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Didn't know I'd have to do additional jobs besides mine!

Posted

So, I'm at a unit that is always understaffed on the tech and secretary side. I'm told repeatedly, "get this experience, because you won't always have a tech, and make sure you also know how to put orders in and do this and that because we don't always have a secretary." Just can't seem to find anyone to do these jobs, they say and staff us adequately.

Well, that obviously means the hospital has the money to pay these folks, but can't hire any in.

So, since I'm being asked to do THEIR jobs, as well as MY job, shouldn't I perhaps receive that extra pay for those responsibilities -- at least a differential of some kind on those nights where we're having to do this triple duty type of work?

I'm sorry, but I'm finding myself doing the job of not only a nurse, but also that of a tech and a secretary -- I should get paid extra for that.

And how can we say that everyone should be "cross-trained?" Are the techs cross trained to do my paperwork? My assessments? Give meds? Are they "crossed trained" to deal with docs and be the end of the line person in terms of responsibility for the patient? No, they are not.

This is NOT cross training - this is asking nurses to do three jobs at once.

How are other units with this?

It is really nice to have a unit secretary and techs but, no, you can't always depend on them being there, and, in that case, it's still the RN's responsibility to make sure that everything (all the necessary stuff, anyway) gets done. Lots of places routinely only have unit secretaries on 1st shift, and, if you work 2nd or 3rd, you never have a unit secretary and you are responsible for entering all your own orders and doing all the other necessary secretarial work ... (Same with techs -- it's great to have them to help, but if, for whatever reason, you don't have one, most of the stuff they would ordinarily do still has to be done, by someone.)

It's not that you're being asked to do other people's jobs on top of your own -- it's a matter of sometimes having more help to get all the stuff done that is, ultimately, your responsibility as the RN. I'm certainly not saying that that is justification for a facility understaffing units or not filling open positions, but, IMHO, it's not just appropriate but necessary to "cross-train" RNs to be able to pick up the typical tech and secretary tasks -- because it's not really cross-training, it's all your (the RN's) job in the larger sense.

That's how I see it, anyway. :) I'm sure you'll get other responses with other views.

racing-mom4, BSN, RN

Specializes in ICU/ER.

I like the concept of getting paid more when you dont have a secretary and or tech. But odds are that will never ever happen.

On my unit we have no secretary we enter in all our orders and have no techs. We also take out the trash and wash out the BSC and wipe down the towers behind the beds as housekeeping does not do that.

On the Med Surg floor they dont always have a ward clerk, and many times they dont have CNAs. In mgmts eyes it is not doing 3 jobs at once, it is doing complete care. Be happy when you do have the extra staffing and help, but for sure learn how to do it yourself as you cant count on always having the help.

UM Review RN, ASN, RN

Specializes in Utilization Management.

I like your point--if you're routinely expected to do three jobs, higher wages might be in order.

However, I have to agree with Elkpark too. It is our job to make sure all these things are done.

I look at it this way -- being cross-trained will only help me do my job faster in the long run than if I had to ask someone to show me how every time.

If the unit secretary is busy with admissions and I get a stat lab or test, I can enter it myself without waiting for her to find it or having to interrupt her to do it.

ukstudent

Specializes in SICU.

I have to agree with Elkpark. The duties of an RN include all patient care. Bathing, feeding etc are part of pt care. Getting orders done, including writing them on the MAR and placing them into the computer is part of nursing.

The fact that some of our lesser duties can be delegated to others (techs and sectaries) does not make them not ours. We still need to supervise our techs and make sure they have done their job correctly. We are still the one responsible to look over the MAR and do the chart check and make sure that orders have been subscribed correctly.

Nursing schools need to do a better job of explaining just what a nurse is and does. Too many new grads and quite a few older nurses seem to think that these basic functions of nursing (that have been given to others) are now beneath them. I am NOT saying this is the OP's view.

I hope that the OP hospital provides extra staff (nurses) for those times that you do not have the assistant help. However, I know most hospitals don't and you get to work even more short with increased work load.

No, don't feel those jobs are beneath me at all. But I don't see how that AMOUNT of work can be completed sometimes on one shift by one individual. I'm not just putting in STAT orders -- I'm putting in ALL my orders, all night long. I'm not doing total care here and there -- I'm doing total care on all my patients, all night long, turning, emptying foleys, doing things that techs should do, and then trying to fit in my own job of managing my pt's care from A to Z and complete a mound of paperwork.

It's just TOO MUCH, and NO, they do not prepare you for this in nursng school. Or maybe then did and I wasn't paying attention -- entirely possible because you really can't understand it until you experience it and see the totality of what they expect of you as the nurse.

NotReady4PrimeTime, RN

Specializes in NICU, PICU, PCVICU and peds oncology. Has 25 years experience.

On our unit the nurse is also the nursing assistant, unit secretary, physiotherapist, pharmacist, porter, social worker and chaplain. Even when we have any of those people on duty, they're usually too busy or unavailable when you need them to actually be of help. The bad thing is, the only nurses who are taught how to process those nasty computerized orders are the elite selected to be in charge. If s/he's off the unit, covering a break in an isolation room or not around for whatever reason, it has to wait. I needed a stat portable chest xray (and our radiology department won't send up a tech until the order's in the computer) on a patient who later died of a suspected PE, and it had to wait half an hour until I could find someone who knew how to do computer order entry and another 20 minutes for the tech to get there. Then there's the fact that we only have two computers on the whole unit that have the software to do order entry anyway. Are we ever given extra nursing staff when we don't have auxillary staff on? HAAAHAAAAHAAAAA!

labrador4122, RN

Specializes in Tele.

I agree with you, we should get paid more for fixing our own charts, putting in orders, doing our own "tech" stuff..........

but in the end.... we are left to do that.

I've had to clean rooms too, and take out garbage like the cleaning people!!!!

not all the time, but sometimes I have to do extra jobs just because I am the RN and i have to make sure my room is ready when my patient comes in. I know it's alot, and it's unfair for me.

but things will never change.

labrador4122, RN

Specializes in Tele.

No, don't feel those jobs are beneath me at all. But I don't see how that AMOUNT of work can be completed sometimes on one shift by one individual. I'm not just putting in STAT orders -- I'm putting in ALL my orders, all night long. I'm not doing total care here and there -- I'm doing total care on all my patients, all night long, turning, emptying foleys, doing things that techs should do, and then trying to fit in my own job of managing my pt's care from A to Z and complete a mound of paperwork.

It's just TOO MUCH, and NO, they do not prepare you for this in nursng school. Or maybe then did and I wasn't paying attention -- entirely possible because you really can't understand it until you experience it and see the totality of what they expect of you as the nurse.

you said it sister!!!!!

nursemike, ASN, RN

Specializes in Rodeo Nursing (Neuro). Has 12 years experience.

It is really nice to have a unit secretary and techs but, no, you can't always depend on them being there, and, in that case, it's still the RN's responsibility to make sure that everything (all the necessary stuff, anyway) gets done. Lots of places routinely only have unit secretaries on 1st shift, and, if you work 2nd or 3rd, you never have a unit secretary and you are responsible for entering all your own orders and doing all the other necessary secretarial work ... (Same with techs -- it's great to have them to help, but if, for whatever reason, you don't have one, most of the stuff they would ordinarily do still has to be done, by someone.)

It's not that you're being asked to do other people's jobs on top of your own -- it's a matter of sometimes having more help to get all the stuff done that is, ultimately, your responsibility as the RN. I'm certainly not saying that that is justification for a facility understaffing units or not filling open positions, but, IMHO, it's not just appropriate but necessary to "cross-train" RNs to be able to pick up the typical tech and secretary tasks -- because it's not really cross-training, it's all your (the RN's) job in the larger sense.

That's how I see it, anyway. :) I'm sure you'll get other responses with other views.

I certainly agree that the RN is responsible and accountable for all aspects of the patients' nursing care, and it's worthwhile to be able to do all of the aspects, yourself, if necessary. At my facility, we're occassionally short of aides and have to pick up some of the slack, at times. It's typical for two nurses to share an aide, so even when we aren't short, the aide may not always be readily available when a patient needs to toilet or needs a bath, and I don't think many of us would make them wait for an aide to get them water or an extra blanket. I really like my facility, but if I were having to do total care on 5-6 patients on more than a once-in-a-blue-moon basis, I'd be gone in a heartbeat.

Our orders are computerized, so we enter them ourselves into the computer, if the doctor doesn't. Our clerks aren't even permitted to take and enter doctor's orders. Usually, the night clerk does get a printout of all current orders to file in the permanent chart, but if that doesn't get done on nights, it's just more work for the day clerk. Running without a clerk, even on nights, is a bummer, and also an exception.

It's true, aides and clerks are "nice" to have. Running water and electricity are also handy. If you have to run without them for awhile, you can't just close the hospital, so you make do as best you can, but they aren't "extras," they're necessities.

nursemike, ASN, RN

Specializes in Rodeo Nursing (Neuro). Has 12 years experience.

On our unit the nurse is also the nursing assistant, unit secretary, physiotherapist, pharmacist, porter, social worker and chaplain. Even when we have any of those people on duty, they're usually too busy or unavailable when you need them to actually be of help. The bad thing is, the only nurses who are taught how to process those nasty computerized orders are the elite selected to be in charge. If s/he's off the unit, covering a break in an isolation room or not around for whatever reason, it has to wait. I needed a stat portable chest xray (and our radiology department won't send up a tech until the order's in the computer) on a patient who later died of a suspected PE, and it had to wait half an hour until I could find someone who knew how to do computer order entry and another 20 minutes for the tech to get there. Then there's the fact that we only have two computers on the whole unit that have the software to do order entry anyway. Are we ever given extra nursing staff when we don't have auxillary staff on? HAAAHAAAAHAAAAA!

And when a patient someday dies for lack of adequate support staff, it's the nurse's fault.

I am so tired of having to do all the other jobs! Either we are short techs or if not I can't find them half the time. Yes it's true that know how to do all of the pt. care, but it's physically impossible. Let's see should I bathe, sit up in chair, change linen, and feed the pt. OR give them this BP med to lower the BP from 190/90, and not to mention my other pts. I'm going to protect my license and worry about what is going to get my pt dead. Plus I have to chase MD's around all day to get orders for this or that to protect their job. I am a new grad so I may be slower at this, but I talk to seasoned nurses who share my opinion. No wonder nurses get burnt out. Pt have crazy acuity, at least where I work. It isn't safe for them or me. Plus I am in debt from student loans and I just spent the last 5 yrs in school making no money-I ask myself is it all worth it? Does it get better the longer I do this or will I just come to be desensitized to it.

cherokeesummer

Specializes in OBGYN, Neonatal.

On our unit we don't always have a secretary or they are so swamped that we have to do our own stuff. We rarely if ever have aides. We do all the moms care, babies care, change linens, pass and pick up meal trays, do vital signs, etc. etc....it sucks but sadly I don't think it will change soon.

loriangel14, RN

Specializes in Acute Care, Rehab, Palliative.

I am surprised by the people that complain of having to do pt care. I have never been anywhere that had aides. All the nurses I work with do all their own cares. I take it as being part of the job. I work in a small hospital and we have to wear many hats. We have no social workers, aides, or chaplain and the ward clerk is only days mon - fri so some nurses wear that hat too.

I am surprised by the people that complain of having to do pt care. I have never been anywhere that had aides. All the nurses I work with do all their own cares. I take it as being part of the job. I work in a small hospital and we have to wear many hats. We have no social workers, aides, or chaplain and the ward clerk is only days mon - fri so some nurses wear that hat too.

Taking out pt. diet trays is not patient care. Entering in every single piddly order all night long may come close, but it's still not patient care. It is an administrative TASK. Emptying garbage cans is not patient care. Answering the phone and directing visitors all day long to waiting rooms and restrooms, or other floors, is not patient care. And I have not been trained in social work, I'm sorry. I am not a social worker, or a Chaplain -- I am a nurse.

These are the things that make a unit function, but are not patient care. MY job, as a nurse, is to coordinate and execute my patient's care. It's a huge job. I am designated as last in line to catch the mistake of a pharmacist or an MD. I am responsible for the well being of my patients from minute to minute, especially those who are at high risk for falls or are in critical condition, and for carrying out orders using skills that I have acquired through specific education to do so.

If I'm so busy taking out garbage, stuffing charts, and/or entering routine orders, I FEAR that I may miss something else that SHOULD take precedence -- and that is REAL patient care. Do they ever wonder why nurses make med mistakes? Maybe it's because they've spent 1-3 hrs of their shift doing non-nurse tasks and so therefore, they had less time to concentrate and focus on what was truly pertinent to their job?

nursemike, ASN, RN

Specializes in Rodeo Nursing (Neuro). Has 12 years experience.

I am surprised by the people that complain of having to do pt care. I have never been anywhere that had aides. All the nurses I work with do all their own cares. I take it as being part of the job. I work in a small hospital and we have to wear many hats. We have no social workers, aides, or chaplain and the ward clerk is only days mon - fri so some nurses wear that hat too.

I recall a night when I had had to cut off a patient's ID bracelet in the process of a difficult, 30 minute IV stick. The band interfered with the only decent site I could find. So, as I hurried to catch up on all the things that had to wait while I started the IV, I asked my aide to put a new band on the patient. It was near change of shift, and one of their duties is to verify that each pt has an ID band. So another aide, who was sitting on his butt at the nurses station (along with my aide--but she had been working hard doing her job all evening, so I didn't begrudge her a sit) chimed in, "Oh, you're a nurse. You're allowed to put ID bands on, too."

I don't delegate because I'm lazy or because I'm "too good" to do menial tasks. I work in a fairly large, tertiary care hospital that has decent resources, even on nightshift. We normally have aides, unit clerks, and a chaplain on call around the clock, as well as a pharmacist, rad techs, resp techs--even someone from care management on call, if needed, although most care mgt and social work is done on days. We have dietary aides on nights, and housekeepers available, if necessary. With all that support, which I very much appreciate, the only chance I usually have to sit is when I chart, and all too often I don't get my charting done until I've reported off to the next shift.

I don't mind working hard. Heck, I kinda like staying busy. I also kinda like it when I have a little extra time after doing the things only a nurse can do to spend doing some of the things I thought nurses do--holding hands and listening, giving baths, showing I care with a cup of coffee and a smile. But I really don't much like it when I have to prioritize and let a wastebasket overflow or a patient lay in filth a few minutes longer so that I can finish a dressing change or address a patient who has lost interest in breathing at the moment. If I don't have someone to fetch an extra blanket for one patient while I'm pushing IV amiodarone on another, the blanket has to wait.

Most of our aides work pretty hard. Our clerks work pretty hard. Our dietary staff works pretty hard. I work pretty hard. When we're short in one of these support positions, or have someone who just won't do their job, I work a bit harder, but mostly, some stuff just doesn't get done, because no matter how many hats I'm wearing, I'm only one person.

racing-mom4, BSN, RN

Specializes in ICU/ER.

I dont want to get flamed for what I am about to say, but Soundof music, If I am correct your a relatively new nurse--like me, I just became a nurse in Jan. In my unit we have no ward clerk so we enter in all of our orders, stuff the charts, fax to pharm, take out the trash, clean the commodes, talk with dietary, even help with PT/OT if needed. I am sure I am forgetting something....where I am going is, it is over whelming to me to balance everything, so the little tasks like entering in orders seem like big tasks. But to the more seasoned nurses who have been doing it for years it is like a blink of an eye. They can go on auto pilot and stuff a chart--where as I am like "where does the valuables sheet go?"

The nice thing about doing it all is we do know all there is to know about our pts. If a Drs says, did we get an albumin done? I know, cause I put it in. or I got it off the fax and put it in the chart.

Also I have worked on Med Surg before where they have a ward clerk and the charts sit up at her desk for hours at a time in a nice little pile waiting for her to get to them. She does not know some orders need to be put in stat, even if we tell her. If something comes acorss her fax she may not realize the sensitivity to it and just put it in the pile to be placed in the chart when she gets to it.

I guess I dont really mind doing everything from housekeeping to med admin for my pts. I only have 3 pts max though so that may make a difference. I do think the longer I am a nurse the more the little tasks will become second nature and they wont seem as big of a deal.

NurseyBaby'05, BSN, RN

Specializes in Neuro/Med-Surg/Oncology.

I don't have a problem with doing the tasks usually handled by an aide or secretary.

What I have a problem with is when I consistently have the same number of patients in an assignment as though those resources are available to me. :madface:

The other problem I have is beign questioned (aka reprimanded) for not taking a lunch or leaving late because of not having said resources and still being expected to do it all without leaving anything out.

Supervisor: "Why are you still here?"

Me: "I had a full, high-acuity assignment. I had no secretary and no aide. What would you like me to skip or skimp-on to get out of here on time?"

Me (too): "Why are you so worried? It's still costing you less than paying an aid or secretary for a whole shift."

:banghead:=How I feel after every shift lately

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