i was wondering, how do you guys delegate to your nursing assistants? i've tried everything... from being direct and to the point "nurse aid, can you please go and assist my patient up to the bathroom?" to being really nice and saying "please, nurse assistant, can you do me a favor and get my patient up to the restroom?"
no matter how i ask they act pissy that i am asking for them to complete ADL tasks. i'm sorry, but i feel that i am way nicer to my techs than i was ever treated when i teched as a student out on the busy oncology floor. now, i work in a low census peds unit. i can't remember how many times as a tech i was told "go get mr. jones a bedpan now." i'm not like that... but you know, looking back at the time i was never really offended by it either. the techs i work with act offended that i ask them to do these tasks.
I wasn't "taking it out" on you. I was just venting over it because to me it was unconscionable to leave the room with a patient in that condition. You should've seen her. The nurse didn't even wipe her face! I know it's not the nurse's fault that the patient didn't tolerate the tube feeding. But a little decency & respect for the patient as a fellow human would've led me to begin cleaning the patient & use the call light to get assistance for finishing up the job. I'm not angry or upset to have to clean the patient. It's part of my job, and I happened to be quite fond of this patient even though she was non-responsive. I'm just upset over the nurse's blatant lack of care for the patient.
"nurse aid, can you please go and assist my patient up to the bathroom?"
I'm assuming you said "nurse aide" because you're not using names in this forum, right? If someone called me aide instead of using my name that would really piss me off.
Is there a description of of NA duties on your unit? I agree with other posters that NA's should know what is expected of them and should be able to do it independently. If NA's aren't doing what they should you should bring it up with your department manager. Also, don't ask do you mind, etc. Simply ask, "can you clean up Mrs. so and so or I've just set up Mr. Smith, can you feed him his tray? But.. do say please and thank you, good manners are important. Also don't be like a nurse on my unit... We are a cardiac floor and do daily weights. If your NA is alone when there should be two, do NOT chase her down all morning while she's doing a million things to get a weight on your pt. that can stand w/o assistance. It will take less time to weigh said pt. and allow NA to do her accuchecks, empty foleys, give water, and setup pts for a.m. care.... And yes, I did end up weighing that patient at the end of my shift after doing all my a.m. stuff (I work night shift). Never mind I had washed all the comletes and setup up half the floor to wash in the a.m. Miss Prissy was incapable of weight her own patient.
I'm sure you're not like that though, but honestly some nurses are extremely needy and I always know I'm in for an interesting shift when I work with the "needy" nurses.
I'm assuming you said "nurse aide" because you're not using names in this forum, right? If someone called me aide instead of using my name that would really piss me off.
Is there a description of of NA duties on your unit? I agree with other posters that NA's should know what is expected of them and should be able to do it independently. If NA's aren't doing what they should you should bring it up with your department manager. Also, don't ask do you mind, etc. Simply ask, "can you clean up Mrs. so and so or I've just set up Mr. Smith, can you feed him his tray? But.. do say please and thank you, good manners are important. Also don't be like a nurse on my unit... We are a cardiac floor and do daily weights. If your NA is alone when there should be two, do NOT chase her down all morning while she's doing a million things to get a weight on your pt. that can stand w/o assistance. It will take less time to weigh said pt. and allow NA to do her accuchecks, empty foleys, give water, and setup pts for a.m. care.... And yes, I did end up weighing that patient at the end of my shift after doing all my a.m. stuff (I work night shift). Never mind I had washed all the comletes and setup up half the floor to wash in the a.m. Miss Prissy was incapable of weight her own patient.
I'm sure you're not like that though, but honestly some nurses are extremely needy and I always know I'm in for an interesting shift when I work with the "needy" nurses.
Sometimes when I was trying to delegate (not as an RN but in another situation) I had a similar situation with an assistant and after a long drawn out conflict/resolution session, he basically told me that he felt like I was just asking him to do things, but didn't understand why I didn't do it myself. So, I came up with a solution I would say:
Matt, I am going to work on X, could you work on Y for me right now, that would be incredibly helpful. Thank you so much.
And then everything could get done. Which was really my goal. :)
you *ask* these people to do tasks that's their *job* to do!!!
why do you feel the need to ask, beg, borrow, steel in order for them to *do* their jobs? whatever comes-up out of the ordinary...if you yourself can't fix the problem & it does comes within their scope of practice...then they should be able to do it. it's your job to prioritize & tell them what you want them to do first in terms of them getting their routine assignments done...but if a patient requires something immergent...then by all means...the techs will *have* to adjust their schedules accordingly.
you know...begging can come off as whining...which many find to be a turn-off & fewer respect. people rather work with someone who knows how to be straight & shoot from the hip...in other words...be a woman/man about it & just tell them what needs doing. i'm not saying to come-off cocky or nasty...just simply tell them what needs to be done is all. stop pussy-footing around it. coming off beggy or whinny makes a person *look* like they're dumping off tasks they don't want to the techs/nas because they can...even if you feel badly about it. the perception may be taken differently. it also makes an easy target for a novice nurse & many will take advantage of cuz they've not gotten themselves quite sorted. try to take the techs/nas' situation & put it on the other foot. wouldn't you think it can be rather *irritating* if say your nurse manager/charge nurse always *ask* or *beg* you to carry out additional duties while you're trying to do your initial ones? don't you think it speaks volume that they can't see that you're stressed-out enough that they keep on adding to your patient load? in other words...change your approach.
on the flip side...as both a civilian & former military nurse...i'm use to having physicians give me & at times... bark verbal orders to carry out (they sometimes even change them mid my doing performing them mind). the point being...never do any of the docs/apns have to *ask* or *beg* me (or any other nurse) to carry them out!!! they simply either verbalize or write them & we do them...simple as that. now...we may not always like or agree with their orders, but i can assure you, they never get any slack or attitude from us over them either. we nurses know better than to do that.
so why do you feel the need to handle techs/nas with kit gloves? they're all adults...right? they all take orders from your unit manager/head nurse, other rns, right up to docs....soooooooo...what's the problem? so why give your nas such power over you? they have to realize that they're working under your direct supervision & license...don't they? if they're not aware of *that* fact...then i suggest you make them aware of it!!!
perhaps you should tell them at the start of your shift...while giving report...what you expect from them. give them their assignments & tell them you'll need them to follow-up with you throughout the course of the shift so that you know if & when those routine & additional tasks are complete...this way...you can document them accordingly. tell them you're legally required to know the 'follow-up' info.
perhaps you should bring this situation up during your next nurses'/unit meeting? or at the very least, tell your unit manager/head nurse so they might intervene. nevertheless...you really should try to resolve this yourself. either take each offender aside, meet with them all, or make a generalize announcement right after giving report so not to single anyone out...but you really should make them aware of their actions (or lack thereof). some people really aren't aware they've got an 'attitude' until it's been brought to their attention. reminds of sexual harassment offenders...they too don't know until the moment the victim tells them they're feeling uncomfortable. only then does the fault become the offender's. should the behavior continue after you've tried talking...then further action is needed.
anyhoo...good luck & keep us abreast of your situation.
I think you are doing it correctly. Be sure to thank them for their help. Good advice here. Sometimes you just have to let it roll off of your shoulders and go about your business.
I sometimes add "while I'm charting (or doing such and such) would you please help Ms. Smith to the bathroom", because I know as a primary care provider we are a team. It's not only the aides job to see patients are toileted but my job as well since they can't be all places at all times. I try hard to build an amicable relationship with the aides. Sometimes it can be done, other times the chip on their shoulder is wedged too tight, so as long as the job gets done that's all that matters to me.
P.S. RN's do it too. Aides come to the nurse and says so and so wants pain medication. RN to AIDE: "He was fine a minute ago until you woke him up!" Charge nurse to RN, you're getting an admission in 444B. RN all snippy "sigh.....grumble.....what is IT" ("IT" is a human being that needs you. :)
I wonder how nurses would feel if doctors and NM's never addressed them by name. Just "nurse". "Nurse, I need you to take care of this for me....NOW, not a week from next Tuesday!" (Maybe they already do?)
We only have 1 CNA on nights with 20 + pts..usually more than half are total care..we all have to chip in to make sure the pts get the care they deserve..whatever the task..when I get overwhelmed she helps me /and vise-versa. She knows her job description and does what she can, and asks for help when needed..just as I do...it's all about mutual respect.
Specializes in critical care; community health; psych.
When I worked as an aide, anyone who responded the way OP describes would get written up. What I especially appreciated at the end of my shift was the "thank you, good job" I'd get from the nurses. It does a long way on the next shift.
I think part of gaining the co-operation of tech's is making a point of showing them you are out there with them. I know we have a lot of things going on that they dont even think about, and have no clue about but thats still no excuse. May i suggest, any few free minutes you have, go look them up, see how they are doing, if there is anything you can help them with. Touch base with them in the morning, and afternoon if nothing else to connect and see if they need you to find someone to help them with that complete they havent been able to get to. When you go in to do your morning assessment on a patient go ahead and set the patient up for bath while you are there. As Rn's we have to make the effort to try to show them, not just tell them we appreciate them. Be out there answering call lights when they are tied up in a room, pass some trays, do a couple sets of vitals for them if you have a minute. I know, it makes for a long day, and we find ourselves running twice as hard when we do these things. But after a while they will realize you are and can be willing to be out there with them when they need a hand and if you have a few minutes. Sometimes you have to SHOW them not just tell them. Actions speak louder than words.
I'm not trying to say people dont do some of these things, but the first time they come up to the desk when they are swamped and see 2-3 people sitting there chatting about their kids, or whats on the lunch menu, or who's going to what night spot on friday, it starts a vicious cycle of uncooperative behavior. They dont see that you just called the doctor and are waiting on the call back, or that you have a stack of orders and labs in front of you that need sorted and taken care of. There are a lot of things behind the scenes that we have to know and they dont. Their care is TOTALLY patient centered, ours isnt and there is no way we can possibly tell them why we are sitting there and LOOK as if we arent doing anything.
Try a few of the suggestions for a couple weeks,, see if things get a bit better. Ive been where you are and gotten the same reactions from people that i worked side by side with, when i changed roles. It took a little time, but i dont get the "attitude" anymore and a lot of the techs will actually change assisgnments so they can work with me. The first one in will change the assignment board unless its plain obvious they have to take the same team they had yesterday.
Specializes in critical care; community health; psych.
Good advice Meownsmile. I much preferred working alongside the nurses. Most of them wisely allowed me feel like I was working for the patient, not for them. The few nurses who rubbed me the wrong way were the ones that referred to me as "their" tech. I think it's wise that they are no longer referred to as "nurse's aides". PCAs are there for the patients just like nurses are there for the patients.
Specializes in PICU, Nurse Educator, Clinical Research.
I work full time (weekends and one day during the week) as a tech on a neurology ICU, while I'm in school full-time; I'll have my ADN in May, and most of the time, I'm the only tech here for sixteen total-care patients. The majority of the nurses are *very* respectful toward me, and don't ask me to do things just so they can go take a break. It's a little different working in an ICU where there's normally a 1:1 nurse:patient ratio. However, there's one nurse here who was in management for several years and just got back into staff nursing who expects me to be at her beck and call. I'll do my job for her- but that's it. She asks me to do things that she could easily do (emptying a foley on a patient on contact precautions, even though she's already gowned up and in the room), and she'll often tell me to do things JUST so she can take a cigarette break. With the rest of the nurses, I go out of my way to help...this is a great learning opportunity for me, as I plan to go into critical care after graduating. Bottom line- it's really individual. I help without being asked, and go out of my way to be valuable to the staff here- but that's because I want to learn.
dansamy
672 Posts
I wasn't "taking it out" on you. I was just venting over it because to me it was unconscionable to leave the room with a patient in that condition. You should've seen her. The nurse didn't even wipe her face! I know it's not the nurse's fault that the patient didn't tolerate the tube feeding. But a little decency & respect for the patient as a fellow human would've led me to begin cleaning the patient & use the call light to get assistance for finishing up the job. I'm not angry or upset to have to clean the patient. It's part of my job, and I happened to be quite fond of this patient even though she was non-responsive. I'm just upset over the nurse's blatant lack of care for the patient.