happens every once in a great while) I will offer to chart their vital signs for them or help them with something else. One of our instructors in NS always told us to treat our CNAs well b/c they could either make you job miserable or good. I will be treating them to lunch once a month or some little something just to show my appreciation. Normally we only have one CNA for as many as 15 pts and she runs her butt off as much as we do so I try to help her when I can.

Good luck with the problem.

RN34TX · Jul 2, 2005

Great Advice. I have been using positive reinforcement as well as when I am caught up (happens every once in a great while) I will offer to chart their vital signs for them or help them with something else. One of our instructors in NS always told us to treat our CNAs well b/c they could either make you job miserable or good. I will be treating them to lunch once a month or some little something just to show my appreciation. Normally we only have one CNA for as many as 15 pts and she runs her butt off as much as we do so I try to help her when I can.
Good luck with the problem.

Positive reinforcement is a great approach and helping each other out with duties can build a great team, but I think that the advice you got from the nursing instructor was perhaps true at times, but very bad.

The day you have to bribe the CNA's with food, treats, and kissing their @$#%!! or else risk that they're going to make my life miserable is a true sign that they have way too much power and control on a unit.

They may be overworked like the rest of us, but the doctors, families, and administration still expect me to do my job everyday, treats or no treats.

I went through the same stuff as the OP when I was a new LPN at the facility that I was a CNA at for 2 years prior. They took advantage of me and treated me like crap. Kill them with kindness and treat them with respect, none of it worked.

That's why I no longer work in any area where I have to depend on CNA's for help, I got tired of begging for it while they ran the show.

GrnHonu99, RN · Jul 2, 2005

Great Advice. I have been using positive reinforcement as well as when I am caught up (happens every once in a great while) I will offer to chart their vital signs for them or help them with something else. One of our instructors in NS always told us to treat our CNAs well b/c they could either make you job miserable or good. I will be treating them to lunch once a month or some little something just to show my appreciation. Normally we only have one CNA for as many as 15 pts and she runs her butt off as much as we do so I try to help her when I can.
Good luck with the problem.

I understand what you are saying!:) Its very nice of you to treat your CNA's to lunch. I think what you and possibly your instructor were saying was that you should treat your aides with respect and hopefully they will return it. Treating the CNAs to lunch to show your appreciation is different then bribing the staff with food to do their work.

In the OPs case, how frustrating it must be for you, having to follow behind these aides to make sure they didnt make up their vitals! Shame on them! They could really harm a patient that way, especially by making up false BPs! I would go to your nurse manager right away, it is your job to advocate for the patients..if these aides are making up their vitals, what else are they skipping over or making up! I would absolutely not put up with that, i mean make fun of me all you want but dont harm or slight the patients the care they deserve! People like those aides have absoluetly NO business working in the health care system at all. After talking with your supervisor i'd give them all one warning and that is it. Good Luck Op! keep us posted on what happens.

HisTreasure, BSN, RN · Jul 2, 2005

I, too am a new nurse in a LTC facility. Age: 23. Right now the aides seem to respect me and my authority, although I do notice the "sarcasm" when pharmacy brings up an order that needs to be signed off. "The nurse is over there." This may be a precursor to what is to come.

I am the youngest person on my floor. Yes, I am the youngest person on the entire floor which has two seperate units! :stone I was also one of the youngest people in my graduating class so I did know what I was in for. The unit secretary, nurses, and aides all refer to me as "Baby Girl" and once or twice when I was brand new to the unit the nurses referred to me as "the little girl". I have yet to be on my own totally, and things may be different once I am, but I do receive the respect my education afforded me. I treat the aides with respect and I value their knowledge and appreciate their friendliness. But I also realize that as far as patient safety is concerned, I am the one with the license on the line and there will be no compromises. But to be honest, I'll take patient safety and my license over friends any day.

grinnurse, RN · Jul 5, 2005

Positive reinforcement is a great approach and helping each other out with duties can build a great team, but I think that the advice you got from the nursing instructor was perhaps true at times, but very bad.
The day you have to bribe the CNA's with food, treats, and kissing their @$#%!! or else risk that they're going to make my life miserable is a true sign that they have way too much power and control on a unit.
They may be overworked like the rest of us, but the doctors, families, and administration still expect me to do my job everyday, treats or no treats.
I went through the same stuff as the OP when I was a new LPN at the facility that I was a CNA at for 2 years prior. They took advantage of me and treated me like crap. Kill them with kindness and treat them with respect, none of it worked.
That's why I no longer work in any area where I have to depend on CNA's for help, I got tired of begging for it while they ran the show.

I definately would not "bribe" anyone or kiss their butts for that matter, what I was saying was that they need to be shown the respect that each and every one of as human beings deserve. What I was talking about but obviously didn't make the point crystal clear was that I want to let them know that they are doing an awesome job (when they are) and foster teamwork with in the unit as a whole. Which of the CNAs in a pinch is going to go the extra mile for the patients? The ones that see respect from the nurses but that goes both ways. The CNAs that I work with are not like any of the ones that you mentioned above at all thank goodness. The nurses are not the only ones getting dumped on, sh** rolls down hill and splashes on each of us in some way. I believe that you catch more flys with honey rather than vinegar and the more people that you have working towards the same goal the better the outcome is going to be and if you call that kissing a**, then that's your opinion but that's not the idea with showing appreciation to the CNAs that I work with at all.

I am sorry that you had such an awful experience where you did and if the CNA's were running the show sounds like management had a problem as well. I just believe and try to live by the Golden Rule "Do unto others as you would have them do unto you". Elkmin got the jist of the post that I made to the OP from the advice of my instructor and I still say it's great advice despite how the original posting by me was taken by you.

Roy Fokker, BSN, RN · Jul 5, 2005

Just think about it through this lens: you are a supervisor.
That's right. A supervisor. If they don't take a temp and a patient suffers because the fever they have doesn't get diagnosed until it becomes septic shock, it's not the aides responsible - it's you. Under the nurse practice act, you are delegating your authority to every act done AND you are accepting responsibility.
If you accept shoddy work, then you can't complain about shoddy work.
Next time you think it's too fast, tell them to do it again, and you are going to check 3 of them at random and your results had better be within a degree of theirs.
You don't have to answer to them; they have to answer to you. Don't accept being baited.
Snide remarks and giggles and stares get one warning (in private) and a severe reprimand that, if they undermine your authority again, you will write them up and see to it that they are looking for another job.
2 quick rules of management:
1. You are the boss, not a friend. Friendship is a mutual relationship, Boss/Worker isn't.
2. Praise in public, criticize in private.
It's human nature to test the limits of anybody in authority over you. You do it too. The question is simply this: how elastic are you? Because if you don't stand, you will fall.
hmmmmm, this is the second time I've said tough things on this site in as many posts. but then, when you are talking about the care of people with whom you have a professional contract, my take is let people call me a hard a** as long as they equate it with the excellence that I feel is mandated.
You stand your ground. It is your hard earned ground to stand on.
~faith,
Timothy.

WOW! Gotta keep this in mind someday when I graduate :)

Thanks man!

tangerine · Jul 5, 2005

You are not alone in this topic!

I have worked LTC for 5 years now, and in MANY of these facilities the CNA'S DO think they run the floor.

I, personally, do not like to write anyone up, however, since, they do not run the floor, and they do not always do as they are suppose to do, the need to write them up, is necessary.

Many CNA's will walk all over you, if they perceive your kindness as weakness. It is a very thin line nurses walk with them.

Some CNA's are worth their weight in gold, and some are not.

One thing is clear, or should be, and that is the Patient. The PATIENT is the top priority, and some employees have a hard time remembering why they are in the building. It is NOT about them, though, some seem to think the entire floor revolves around them. It does not.

If this sounds stern, it is, to those employees, who like to sit at the desk and do crossword puzzles, and eat, and talk and talk. Does this happen? Of course, it does. Do we, as nurses have a responsibility to not let it get out of hand? Yes, we do.

As, I mentioned, earlier, this is a very thin line, and if weakness on your part is shown or perceived, some employees, will take it to the max.

Do not allow some employees to change your goals or your ambitions.

If you treat your co-workers in a respectful manner, you should receive no less in return.

Will there be those who challenge you? Yes, without a doubt. How you choose to deal with this situation, time and again (it WILL happen more than once in your career), will ultimately, show your character.

Good luck, with your career and your choices.

Carolanne · Jul 8, 2005

You're the new kid on the block and many eyes are focused on you. How will she handle it, how flustered is she going to get, when is she going to lose it? There's probably a little bit of jealousy, too, over your accomplishments and increase in pay over the aides. I think it's a common scenario, I see it in my hospital too all the time. But don't sweat it, they'll get over it. Just be your professional courteous self and walk around the horse-droppings, and focus on what you went to school for in the first place, be a nurse. The office politics will fall into place soon enough.

TypicalFish · Jul 9, 2005

Just think about it through this lens: you are a supervisor.
That's right. A supervisor. If they don't take a temp and a patient suffers because the fever they have doesn't get diagnosed until it becomes septic shock, it's not the aides responsible - it's you. Under the nurse practice act, you are delegating your authority to every act done AND you are accepting responsibility.
If you accept shoddy work, then you can't complain about shoddy work.
Next time you think it's too fast, tell them to do it again, and you are going to check 3 of them at random and your results had better be within a degree of theirs.
You don't have to answer to them; they have to answer to you. Don't accept being baited.
Snide remarks and giggles and stares get one warning (in private) and a severe reprimand that, if they undermine your authority again, you will write them up and see to it that they are looking for another job.
2 quick rules of management:
1. You are the boss, not a friend. Friendship is a mutual relationship, Boss/Worker isn't.
2. Praise in public, criticize in private.
It's human nature to test the limits of anybody in authority over you. You do it too. The question is simply this: how elastic are you? Because if you don't stand, you will fall.
hmmmmm, this is the second time I've said tough things on this site in as many posts. but then, when you are talking about the care of people with whom you have a professional contract, my take is let people call me a hard a** as long as they equate it with the excellence that I feel is mandated.
You stand your ground. It is your hard earned ground to stand on.
~faith,
Timothy.

Excellent advice, as usual, Z.

jeepgirl, LPN, NP · Jul 10, 2005

this happens to everybody i think. i swear... it was one of the biggest problems for me. i still have issues, but for the most part they have started to listen. it was just so amazing to me that a more experienced nurse, older than the techs could ask / tell them what they needed to do and they wouldn't bat an eye, but when I do it (newer nurse, much younger than them) did it they refused to even acknowledge my exsistance. And, of course, I received no help from my manager or senior nurses reguarding this! But, our new GN has noticed it also, so I haven't been taking it so personally. It's an inferiority thing, I think.

BETSRN · Jul 10, 2005

Let's see..... I am a new nurse, started working 4 months ago in LTC. I am 23 years old. The problem is: Where I work, there is 1 nurse on the floor, and 2 to 3 aides. They are all older than me, and doing this for years. I love my aides(I really do, I was an aide for 5 years), but sometimes I feel like they walk all over me.
The one night, after I had made the temp board out, they took it and withiin 10 minutes, they had it all filled out(7 pts TPR). The numbers were all so close. But I didn't see them make them up, so I asked them: Wow, that was quick. Are you sure these are the real temps? Well, as you can guess, they were PO'd.
They constantly try to get out of assignments and work. They skip over residents during rounds, and when I say something, they ALWAYS have an excuse.
Then this one is the best one yet. They will ask me about a condition or a med, and when I don't know the answer, they will give that look(you know the one, it's like well you're the nurse, so you SHOULD know everything). Then they giggle. It's so childish, these are grown women I work with.
Sorry so long, just needed to vent. I hope I am not the only one who has ever had this happen to. Some nights, I just feel like maybe nursing is not for me. But then that one patient who kicked your butt earlier gives you a hug, and it's all worth it.

I would suggest that you take this problem to your supervisor, telling her that you want to work this out on your own. However, making her aware will help you to speak with these aides.

After you have spoken to your supervisor and have her blessing, then go to these aides and speak to them, either one on one or as a group. You can tell them that you have already discussed this with your supervisor and that she/he is aware of the issues you are presenting.

Stand tall and remember, you may be new but you are an RN and they are not. You were there once and you chose to go farther: something these aides did not choose to do. You can work as a team but you ahve a license to protect: they do not.

If you do not trust the temp thing, go back and take a few afterward and see what's up. Remember, they are working under your license. If they screw up, it ultimately rests on your shoulders.

Sarasgrd94 · Jul 10, 2005

I agree with the others. I think you should go talk with you director of nursing. Do not let them cause you to question whether you choose the right profession.