Aides and Nurses - Different Outlook, Lack of Understanding


I find a lack of understanding on the part of some of our aides as to what the nurse's view is on certain things.

The aides think we do too many vitals, weights, I & O, rounds, etc. and decide, on their own, that they are unnecessary and do not do them. One of them was in the habit of removing IV's she thought were unnecessary. I reported her after she continued doing this after I'd told her not to. We had to stick the patient 5 times to restart his saline lock for antibiotics. Family was quite angry and I don't blame them. Another nurse told them the truth, though, which made them livid and they c/o to the DON, who fired the tech.

They want to sleep on duty while they are supposed to be watching to make sure nothing happens to mental patients and have a complete lack of understanding, apparently, that the patients will not wake them up to say, "OK, I'm going to kill myself now, or swallow scissors now, or cut myself now, stop me if you can." They do not seem to grasp that not only are they going to be fired and maybe prosecuted, blackballed, whatever if the patients suffer harm but that they are also jeopardizing my license and livelihood and ability to support my family if some investigator decides I was not properly supervising the aides - although how I am supposed to ride herd on them and still accomplish my own work is not totally clear to me.

I spend a lot of time and emotion on trying to make clear what I expect of aides, one thing being that they need to tell me if they need to leave the floor, other than for a quick potty stop. And if I say that they need to wait until their peer returns from his break, they need to wait. Some are wonderful, some get huffy, I hate all the upset and anger they toss my way at times. They do what I say, though, like it or not, as I have made it clear that I will do the write-up's that are sometimes necessary if they don't. They might not like me but I have earned their respect and they know not to cross me. Actually, I think they like me well enough and I even like them.

How about you? Do you have such troubles? Do you have the respect and cooperation of your techs? Do you like being in charge? Do you enjoy working with unlicensed staff?

Tait, MSN, RN

6 Articles; 2,140 Posts

Specializes in Acute Care Cardiac, Education, Prof Practice. Has 16 years experience.

I will say I have had some pretty good luck with techs. Generally I have a hard time dictating what they need to do aside from the typical "VSS q4, accu check ACHS, tubes/drains hey can you go put a foley in on #15 (yes our techs can do foleys )".

I find when I don't know my tech well I will have a hard time asking for help, so generally if I can I do things on my own to show I will, then ask for help with things I can't do (such as boosting etc).

If I hear that my patient is asking for something, and it doesn't appear my tech will do it anytime soon, I will generally go do it. This often gets the "oh no hang on I was on my way!" speech, to which I usually just smile and tell them its no big deal, and that I have time to get it.

Generally I believe my techs understand that my patients come before anyone else, and that I am more than willing to help out when they are busy.

As far as techs who seem to think they know your job better than you...

Put them in thier place. Remind them you are the one with the degree and the student loans. I think techs that are in school are sometimes the worst because they have a little bit of knowledge and are bound and determined to use it.

I have had problems like this with one CNA that was in her 60's. She liked to do things her way, would often not report things to me, and copped an attitude everytime I would request something specific of her. However after some time we sat down she called me a bossy newbie and I called her an old bag and after that we got along great.

Sometimes you just have to feel it out.

However, sounds like the tech you are speaking of is doing a lot things he/she should not and needs to have her scope of practice explained to her/him by a supervisor.


PS. I use tech and CNA interchangeable, forgive me. :)

PSS. Sounds like you already have this under control, sorry didn't mean to sound "advicy", this is just generally how I handle it.

Virgo_RN, BSN, RN

3,543 Posts

Specializes in Cardiac Telemetry, ED.

The aides I work with seem to feel they're overworked because they have ten patients and I "only" have four. If I ask for anything extra, like a set of orthostatics or for them to put the results of a hemoccult that they did into the computer, I get "the look", and noncooperation. Yet, they *always* get their breaks, and don't seem to notice how many nurses work straight through with NO breaks on a regular basis because we are BUSY!!!! The ones that are in nursing school, I just smile and remind myself, "You'll see when you're a nurse!!!!".

Tait, MSN, RN

6 Articles; 2,140 Posts

Specializes in Acute Care Cardiac, Education, Prof Practice. Has 16 years experience.
The ones that are in nursing school, I just smile and remind myself, "You'll see when you're a nurse!!!!".



50 Posts

Specializes in Oncology.

To whom nurse it may concern.


I cannot believe that, after finishing chewing each other's and eating your young's, you decided to take on CNA's and Nursing Students. That's very courageous of you. Maybe the DOCTORS are right, when they tell you that they are the ones with the Big Degree.:nono::nono::nono:

pagandeva2000, LPN

7,984 Posts

Specializes in Community Health, Med-Surg, Home Health.

Because the aides and techs are educated differently, they do not understand the responsibilites of nurses. I have this issue several times in my clinic. For example, we have a row of charts placed in the nursing rooms for those that need nursing services such as injections, counseling, medications, treatments, and to be sent to the emergency room. I have a tendency to look into the chart before I call a patient so that I can prepare what I need before I call them. The aides will come and drop a patient before me in the room without asking me if I was ready. Meanwhile, the unsuspecting patient that was dumped off may wonder why I am still typing on the computer rather than servicing them, and I have to explain that I am still charting on someone else, or at times, I may have to ask that patient to step out because I am about to administer a nebulizer treatment to an asthmatic.

Other times, if my charts are finished, I go to see if other nurses need help, so, I will remove some of theirs and take responsibility for them, and then, the aides will come and demand that I see their patient first because 'they were next'. Sometimes, I can't do it that way, because if it is a patient that is elderly, one that has to go to the ER or whatever, I have to regroup how I originally planned to work.

I don't know the right answer for each person, but, I do try and explain to them so that they feel included and understand a bit better. Sometimes it works, sometimes it does not.

pagandeva2000, LPN

7,984 Posts

Specializes in Community Health, Med-Surg, Home Health.

Oh, and I wish to add that this is not a bash on the aides or their educational level. They are valued and appreciated. A good aide is more than worth their weight in gold.


64 Posts

Specializes in Acute/ICU/LTC/Advocate/Hospice/HH/. Has 9 years experience.

started as an aide at 16, now an rn and do everything I can for the aides, including lunch, and most important....getting the other nurses off their butts to help with pt care. A good Aide can make or break you!! Recently caught one of mine stealing $ from a patient. Sticky situation. Bottom line elder abuse, reported.

weirdRN, RN

586 Posts

Specializes in Long Term Care.

I have had my share of difficulties with aides.

When I first became an LPN, I found my *friends* not doing their jobs. So I followed the advice of a more experienced nurse. I documented it and I checked after them all the time. It was time consuming and the backlash wasn't worth it. I should have just moved on to another facility right from the start.

As an RN, at a different job, I was accused of abuse because the aide did not understand the methods I was using to provoke the patient into caring for themselves.

Go figure.

I think sometimes, that because we are not all trained with the same goals in mind that the differences are insurmountable.

Doctors are trained with the goal of curing disease, Nurses with the idea of treating the individual, not just the disease process, Aides... well, to be honest I sometimes wonder whtat the focus is other than being able to get a job and feed the family.


64 Posts

Specializes in Acute/ICU/LTC/Advocate/Hospice/HH/. Has 9 years experience.

We all have the same goal really. Impacting a life either positive or negative. All I want is a smile and then I know I have made a difference. God bless the aides that work till they drop, those are the ones who take the most grief and get the least appreciation. Most of my CNA's got earings or necklace for xmas. The one's that stand out and do without complaint, got $50 gift certs. and a new set of scrubs. They know I appreciate them. One LVN was telling a CNA to get this and that and then do this and after she just turned away and started to chart. I stopped the CNA halfway down the hall and said "Thank YOU Thank You Thank You" loud enough for the LVN to hear it. Even that little thank you goes a long way. I think the LVN got it though.

Katie82, RN

642 Posts

Specializes in Med Surg, Tele, PH, CM. Has 41 years experience.

I have not been in acute care for several years, but the Nurse/Aide issue is as old as nursing, and takes place in any setting where you have professional/para-professional staff. The key is mutual respect, and we do not command respect simply because of our degree. I have always gotten along with my para-professionals because I realize how valuable they are to me, and I treat them accordingly. Take the time to give them report, don't assume they are out of the need-to know-link. I made use of any "teachable moment" I could find to help them understand why some issues are important. Teamwork is important in healthcare, even if it's a team of two. I know a little attitude gets in the way,but I have always tried to ignore it. I try to remember that they work with us, not for us.


64 Posts

Specializes in Acute/ICU/LTC/Advocate/Hospice/HH/. Has 9 years experience.

Got my RN because I was tired of breaking my back for minimal pay, but I sincerely enjoyed what I did and found that I was really good at it. Barely cracked a book during school cause patho was something I could just wrap my brain around. I agree it is about respect. I am a weekend supervisor at a LTC/Rehab and there are fewer complaints and incidents on the wknd. Took some time to educate the nurses to their job of "patient care" and disabled the overhead page system for a weekend. Nurses went crazy cause they could not page "CNA to 314." They had to get up and ensure patient safety at the minimum if not actually assist the patient. I take pride in the fact that the patients are happier when administration is not in the building. Still working on my own ability to delegate though.

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