I’m in month 8 of a new position, it’s in a dialysis unit, but this isn’t specific to dialysis.
Last week a new, or newly reinforced policy for the techs to weigh the patients on the way out was reinforced. Seems like an easy enough task to complete without fanfare. Well, on Friday evening, a couple hours into the shift, the 4 techs who were on shift all went straight to the Manager with the story of “ Joe (the RN) wont help us. So, the manager came out to the floor and told Joe RN that “the techs all said that you won’t help.” Joe RN was completely blind sided as he was busy preparing meds, checking patients in and assessing them, and so forth. Joe RN has had zero complaints by staff and patients, and the Manager “knows” that this cannot be true. So everyone went on with their business and completed the shift. However, there was no more communicating between the techs and Joe, the normal, appropriate communication ended.
Joe has had a great report with the techs he was working with, no issues whatsoever, until now. All the techs involved have always been great at communicating and asking “can I get some help,” and Joe has always been the type to say “I’m glad to help.” The techs are not happy with the reinforcement of having to accept their responsibility of weighing the patients out, and for some strange reason, this shift not one of them asked for help, but all went to the Manager with complaint (lie) that “Joe won’t help us.”
Joe requested a huddle with the staff before the Manager left for the evening. And the techs all complained and nothing was accomplished. The Manager told Joe that he doesn’t believe the techs story, yet does nothing about it...
The main concern: Joe RN doesn’t feel that the patients are safe, nor is he safe with behavior such as this being allowed. Joe works with this same crew on the evening shift twice per week.
Joe has never seen or experienced anything like this before. It appears that the Manager has no control over the techs behavior, and their ganging up on the RN and all sticking together with the same lie is very, very concerning.
So, yeah, I am Joe (not my real name), and this has me so stressed that I haven’t been able to get it out of my mind all weekend, nor can I get rid of this headache all the stress has caused. I don’t know what the hell to do about this, seems like the staff is out of control and I am concerned about my upcoming shifts, patient safety, and my own future.
I guess I would want to sit down with one tech at a time and see what the trouble is.
As suggested above, do not show anger, do be open to hearing some unpleasant remarks.
Take time to reflect on these remarks before you respond.
"I appreciate you sharing your concerns with me, Gertie (or whoever, LOL). Let me have some time to think about what you've told me. And I would appreciate any suggestions you have for changes I need to make. What do you think I can do to improve?"
And then, if any of them actually share any suggestions and honest complaints with you, do take time to think them over. Some will likely say nothing or will be snippy, snotty, and otherwise negative and unhelpful. It's often easier to be cowardly than frank, so don't be surprised if they chicken out when sitting down with you 1:1. Still, glean what you can from them.
I hate that we have to kiss up to those who are supposed to be working under our direction, but such is modern life. Find a way to do this.
Your Manager should be sitting down with each tech individually, too. And with you. If I were the boss, that is what I would do. Then I would decide what changes might be needed, and I would figure out how to accomplish them. I would require written input from every tech and from you.
Timetable would be established. And I would check with each staff member involved every single day so I could gauge how things are going.
If your boss doesn't initiate meetings, you go to her.
Some heads might need to roll. Hopefully not yours if you enjoy this job. Best wishes. Let us know.
My two cents...this post is a terrific example of exactly why nursing will never actually be a "profession", and consistently manages to destroy itself from the interior....Nurse Joe is accused of not helping the techs, and the accusation made by techs to Joe's boss is brought to Joe's attention. Epic fail, and here is why:
1. Techs are the low people on the totem pole team, and do not supervise or evaluate Nurse Joe. Chain of command is key here.
2. Techs do tech tasks, and nurses do nurse tasks. Asking Joe, the nurse to do a tech task is the same as reverse delegation. Just as Joe is not going to ask the MD to help him administer meds that day, techs need not ask Joe to do their job.
3. Reverse delegation from tech to nurse needs to be stopped in its tracks at the time it begins.
4. Correct response from Manager should have been..."Thank you for your input. I see you are working fully staffed today, and therefore, there should not be a need to reassign tech duties to nurses at this time. I see no reason why Joe should be utilized to help weigh the patients today. Joe has a full workload of his own. " Period, end of story. No need to notify Joe of the internal tattling/ backbiting/ back stabbing.
Conclusion: Management who allows techs to reverse delegate to nurses has no ability to recognize chain of command, and its utmost importance in the workplace.
My two cents...this post is a terrific example of exactly why nursing will never actually be a "profession", and consistently manages to destroy itself from the interior....Nurse Joe is accused of not helping the techs, and the accusation made by techs to Joe's boss is brought to Joe's attention. Epic fail, and here is why:
1. Techs are the low people on the totem pole team, and do not supervise or evaluate Nurse Joe. Chain of command is key here.
2. Techs do tech tasks, and nurses do nurse tasks. Asking Joe, the nurse to do a tech task is the same as reverse delegation. Just as Joe is not going to ask the MD to help him administer meds that day, techs need not ask Joe to do their job.
3. Reverse delegation from tech to nurse needs to be stopped in its tracks at the time it begins.
4. Correct response from Manager should have been..."Thank you for your input. I see you are working fully staffed today, and therefore, there should not be a need to reassign tech duties to nurses at this time. I see no reason why Joe should be utilized to help weigh the patients today. Joe has a full workload of his own. " Period, end of story. No need to notify Joe of the internal tattling/ backbiting/ back stabbing.
Conclusion: Management who allows techs to reverse delegate to nurses has no ability to recognize chain of command, and its utmost importance in the workplace.
Wow. I couldn’t disagree with you more. We need to work as a team, not create task silos.
I hate that we have to kiss up to those who are supposed to be working under our direction, but such is modern life. Find a way to do this.
No we don't, and no, we shouldn't. Once we do, we are permissibly, one teaspoon at a time, allowing the misery of reverse delegation to take root, and grow into an unmanageable monster. This is why nursing will never be a profession.
What would the response be if I went above the head of my doc, to tattle on him to the head of the Department of Surgery? Doc XX won't help me hang my pre=procedure ABT drips, and doesn't help with PACU vital signs?
Wow. I couldn’t disagree with you more. We need to work as a team, not create task silos.
A well functioning team realizes the difference in tasks/ duties/ rank/ education / licensing, chain of command, and works within those parameters while respecting authority, and those who report to whom.
Just as we cannot have a functioning surgical team when the MD is expected to stop what he is doing to do nurse tasks, there is not going to be a functional dialysis team, when the nurse is expected to do tech tasks.
It would be a completely different story, however, if the complaint was, Joe is harassing and belittling me, talking down to me, and not showing me basic workplace/ human respect. That is where Manager needs to observe, and intervene if he finds the allegation credible.
I once worked in a nursing home where there was a never ending revolving door of LPNs and RNs in a facility where the nurse to patient ratio was basically a dream and acuity was low. I was not sure why this was, and felt lucky to have been hired.
Not long after hire, I noticed CNA Donna telling the LPN staff to weight their own patients, give showers, answer call bells, and change patients clothing.
Then I noticed CNA Donna yelling at LPN staff when LPN staff told Donna to do these tasks. When I told CNA Donna that reverse delegation is not acceptable under these circumstances , this made CNA Donna mad.
CNA Donna went above RN, to DON to complain. DON told RN that Donna is complaining. Both RN and DON told CNA Donna , again, that reverse delegation is not going to be tolerated under these circumstances.
CNA Donna became angrier, and went above DON to Administrator. Administrator sided with CNA Donna, and then Donna continued her reverse delegation to LPN, RN, and DON.
LPN, RN and DON found new jobs and left. Agency staff had to be hired to fill in the gaps. Administrator was eventually fired for running the facility in the red. CNA Donna was allowed to continue, until 3 cycles of this repeated itself, and finally CNA Donna was fired.
This really sucks, but unfortunately there are just some units where the techs truly do rule the roost and the manager doesn't have the guts to discipline them. It's completely concerning and unsafe, you're correct. I'm sorry I don't have magical solutions for you, I feel for you and hope that you can find a way to an answer (or a better job).
Perfect attestation as to why nursing will truly never be a profession. Thank you. And yes, this is the kick start to the never ending revolving door of nurse turnover on units, and facility wide. It really has to stop, and until it does, the profession will never be a profession.
Sometimes, it’s perception. For instance, if you ask a tech to do a menial task and then you go sit down. It looks like you are dodging certain types of tasks. They just see you sitting, but they don’t realize that you are, for instances, gathering information to call the MD on a critical issue. So, instead, say, can you do X, I need to do Y. And use thank you and please.
Saying please and Thank You are necessary/ needed components of everyday work, in nursing, and out, so I agree with this statement 100%. Workplace dignity and respect are major components to team building, and getting along in the workplace.
Where, I tend to disagree (sort of), is that the nurse (licensed/ educated/ supervisor) must justify delegation , by softening the "blow" to the tech , by pandering and making an excuse. 75% of a nurses job today is not bedside care, like it used to be. We are habitually required to administrate/ unit clerk/ document/ make phone calls, which necessitates delegating menial tasks. Pandering/ making excuses for it only confuses the tech to incorrectly believe that nurses are required to do menial tasks. We aren't.
The techs have a primary responsibility and you can only help them if you have time. If you don't, you don't. Do they prepare your meds if you get behind? Of course they don't. Because they can't.
Let them complain. You seem to have a supportive manager.
I could care less what negative Nellie's think about me.
I don’t do dialysis; I work on a med surg floor. If I need to give a blood pressure med and the vitals haven’t been done, and the patient needs more water and needs to go to the bathroom, I’m going to do it. Or, if I need to do an assessment in the middle of the night, I’ll try to do all the tasks I can to cluster care (bathroom, weight, turn, vitals, change a brief, whatever). I’m not going to make the patient wait for the NA.
I work as a team. I work with some excellent NAs; they do their job to the best of their ability. Sometimes, they can’t do everything. And sometimes, I do the “NA tasks” because I’m part of a team and they need to be done and it’s in the best interest of the patient.
I don’t do dialysis; I work on a med surg floor. If I need to give a blood pressure med and the vitals haven’t been done, and the patient needs more water and needs to go to the bathroom, I’m going to do it. Or, if I need to do an assessment in the middle of the night, I’ll try to do all the tasks I can to cluster care (bathroom, weight, turn, vitals, change a brief, whatever). I’m not going to make the patient wait for the NA.
I work as a team. I work with some excellent NAs; they do their job to the best of their ability. Sometimes, they can’t do everything. And sometimes, I do the “NA tasks” because I’m part of a team and they need to be done and it’s in the best interest of the patient.
I'm not saying you or I, or others are bad nurses when we do tasks that are more appropriate for a CNA. We all have, and we all do, when the situation calls for it. Sometimes it takes a team of people to lift a patient off the floor, or from bed to chair. Sometimes it takes a team of people to position / hold a patient , while the nurse changes the dressing, or inserts a new foley. I get it. At times, we have to .
I was responding to the OP, in the context it was presented, and to reinforce the point that reverse chain of command and reverse delegations are serious issues and pitfalls we as nurses must recognize and handle in ways appropriate , so as not to continually rip our hair out trying to do everything.
So, a new policy was implemented very recently that techs will weigh all the patients on their way out the door. I have questions.
I am curious how this was handled before the policy, or were patients simply not usually weighed?
I am also curious how much actual work this adds to a shift. Forgive me, I have never worked dialysis. I do know that weighing a non ambulatory, possibly morbidly obese person can be quite a lot of work.
The nurse is likely already filled to the max with tasks only an RN can do.
Is it a case where if the RN drops what he or she is doing, and helps weigh patients, they will then not be able to complete their work in 8 or12 hours and have to fight to be paid overtime?
And the most important question I have is, what does your resume look like?
Kooky Korky, BSN, RN
5,216 Posts
I guess I would want to sit down with one tech at a time and see what the trouble is.
As suggested above, do not show anger, do be open to hearing some unpleasant remarks.
Take time to reflect on these remarks before you respond.
"I appreciate you sharing your concerns with me, Gertie (or whoever, LOL). Let me have some time to think about what you've told me. And I would appreciate any suggestions you have for changes I need to make. What do you think I can do to improve?"
And then, if any of them actually share any suggestions and honest complaints with you, do take time to think them over. Some will likely say nothing or will be snippy, snotty, and otherwise negative and unhelpful. It's often easier to be cowardly than frank, so don't be surprised if they chicken out when sitting down with you 1:1. Still, glean what you can from them.
I hate that we have to kiss up to those who are supposed to be working under our direction, but such is modern life. Find a way to do this.
Your Manager should be sitting down with each tech individually, too. And with you. If I were the boss, that is what I would do. Then I would decide what changes might be needed, and I would figure out how to accomplish them. I would require written input from every tech and from you.
Timetable would be established. And I would check with each staff member involved every single day so I could gauge how things are going.
If your boss doesn't initiate meetings, you go to her.
Some heads might need to roll. Hopefully not yours if you enjoy this job. Best wishes. Let us know.