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.

[caliotter3]

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.

Possibly doctor and/or family calling too.

[loriangel14, RN]

Where I work there are no aids on nights.Guess who does the rounds and changes bottoms at 0600. I think the OP should help.Many hands make light work.

[nickos]

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.

I know that some places do hourly rounds, but I wasn't clear about exactly what the OP meant. If the above is the case, then I don't see how the OP can be expected to put off her morning rush work that HAS to be done. It doesn't sound to me like they are unwilling to help in general, but rather that they have their hands full at that time of the morning. If that is the case, I think that the aides starting just a little earlier is a good idea.

If the opposite is true, and the nurse has the time but feels like they shouldn't have to help at the end of the shift for incontinence care, then I would lean towards saying that it would be best if they lent a hand even if they wanted downtime like the aides have earlier in the night.

[6mostogo]

What is the census like for the 2 aides? What do you considered "strapped?"

I might be going out on a limb, but I've been a CNA 9 years, and I've never expected the nurse to help with bed checks. Obviously the nurse is qualified and able to help as needed, but I in turn can not help with the nursing duties which need done. Now, if the census is high and/or the 2nd aide called in, I would understand the need for help, but the two aides should be asking each other for help before pulling a nurse from med pass. If the two aides can't finish in 1 1/2 hr, then start 2 hours before shift change. At shift change, the day shift aides should be doing a walk though with nights anyways for the next scheduled bed change.

Obviously they can get it all done in two hours, as you say all night long they have time to sit and talk b/t q2h checks... I never had time to sit and talk when I worked nights.

[SaltyNurse]

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

Of course "booty duty" is every nurse's responsibility. The great majority of nurses have no issue with that. I agree that nursing is more than charting and passing meds. However, a nurse can't opt out of those responsiblities in order to please the aides. And the aides certainly can't assess, treat, document, etc. to free up the nurse for "booty duty". The nurse must take care of those things, that's the whole purpose of having "help". It's not cool for the aides to be overburdened, by any means. However, they shouldn't complain about doing the work they were hired to do. The nurse's first priorities are to take care of the needs that cannot be delegated without the pressure of delegatable tasks just to please the subordinates.

At the risk of my own booty getting flame-singed- I will say I am so, so, so happy to work in the type of environment in which I don't have to sweet talk, coax, cajole, what have you, an aide to do their job. In my unit, on my shift, there are NO aides. I have to do it all. And I'm more than happy to. I know my patients' hygeine will be taken care of promptly, thoroughly, and in a dignified manner. When I did work in a department that had aides, it was quite the crapshoot, depending on whether the aide took pride in his/her work or whether he/she was just there to git 'er done with as little trouble as possible.

Good luck, OP

[SMOOTH]

From my experience. The noc aides are normally lazy and try to get away from alotta things. Its no wonder the AM shift gets mad at them everyday.

If you see them sitting around, I would 'joke' around with them and tell them you smell something.

Also at the start of your shift, have a quick meeting with them and telling them what your expectations are. Let them know you will be willing to help out, but that you have other duties as well and you EXPECT them to pull their weight.

good luck.

[jerenemarie]

When I worked the noc shift I went on rounds with the aides & helped with changing & repositioning & I also answered lights. The aides respect those nurses who go out & "get their hands dirty"!

Thanks,

Jerenemarie

[mamamerlee, LPN]

"L&Dnurse2B" The OP states she does help when she can, but during the morning rush it can be too time-consuming to stop and help. So get off your high horse, and when you do become a nurse make sure you read and absorb everything before you make comments.

I agree with gentlegiver - do what you can to help earlier in the shift, then it makes them feel that you are part of the team.

And, as long as you are in uniform, you will be wiping bottoms.....

[aehart]

I think it is important for everyone to help with incontinence care....from aides to RNs. Of course it gets busy....for everyone, but that doesn't mean anyone should be exempt from helping out. Maybe you could round on the incontinent patients before you start your busy time. That way it cuts down on the people who need cleaned up when you're busiest. Working with each other comes down to two major things: Compromise and prioritize.

[guest2210]

My first job at an LTC facility after NS, I was reprimanded by the night supervisor (an LPN) for helping the aides with bedchecks during the night, because "none of the other nurses do it". It didn't stop me from helping them and assessing my patients.

What about the q2h toileting schedule for the pts who are ambulatory? If the cna's have ample time on their hands during the night, this could keep them occupied and possibly make the morning bedcheck go a little better. Just my 2 cents....

[Simply Complicated]

The way I look at it, having RN behind your name doesn't make you better than someone else, just qualified to do a different job. I am the type nurse who helps out whenever I can. I answer call lights, I put people on bedpans, I help with baths.

I also work with nurses who will go out of their way to find the aid, and tell them to bring room X an apple juice, when they could have gotten it faster than it took to find the aid. It sucks because the nurses who don't help make it harder on the ones who do help.

Aids that just don't care and cut corners every way they can.. different story!

[Bobylon]

Can't really comment, beings that on the floor I work on and 11p-7a, there are only 2 R's and 1 to 3 L's, virtually never, ever a CNA or PCT..... we nurses do everything (unless the floor is full and acuity is through the roof, we MIGHT get a CNA....but rarely....extremely rarely). And we gladly help each other (and the PCT/CNA, should we be lucky) as, in the end, it's a team effort to take care of these folks in our care. Love my floor and co-workers .... and MOST of the "clients"