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Discussion

Beligerent HCA

First, a little background:

Our LTC unit is staffed with 1 RN and 3 HCA's; one of the HCAs is particularly dreaded by the other 2 (and most staff) because she rushes the pt's and isn't thorough; she rarely actively listens (cuts off the speaker with lots of "okay"s, like she's getting what you're saying but doesn't actually listen), and does not seem to incorporate feedback into her practice. She has been working on our unit for about 4 months (or more? it seems like too long!!:uhoh3:), some of the pt's wave her off because they don't like her (100 year-old folks cannot be rushed!), and staff are fed up with her. It might be easier to work short than to have to babysit her and make sure she's doing things appropriately. How can you assess someone's skin as you help them get ready for bed if you're in that much of a hurry? She's also put pressure on other RNs to let her leave the unit outside of her breaks for goddness-knows-what... (I'm not the unit manager, but shift's charge nurse)

Now, my question...

I'd like to prevent a culture of negativity today (I'm an idealist, I know:rolleyes:) by giving a little blurb after report...something like, "We had a great shift yesterday, thank-you for being efficient and gentle with the residents"..."we don't get to go home any earlier just because everyone's in bed"..."Remember to check skin when you're helping people to the BR or getting them ready for bed"...etc. ...But I don't want to sound too harsh or too flaky. Any suggestions? Should I open with a joke?

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What's wrong with just how you said it here? No joking. Don't be surprised if it doesn't work, because the HCA it will be aimed at does not see herself doing anything wrong, but it's worth a shot.

I think what you said here was just fine. Good luck with that HCA.

I'm not sure what an HCA is (hope I'm not being dumb here), but you may have to pull her aside and talk to her directly, if you are in a position of leadership. If not, you may have to talk to a supervisor that is.

HCA = Health Care Aide

Be as direct as you can. I read an interesting study recently about how incompetent people lack the ability to recognize thier own incompentence AND even lack the ability to recognize competence in others. What this means for you is that the HCA will NOT realize your comments are directed at her as she doesn't see her shortcomings and won't even recognize others ability to do thier jobs better and as a result improve her own.

This study also mentioned that these people can change. But, they need firm direction and training in how to logically assess problems. You will have to tell her outright what she is doing wrong, how she can improve and what she can do to measure her own improvement.

I know that it can be difficult to be forthright with people. It's scary! But, think of it this way; the safety of her patients and the peace of your coworkers is on the line...they deserve your honesty and management skills put to the best use in solving this problem.

The link to the article about that study is below.

http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2000/01/18/MN73840.DTL

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