Difficulty with Nurse Aides

[speckRN]

I have found over the past few years, the longer an aide has been on our unit the less they will accept that the RN is supposed to deligate tasks to them. We give a report to the aides normally around the beginning of our shift, and then the aide is supposed to carry out these tasks, if they are unable to for any reason they should come to the RN and let them know, however, this rarely happens. Most of the time it is just left undone, and then the following nurse needs to pick up the slack or if you are a 12 hour nurse and the aide has left it is your responsibility to see that it gets completed. Most of the time, you get flack from the oncoming PCA that does not feel they should do a task that was deligated to another aide. I am constantly reminding them that it is a 24 hour job and remember it is the patient who suffers the most:scrying: , not them. Also, I have found that most of the PCA's (Patient care assisstants), feel that the nurses are lazy and that they sit around doing nothing:deadhorse . What they don't realize is that alot of your time is spent discussing medical issues with the Doctors, other health care professionals (i.e. case managers, social work, diagnositic departments, etc.), also with family members, and the patient themselves. Also, the RN has much more documentation that needs to be completed, and make sure all of these things are done in a timely, safe, efficient manner. Our license is at risk, not theirs. How can I get them to understand this without them thinking that I am looking down on them for not having a degree. They all know that I believe that their job is very strenuous, but they still don't get it. I am truely tired of having to explain myself to staff, who have been on the job long enough to know.

[TheCommuter, BSN, RN]

Ten months ago, when I was a student during a clinical rotation, I had an issue with one of the long-time CNAs at this sub-acute facility. She would always make a snide, rude comment about the care I was giving even though I was not caring for any of her patients. I usually remained silent to avoid causing trouble at this place.

One morning I needed to enter my patient's room to pass meds, but the CNA refused to allow me to come in. She angrily stated, "No one comes into my room while I am with a patient!" I walked away and told an LVN about the CNA's comment, but the LVN said, "Just don't go into the room."

I then told my instructor about what had happened. My instructor then proceeded to tell the D.O.N. about the day's events, and the CNA quickly backed off. It seems to me that the CNAs basically possess an outrageous amount of control and influence at these healthcare facilities.

[SharonH, RN]

Is there any repercussions for this behavior? What I have found is that some nurses give the aides no slack whatsoever so that when they are working with someone who is "nice", they tend to take advantage. Personally, the middle of the road approach always works for me, I always work with them as a team and when I delegate they do it. However, I have no problem expressing my displeasure when something isn't done as I asked and yes I have written someone up before but that is a measure of last resort. I never resort to drama or confrontation, I just follow-up with action.

[Genista, BSN, RN]

I am wondering if this is a problem that is culturally tolerated on your unit? Are other nurses having the same problem and accepting it? If so, then perhaps a unit meeting is in order. I would get your nurse manager involved, too. Our carepartners (nurse aids) are great, but once in awhile one may have a problem such as a negative attitude, or avoiding work, forgetting tasks, etc. This type of behavior is not accepted on our unit, and we bring it to the nurse manager, who counsels the employee in question (if they don't respond to RN requests).It's one thing to be busy and not get to tasks, but another to be avoiding work and/or "forgetting" tasks (irresponsible).

But I hear that on some units, nurse aids are so hard to keep, that this unfortunate behavior is tolerated. I also have to mention, that some RNs can be very rude and condescending when working with aids. I am sure you are not that way.I hope the aids where you work are treated with respect as a part of the team.It could be important to have a unit discussion with all the nursing staff (nurses, aids, etc.) about what the aids' roles are, and how they are part of the nursing team, and what the RN does. I still have to do total patient care on some days (I work acute care and it depends on our staffing matrix). It isn't so much the tasks that are hard, as we both know, but rather, that it makes it harder to do the RN tasks when acting without the help of an aid. On the days when I have a good aid- my patients get so much better care, and I can be free to do nursing tasks like medicate people for pain in a more timely fashion versus getting folks on/off commodes and making the patients in pain wait.

Anyway, I would start documenting problematic behavior and bring it to the nurse manager. Perhaps a private meeting with the aids would help, as well as a staff metting for all. We also try to remind our aids how important and valuable they are. We have some really top notch ones...who are proactive and find work to do even on the slow times. Good luck. It's hard doing total care. I hope you can all work something out.

[Kim O'Therapy, BSN, RN]

I am so sorry to hear about this problem you are having. I am currently a BSN nursing student who has worked for years as an CNA. I currently work part-time in a major metropolitan cancer center and have also worked LTC. I would NEVER act like the aide in your story! I know what my scope of practice is and that part of my job description is to have tasks delegated to me by the nurse I am assigned to. I have had nurses that "look down on me" and nurses that helped me if they had a moment; however, I never "expect" the nurse to drop his/her work to do my job. If I am in a major jam (lifting, combative pt., etc.) and need help, and no other aides are available, then I will ask a nurse to give me a hand. I consider myself part of a healthcare team with the nurse quarterbacking. I too get frustrated with aides (or any worker) that spend more time and energy trying to get out of their work, than actually completing it. IMHO, if an aide doesn't like be "bossed around" by his/her nurse, then he/she needs to quit complaining, grumbling, and resisting their work and go back to school and become a nurse! Sorry this is so blunt, but its just how I feel.

[farishtaRN]

I worked at a wonderful hospital where we did rounds (the RNs) and so did the PCT/CNAs. That way, as much as we were keeping each other accountable as the nurses, so where the PCTs -- that way, if something hadn't been done that should have been, they heard it from each other and couldn't be upset at anyone but the PCT going off duty. I have had many great PCTs and I think that they have a really hard job for which they don't receive a lot of credit (even less then the RNs in my opinion), and giving them the opportunity to do rounds with each other seemed to help give them a feeling of responsibility and investment in the patients care.

[LPN1974, LPN]

Ten months ago, when I was a student during a clinical rotation, I had an issue with one of the long-time CNAs at this sub-acute facility. She would always make a snide, rude comment about the care I was giving even though I was not caring for any of her patients. I usually remained silent to avoid causing trouble at this place.

One morning I needed to enter my patient's room to pass meds, but the CNA refused to allow me to come in. She angrily stated, "No one comes into my room while I am with a patient!" I walked away and told an LVN about the CNA's comment, but the LVN said, "Just don't go into the room."

I then told my instructor about what had happened. My instructor then proceeded to tell the D.O.N. about the day's events, and the CNA quickly backed off. It seems to me that the CNAs basically possess an outrageous amount of control and influence at these healthcare facilities.

I would question this cna's behaviour in a heartbeat.

No aide should be allowed to keep other pertinent personnel, such as a med nurse out of the room. Even if you were a student, you were the patient's medication nurse that day, and you had every right to go in that room, IMHO, as long as the patient's privacy was respected.

What if the aide was doing something inappropriate that she didn't want someone else to see?

I just do not agree with that behaviour at all, or the LVN's response to your reporting it to her.

Now if it been a janitor, maintenance, dietary person, office personnel or someone of that nature who had tried to enter while the patient was being given care, I would agree, but not a nurse.

[Daytonite, BSN, RN]

Everyone reaches a point when they have to take the bull by the horns and do something about a problem. Yours has come. It is time to exert your authority. Like any other nursing procedure, it is a skill. You actually were exposed to some of it in nursing school, but you have probably forgotten a lot of it. It takes a little knowledge of assertiveness and how discipline should be carried out. You are, after all, an RN. That makes you a supervisor of a nursing assistant and/or PCA. They are never going to understand the depth and responsibilities of your job because they are nursing assistants, so don't expect it from them if they aren't willing to take the time to understand it. You just have to let the comments they make about nurses sitting around being lazy slide off your back. If they have the boldness to say something like that in front of me, I am taking them aside to a quiet place or a private room and telling them to stop talking like that in front of me. Until they walk a mile in my shoes, there is no way they can know whether I'm being lazy or not.

You have to address the things these workers are not doing. If you are assigning tasks for them to do, then you now know that you have to follow up with them throughout the shift to see that they are getting done. That way that have no excuse when, at the end of the shift, they still haven't gotten it done. You tell them if it happens again you are just going to have to write them up, or report their failure to do what they have been asked to do, to your manager. That's after Day 1. The next day and every day afterward that it happens you have to write them up and report them to the manager. They are being insubordinate. By checking with them throughout the shift, you are literally telling them that these things you are asking to be done are important and take priority. If they tell you they have other stuff to do, you just tell them to make XXX the next thing on their list--period.

You have a lot of authority over them--more than you think. However, you have to let them know that when you give them tasks to do you expect them to get done. It they don't do them, then they have to know that there will be consequences from now on. If they get mouthy about your new found authority you quickly tell them not to talk to you in that tone. And, if they keep on doing it you just look them in the eye and tell them you are going to report their behavior to the boss. If that doesn't do it, then you have to start writing up these incidences to give your manager something with teeth in it that she can use to discipline these characters. Undoubtedly, there will be one in the bunch who will want to stand up to you. Usually, they topple helplessly when you get them alone and confront them or really find something they can get into trouble for. They laugh at threats. However, actually write one of them up and watch how seriously they take your instructions then. Most subordinate workers understand the serioiusness of being written up even though they may act real mouthy and defiant when talking about it with their cronies. As I said, there comes a time when you have to take the bull by the horns and put the pencil to the paper and take care of business.

I also suggest that you speak with your manager or a supervisor and tell them what is happening and ask for suggestions as to how to handle it. Don't let these people run all over you. You cannot be their friend and supervisor at the same time with the kinds of attitudes they are displaying. If you don't do something to stop this, it is only going to get worse.

[shomelggs]

I work in a loca STL hospital and I hat to hear that about aide. I have been and aide to 2 1/2 years while going to nursing school. It really bugs me when the staff this includes the nurses and aides don't work together as a team. Our primary goal is to there to help the PATIENTS!!!! We are not there for each other. I think most people forget that our mission is PATIENT CARE.

I just wasnt to encourage everyone even the RN and AIDE we can all help by just doing a part to care to the PATIENT. This is the person that will benefit in the long run.

[chadash]

Ten months ago, when I was a student during a clinical rotation, I had an issue with one of the long-time CNAs at this sub-acute facility. She would always make a snide, rude comment about the care I was giving even though I was not caring for any of her patients. I usually remained silent to avoid causing trouble at this place.

One morning I needed to enter my patient's room to pass meds, but the CNA refused to allow me to come in. She angrily stated, "No one comes into my room while I am with a patient!" I walked away and told an LVN about the CNA's comment, but the LVN said, "Just don't go into the room."

I then told my instructor about what had happened. My instructor then proceeded to tell the D.O.N. about the day's events, and the CNA quickly backed off. It seems to me that the CNAs basically possess an outrageous amount of control and influence at these healthcare facilities.

Wooo! that is scary!