Faulted by aides who want help with incontinence care

[Calliehoo]

Hi,

I'm a nurse only 2 years out of school and this is my first nursing job, in psychiatric nursing at a small, acute-care psychiatric hospital. I was first a staff nurse, and then when I switched to nights I became (by default -- LPNs can't do charge) the charge nurse on the geri/medical unit.

I'm having a problem with the aides. On nights, we usually have two. They are not overburdened by work, to say the least; they have ample time to sit around and talk while I and the other nurse are working. It tends to get very busy for the aides in the mornings, with incontinence care, but I'm busy too at that time, writing notes, preparing for report, dealing with patients -- the charge nurses have their own patients (usually from between 7 to 10, depending on census).

One or two of the aides (who tend to be malcontents) spoke to the nursing supervisor that I don't help them enough on the floor, meaning incontinence care. The fact is, I do when the aides are strapped, but not 1 1/2 hours before the end of shift. The nursing supervisor suggested that to motivate them and to improve morale I participate more in that type of thing.

My question: Is it a common expectation that a charge nurse wipe bottoms? Staff nurses, too? Are the aides trying to run the unit, and is the nursing supervisor assisting them in their goal?

Thanks so much. This is my first post.

[L&Dnurse2Be]

Umm...do you really think that you are exempt from wiping bottoms because you are a nurse? I would rethink things. Incontinence care is everyone's responsibility. As a nurse you should take that time to make a full skin assessment, and check on your patient. I know that you have other responsibilites that keep you from always helping the aides, but never think you are above wiping bottoms, that is just part of nursing. I can see why the aides are giving you trouble... just my 2 cents.

[roser13, ASN, RN]

L&Dnurse2Be, may I just ask....are you a nurse?

[SuesquatchRN, BSN, RN]

Calliehoo, it sounds like they want help on last rounds and that is emphatically not something with which you can help. You have, at that time, a a.m. med pass, cart prep, narc signing and counting, and report, not to mention charting.

[kiszi, RN]

Every unit has it's own politics. Each shift, too. I've worked all shifts and noticed that night shift nurses are sometimes expected to help out more. No place I've worked has "required" me to do "aide" work, but I always helped out as much as I could. Your sup. isn't blowing hot air by talking about how it will help the aides' morale if you help them. And they will, in turn, be more willing to give you a hand when you need it.

I would suggest doing what you can to prepare your notes/report before the "big rush" in the mornings so you'll be more free to help. A little help may go a long way.

That's not to say your aides are or are not running the floor or manipulating your supervisor. But the point is, you're a brand new nurse, these are your co-workers, and it's best for everyone involved if you make an effort to lend a hand and "feel out" the unit to see what is expected of you.

Also, as a new nurse you will find your time management is not optimal right now. That will improve with time.

P.S. everything in an aide's job description is in a nurse's, including wiping bottoms.

[nickos]

I want to make sure I understand the OP.

Are you saying that the aides put off even checking/cleaning/changing pts until the last hour and a half, and THEN expect you to help them? If so, that's screwy on a number of levels...

[mammac5]

Unless you've been working with these NAs for years and really trust their judgement, you can't chart the skin assessment without actually seeing it for yourself...as long as they're soiled, you may as well take a peek at the skin.

Having said that, you have a lot of add'l responsibilities as charge and I can see why it's important to pick and choose when you are able to pitch in with direct, hands-on patient care.

On the other hand, I can see mgmt's side of this issue as well: NAs are hard to find and keep so mgmt wants to keep them happy and on the job as much as possible. It would have been great, though, if mgmt backed you up and instructed the NAs to come directly to you with a plan of how patient care could be delivered in a better way during crunch times rather than just telling them (apparently) that mgmt was going to deal with you.

In other words this is actually a complex problem and not just an issue of whether or not charge nurses wipe bottoms.

[Batman25]

Anyone and everyone should wipe heinies as needed. The question is are they really burdened and do they really need the help OR are they trying to take advantage of you and involved in a power struggle. Which do you feel it is?

Also, if they have ample time to sit and hang out while the nurses are working you need to delegate them more work. There should be more balance.

[SuesquatchRN, BSN, RN]

I want to make sure I understand the OP.

Are you saying that the aides put off even checking/cleaning/changing pts until the last hour and a half, and THEN expect you to help them? If so, that's screwy on a number of levels...

nickos, aides do "rounds" at specific times to check that the residents don't need changing. While I am more than willing to wipe a bottom I do NOT have time ate certain times during the shift, and the last two hours on nights cannot be rearranged. Been there, done that. The meds are schedued for 6 am and take a long time to pass.

[gentlegiver, ASN, LPN, RN]

Would it be possible to help them out with other scheduled rounds, say, earlier in the night? If possible then perhaps they would be willing to give you a "pass" on the AM rounds. That being said, did you explain to the NM that they want you to stop Med Pass to help them??

I have that arrangment with my CNAs. I'll help them thru the night but when morning comes I have to do meds, chart, give report etc... Works out great.

[anewday]

Umm...do you really think that you are exempt from wiping bottoms because you are a nurse? I would rethink things. Incontinence care is everyone's responsibility. As a nurse you should take that time to make a full skin assessment, and check on your patient. I know that you have other responsibilites that keep you from always helping the aides, but never think you are above wiping bottoms, that is just part of nursing. I can see why the aides are giving you trouble... just my 2 cents.

I couldn't have said it better myself. I wish people would realize that as a nurse you are not above wiping bottoms, putting patients in the bathroom, giving showers and all the other basic nursing duties that many think they are too good for. Nursing is more than charting and passing meds. What if you worked on a unit with no aides? Then what? Yes and examining the skin of an incontinent patient is apart of nursing assessment. What better time to do this than during incontinent care

[caliotter3]

My opinion is that the aides are trying to run the unit and the manager is assisting them. Surely you have the judgement to be able to tell when you should and can help and when you shouldn't and can't. The aides can start half an hour earlier if they are incapble of getting their work done or they can put more effort into speeding it up. Often all it takes is for them to work in pairs like we used to do. When aides work in pairs they free up all sorts of time.