Does anyone else ever get tired of "stupid" nurses?

[twinmom2k]

I swear I am so tired of nurses that can't think for themselves and don't think for themselves. I am the weekend house supervisor for my LTC facility. This means I am in charge of pretty much everything. I love my job don't get me wrong. I just don't understand some nurses thinking process. Such as: Last Saturday we had a patient that began doing poorly. There was confusion as to whether this patient was supposed to be comfort measures only or not. Basically the family was arguing amongst themselves about what they wanted. But this really has nothing to do with my point. I was called to the unit to assess the patient. When I get there the CNA for that patient tells me she can't get a blood pressure or a good pulse ( the patient did have both she just couldn't get it) I ask the nurse what she got, and she tells me she didn't try. She just sent the CNA down to get it. With an electronic BP to boot. Now I know CNA's are trained to get vitals in our state, but come on. If you have a critical patient is that really who you want to depend on to get your vitals? And I would never use an electronic BP cuff to assess a critical patient. They are fine for routine purposes but we all know they sometimes are not reliable especially in a difficult case. The nurse was completely oblivious to the fact that she should have gotten the vitals herself.

I ended up getting the vitals myself and sending her out to the hospital. This kind of stuff just drives me crazy. It happens all the time where I work. The last weekend I worked a similar situation happened where the nurse did the exact same thing and called me to the room. I get there and there are THREE other nurses standing there all looking at me to do something. They hand me a sheet of paper that has the vitals written on it. It says b/p 78/41, Pulse of 97. So I ask who got the vitals. The CNA in the room says I did. I asked her with what and she gives me the electronic bp cuff. So I get the manual bp cuff and stethescope and take them myself. I get 108/64 and a AHR of 54. Now does this not sound ridiculous to anyone else? That not one of the other three nurses in the room doubted the accuracy of the electronic bp cuff? Not only this but once I get the vitals I go to call the doctor on this patient who is lethargic and very pale, and her nurse goes to lunch leaving me to send her out to the hospital by myself without even offering to do anything.

Okay I am done ranting. I just get so frustrated that some nurses cannot think for themselves. Sometimes they call me to a residents room and haven't even gotten vitals yet. They just want me to do everything. I don't mind helping them and usually I do it all for them. But it would be nice if they would at least offer to help and stay around to see what is going to happen.

Well thanks for letting me vent and I apologize if this is not the forum to voice my concerns.

[cube]

Actual conversation with cardiovascular intensive care nurse:

Nurse: Heres a specimen for a type and cross. (pink top tube)

BB Technologist: OK, thanks

Nurse: Is it supposed to do that?

BBT: do what?

Nurse: Turn into a gel like that

BBT: That would be the CLOT.....

Nurse: Oh, Ok

A pink top tube contains EDTA, an anticoagulant. It is not supposed to clot so that plasma can be removed from the red cells. Red top tubes do not have an additive, so they are supposed to clot in order to obtain serum.

[rebel_red]

Hmmmm I admit I have the apparantly bad habit of saying "my aides". I also say "my supervisor", "my patients" and "my facility" and ya wanna know why??? Because the are all in some way "MY responsibility." I have the responsibility to listen to my aides, keep my supervisor informed of assessments and nursing interventions, to keep my patients medically stable and facilitate the healing process and contribute to my facility's mission. Why because it is my license.

As to the other issue....I wonder about it myself because on overnights I often have the whole floor, sometimes without another nurse and as always rely on the assessment skills taught in school. I send alot of our folks out to the local hospital for eval based on my assessments.... However I do see nurses doing what I call "bagging it". Waiting for the next shift to do "it", whatever it is...This is so appalling. I am not super nurse, yet I wonder how can miss these declines in condition and not do an assessment and intervene??? Wish I had the answer... I sent 5 patients out last Saturday alone, all of whom were kept for various admit diagnosis. All of whom according to nurses notes had these conditions brewing for 3-5 days.... When you find the answer let me know and I'll pass it on to our DON and UM....

sigh

Tres

[CashewLPN, LPN]

Mod Calling

wow... new life on a very old topic... Ok, if this topic, has indeed gotten a breath of fresh air, and remains alive, I'll let it stay here, if not, I'm going to help it to the cornfield so that new, more alive thoughts and discussions can take its place...

Just an fyi...

--Cashew

[Else567]

I am a nurse,LPN,I am charge in a LTC setting,I have had too many cases to remember,where i did everything,right down to sending them out,via 911.

You as the Supervisor,why are you NOT taking the ''STUPID NURSES'' too task,seems to me,you are not assertive enough,I cannot imagine my Supervisor just letting these types of incedints pass.

by you always doing everything for these nurses,who seem very incompentent,they are in essence taking advantage of you.

They need some serious inservicing on PT assessment.

Sorry if I'm harsh,been a nurse a very long time,worked in Tele,LTC,micu(crossed trained in Pa)

Happy first day of summer!

Nurse Else*

[rn/writer, RN]

Your facility needs a new--and well-publicized--protocol for assessing questionable patients. You might think about designing a flow sheet for exactly this type of situation. I've been an EMT for 16 years and a nurse for 11. In EMS, we have all kinds of rapid assessment tools with many boxes to fill in. We begin with first impression and chief complaint and progress to either a medical or trauma evaluation.

An actual assessment tool (flowsheet) could help educate the ignorant and give a kick in the butt to the lazy. Document not only V/S but who took them and by what method. Ask for repeat vitals at 5 min. intervals. List interventions tried and other pertinent information.

If such a tool is used as "quality assessment," it can remain an informal work sheet and need never be put in the chart. Such a tool is handy when calling a doc. It can also be used afterward for remedial instruction.

The really important thing about a flowsheet like this is that it shows a progression (or lack thereof) of increased concern and intervention and it gives staff direction as well as notice of accountability.

I'm sure there are people out there who will still be problematic but an assessment tool might help you to assess them as well as the patient and give you some back-up when pointing out deficiencies to higher-ups. At the very least, it might show that you're trying to come up with a solution.

I wish you well.

Miranda

[blondiii]

A person in a managerial position (nursing or wherever) who believes her/his subordinates are "stupid," will indeed encounter a lack of motivation in the workers. The old self-fulfilling prophesy thing. It makes me very clumsy and nervous, a bumbling idiot, when I've had to be around people who think I can't do a job. I bet it is really hard to be a manager though, especially with nursing, where peoples' lives are at stake. Good luck in the future with the crew, and I hope you'll be a better captain.

[eightB]

I do agree there are some nurses in all titles that make you speechless with their lack of.... skill, common sense (I really don't want to call anyone stupid). I've read all your postings and yes I've come face to face with nurses that just don't seem to care, not just about the patients but about their Licencse they worked so hard to get. What is wrong with them? :angryfire

I also see you all have a hell of a lot more responsibility that I do. I work for a city hospital and they limit the amount of work and LPN can do with their polices and procedures. It wasn't because they felt LPN's couldn't completely the work correctly but because we were doing it all and the RN's couldn't answer simple questions on their Pt. So now we are only to assist the RN.

We are not allowed to make objective assesment only subjective. We can't infuse any fluid on a pt with central line, can't preform Blood transfusion. The list is long so I'll stop there.

After reading all of your posts I have nothing to complain about. Other that working with some of the most useless nurses ever to grace a hospital.

Sorry for getting of the subject

[solarwind]

yah well. . .

I have been doing this sort of work myself for the last 5 years depending on the facility and it can be very challenging. Sometimes a facility doesn't even want someone to "supervise" but need it by dhec standards. And may hire you by title but just another regular floor nurse. Don't get me wrong that is fine too. . .but I would rather be one or the other if they don't really need someone to over see the process of nursing, I'd just as well work the floor and be responsible for it alone. One facility I was at was serious about this process and wanted a supervisor. . .I did rounds twice a day in every room assuring that the residents were cared for and rooms were orderly. Nursing assistants were responsible for intialing and correcting what I had checked that was wrong. It's the little things. . .vital signs were done before 11am so the nurses could assess them and get to them. Water and ice was given out twice a day, residents were up, cleaned and dressed. Beds made at a certain time. And still had time for the nursing interventions. If I wasn't doing rounds, they actually would call me and ask when I'm coming. You see here is the expectation and order they anticipated. Most of them knew without question that if a resident's condition was declining that a full set of VS were expected.

I was there for four years and felt I had them trained.

You see, nursing homes are a different animal then hospitals. DHEC standards for nursing homes haven't changed in more than 20 years. The ratio of nurses, nursing assistants to residents have stayed the same. Although, there are now assisted living homes and other alternatives to the nursing home. So now you have more total care and acute cases in nursing homes then let's say 20 years ago. For the most part nurses don't have time to supervise the floor while also carrying out the expected duties of the med pass, wound treatments, and nursing interventions that are required to perhaps 40 residents. I felt I was there only to support the nursing process where this system of care has pretty much tied the hands of nurses.

I had the time for the call for the declining resident and took over the duties from there. The time for discharge and admission process and a host of other things that could go wrong on the floor. I did wound treatments on the slower days to help out the nurses. But the nurse always knew that she was responsible for them If my hands became tied.

If your facility does not free you up to able to do this, I suggest it's the wrong facility for you as a supervisor. I've been in both, just make sure that the facility is serious about the quality of care delivered and take into consideration of the nurse ratio to residents to care for. If you have worked on the other end of the spectrum as a nurse, you get a better idea of what it's like and appreciate the back up a supervisor brings to the floor.

[NNNikki]

Okay - it sounds like you need a little intervention on the nurses in question but teh question is what?

First thing to ask is Could they do it if thier life depended on it?

If teh answer is no then you need education.

Just because they have been through college does not mean that they know how to assess correctly - never mind that assessment if a major study in some places there are some major fallacies within the theoretical unperpinning of patient assessment - but that is another thread. All I will say for now is check and see if they have been taught to assess normalacy or abnormality. i.e. Do they understand teh significance of Korotkoff sounds and how these will affect an electronic BP measurment.

If the answer to our question of could they do it is yes tehn we have to ask why they will not do it and here we have several possibilities

1) motivation

2) lack of self-confidence

3) personal factors

4) laziness

Sometimes it is a matter of the "stomaltherapist effect". In hospitals who have a stomaltherapist nurses do not bother to learn how to assess and treat wounds - tehy call the stomaltherapist in hospitals that do not have this position the nurses are forced to do it themselves.

They may be sitting back because they think you will do it. In this case an inductive talk would be the best strategy. DO not "lecture" them because they will only close thier ears as they have "heard it all before". Instead have a teachig session that asks questions that challenge thier knowledge e.g. Why would you do an apical heart beat on a patient with an irregular pulse?

I hope this helps.

I know this thread is very old, however, I must commend you on your outstanding assessment of the individuals that are being called into question. I, as a new nurse, find myself asking very simplistic questions, and even having to admit that I haven't the experience or can't remember how to do something taught in school. I feel sometimes there is a lot of impatience with me but the truth of the matter is, I hadn't encountered a lot of things in clinicals that I do now in the field, and besides, the differences between theory and application sometimes are literally night and day. Thank you for shedding light on this (though be it 4 yrs ago;)

Nikki

[TheCommuter, BSN, RN]

Very old thread alert. . . this thread is over 4 years old, although the numerous posts still remain extremely interesting to this day!

[Babygrl21699]

I know exactly what you are saying. I just got promoted into nurse management and I wonder honestly where some of my nurses got their licenses, or how they got them for that matter. We have residents sent out almost every weekend because they are haveing severe abdominal pain or something of the likes. Nurse calls doctor says she needs and order to send resident out, sends resident out, and then approximately 4 hours later resident is back with bowel obstruction or constipation as the dx. Hello what do we have MOM for and suppositories. Just this last weekend I had a family memeber come to me and complain that a nurse was on her cell phone her whole shift, and when someone approached her ie family or a resident, she would tell the person on the phone to hold on and lay her phone down to help them and then go back to talking on it. She also told a family member can't you see I'm busy right now i don't have time to talk to you. ARRRGGGHHHH some peoples kids.

[NeuroNut]

In my hospital they are getting rid of the LPN's.. which means in two months, I am out.. after 19 years. My frustration comes in when (and this is a true story) a new RN came up to me last weekend and told me she had only put foley's in female pt's, and needed to put one in a male, and she asked me should she just go until she saw urine, or should she advance it further after that... I sat there dumbfounded.. this was a RN. They want to get rid of us LPN's and keep those kind of nurses??? I just don't get it