Aides and Nurses - Different Outlook, Lack of Understanding

[Weeping Willow]

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?

[Tweety, BSN, RN]

The fact is, the aides are there to help the nurses. Period.

Actually, they are there for the patients, not the nurses convenience, which is how some nurses treat their techs. But it is their job description to take direction from the licensed nurse.

Again, teamwork is the key, for the sake of the patient, but not all of us, licensed and unlicensed alike get this.

[Ruby Vee, BSN]

lately, i have been wondering about the use of nursing assistants in the hospital setting. do you think it would benefit patients to have total care from a rn who has a lighter patient load?

.

i've been wondering the same thing. i work in icu, and we still have a few patient care techs. they seem to spend most of their shift in the break room "on break" and the rest of it hiding, only to emerge every other hour or so to do a set a vital signs and an i & o. they not only get all their breaks every day, but take time to walk to the market to buy their lottery tickets every day that the weather is nice. (that's not break time. they'll take an hour going to the market, then come back and sit down with some food they've purchased and take their break.) we have one tech who actually can be counted on to do some work . . . out of about 8. if i'm working with one of the other 7, i know not to count on them for anything. they'll disappear with no notice.

while making assignments not too long ago, the charge nurse asked me if a particular tech would work with me. "what do you mean?"

"oh," said the charge nurse. "prissy only likes certain nurses and if i put her with them she'll do her job. otherwise she spends the whole shift in the break room complaining about the nurse."

i've worked with some great aides in the past, but at this point i'd just as soon get rid of the lot of them and expect to do my own work. all of my own work.

[husker_rn, RN]

I guess I am one of the lucky ones; my CNAS do a great job as a rule. In the beginning I had to earn their respect; we see lazy CNAs but forget sometimes they become bitter working for lazy nurses....and we all know some of those too. I've told my staff that we all have lazy days...we just can't have them everyday. And I help them as I can too. I try to explain why I want what I want. Some things we'll talk about now, some things we'll talk about later and some things we don't talk about at all. Now they come with good questions about our clients health issues; and I enjoy teaching them.

[perfectbluebuildings, BSN, RN]

..deleted

[Ruby Vee, BSN]

to whom nurse it may concern.

dear,

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:

it assumes that the op (and whomever else posted in this thread eats their young, chews on their co-workers and is mean and nasty to cnas and nursing students. i didn't find that to be the tone of the op at all.

[Ms Kylee]

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.

It is true... a thank you means a lot.. especially when you're having a pretty awful day.

[Ms Kylee]

I can see how that might be degrading. When I was an aide, at the beginning of my shifts when I went room to room to check on each patient and introduce myself, I made my role clear to them by telling them that I am the one who brings snacks and warm blankets and helps them to th bathroom. Your nurse brings the medications and takes care of treatments, but I can check with your nurse if you have any questions. I didn't feel degraded at all because I accepted that my role was different from that of the nurse and went out of my way to let the patients know. I didn't feel that wiping butts was beneath me, because that was my JOB. I knew the nurses were too busy to do it, and that's why I was there. The way I see it, the patients have all these people that come and go, and it's hard to keep track of who does what. If I can explain to them at the beginning of my shift and make things easier, then why not?

I also include "I'm here to make sure you're comfortable. I can't bring your meds, but I can let your nurse know if you need them." Most patients are appreciative, but every so often you get the demanding one that is a PITB.

[pickledpepperRN]

This thread reminds me of a shift in telemetry when I received a transfer from ICU just when dinner trays arrived. Usually it was a priority to pass the trays before the food cooled off so we all worked together.

But this patient arrived with a minimal report given by the supervisor not the nurse who cared for the patient.

I needed to assess the patient and the chart. I discovered that the K+ was low and there was no evidence that it was reported. I called the ICU and the nurse said, "I just got an admit myself. We were so busy I didn't have time to check the morning lab results."

I had to cal the doctor and give oral potassium stat.

Boy did I thank the CNA's who passed trays and set my other patients up for dinner!

We have to work together for OUR patients.

[Virgo_RN, BSN, RN]

Actually, they are there for the patients, not the nurses convenience, which is how some nurses treat their techs. But it is their job description to take direction from the licensed nurse.

Again, teamwork is the key, for the sake of the patient, but not all of us, licensed and unlicensed alike get this.

Semantics. If we didn't have aides, who would be doing all the things the aides do? The nurses. I agree we do it for the patient. I didn't think that needed to be said.

[chadash]

These post make me realize I work with great nurses. They never degrade me, they always are careful not to impose.

Real teamwork must be predicated on empathy.

Today I made a mistake in how I treated a nurse. I was holding on to an alzheimers patient to stop her from pulling her foley, and found myself telling the nurse how to resolve the issue. Really out of line. I guess I was just frustrated with my dilemma, and forgot to think before I spoke....hadn't had lunch....a million excuses. But, imperfection in ourselves is the best teacher. We are going to mis-speak, screw-up... and we need to allow our coworkers the same grace we allow ourselves.

I learned that from the nurses I work with, who have shown me grace over and over.

[Tweety, BSN, RN]

To whom nurse it may concern.

Dear,

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:

Nurse/CNA dynamics are a big part of our day and sometimes we need help to deal with it and come to understanding. Please allow us this. We are not "taking them on".

[Kunzieo]

What I find frustrating is that I am expected to understand things from an aide's point of view (which I do because I was one), but I don't feel that the nurse's point of view is understood by the aides. It's like a one way street. That's why I can shake my head and smile that the aides that are in NS will someday understand. And most likely, they will be embarrassed at their lack of understanding when they were an aide.

:angryfire

I am so SICK of people saying that. "Oh...just wait until you are a nurse..then you'll know how rough it is..."

What makes you think that an aide doesn't "understand" what all your job entails? Believe me, I KNOW what nurses do (at night anyhow.) I've watched them do it for over two years.

I know they are responsible for all cares and treatments, no matter if it is myself or the nurse performing them. I know that they have millions of miles of charting to complete. I know they also have to cater to certain patients and families. I know they have supervisors breathing down their backs, always pushing the latest patient surveys and new campaigns for patient care. I know that they are fighting with the docs to get the right course of treatment for their patients. That they are constantly assessing everyone and everything in their head, constantly evaluating, prioritizing, and re-prioritizing when a really sick patient throws everything off schedule. And they do all this without taking more than a 10 minute break, sometimes not having time to eat, sometimes hardly having time to pee.

When I complain about certain nurses, it is NOT because they are misunderstood.

Respect is earned, not given.

And having an RN after your name does not automatically mean you have earned respect.

/rant.