Faulted by aides who want help with incontinence care

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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.

Specializes in med surg nursing.

OK, I'll probably get some negative feedback for this but here goes. I get angry when I answer a call bell to get someone on/off the bedpan and I ask the aide who is walking past the room to go out and smoke and she replies in her most abrasive voice..WHY CAN'T YOU DO IT? Believe me if I didn't have to medicate another patient AGAIN with pain/nausea medication that she asked for 15 minutes ago, I would. What I would like to do, but I won't, is when the aide answers a call bell and tells me that a patient needs her pain/nausea medication... ask her WHY CAN'T YOU DO IT? We as nurses can and will do the CNAs responsibilities but they cannot do ours. So when the aides punch out on time and I'm staying late to do the job I'm responsible for i.e. charting, end of shift reporting, etc, I get a little resentful.

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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. :confused:

This is very true.

Additionally the aides become more busy toward the end of shift because residents are naturally waking and wanting to be toileted and so forth...

By starting a little earlier with last round and starting with those who ambulate to the toilet first, one can possibly alleviate some of the stress ahead of time. If the aides are doing good checks and changes and repositioning all night long - the last round shouldn't be such a challenge.

I have worked with aides who will turn the residents, but will try their best to leave changing until later in the night....NOT good!:crying2:

It would be a good idea for you to spot check your residents if you're not already doing so. Do your skin assessment at the same time. This will give you an idea as to whether the work is being done as it should or being left for last round - thus contributing to the problem at hand.

Offer to help with earlier rounds, as often as is possible, and then be honest with your aides...

Tell them that you can assist with rounds earlier in the shift, but on last round you have XYandZ to tend to. They will probably be receptive if they get the impression that "you're not too good to wipe butts."

Also, if they know you are known to "pitch in with rounds," they are probably going to start taking better care that the resident cares are done properly...which in turn will make for less time for them to sit around....JMO.;)

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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.

If this is true, I agree that the aids SHOULD start doing rounds earlier. The OP is making it clear that during the time they need help, SHE is busy then, as well. If she stops what she is doing to help them, exactly when is she to finish her own work?

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Specializes in Psych.
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

Thanks for your replies, but you've entirely misunderstood. I shower patients, change beds -- soiled and otherwise, wipe bottoms, get supplies, clean urine and stool (including explosive diarrhea) off floors and seats and walls, clean vomit off (fill in the blank). I also fill the supply closet, fill the linen closet, and do patient laundry. All this in addition to my other duties as charge. As a newish nurse who's only worked at this one facility, I was asking (and have now had answered) the question as to how other nurses handle this, particularly in light of juggling their other duties, charge or not.

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Specializes in Psych.
"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.....

Sorry for the delay in responding. Ah, life.

Thanks so much to mamamerlee and others who gave me great suggestions for better prioritizing and team building, among other thoughts (and for also having my back). As I'd said, I am new (green!), and am awed by those of you who make this work look easy (when we all know it isn't). :yeah:

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I love how some of you were so quick to assume that the OP was "above", as someone wonderfully stated, booty duty.

Where in the heck did you get that out of the original post? Because I surely did not sense any "holier than thou" attitude from the OP.

Just read the message for what it is and stop trying to read into things.

To the OP, if they have time to sit and chat, they don't need your help. Sounds like they are just trying to get away with things with the new charge nurse.

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Specializes in pulm/cardiology pcu, surgical onc.

I believe it is a team effort BUT at certain times of the shift the nurse and aides have different duties to complete before hand off to the next shift. Delegating to difficult lazy aides can be very frustrating. They already know what you'll do and just trying to see how far they can push you. Push back a little. Ask them if they can help YOU at the end of the shift.

I had the misconception in my head when I was an aide that when I saw a nurse sitting down, seemingly doing nothing, I assumed that she just likes to sit at the end of the shift and watch me run to answer call lights and what not. Now I know better ;)

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