Aids giving me trouble-what to do?

[BrazoriaLVN]

Hi everyone,

I'm a new LVN that works at a LTC facility. I am having trouble with my CNA's. I am very familiar to the facility I am in, working there as an aide for 3 years. This time around, I work a different shift and everyone is different except for one or two so we never worked together. I actually don't have any issue with the ones I knew. It is the other ones. I get repeated complaints from morning shift that residents are double diapered, dirty, chux dry with soaking wet bed sheets, etc.

We also have a resident who gets OOB multiple times during the night. He has a pressure alarm, and there's no doubt anyone can hear it anywhere in the facility. I was doing med pass when I heard it go off, so I asked the aide to please go check on him. He told me that his alarm "his wiring problems" and goes off even if he stays still. I was a little weary, but I said ok because I had tons of synthroids to pass. After coming out of two more rooms the alarm was still going off. I went to the room to find the resident across the room. Thank God he hadn't fallen yet.

I know it is my responsibility to check residents when alarms are going off, but I worry I will be doing a g tube feeding and they will be in the break room yukking it up while a poor resident is on the floor. I have also had them drop someone and fail to tell me-another resident went to the DON and told her that his roommate was dropped and nobody did anything! Needless to say I was furious. I also tell them multiple times how to position residents in the broda chairs, but it seems to fall on deaf ears. How can I handle this professionally? I feel so useless

[MN-Nurse, ASN, RN]

Write 'em up. If they continue to endanger residents, tell the Dept of Health.

Oh...and find another job ASAP if management does nothing about the problem, or more likely, blames you.

[blamejoe]

agree with MN-nurse. I didn't like it too much when I was an aid, but the fact remains that one of the duties of an aid is to follow instructions as given by the primary nurse. It was the job I agreed to take at the time, and I remedied it only by becoming an RN. Had I stayed an aid, I would still be expected to follow directions regarding basic patient care and safety.

These aids are testing limits with you because they are not familiar with you. If they were smart they would ask the aids who you have worked with what your expectations are, and would not be challenging you.

P.S. Even if the alarm is going off due to a wiring problem, it still needs to be turned off, and it's pretty upsetting that they care so little about the patient's comfort that they would have him lie in a bed listening to that incessant beeping. Someone needs to check, every time, no matter what.

[Kooky Korky, BSN, RN]

You must get tough inside. You must not allow them to frustrate you, guilt trip you, etc.

You can try befriending them, you can try letting them know clearly what you expect of them, you can educate them, you can ask for their input as to what they need to do their jobs to your satisfaction. Perhaps your Educator can inservice them.

Whatever you do, do NOT continue to let them BS you, do not let them get away with yukking it up in the break room while residents are unattended. This is totally unacceptable.

Let them know that they can go on break one at a time, they must answer lights, etc., whatever you expect of them. Do not beg or plead. Believe yourself before you work on them believing you mean business.

In the end, you might get lucky and see the changes you need from them. If not, you must start the write-up's.

Just keep in mind that a whole lot of people come to the job only for the paycheck and will try to get away with doing as little work as possible. This is a sad fact of life. You must make them toe the mark, unfortunately, as you are the nurse and your backside will be in a sling if you don't.

[xtxrn, ASN, RN]

Bottom line- if something happens, and a pattern of their neglect is revealed, you will be asked why you didn't do whatever needed to protect the residents. They have accountability also, and can be sued- but it's the LTC nurse who gets the worst interrogation.

You aren't their friend. You're a patient advocate. If they don't want to do their job, maybe they need a new one- and the only way to find out is to consistently write up legitimate problems (sounds like you have plenty of material ).

It's great to have friendly co-workers- but at the end of the day, you have to defend the care that is given :)

i went from being the agency aide to the night supervisor (as a GN- back in 1985), and was supervising my former co-workers, in a span of 4-5 days....an agency aide on Friday night- the supervisor on Tuesday (I think- I know it was less than a week). It was hard. Fortunately, I'd gotten along well with them, and a couple of them were really helpful in my transition- but it wasn't a walk in the park. But it worked out.

[learninmama]

Agreed! Write em up & keep on them! Each time I write someone up I sit down with them & go over the write up. I tell them what my expectations are from them & also keep their job description handy. I told each of them they had a choice to make we could work together or against each other.

After a week of write ups daily they straightened up. (yep I did 40+ write ups in a week LOL) They have quickly figured out I am a team player & if they ever need help with anything I'm there.

I now tape a list to the top of the desk each night-

-Do your rounds! Make sure your patients are clean & dry!

-Make sure all alarms/restraints are in place & checked hourly.

-Answer ALL call bells/alarms in a timely manner.

-If you need help or have a question ASK!

-Etc etc

-Have a great night & thank you for being a valuable part of the team!!

[BrazoriaLVN]

Write 'em up. If they continue to endanger residents, tell the Dept of Health.

Oh...and find another job ASAP if management does nothing about the problem, or more likely, blames you.

Actually, management is VERY supportive(thank GOD). They have put up numerous notices to the CNA's that double diapering etc is grounds for immediate termination. It's just me being nervous about speaking up I guess. I hate to offend anyone, but I'm realizing patient safety is a lot more important than possibly hurting someone's feelings.

[xtxrn, ASN, RN]

Putting up numerous notices are just threats if they don't follow through- You are right with this- they should be doing their jobs. :)

[chall2011]

I'm an aid at the moment and currently in nursing school. What has been posted so far is on point. I've only been an aide now for a little over 5 months. I worked in LTC for 3 and now am working in an ICU. ANYWAYS...

It is time to pull rank. I've been in this work for 5 months and all ready I'm observing ridiculus politics that are frankly just meaningless and basically fall depth to just the idiosyncrasy and fault of being human. I want to be a nurse some day and the **** I see passing between fellow aides gets on my last nerves. The best advice I can give is to lay aside bipartisanship and lay reality down. Talk to the DON and lay out time for an intervention. Sorry, but theres too many people out there who want a job that can do a better job at treating people in the twilight of their lives.

[Sparrowhawk]

You're gonna have to follow them up after last rounds and make sure they're doing their job if not more then one round, and tell them if they don't to xyz you WILL write them up.

[tokmom, BSN, RN]

First let them know what YOUR expectations are. They will play dumb and pretend to have no clue on what you wanted.

Second, let them know what facility policy is. They will play dumb and pretend to have no clue that double diapering is wrong.

Thirdly, once you post this and they have all read and signed they understand policies and your expections, keep a copy of the signed papers

Next time they pull this BS, write them up. If they complain, show them the paper they signed.

[xtxrn, ASN, RN]

I'm thinking they've had enough time to just do their job...forget the warnings- if they're off orientation and not 'new' to nursing homes, the drill is the same.... get rid of the dead weight. :)