Aides who go over your head

[Not_A_Hat_Person, RN]

I'm a backup charge nurse in LTC. My shift has a charge nurse, a med tech or nurse, and 2 aides. January was an expensive month for me (malpractice insurance and license renewal), so I picked up some shifts this weekend. I wish I hadn't.

An aide got hurt a few weeks ago (I'll call her Hurt). I found out Friday night that Hurt was coming back Saturday night. That meant 3 aides instead of 2. Usually, the "extra" aide is orienting; having an extra pair of hands that knows the job was fine with me.

The schedule has had some holes lately, for a variety of reasons, including Hurt being hurt. Other aides have been filling those holes. Tonight, one aide was starting a double shift (after doing a double the night before, I'll call her Doubles), another (I'll call her Other) was ending a double. When Doubles and Other found out Hurt had a lot of restrictions, including no pushing wheelchairs or lifting, they were incensed. "It's not fair! We'll have to do everything while she sits around! We're exhausted! We need to call the on-call nurse!" Never mind that they're getting overtime, or that no one forced either of them to work a double shift (or 2 doubles in 2 days). It was time to get the residents for supper, so I said we could discuss it after supper.

Ten minutes later, my portable phone rang. It was the on-call nurse. Doubles had just called her, complained about Hurt, and threatened not to show up if she had to work with Hurt the next day. I had a revolt on my hands.

I've had problems with Doubles before, and I was ready to tell her to walk. The on-call nurse, who had no clue about Hurt's restrictions, was more worried about my shift being short-staffed the next day. I was worried, too, but I could have dealt with it. In the end, after 20 minutes on the phone, Doubles decided to come to work tomorrow after all, and I'll have to help Hurt with her group.

I am so angry. I was undermined. It has happened before in other jobs, and never ended well (though karma struck nicely in one case). I'm not good at confronting people about bad behavior; it tends to backfire. Next shift, I have to work with Hurt and Doubles. I'm trying to think of a way to tell Doubles that she was out of line without losing my temper or my tires. I was hoping the on-call nurse would say something to her (I don't know if she did).

Any advice? How can I tell Doubles she was out of line without trying to mud-wrestle a pig?

[Scrubby]

My advice is to try and look at this objectively without getting emotional about it.

Try to see this from Double and Other's perspective. Is Hurt's restrictions impacting on Double and Others workload? Do they have a legitimate reason to complain about it and are they being put at risk for having to do more lifting, pushing, manual handling?

You said that you would have 'dealt with it' if you were short staffed. Be honest here, would you have dealt with it? Or just expected Doubles/Other to carry the workload anyway because you don't have the resources? I don't want to sound offensive here but maybe they don't trust you or the facility to really provide enough help for them and are simply venting and frustrated about it.

I have worked in units where there is a lot of people on weight restrictions and it can be incredibly unfair to be expected to do the majority of the heavy work. Maybe you need to have a good think about whether Double and Other's complaints no matter how unprofessional they have been expressed need to be considered here.

[morte, LPN, LVN]

My advice is to try and look at this objectively without getting emotional about it.

Try to see this from Double and Other's perspective. Is Hurt's restrictions impacting on Double and Others workload? Do they have a legitimate reason to complain about it and are they being put at risk for having to do more lifting, pushing, manual handling?

You said that you would have 'dealt with it' if you were short staffed. Be honest here, would you have dealt with it? Or just expected Doubles/Other to carry the workload anyway because you don't have the resources? I don't want to sound offensive here but maybe they don't trust you or the facility to really provide enough help for them and are simply venting and frustrated about it.

I have worked in units where there is a lot of people on weight restrictions and it can be incredibly unfair to be expected to do the majority of the heavy work. Maybe you need to have a good think about whether Double and Other's complaints no matter how unprofessional they have been expressed need to be considered here.

except that Hurt was extra, so the other two would have been working as the only two aides anyway....what ever Hurt did was going to be something they didnt need to.....

[DogWmn]

Yes it is their right to go over your head just as it is your right to go over your super's head if you feel you have a legitimate complaint.

To nip this in the bud, I would have a brief start of shift meeting outlining the situation to all your CNA's. I would identify all that Hurt can do and that she/he will be responsible for those duties during the shift so Double and Other KNOW they are not responsible for those duties and Hurt knows what is expected of her/him.

Anytime you are in a situation where an employee is returned to the workforce in a "light duty" situation and the job requires lifting ect. there can be resentment, no matter if it's nursing or bricklaying.

Good luck

[David13, MSN, RN]

"Doubles" was out of line. She did not, if I am understanding the OP correctly, follow the proper channels for addressing an issue with which she was not satisfied. It was not up to "Doubles" to call the on-call nurse and, in my opinion, this breach should be addressed through whatever disciplinary procedures exist at your facility. When everyone tries to be in charge, there is chaos, and "Doubles" needs to understand that what she did is not acceptable behavior. Chains of command exist for a reason, and one of those reasons is so that chaos does not reign supreme.

[Guitar_Heroine]

Sounds like a lot of fun personalities... sorry for the rough night! I don't work in LTC but these sound like issues that administration should be addressing - as a relief charge I would want my supervisor making the call on an employees ability to work/restrictions after an injury, and then with OT pay involved too! I woul let them know you're frustrated that they didn't give you an adequate chance to try and reach a solution before going over your head. But really don't take it personally. It sounds like a lot of TIRED and probably cranky employees!

[fuzzywuzzy, CNA]

I'm having trouble understanding why you're mad. Because Doubles called another nurse to change the schedule instead of you? Was this the regular charge nurse that she called?

Like someone else said, it sounds like people were just tired and cranky, nothing personal.

"Never mind that they're getting overtime, or that no one forced either of them to work a double shift (or 2 doubles in 2 days)." No one forced you to pick up a shift either and yet you're complaining about it. Maybe they had an expensive month, just like you. They probably make less than half of what you do.

[morte, LPN, LVN]

i can certainly understand why the OP was upset, there was no short staffing, in fact there was extra staff....what was the complaining aide's issue?????and i dont see where it was her/his place to be calling the on call to complain.....about....nothing! which means she was taking work time to complain about....nothing!!

[SuesquatchRN, BSN, RN]

She was out of line, but what can talking to her about it do? She got her way.

[Batman25]

I wouldn't have had a problem with Doubles calling the on-call nurse IF a significant amount of time had gone by and the issue wasn't addressed. This was done in 10-20 minutes in the middle of meal time. This wasn't the proper time to address it. I also don't like the fact that Doubles threatened not to show for their next shift. That's out of line and allowing the inmates to run the asylum. You don't show at my facility with good reason and you would be out of a job.

[systoly]

DogWmn is right. When a staff member is on light or restricted duty, everyone needs to have a clear understanding of their duties and responsibilities. As DogWmn said, this needs to happen at the beginning of the shift. I usually have a plan for this type of situation, but at the beginnig of the shift, I explain the situation to everyone, give them my plan and ask for input. More often than not the CNAs not on any restrictions come up with a better plan than I did, because they know what will be most helpful to them. If there's some complaining, that's ok, we all need to vent and preferably before we take it to the floor. My feeling about calling the on call nurse is this: you can call anyone you like, but as far as I'm concerned the matter is now between you and the person you called and I'm no longer involved. When it comes to threats about calling in it depends, if it's just the frustration coming out I'd validate and say,"you really don't mean that right?" If it's indeed a threat as in,"...if condition xyz is not met, I'm not coming to work tomorrow", you just harm yourself, because now I can no longer accomodate you in any way and you either show up tomorrow or you won't work on my floor again.

[southernbeegirl, BSN, RN]

why not assign Hurt to do things like all the VS, ice, feeding, making beds, straightening rooms. i float CNAs on light duty like this and it works for us. the CNAs on the floor have to pick up her patients but she's countering by doing all the nonlifting stuff on the floor.