CNAs, LPNs, RNs and Pumps and Pearls Please Advise

[SuesquatchRN, BSN, RN]

I was recently made unit manager of a 44-bed ward.

Nights, on which I have worked, have been a true disaster. This morning two brand new just-off-orientations aides left the units a disaster. People soaked throught their pads to the bed, one very frail woman in feces and urine and THREE new areas threatening to open, you get the picture. People soaked through 24 hours briefs, double-padded which is against policy and common decency, people with SIGNS saying not to use plastic with double plastic soaker pads.... the charge last night asked another unit to swap an experienced aide with one of ours and they flat-out refused. They were written up.

One aide will sail off the unit without writing witness statements to falls and I end up cat-herding to get what I need for incident investigation and reporting. The usual aides NEVER do a full three rounds and the state of the residents in the morning makes that obvious.

Today I have my weekly care planning meeting with the other disciplines. My usual charge is off and the other regularly scheduled nurse calls off. She really has been sick. The float shows up. I'm putting out fires all over, being called into multiple rooms to assess and be informed of the previous night's neglect, and at 7:20 for the 8 am med pass I say to float that I'll take med cart 2. That's the easier one but the unit mgr usually takes it because she has other duties. She tells me she's planning on taking that one. Okay.

I keep getting interrupted for valid reasons. at 9 a.m. float sails by and tells me she's gooing on break. When she returned I asked if she could finish my pass as was already late and had my meeting at 11 for which I needed to prepare. She respons that she has treatments. I tell her I will help her after the meeting. She disappears and ignores me.

I get started on my own work and the DON shows up to mention that my cast is out and unlocked with meds on it. I apologize, and say, "I'm waiting for M to finish the pass." M shows up and I hand her the keys. She says, "Why are you giving me your keys?" "To finish the meds." "They're late. They can't be given now." Now, they still need their meds. DON backs me up. She takes the cart and I thank her. She yells across the unit, "Well, I don't have a choice when the director of nursing tells me to." I said, "*I* asked you to." Challenges me. "Yeah? Where've you been the last 45 minutes?" "Where've YOU been?" "Doing my job!"

I. was. livid. When to the Don and she told me that M was mad at her because she said she couldn't leave early since we were short nurses.

I need help on: What do I do about nights? The DON is aware, and the experienced aides are in trouble and we will "educate" the newbies (who have obviously been taught by SOMEONE how to take shortcuts.).

And direct insubordination. I do NOT throw my weight around, I toilet people, assist with direct, poopy patient care, and do what needs to be done. Is she testing me? Is she just lazy?

Help!

And thanks.

And I actually love the new job. But I am developing a thick skin very quickly.

[Nascar nurse, ASN, RN]

1. 11-7 - a nursing manager needs to come in on nights and supervise for a few shifts. They need to know that unexpected rounds can occur at any time. We had to do this a few times and it didn't take long til they "got it". They knew any one of us may show up at 2am and do rounds with them and they got that we weren't gonna give up until things were done correctly.

2. As the unit manager.. I tend to approach things much like you do, at least initially. I am guilty of hinting first, then asking, then explaining why I want it my way and eventually I get to "Because I said so and I'm in charge". Probably not the best style, but you do have to have that "Come to Jesus" discussion now and then. Maybe you are to that point.

Good luck. Glad you like your new job.

[SuesquatchRN, BSN, RN]

Probably not the best style, but you do have to have that "Come to Jesus" discussion now and then. Maybe you are to that point.

Not only am I to the point, that we were on the verge of a "come to Jesus" discussion were the exact words I used in discussion with my DON.

[caliotter3]

When the assistants weren't up to snuff with their rounds on night shift, at the places I worked when someone cared (which wasn't often), a boss would make surprise attacks and go through the floors checking. I think this is a good idea, especially if it is done on a periodic basis and not just once to scare someone.

Your facility needs to develop the pool of CNA applicants so that it can fire the offenders and have someone to take their job. After a firing or maybe as many as three, the CNAs who remain who want to keep their job, will turn around. And insure that your HR person knows to put not eligible for rehire in anybody's folder who gets fired for leaving residents in urine soaked beds all night. Even if you have to work short for awhile fire at least one offender to get the ball headed in the right direction.

[SharonH, RN]

And direct insubordination. I do NOT throw my weight around, I toilet people, assist with direct, poopy patient care, and do what needs to be done. Is she testing me? Is she just lazy?

Frankly, that's the problem. She thinks you are still on the same level. You would think that people would respect your willingness to help out but they don't. It's a sad statement on humanity but that's the way it is. You need to establish a clear separation of roles and be the manager. Later once, they understand who is in charge, then you can help out.....if you have time.

[SuesquatchRN, BSN, RN]

Frankly, that's the problem. She thinks you are still on the same level. You would think that people would respect your willingness to help out but they don't. It's a sad statement on humanity but that's the way it is. You need to establish a clear separation of roles and be the manager. Later once, they understand who is in charge, then you can help out.....if you have time.

You know what really frosts my cookies? Most of the staff are thrilled of the fact that I pitch in when necessary and respectful of the fact that I am the boss. But one or two bad apples really mess it up for everyone and take advantage. It is not unusual and is expected that a manager will take a cart when it is short. It is not acceptable that someone will outright defy me. But you are absolutely correct and I simply will have to not step in. But when someone needs the toiler and has a modicum of continence left I really hate to make then wait and perhaps force them into the humiliation of soiling themselves, esp if they're A&O and still adjusting to their diminished capacities. The first thing we learn is that that is "bad" and it's really hard to shake.

She has no idea of how much damage she has done to herself today.

[Jules A, MSN]

((Sue)) No advice but I am confident that you will figure it out. Best of luck. Jules

[jtmonique]

Im young I know but before I became a nurse I was a supervisor for many years...You have to throw your weight around and command respect, I know it can be tough at first you want to earn their respect but if they are blatantly going against company policy (and good nursing judgement) you have to be direct and to the point. You know that your nursing license can be lost for not providing good nursing care.... I just got a new job where I will be training to be a unit manager after my 90days are over....Keep us updated Im going to make you my inspiration!!!

[SuesquatchRN, BSN, RN]

Keep us updated Im going to make you my inspiration!!!

Oh, my. :redpinkhe

The DON does like me, and knows I can handle this. In fact, there is a unit in terrible shape and she's thinking I belong there because I can handle it. You're mad at me? Oh, well. Maybe my strong personaluty will fianlly be an asset.

:)

[DogWmn]

All the prior suggestions were great and Congrats on your new mgmnt job.

Surprise night rounds is a great idea.

I'm shocked at M for shining you on about the meds and M needs a "come to somebody meeting" and a formal write-up. I won't go on my usual tirade about the lack of respect for our fellow human beings - but M sounds like she needs a Ms. Manners session.

I do feel bad for the noobie aids who got thrown to the wolves, it's tought getting that organized to get through everything and I hope they can work with some skilled people to show them the way. CNA's might be tomorrows nurses and I'm sure they might be as frustrated as you since they can't get it all done yet.

As for the other's they need to head on down the road if they don't like working there.

I like the pool of CNA's.

BTW, SuesquatchRN - I wish we lived close I'd come work for you any day based on reading your posts.

[SuesquatchRN, BSN, RN]

Thanks, DogWmn.

I am going to approach the DON tomorrow about working Thursday from 3 am to noon in stead of the usual 7-3. Surprise!

[caliotter3]

Oh, oh! Here she comes! Hope nobody at your place sees this and spreads the word! (Quick, put your Nurse Jackie avatar on again.)