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.
Well, I took Thursday off instead of ystdy (I'm RN supe this weekend) and my oh my! The DON did something. For the past couple of days the night aides have been there past shift change FINISHING THEIR ROUNDS. And the LPNs who gave me snark are slinking around not looking at me.
Of course, the one who gave me attitude Tuesday was supposed to work this weekend and called in so I had to take a cart again but somehow, without the nastiness, things went well. Of course, I have care plans and MDSs up the wazoo, nor have I been able to do wound assessment or body audits....
*sigh*
Maybe the DON saw this thread and realized who Nurse Jackie is for real.
Specializes in med-surg 5 years geriatrics 12 years.
Sue, sounds like you have a big power struggle going on. Those in charge don't always have the power and it sounds like that has been the case in the past. I'm behind you 110 %. Good luck lady.
Sue, sounds like you have a big power struggle going on. Those in charge don't always have the power and it sounds like that has been the case in the past. I'm behind you 110 %. Good luck lady.
When the guilty party calls in sick at strategic times, that usually is one of the signs of a power struggle. As if anyone really was going to miss her.
Now that things are starting to look up, don't cut 'em any slack. You know how easy it is to backslide. Good luck keeping this going in the right direction.
I think a couple of things did it, caliotter, and it was mostly the DON. And I am really not a rhymes with witch and they know that. And most of them are excellent, as well. We're all finding our way together. Except nights - they liked to get away with too much and did it for too long.
Welcome to the club! We have jackets! I am where you are every single day. By the way, I am the nurse who would have taken the hard cart who would have gladly taken your keys so you could go to your meeting because you are clearly the kind of nurse i want on my side watching my back. You step up for the good ones you do extra for them at least that was how i was brought up. Incompitent CNA"S are a industry wide epidemic. If I had my way A CNA would not only be summarily fired at the first sign of laziness or insubordination they would have their licenses revoked. Do they not know that the situations you described can be called abuse? They probably dont care. When you get a CNA who actually cares you treasure them because they are worth their weight in gold. Unfortunatly you are probably stuck with what you got. I know I am with mine. I ask two things from my CNA's. Do your job and act like a profesional adult. There are soooo many nights that I go zero for two that it drives me crazy. Why do i always look so stressed out? Is a common question posed to me by my unit manager.
Gee. Let me think. Is it because the nonenglish speaking resident with dementia and a colostomy that I expressly told one CNA to watch like a hawk is on the floor holding a full colostomy bag in one hand and the wrong end of a freshly pulled Foley in the other? And where is that CNA? Outside updating her myspace page of coorifice! or maybe it's the patient with the 103 fever and the pulse ox of 77 that another Cna has failed to tell me about after she wrote these troubling vitals on the vital board a half an hour ago. Why has it taken me so long to discover that resident? maybe it's becuse I'm answering the cries of help from a resident who badly needs to be toileted who's aide is 55 minutes late for the third straight time. Or maybe I'm dealing with an irate family member who still has food from lunch smeared on his face at 4:00pm and is wearing the same soiled clothes they put him in two days ago. Times like this i wish I was a waiter again!
or maybe it's the patient with the 103 fever and the pulse ox of 77 that another Cna has failed to tell me about after she wrote these troubling vitals on the vital board a half an hour ago.
I swear I am screaming inside, just feeling your pain!
Could just be ignorance.
I am convinced that if CNA classes actually bothered teaching the WHY behind tasks (and I mean a good solid scientific "why") then those who are as dumb as rocks would get weeded out and those "get it" will understand the seriousness behind the tasks they do... or so I would hope.
I think in your case though, someone was just being huge lazy***.
One of the things I have found is that most people, period, and esp. the aides who care, love to learn. As a nurse was explaining to the family (on the phone) that the resident was having periods of apnea I whispered "not breathing" and she immediately substituted those words. I explained to the family and the aides ystdy what Cheyne-Stokes respirations mean. In clinical terms translated to layman.
I'm working hard at not getting annoyed. The other syndrome here is, "Oh, she's always like that." Really? Crying all the time? And we have tried everything? Really? EVERYthing?
Although this kind of fight will surely take at least one of her "nine" from her, she will improve the lives of countless people who need good care and good leadership where she works, as well as inspire all of us who follow this thread!
you are so right about the cna classes. Unfortunatly though it seems that the #1 priority of these classes is to graduate everyone so you can restore your cna floor deficits. In one case the class instructor actually passed a "Student" who was illiterate--truly illiterate couldnt read, couldnt write just so she could serve as a body on the floor for three months until she of coorifice failed her exam. How can you teach such a vital job in two weeks of class time and a few hours of floor time? I'm overjoyed when one of these "graduates" can take an accurate blood pressure without cutting the blood flow of the residents arm! In nursing school you are taught by real teachers and we had two months of class time before we even saw a patient and you knew the weight of what you were undertaking well before your first clinical day. In my experience it seems that our facility attracts alot of people who dont really care about doing their job well they are there to do as little work as possible and then leave. "It pays better than working at Target" is what I heard one CNA say. Enough said about that CNa's committiment to her job
caliotter3
38,333 Posts
Maybe the DON saw this thread and realized who Nurse Jackie is for real.
