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?
Our aides don't do end of shift vitals (many of them refuse to do vitals at all). I&Os can be charted in the half hour prior to shift change. CNA charting takes very little time. It can be done in short bursts between call lights. The deadline for CNA charting should be shift change, leaving the off going shift available to answer lights.
Another thing that would be helpful is if the aides would do periodic rounds with the nurses, checking in with each nurse to see if there is anything that needs to be done. If I could count on an aide checking in with me every once in a while, I wouldn't have to go tracking them down.
Specializes in Trauma acute surgery, surgical ICU, PACU.
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.
:)
Well, no. Aides will always be aides. They will always have less education and be required to do tasks rather than problem-solving and decision making. They will always have less responsibility. That does not discount the hard work they do. I worked as an aide in school, and I saw both sides many times over.
On my unit, the aides used to be able to do vital signs, etc - and now they aren't because that is something that should be interpreted and understood AS it is happening. Some of them are resentful of that - "They took that away from us and told us we were stupid.". Some people do have esteem issues (and that is easy to deal with by giving them respect for what skills they do have), but for some it is a crutch. An excuse to launch attacks against another group of staff.
I don't think it's possible to change the role or function of a set of employees in most settings. And I don't think that's the answer to disrespect on either side of the fence.
I think as long as there are differences, there will be resentment. It's up to the managers and leaders on the wards and in hospitals to create a climate of respect - and to tell people to pull their socks up if the aren't respectful to others.
Well, no. Aides will always be aides. They will always have less education and be required to do tasks rather than problem-solving and decision making. They will always have less responsibility. That does not discount the hard work they do. I worked as an aide in school, and I saw both sides many times over.
On my unit, the aides used to be able to do vital signs, etc - and now they aren't because that is something that should be interpreted and understood AS it is happening. Some of them are resentful of that - "They took that away from us and told us we were stupid.". Some people do have esteem issues (and that is easy to deal with by giving them respect for what skills they do have), but for some it is a crutch. An excuse to launch attacks against another group of staff.
I don't think it's possible to change the role or function of a set of employees in most settings. And I don't think that's the answer to disrespect on either side of the fence.
I think as long as there are differences, there will be resentment. It's up to the managers and leaders on the wards and in hospitals to create a climate of respect - and to tell people to pull their socks up if the aren't respectful to others.
So, rethinking what the nursing assistants do in your workplace did not go over real big. Hmmm.
Actually, the nurses doing vitals make alot of sense. They do our first post op vitals, and sometimes I wish they did the first four, but I know time is an issue, with so many post ops coming in. I end up tracking them down anyway to report, they probably could do them just as easily.
It really comes down to the best and safest care....
I do not agree that there needs to be resentment because there are differences.
As a nursing assistant in my facility, I do vitals, baths, I&O's, beds, bum wiping, turning, positioning, emptying Foleys and other drains, and anything else that the nurses ask of me. I also answer call lights and play waitress for those demanding family members who think their loved one is the only one on the floor.
What I do not do is pass meds, anything with IV's, dressing changes, etc.
And when you have 17 patients to chart vitals and I&O on, it isn't a short burst in between call lights. It's a good 30-45 minutes of charting depending on how fast the computer wants to work.
Specializes in Trauma acute surgery, surgical ICU, PACU.
I do not agree that there needs to be resentment because there are differences.
So where do you think the resentment comes from?
Our CNA's must not be as well-trained as yours. I can't see most of them safely doing vital signs. Sure, taking a BP. But knowing whether it's a safe BP, or whether the condition of the pt needs to be evaluated further... that's a lot of responsibility.
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?
At my place the techs have a different department head than the nursing staff does. That is the only person who tells us what are duties are. We are also reminded that we are there to do a specific job, not to make the nurses life easier. We aren't supposed to ask them to do any tasks for us and they aren't supposed to ask us. We are all expected to do our own jobs. When a worker needs help with a certain task they are to ask someone from their department. Techs get help with tech work from techs and nurses get help from nurses.
So far, it seems to work pretty well. Of course, there are a few issues, but no system will ever be perfect.
As a nursing assistant in my facility, I do vitals, baths, I&O's, beds, bum wiping, turning, positioning, emptying Foleys and other drains, and anything else that the nurses ask of me. I also answer call lights and play waitress for those demanding family members who think their loved one is the only one on the floor.
What I do not do is pass meds, anything with IV's, dressing changes, etc.
And when you have 17 patients to chart vitals and I&O on, it isn't a short burst in between call lights. It's a good 30-45 minutes of charting depending on how fast the computer wants to work.
Is this med/surg? What kind of unit do you work in>
As a nursing assistant in my facility, I do vitals, baths, I&O's, beds, bum wiping, turning, positioning, emptying Foleys and other drains, and anything else that the nurses ask of me. I also answer call lights and play waitress for those demanding family members who think their loved one is the only one on the floor.
What I do not do is pass meds, anything with IV's, dressing changes, etc.
And when you have 17 patients to chart vitals and I&O on, it isn't a short burst in between call lights. It's a good 30-45 minutes of charting depending on how fast the computer wants to work.
It is indeed tough demanding and backbreaking work. Thanks for the reminder.
At my place the techs have a different department head than the nursing staff does. That is the only person who tells us what are duties are. We are also reminded that we are there to do a specific job, not to make the nurses life easier. We aren't supposed to ask them to do any tasks for us and they aren't supposed to ask us. We are all expected to do our own jobs. When a worker needs help with a certain task they are to ask someone from their department. Techs get help with tech work from techs and nurses get help from nurses.
So far, it seems to work pretty well. Of course, there are a few issues, but no system will ever be perfect.
That is an interesting idea, having separate supervision for techs and nurses. Do the supervisors interact and manage resolution of conflicts? You must have a clear demarcation of tasks....
I'm not complaining. I love my job and the opportunity it provides me to spoil my patients a bit. BUT I get sick and tired of being hunted down by other nurses that make me do the other NA's on the wing's job because they can't find them. This happens 3-4 times a shift.
In my review, this was brought up to me that while I'm helping the nurse out, I'm essentially taking myself away from my patients. I understand that, but if a patient comes back from a procedure and they need postop vitals Q15 for an hour and they're not done, then we're all in trouble. I've had my nurses for the day tell me don't do them, and let the nurse do them. *Rolls my eyes* It's just easier for me to take them than it is to argue about it, and my wing's patients won't fall apart if they have to wait 5 minutes for a glass of water.
Our CNA's must not be as well-trained as yours. I can't see most of them safely doing vital signs. Sure, taking a BP. But knowing whether it's a safe BP, or whether the condition of the pt needs to be evaluated further... that's a lot of responsibility.
I wonder if there are any out come based studies on what is the best approach?
Vital signs can be very baffling to me in post op patients. For instance, sometimes their temps are sub-normal, which panics me (visions of cardiac issues) and the nurses have the education to know what and when to respond. I am sure we are not any more well trained. We just try very hard to listen to the nurses.
But, as in an earlier post, I am becoming more and more pro-total RN care.
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.
Probably because you and the nurses you work with are great caregivers!
I work registry sometimes. All degrees of adult illness from SNF to ICU.
Most CNAs are so very helpful when they know the patient and I don't.
I would be glad for insight in dealing with a patient such as the ideas you describe.
Rarely someone is rude and unwilling to do their work. I admit I thought, "Wait until you graduate." when a teen who had trained as a CNA in highschool refused to help me clean a large incontinent patient saying, "You a RN. You make the money. I done my work already." ( She said some words I cannot type in the room of the confused dirty patient before she just plain left. I had to find someone to help. An LVN said, "I'll be glad when she starts school."
She was to start an expensive BSN program in a few weeks. I wonder if she stayed in school.
Virgo_RN, BSN, RN
3,543 Posts
Our aides don't do end of shift vitals (many of them refuse to do vitals at all). I&Os can be charted in the half hour prior to shift change. CNA charting takes very little time. It can be done in short bursts between call lights. The deadline for CNA charting should be shift change, leaving the off going shift available to answer lights.
Another thing that would be helpful is if the aides would do periodic rounds with the nurses, checking in with each nurse to see if there is anything that needs to be done. If I could count on an aide checking in with me every once in a while, I wouldn't have to go tracking them down.