Being treated like dirt from the aides...

[Dempather]

So frustrated after this 12 hour shift. It was a horrible day.. and I got so much attitude from the nursing aides I worked with. SOOOO much crap. I ask a simple question, and get the roll of the eyes or a face.. . or have one warp around what I said and repeat it back to all the others in a form completely different than what I actually asked. I know this is a process a lot of people go through... especially in the beginning. Even my supervisor asked me how I was doing with the aides on the floor.. because she sees some of their attitudes, too. For RNs... does anybody have advice on how to work better with nursing aides so that there's a mutual respect and understanding? I try to offer my help as much as I can... whenever I can. If any aides are reading, as well - I'd love to hear both sides. I've worked alongside many great aides that are incredible at what they do. It's so hard sometimes to appreciate your own work or theirs when there's that much tension... thanks for letting me vent.

[Dempather, RN]

Bethin,

You're advice is really helpful. These are all things we learn, but I think sometimes overlook when so many things are going on - especially when we're new and haven't begun to prioitize (even though estalishing good relationships and communication with the nursing aides are really important things).

[ceen]

If I am assigned a pt, I assume that that patient is my responsibility. If I am lucky enough to have an aide assigned to that patient as well, I consider myself lucky, and I thank the aid for anything she may have done for my patient. If a patient needs water, I try to get it, if a bell is ringing I try to answer. I make beds with the aids... start at one end and work our way around. She helps me and I help her. This way when I get stuck doing something that she can't do (like doctor's orders or dealing with a really sick patient etc) she is understanding and she will take on some of my work that she can do.

I've worked with a fair amount of lazy aids, bosy aids and know it all aids... but I have also worked with the same amount of bosy, lazy and Know it all RN's.

I think that someone earlier said it best... Respect them and the work they do do and you will get it back. An aid is not "less than" an RN they are just doing a different job.

[RN and Mommy]

I agree that it is very important to make the CNA's feel that they are a valuable part of the team. I worked as a CNA for 4 years before graduating nursing school and I make sure I respect the CNA I am working with and say thank you when appropriate. I also think that I have taken on delegation appropriately and when I am truly not busy with anything else, I will get in there and pass a dinner tray or get a patient up. CNA's work very hard and a lot of them are not appreciated (not saying that you don't appreciate them). I also know that there are a lot of CNA's who may be older who feel like they know more than the new grad nurse and feel that she has no idea about how to take care of a patient. There is so much more to being a nurse than I realized when I was a CNA. It may look at times like I am not doing anything, but I am waiting for something or trying to think through a situation. It is very stressful and I let the CNA's that I work with know that if they need me, call me. I just try to make my CNA's feel like they matter.

[NurseyTee]

The way I look at it is this... we are all people and I try to treat them as I would want to be treated. I tell all of the aides I'm working with that I can't be a good nurse without my aides. They are my eyes, ears and hands; I'm not able to be everywhere at one time. I do have to RARELY, get to the "rules" of our establishment and point out one or two, but I typically never have to do this. I am fortunate to work with a great bunch of girls who really care about the pts and doing a good job. With that kind of attitude, you can't go wrong.

[Daytonite, BSN, RN]

i was bothered when i read your original post and saw "even my supervisor asked me how i was doing with the aides on the floor.. because she sees some of their attitudes, too." that set off red flags for me! you can give all the respect you want to people and treat them as nicely as you want, but the bottom line is that there is no excuse for rolling of the eyes and childish behavior. that doesn't come from disrespect. that's just flat out misbehavior and acting out in a very unadult way. they make that choice and it has to do with their own control of their behavior. over the years i've had to learn that the management of subordinates, and that's what this involves, is a skill that you have to learn. unfortunately, nursing school just doesn't prepare you for this. or, for childish reactions. one of the books that was required reading in a class on group behavior that i had to take in my bsn completion program was by eric berne, m.d. (a psychiatrist) called games people play: the basic handbook of transactional analysis. in it he defines a lot of this kind of behavior and what people are trying to accomplish when they are doing these kinds of things. hint: making themselves feel superior to you in a lot of cases, or taking control of situations. now, for his purposes of therapeutic treatment, it's handled one way. for the purposes of an employment situation where we have to accomplish tasks in service to our patients, we have to handle it another way. i have two other books that i also used over the years as guides to help me: managing difficult people: a survival guide for handling any employee by marilyn pincus and working with difficult people by muriel solomon. don't get me wrong. you always assume that this behavior comes first from ignorance or your own inadvertent disrespect of someone else's feelings in a situation and correct that first. however, after reading the comment your supervisor made, i doubt that the problem lies exclusively with you. your supervisor sees the problem. it bothers me a bit that she didn't make any suggestions to you as to how to handle these clowns.

the way is through assertiveness and learning to speak in an assertive way. when you delegate you must make your instructions clear and leave no room for doubt. you must then follow up on the instructions you gave. in my quest to develop my leadership skills over the years i've taken a couple of classes in how to handle difficult people, basic communication skills and basic management skills. in the end, i always had to plan out what i was going to say to one of these clowns and then just get up the nerve to say it. your heart rate goes up, sweat beads pop out on your forehead, you get butterflies in your stomach, and i found myself having to concentrate on not yelling or screaming, but you do survive. it gets easier each time you do it, too. you only have to make an example out of one of them and the rest usually fall into line. if they want to act like children, then you have to treat them like a parent treats and disciplines a child. they get that. the trouble is, they often revert right back to their clown behavior with other people when they can get away with it or when your back is turned. my feeling on that? ok. just don't do it with me anymore or you know exactly what is going to happen. i'm not complicated to work with and the aides who worked with me knew exactly where i drew the lines they could and couldn't cross.

you have to blame part of this on the leadership of your unit. you are not the only person they do this to, i guarantee it. who ever is in charge has permitted this to go on without taking effective action to stop it. they could pull these clowns in and give them good talking to's or give instructions to you rns on how to handle them. sounds like they are doing neither. that's sad! this is one reason facilities lose their nursing staff. it's easier to just quit and walk away from a troublesome problem like this. however, you can also look at it as an opportunity to learn a really valuable skill. what's left is for you to take the reins and drive this buggy by yourself. you'll end up feeling a lot better and that you've accomplished something.

i'm giving you some links on delegation. when you give people tasks remember to tell them specifically what you want them to do, when it should be done, if you want feedback, when you expect them to report it back to you, and most importantly, follow up on it. just like you evaluate all your nursing interactions on a care plan, you do the same with all tasks you delegate out. when you give an instruction, practice the actual words you want to say in your mind. i used to write them down on the back of my "brains" so i wouldn't forget them. if they fail in any of your instructions, you have to get on them right away about it. i used to write those words down on my "brains" as well! "i asked you to tell me what that blood sugar was, now what was it?" and "when i tell you to do something i expect you to do as i asked." after a few times of this, they get the message that you mean business, or else you start telling them you are writing them up, and you do just that. never give a warning (that sounds better than a threat) that you don't fully intend to back up. and, don't be a wimp about it. these clowns deserve every bit of trouble they end up getting into. you will have done your part and given them plenty of chances to do the right things by giving them clear instructions on what to do and how to do it. doing this with difficult aides often resulted in them not wanting to work with me (can you image that?) or in them quitting. either way, my problem was solved. and, i never had to roll my eyes once! the first case of this that i encountered was an lvn who rolled her eyes at me, was very insolent when speaking to me, and did all kinds of things she knew i wasn't going to like. and, as a newbie rn and a milquetoast, i helplessly stood there and let her run this act on me. i would handle that situation much differently if that happened today.

i wish you well. just keep in mind that dealing with these clowns involves a skill that like any other nursing procedure involves practice in order to master.

http://www.leadershipdevelopmenttraininghowto.com/elements.htm - the elements of delegation

http://www.ehow.com/how_3816_delegate-responsibility.html - how to delegate responsibility

http://www.see.ed.ac.uk/~gerard/meng/me96/documents/aspects/delegate.html?http://oldeee.see.ed.ac.uk/~gerard/meng/me96/documents/aspects/delegate.html - delegation. everything you need to know about delegation presented concisely.

http://www.indiananurses.org/education/principles_for_delegation.pdf - principles for delegation. a 24-page document from the american nurses association. this is really a scholarly paper on the subject and should only be read when you are relaxed and able to think clearly.

[RGN1]

Seems to me it's all about teamwork, from both sides. Appreciate what each other does & help each other out when the need arises.

I've been lucky to work with superb HCA's (our CNA equivalent) & I always let them know how much I value their input & their help.

I agree that communication is the key here & that should go both ways.

A thank you (in both directions) goes a long way.

So RN's give your CNA's a "pat on the back" & CNA's appreciate the different stresses your RN's are under. Together you'll make the working environment a good one - then it will be better all round.

[chris_at_lucas_RN, RN]

I have experienced some pretty poor treatment from aides also, and I saw a lot of improper, unnecessarily poor behavior and attitudes when I was externing in school (aide duties, aide scrubs, and aide by any other name?).

When I got my RN, I had aides that told me what I would be doing as far as the tasks with the patients, because they "didn't have time."

Certainly my experience is limited to what I have personally experienced.

But now I am a manager, and I supervise RN's, aides and some other non-nursing staff.

I still get guff at times. But here's the deal. I am happiest when everybody is happy, but this is a business, and our product is good care first and good teamwork second (hard to rank them, but that's where I'm at, at the moment). It is not about making someone happier in their job, it is not about preserving feelings, it is not about hoping people will like me or how I manage them.

It is about getting the job done and done well. I make decisions, I give directions, I am open to ideas, suggestions and criticism, but in the end, I will make the decision, and I expect it to be followed. And if I cannot trust my staff to do what is needed, I make an opportunity for explanation, because maybe there is another way, better or just as good, that will work.

But in the end, I expect the work to be done the way I ask them to. It's business. It's management. As nurses, we supervise those aides, and if we are getting guff, or the patients aren't being taken care of, the sad hard fact is that it is because we are putting up with it. If we don't have the power to make the change, then the individual who does, must.

I've grown quite a little spine since getting my RN!

[Slobgob]

Let me tell you what works for me:

I'm a new nurse, but I've worked in three different hospitals (Intern, Extern, New Grad)... So I know what it takes to get the CNAs to quickly warm-up to you.

1) Introduce yourself. Call every CNA by their first name. Being called by your first name always shows a connection... it humanizes the relationship.

2) When you TELL them to do something, word it "Can you" or "Do you have time"... 99% of the time they say yes, unless they are incredibly busy.

3) Next time they're cleaning up a Code Brown... get right in there. Don't wear some mask, don't complain about the smell. The smellier, the better! Get your gloves dirty and show them you're part of the team.

4) Give them mini-reports about your patients, especially the acute/high-risk ones. Show them what you're worried about, and let them be part of the assessment process. They are your eyes... everyone loves eyes.

5) Ask them, what do you think we should do? Lots of them are in nursing school and have intelligent answers. Some of them have no schooling and have intelligent answers. Regardless of whether you agree or not... it shows that you respect their minds.

6) Bring muffins to work in the morning.

I could go on... forever...

The basic concept is... get down to their level. We all know that you're suppose to get down on your knees for face-to-face contact with children. No disrespect intended. Use that approach metaphorically with the CNAs... It works.

[mom2michael, MSN, RN, NP]

An aid is not "less than" an RN they are just doing a different job.

:yeahthat:

[RNKay31]

I really hope things work out for you, all the best. Be sure to CYA.

[Duncan3178]

I have been an aide for almost 10 years, and am about to finish my RN. Every time an RN gives me a "thank you" or a "I appreciate your help" goes a long way. It is nice to know that the nurses appreciate me running my butt off all night long. There is no excuse for disrespect on any level whether it is RN to aide, or aide to RN. We are all there for the same reason, for the patients.

One thing that I think I will carry with me from being an aide is that if an aide tells you that something is wrong with a pt, the RN needs to high-tail their behind into the room and check things out. The aide may not have the skills or critical thinking to know what is going on, but they know that something is going on. The aides are the ones who spend the majority of the time with the patient. They can recognize if there are any changes. I dont know how many times I have sensed that something was wrong, and indeed there was when the RN came in to room to assess.

[saguaro13]

Being treated like dirt from an aide infuriates me to no end. And I hate to say but you can bring muffins in, call them by their first name, pitch in and help, etc etc. A bad aide with a bad attitude doesn't change. I am all for being polite, nice and helpful, working as a team, but if that doesn't work, well all is fair in love and war! After all you are their "supervisor" they answer to you, not the other way around! You must be assertive and not take the attitude, or ignore it, which is the best way, tell them what you need, expect them to do it, help them when you can, be polite, but FIRM. Just remember, there is a big difference in each one's attitude. Find out which ones are the bad apples and treat them accordingly, the good ones, treat like gold :) I find that the ones that are good, nice and polite and respectful of me, I will go to the end of the earth for them. The bad ones, get nothing in return from me. And when they give me the attitude, I give it right back, tell them to go do it, and if I still am not successful that way, then I take it the next step. Bad attitudes and people bring everyone down, including the pts! don't let them push you around, they will do it forever :) good luck!