So my new place of work is slowly turning into a crappy place. over the last month RNs have gone from 3-4 pts to 5-6 plus managing IVs for the LVNs who have gone from 4-5 to 6 pts. Poor CNAs have gone from 7-8pts to 10-14pts each!!
We are all suffering and mistakes are bound to happen, and have been happening. Patients are suffering, and so is the reputation of the facility. Can we expect anything BUT a less than perfect standard of care with such overload on all the staff?
Well, I'm being written up for something a family made a huge issue about, no one in the team is getting blamed but me. I've got alot on my mind on what is unfair in this case but what can I write in the comments to make myself seem just and the write up unjust?
CNA got no consequences for the mistake, none. But because she falls under my license, I have to take the write up. CNAs have been seen standing together around the corner, listening to music, on their phones, and when it comes to answer a call light, they simply say "I was busy" and they go free. What can I say to defend myself??
btw I was told word for word "nothing else matters except the care we provide. Even if you're right, it doesn't matter." Makes me feel like I have no rights as an RN!
Thanks, any advice would help before I go in to sign this write up.
+middleagednurse :: That's exactly what's wrong with nursing. We are responsible for catching even the slightest cough that could potentially be fatal and "critically think up a storm" yet when it comes to being treated as people, "we don't have any rights"?? bull.
+Beentheredonethat thanks, I've applied to about 4 jobs since then, whatever was available, really. Can't refuse, don't wanna fall under their radar of attention and become a potential target. I've seen people get fired/quit because they fell under the radar of attention of the higher ups.. I wanna lay low and get out quietly.
+Buckybadger, the reason why I said it is because that's what I've been told and that's what we study! our inferiors are working under our license, we oversee their work. Hardly ever do I feel as their supervisor, more like "please don't risk me losing my license"...
Do not admit to any fault on your part, they don't care. Do not point fingers, they don't care. Don't fall on your sword and promise you'll try harder, they don't care.
Do describe the situation in factual terms, and state you disagree with their version.
Write ups are a means of documenting patterns and reasons for dismissal. When you include your version, you create the pattern for wrongful discharge.
I agree 100%. What a great idea to sow the seeds of a wrongful discharge if it were to come to that. Why should a nurse say their sorry or promise to do better if it was not their fault and they did nothing wrong, but were blamed for the CNA not doing his/her job! I think sometimes disciplinary actions are meant to put the person in their place, make them feel small, and are a guise to give a bad eval and no or little raise. From what the OP said this seems to have little true merit and more of admin trying to make an example of the nurse for the rest of the staff. Ironic to hold customer satisfaction against a nurse, when admin is certainly at fault for the blatant understaffing that is going on. Personally if it were me I would stand my ground and not back down or apologize. I would instead look for another job ASAP!
I also agree I don't feel like a supervisor and the few times I've tried to get a CNA to do their job I got resistance, even outright defiance and insubordination and then the supervisor didn't back me. They only wanted us all to get along and felt I should have just done the CNA's job myself rather than make an issue of their refusal to do their job. Like someone said why do we need to supervise CNA's as they are adults and should do their job like adults without needed to be reminded like children! Nobody needs to remind me to do my job as a nurse. I do what needs to be done without needing to be told or prodded. I have a strong conscience that would not let me do otherwise!
I agree 100%. What a great idea to sow the seeds of a wrongful discharge if it were to come to that. Why should a nurse say their sorry or promise to do better if it was not their fault and they did nothing wrong, but were blamed for the CNA not doing his/her job! I think sometimes disciplinary actions are meant to put the person in their place, make them feel small, and are a guise to give a bad eval and no or little raise. From what the OP said this seems to have little true merit and more of admin trying to make an example of the nurse for the rest of the staff. Ironic to hold customer satisfaction against a nurse, when admin is certainly at fault for the blatant understaffing that is going on. Personally if it were me I would stand my ground and not back down or apologize. I would instead look for another job ASAP!
I also agree I don't feel like a supervisor and the few times I've tried to get a CNA to do their job I got resistance, even outright defiance and insubordination and then the supervisor didn't back me. They only wanted us all to get along and felt I should have just done the CNA's job myself rather than make an issue of their refusal to do their job. Like someone said why do we need to supervise CNA's as they are adults and should do their job like adults without needed to be reminded like children! Nobody needs to remind me to do my job as a nurse. I do what needs to be done without needing to be told or prodded. I have a strong conscience that would not let me do otherwise!
I completely agree. Understaffing has been an issue and all the higher ups are turning the other way when anyone says that that's to be blamed for all the mistakes. they simply say "yea we know you're busy but.. still as a nurse bla bla" I got a "one on one" for not following up in documentation regarding a pain medication.. like, I would know if the pain med didn't work, I would've followed up with a stronger med! but no, it's because I didn't go back, click the pain med and do the follow up. I got lectured on what as a nurse I must be doing. "Assessments are basic".. yea no ****! But what if I'm late on med pass, i'm in trouble. If i stay overtime, i'm in trouble. if I don't do my job, i'm in trouble. so.. i'm in trouble no matter what!
And regarding the CNA issue, if nurses tell them "sorry i can't help you do a pull-up" they go straight to the higher ups and nurses get in trouble for not helping the CNAs. and CNAs intentionally don't ask another CNA because they know if we say NO, we get in trouble. I mean, is this not sabotage??
You were probably also told that as a student in clinicals that you "we're working under your instructors license" too, right?
+middleagednurse :: That's exactly what's wrong with nursing. We are responsible for catching even the slightest cough that could potentially be fatal and "critically think up a storm" yet when it comes to being treated as people, "we don't have any rights"?? bull.
+Beentheredonethat thanks, I've applied to about 4 jobs since then, whatever was available, really. Can't refuse, don't wanna fall under their radar of attention and become a potential target. I've seen people get fired/quit because they fell under the radar of attention of the higher ups.. I wanna lay low and get out quietly.
+Buckybadger, the reason why I said it is because that's what I've been told and that's what we study! our inferiors are working under our license, we oversee their work. Hardly ever do I feel as their supervisor, more like "please don't risk me losing my license"...
+Buckybadger: yes, but who gets the write up? the lower people. The charge nurses/supervisors may get their butt chewed but higher ups in this facility are all one, mixing together with outings etc, so no one really gets in trouble.
and my supervisor that day had been on the floor helping accommodate for the 6 pts to each nurse by doing a couple med passes and hanging IVs so she was bragging about how she "cares" and was helping on the floor versus being in the office. So from her perspective, she was already doing so much so we shouldn't be making any more excuses.. the funny thing: she told me to go in to the family and not make excuses and just apologize. the family didn't want to hear apologies, which left me with nothing. As soon as SHE goes in, the first thing she does is apologize because we were short staffed.. i overheard and was like "wow.. hypocrite"..
Specializes in M/S, LTC, Corrections, PDN & drug rehab.
+Buckybadger, the reason why I said it is because that's what I've been told and that's what we study! our inferiors are working under our license, we oversee their work. Hardly ever do I feel as their supervisor, more like "please don't risk me losing my license"...
Where do you study that CNAs are working on your license. I would like to see that article. The only one responsible for your license is you. The only one who would cause you to lose your license is you.
I am a new grad so nursing school is still pretty fresh in my mind. We have NEVER been taught that ANYONE practices under our license, nor were we practicing under another nurses license in clinical.
My license states my name, that's it. It does not say mrsboots87 and support staff being supervised. You are responsible for your own license. If a CNA makes a mistake it is their certification they are working under. The only time you are responsible directly for their actions is if you delegate inappropriately or unsafely. Basically, don't tell an aide to push your IV narc or assess a patient with a fresh unit of PRBC hung 5 minutes ago. Delegate tasks within their scope and you're fine.
In most every scope of practice of both RN's and LPN's UAP's are delegated. And once delegated, the nurse delegating is the responsible party.
CNA's "working under their certificate" is incorrect. They are working under the facility policy, as well as the person who delegates to them, the licensed nurse.
OP, when you are asking someone to do something and they are not doing it, they need to be written up each time. You need the support of your manager, your DON. Or the climate doesn't change, and patients get hurt. Document and report anyone who is not doing what needs to be done that you have delegated to do so.
CNA's and other UAP's may not directly "work under a licensed nurses's license" in the classic sense of the phrase. However, a patient for instance, has skin breakdown due to not being cared for and the nurse asked the CNA to do peri care and turn and repo every 2 hours....and it was not done for say 4 hours (until nurse could get into the patient's room due to patient acuity/load) who is going to take the fall for that? I can guarantee it may not be the CNA, but the nurse who holds the ultimate responsibility.
Much like as an LPN, I have my own license to protect, however, if say a busy and overloaded RN asks me to medicate a patient with IV push. My facility doesn't allow me to do IVP. But I do it anyway and it causes harm to the patient. It is most certainly on me, but also on the RN who delegated inappropriately. If an MD asks an RN to write orders at will as to not disturb them at night--and they will "sign off anything in the morning" and a patient tanks--same type of thing.
OP, it may be time (should you decide to stay in this facility) to ask what specifically you are to do if you delegate and the CNA doesn't follow through. The CNA's need to be directed more specifically. And monitored more closely. And you may have some ideas on how that could happen to the benefit of the patient.
that includes to take into consideration how the system contributes to mistakes. However, it does not equal "blame free" and even if a root cause analysis points towards contributing factors, you are still being hold accountable.
If you can not finish all your tasks or did not follow policy and procedures, you need to alert your manager or the charge nurse that you need help. Perhaps you assignment is "off" and too heavy or too acute. I can tell you that "too busy" does not mean anything to management nowadays. They should promote a fair and just culture but that may not equal with what you perceive as just.
I have worked in facilities that lets CNA get away with everything. CNA "disappearing" or "busy" and such . I found CNA sitting behind the curtain of a patient's room snoozing or "hiding".
If you find that it is an impossible workplace, nod and smile and move on - apply to other jobs and places.
Specializes in Complex pedi to LTC/SA & now a manager.
CNAs don't work under your license. They work under your direction, supervision and delegation. No one else works under your license. As a licensed nurse you are responsible for appropriately delegating, directing and supervising CNAs and other UAPs working with you. As the licensed nurse you are responsible for knowing the UAP/CNA scope as well as facility policy. If you delegate a skilled nursing task to a CNA such as admission assessment or invasive procedure you will be held responsible for improper delegation and the results.
+Buckybadger: yes, but who gets the write up? the lower people. The charge nurses/supervisors may get their butt chewed but higher ups in this facility are all one, mixing together with outings etc, so no one really gets in trouble.
and my supervisor that day had been on the floor helping accommodate for the 6 pts to each nurse by doing a couple med passes and hanging IVs so she was bragging about how she "cares" and was helping on the floor versus being in the office. So from her perspective, she was already doing so much so we shouldn't be making any more excuses.. the funny thing: she told me to go in to the family and not make excuses and just apologize. the family didn't want to hear apologies, which left me with nothing. As soon as SHE goes in, the first thing she does is apologize because we were short staffed.. i overheard and was like "wow.. hypocrite"..
Satsun
21 Posts
I'd been thinking about it but after this situation I'm definitely searching. thanks