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?

[pebbles, BSN, RN]

I *am* really sick of CNA's who don't understand my work dissing me and my work, and deciding what is or isn't important about patient care.

I had a CNA tell a new nurse the other day that "this patient isn't really an ICU patient anyway, the alarms don't matter, she shouldn't even need a monitor". Well, actually, that patient was pretty darn sick. But the CNA couldn't understand that because the pt wasn't on a ventilator.

I've heard and been subjected to countless ******** sessions about nurses being lazy - I really believe that these less-educated CNA's do think that RN's get paid to sit around all day. The ignorance about the work of nursing and what it is that nurses are paid to do - is what leads to that disrespect. And I am sick of it.

I don't feel that I disrespect the CNA's or their work, so why are they so disrespectful to mine????

[Virgo_RN, BSN, RN]

I have a lot of faith that most of the aides I work with are compassionate people doing a very difficult and demanding job.

I've been working on getting together with the aides at the beginning of the shift to give a report and let them know the things that need to be done, but often I don't even see an aide until halfway through my shift, when they approach me to let me know they're going on break. Frustrating, yes. If I need help, I typically have a choice between doing something myself or spending ten minutes trying to find an aide. Typically I do it myself, while all of my other work is piling up relentlessly.

I wish the solution were as simple as communication. Communication can't happen if you don't have someone to communicate with. I think the solution in my case is that we need to hire more aides. But that's not happening, so how can I make the best of the situation as it is? I need help. Without help, I don't have time to look up labs or imaging results, or keep up with chart checks, or take my breaks, let alone to pee or get a drink of water. I feel that patient safety is at risk because I'm so busy running around like a chicken with my head cut off, that I might miss something.

I'm not just griping. I am trying to change things at work. I'm just frustrated because it seems that my efforts are continually stymied, and a big part of that is the attitude of the aides. An example of that; the other night, the aide approached me to let me know that they were going to dinner. They hadn't done VS, and I said I'd like to go to dinner too, could they please do some VS before they went. I'd do some and they'd do some, and we'd both go to dinner after. Team approach, right? No. This didn't work for the aide. Rather than argue or debate, I said fine, I'll get all my VS, you go to dinner. I had to call another nurse to help me get VS and do the med pass so that I could go wolf down a half a sandwich and get back to the floor right away.

Or later, I asked said aide to get a set of orthostatics on one patient, because I was behind and desperately trying to catch up. "No. I'm behind on my ice waters and I don't have time.".

Or, the aide reported a negative hemoccult to me, and I asked them if they could please chart it. "No. I don't remember how.". Fine. I'll chart it, but could you please get the lot numbers off the card and the bottle? "You're kidding me, right?". Fine. I'll go into the patient's bathroom and look at the card and the bottle so I can document the lab test that you did.

Yes, I understand being busy, and I understand teamwork. Just wish I could get a little.

[chadash]

I *am* really sick of CNA's who don't understand my work dissing me and my work, and deciding what is or isn't important about patient care.

I had a CNA tell a new nurse the other day that "this patient isn't really an ICU patient anyway, the alarms don't matter, she shouldn't even need a monitor". Well, actually, that patient was pretty darn sick. But the CNA couldn't understand that because the pt wasn't on a ventilator.

I've heard and been subjected to countless ******** sessions about nurses being lazy - I really believe that these less-educated CNA's do think that RN's get paid to sit around all day. The ignorance about the work of nursing and what it is that nurses are paid to do - is what leads to that disrespect. And I am sick of it.

I don't feel that I disrespect the CNA's or their work, so why are they so disrespectful to mine????

I have seen this, and understand your frustration.

If delegation and education is the role of the nurse, can you all think of some ways to "educate" the nursing assistants?

[Virgo_RN, BSN, RN]

:angryfire

Respect is earned, not given.

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

/rant.

Likewise.

[pebbles, BSN, RN]

I have seen this, and understand your frustration.

If delegation and education is the role of the nurse, can you all think of some ways to "educate" the nursing assistants?

I don't think it's my role to always be educating people who don't want to be educated. The ones who genuinely don't know lots about nursing, I talk a lot to them about what I do, and what decisions have to be made, why, etc. Then they get a glimpse into the world of nursing from my perspective and we both benefit.

The problems are the CNA's who want to think of themselves as superior to the "lazy" nurse, etc. The people who don't want to understand the other perspective. My unit is not a healthy workplace by any stretch of the imagination - at some point, it does become the managers' job and not the bedside nurse's.

[chadash]

I don't think it's my role to always be educating people who don't want to be educated. The ones who genuinely don't know lots about nursing, I talk a lot to them about what I do, and what decisions have to be made, why, etc. Then they get a glimpse into the world of nursing from my perspective and we both benefit.

The problems are the CNA's who want to think of themselves as superior to the "lazy" nurse, etc. The people who don't want to understand the other perspective. My unit is not a healthy workplace by any stretch of the imagination - at some point, it does become the managers' job and not the bedside nurse's.

That is a great point, that management has the responsibility to set the tone in the workplace. Any ideas of how management can "manage" the team better? Education?

punitive measures? rewards?

What guidlines in hiring practices, and orientation could help?

[Tweety, BSN, RN]

What makes you think that an aide doesn't "understand" what all your job entails?

Because I hear things like "you're not really doing anything why don't you do it yourself", "all you have to do is chart and pass meds, I do all the work" (this one from a tech that just passed her 25th year at this facility. Things like that.

I've also had more than one CNA graduate into RN status saying "I'm sorry I gave you such a hard time.......I had no idea....now I know".

But I understand what you're saying and appreciate that you are understand and it must feel demeaning to hear us say "wait until you're a nurse". I hope when I'm ranting it's understood that I'm not talking about all CNAs.

[pebbles, BSN, RN]

That is a great point, that management has the responsibility to set the tone in the workplace. Any ideas of how management can "manage" the team better? Education?

punitive measures? rewards?

What guidlines in hiring practices, and orientation could help?

No offense, but I'm not a student.

How about a new manager.

[Virgo_RN, BSN, RN]

I think what would help my unit would be two things; better staffing, and more structure. Right now, the aides come onto the floor and get report from the previous aides, then you don't see them again unless you're fortunate to cross paths with them, and then they're in the middle of something and can't stop to get report.

I think it should be more structured. They should get a *brief* report from the offgoing shift, who should remain on the floor answering call lights until their shift ends. We have a half hour overlap, which should give the new shift time to go room to room while the offgoing shift answers lights. They should go room to room, checking the three Ps; Pain, position, and potty. After doing a round, they should seek out their nurses for report; find out which patients they need to get VS on, which patients need to be ambulated, which patients need hemoccult testing, etc.

The way it is now, it seems that the offgoing shift leaves as soon as they've given report, so the oncoming shift has to hit the floor running, answering call lights instead of having the opportunity to round first. This puts them behind the eight ball from the start.

[chadash]

No offense, but I'm not a student.

How about a new manager.

Just wondering, could we be struggling with functional fixation? Maybe we need to rethink the roles in healthcare totally. If we don't, who will?

I am not a student either, I am a Nursing Assistant.

:)

[Ms Kylee]

My last half hour of my shift is spent charting end of shift vitals. If I had to answer call lights while the new shift came on, I'd never get out of work before 7PM.

What gets my goat are the nurses that want to hog me all to themselves and forget that I have 3 other nurses that need me too. And then the nurse that says "Don't let Nurse X hog you. I need you too. You tell her that." No, I'm NOT going to tell her that. If you think I'm being hogged, say something about it. Otherwise, I'll finish up with whatever Nurse X wants me to do, and then I'll come back to you. I'm not going to stop in the middle of a diaper or bed change because I'm needed elsewhere. I'm busy with a patient right now. I'll be back as soon as I can.

[southernbelle319]

They should get a *brief* report from the offgoing shift, who should remain on the floor answering call lights until their shift ends. We have a half hour overlap, which should give the new shift time to go room to room while the offgoing shift answers lights.

This is how it's done the majority of the time at the hospital I work at. Whenever I work units like Psych, Hospice or Rehab the aides and nurses are all in report together with one of the night shift (I work days) nurses giving report. The only time I leave in the middle of report is when I go to psych and have to do safety rounds with someone who's going off shift. Whenever I work on other floors in part of the main hospital I get my assigned patients from the charge and get report from the off going aide. I know what I have to do on each floor when I get there and if I have a question about something I ask and hope I don't have to ask again. It doesn't happen often, but when there is absolutely NOTHING for me to do, I go to the nurses and ask "What else can I do to help?!" Even if it's just a small simple task because I know they could use that extra few minutes to jump on the computer to chart or better yet, eat something.

*Sorry, I think I went off track a little lol*