Disrespectful Nurse aids

[holdensjane]

I am a new grad RN that started in October. Overall people on the floor have been supportive. But I'm having trouble with some of the assistants. I work on an oncology floor so weights and I/O are important. alot of the times they will chart numbers that are way off and when I ask them to do it again they will give me attitude. I always say please and thank you. Well just three of the assistants there are like that. They're all regulars on the floor and have been there many years and are many years older than I am. I'm only 22 and look like i'm 16. Today one of my patients have been having high BP for several days so I gave a bp med and at nine and asked if the PCA would check it again in an hour. Nine is around the time she gets the vs in the chart and reports to me a higher than normal bp. anyway, she says "well I just took it right now...." with attitude. then in the afternoon comes around and comes up to me and tells my patient's bp is 135/87, then she says she got confused between patients and its actually 178/90, and then after another second she says "no wait, rm 09 its 157/75". I say okay not thinking anything and casually just asked her to record it in the chart. She was standing right there next to it and chatting with someone next to her. The next thing I notice she's going into another room to take another bp and says to me "oh no, i got the wrong patient again, 09's bp is 135/87". This time I was thinking "okay which is it" but i didn't say that I just say "okay can you just record that in the chart please" and she says "YES I WILL LATER, I am taking vs right now, I cannot do that". Ok so i figure she's busy so i say "well could you just read me off the vs and I'll record them just so I have something to work with", then she got irritated and said okay and left to continue her vs. and nothing happen. So i got frustrated and took the dang bp myself. The reason I wanted her to write it down was because I knew she was confused so I figure if she writes it down, I will be getting the right BP since she'll have to decide which BP it was and it will be official for me. Oh yeah and earlier in the morning she was emptying out stool and asked me to come see it (i was in the room) she had already flushed it at the time but there was still some red tinted fluid left. I asked her if there was urine mixed it and she said that there was not because the urine was dark but normal. Well I didn't see the urine so I was trying to assess the situation her dark but normal can mean something different that me right? so I asked her again "so there was no red in the urine at all?" and she said "OF COURSE NOT" to me in front of the patient. Like I had just asked her a stupid question, I just wanted to know if maybe the urine spilled over to the stool. anyway, she proceded to say "maybe you want to get an order from the dr. to check blood because let me tell her the smell of the poop and the color I think is blood, it does not smell normal". she said that to me and the patient. Of course I'm just starting out but I was also a PCA before I starting working as a nurse there and sometimes would float to that unit. The patient said she had tomato soup last night. Then the PCA just said "well I'm just telling you". I personally didn't think it was that big of a deal because tomatoe soup sounds reasonable an answer but I figure i'm a new grad and was willing to hear what the pca had to say, but I just felt really disrespected. when I was a pca I NEVER acted that way. I went and told my preceptor the situation (just with the patient, not the pca) and she said that it was probably the tomatoe soup too. I feel like i shouldn't bring this stuff up as a new grad cause I don't want to get black listed. Somtimes I'd rather just suck it up and do things myself. I don't get this from many of the other PCAjust the older ones who have been on that floor for many years. a big part of me is saying just to suck it up, what would you do if you were in my situation? btw, the three assistants that do this are also big gossipers. i keep thinking maybe its something I'm doing, but I always say please and thank you I just feel like they get annoyed when I ask them to do something. when i was a pca i always her how pcas are lazy but i never understood because I always tried to do what the nurses told me. and now more and more i'll hear from nurses that pca are unreliable and will find an excuse to keep from doing something.

[RNroseshea]

Sorry to hear what you are going through as I can identify with being 26 but looking 19-20 (even some think I am somebody getting credits for high school nursing..which I have never heard of but patients have said it to me). I was a sna first before being a RN and even when being a sna, most of the good nurses checked their own bp because of the parameters and ultimately their license. However, in the future, I would suggest checking my own bp on patients with those meds because your license is on the line, not the cna. I work telemetry and I check all bp meds right before I give them and count apical pulse myself. Those 3 cna's do not sound too trustworthy so I would take the situation into my own hands to prevent any mistake on the patient.

I have had cna's even ask me what was the output for a patient (when I was clearly the one emptying the urinal that had been sitting bedside for hours) and I would tell them that I will chart it myself. It seems that at times they don't want to do their job even for patients on strict I/O (with IV's, TPN, lipids). Your patient may even spike a fever without you knowing because some can write down whatever values they want. I do think that some do make a mistake at times but I would ignore their behaviors and take care of my patient first.

Good luck with dealing with them as they appear to be a handful!

[Natkat, BSN, MSN, RN]

It seems to me she has her panties in a knot because you have moved on to the next level and she can't, for whatever reason. That issue can be dealt with over time, but the priority today is making sure the patient is okay.

If it were me, and the person couldn't clearly remember who had what blood pressure, I'd go take it myself. There is too much at stake at the moment. I'd also walk behind her and assess urine and stool after she has done it, not saying anything to her, just because I need to know.

The problem is that while she's taking out her frustration on you, it could leave you in a really bad position. This might be her intention, but then again, maybe not. Some people are capable of being that hateful. There is also that chance she's just having a hissy fit and not giving any thought to how her temper tantrums are putting the patients in danger and your license in jeopardy. If you can focus on making sure that the care is done right, it will keep you from thinking about her so much and it won't get to you so much.

Chances are, she'll get over her resentment over time and she'll be more cooperative. You can decide for yourself how long you're willing to wait for things to change. If after, say, 3 to 6 months she still acts like that, then I would think of moving on.

You could try confronting her but size up the situation carefully. Sometimes these things can backfire. In this case you have to be more careful because she's been there a long time. It's harder to get rid of people who have been around forever. Meantime, as someone suggested, jot down incidents as they happen. I sincerely hope you won't have to do anything about it and she'll settle down. But just in case it doesn't get better or, God forbid, it gets worse, you have documentation.

Good luck.

[COTA_2007]

motorcycle mama said:

I had an aide once call me to get up from my charting to come stand at the shower room door to keep an eye on her patient. I thought she had something important to do. She went and sat in my seat and called her friend to see if she wanted to go out that night.

It didn't happen again.

That reminds me when I used to work on an adolescent psych floor as a tech. I was doing a 1:1 down the hall watching a patient and another tech was in the dayroom watching the other kids. Anyways the other tech called over the LCSW to watch the kids, because she had to do something. The LCSW and myself kept looking over at each other wondering where she was. It turns out she was around the corner talking to her friend from housekeeping for an hour while the social worker watched the kids for her.

Some times I noticed techs can be brazen and really try to push limits with other staff to see how far they can get with them. It use to upset me when I was a tech to see them taking advantage of other.

[Ms Kylee]

We're not all like this... some of us take things seriously. I am lucky that I have nurses that come and check urine and stool if I say something just doesn't look right, can you check it? And I don't flush it till they say I can. When I take vitals, I take a sheet with me and write down every patient's room #, their vitals, and the time I took them. Anything abnormal, I report to that patient's nurse, and when I chart, I write "reported xxxx to XXXX, RN". That way my butt is covered, and so is the nurse's.

I just cannot believe aides act this way and get away with it. This crap wouldn't fly for a minute on my floor before she would be shown the door.

[Tweety, BSN, RN]

Kylee45 said:

We're not all like this... some of us take things seriously. I am lucky that I have nurses that come and check urine and stool if I say something just doesn't look right, can you check it? And I don't flush it till they say I can. When I take vitals, I take a sheet with me and write down every patient's room #, their vitals, and the time I took them. Anything abnormal, I report to that patient's nurse, and when I chart, I write "reported xxxx to XXXX, RN". That way my butt is covered, and so is the nurse's.

I just cannot believe aides act this way and get away with it. This crap wouldn't fly for a minute on my floor before she would be shown the door.

It's maddening that a few bad CNA's can ruin reputations isn't it? Kind of like when people say "nurses eat their young". ?

I've long learned that when a CNA tells me to check something out with a "this patient doesn't look right" statement, I immeidately drop what I'm doing and check it out. 99.999% of the time they've just saveed a bad outcome from happening and and perhaps even saved a life. We RNs like to take the credit, but often it's the astute eyes and ears of the CNA that is most important.

[abooker]

I'm very fortunate with the aides I usually work with on my hall. There are problems sometimes when aides usually assigned to other halls float over to mine. I've heard a lot of attitude; "This isn't my hall" (after asking for monthly vitals) and "That resident is not assigned to me" (In response to helping a lady to the bathroom while the other aide was at dinner) and my all-time favorite, a complaint about me to my supervisor - "Make that nurse stop telling me how to do my job!"

I'm wondering if sometimes you have to reprimand someone, and then the other disrespectful aides get the message - at least for awhile - that you expect them to do their jobs. For me, it isn't the disrespect, but the fact that vital signs aren't complete, residents aren't turned on schedule, and there is dried, crusty stool all over the resident I'm treating for a pressure ulcer, even though her brief is clean. This last problem re: dried stool is purely hypothetical and would never happen where I work. Never, ever.

Where I've encountered disrespect, from aides and peers and supervisors, is when I question whether something is right, and I get what I call the "How DARE you" response. I think the "How DARE you" statement comes from a guilty conscience. When I shared the hypothetical dried stool problem with my NM, I was told, "You can write her up for insubordination" (I'd immediately pointed out the problem to the aide and had requested she clean the stool so I could do the dressing. I received a huge "How DARE you" response. She called me the B word).

If this had actually happened, I'd want to write that aide up for improper personal care technique.

But I can't write the aide up for this, because I couldn't prove it - I couldn't prove that my resident hadn't produced a very dry, smeary stool that had hardened instantaneously on contact with this resident's skin without a drop of it getting on her brief. And I hadn't personally inserviced this aide that she needed to clean residents' bottoms when changing their briefs. And I couldn't prove that some sudden, previously unreported emergency had occurred which forced this aide to heroically rush to the side of another resident in distress, thus leaving the trivial dirty buttocks issue unresolved. Grrrrr ...

Addressing a personal care issue would imply, hypothetically, that my facility as represented by this hypothetical aide might possibly have provided improper personal care, and this must never be documented anywhere, ever.

Insubordination is ok to document.

Disrespectful nurse aides ... is that the core issue, or is there something else going on? The "How DARE you" response is disrespectful, as is being ignored, or gossiped about, or lied to. The problem is that writing someone up for insubordination leaves you open to a "not a team player" attack. I've only been nursing for a year, but the key for me is to not take it personally. The B word is kind of complementary, really. I know that sounds weird, but if the best response someone can come up with is a personal attack, than they've realized they can't argue with the facts of whatever you're questioning and must stoop to change the subject by attacking you, personally. If you're getting "attitude" you've won.

Remember, being a good nurse is not the same as being a nice nurse. Insist that people do their jobs to the best of their ability, and they'll treat you better. Don't take "attitude" personally; it's their chip on their sholders, not yours. The vast majority of aides are great, they just don't get recognized or appreciated because often their job is noticed only if they're not doing it. Try to catch the problem aides being "good" and complement them on it, if you are sincere.

Best of Breed

[jlcole45]

I know it's hard girl but you have to call them on it - as it happens. Be assertive, brief, and clear. No smiles, no apologies, and only a thank you when it is done properly. You are the RN, and your job first and foremost is to be a patient advocate.

You must have accurate vitals!

It's time to do some writing up! The heck with being nice, you're there to do a job not make friends. A patient's health is on the line and if they don't get that then they need to find work and the nearest fast food joint.

As you can tell I've had my fill of incompetent, lazy, uncaring nursing aides with an attitude.

It's a shame because it's usually just one or two but their bad apples and sometimes their attitude rubs off on the good ones.

Good luck.

[mizfradd, CNA]

Tweety said:

It's maddening that a few bad CNA's can ruin reputations isn't it? Kind of like when people say "nurses eat their young". ?

I've long learned that when a CNA tells me to check something out with a "this patient doesn't look right" statement, I immeidately drop what I'm doing and check it out. 99.999% of the time they've just saveed a bad outcome from happening and and perhaps even saved a life. We RNs like to take the credit, but often it's the astute eyes and ears of the CNA that is most important.

Thank you!

Some of us are proud of our chosen career as CNA's and strive to do our very best for our patients and superiors.

I enjoy my work and believe me, there's not a jealous bone in my body over not being an RN....I never wanted to be one and I'm perfectly happy with my choice. I love being a caring and hardworking CNA.

[al7139, ASN, RN]

I read this and had to put my two cents in:

I am an RN and I spent part of nursing school working as a nursing assistant. Because of this I can look at both sides of the issue.

As a nursing assistant, I worked with nurses who I got along great with and nurses who I couldn't stand. Now, I understand that nurses have their role, and the assistants have theirs.

I have found that the nurses who I hated working with when I was an NA had the attitude that they couldn't do anything but push meds and do assessments, and they were above the "lowly" tasks of getting vitals, toileting, or bathing a patient. If I needed help their attitude was that it was my job, and deal with it. Meanwhile they are talking on the phone, or sitting around and gossiping with their co workers.

There are nurses that are just the opposite, and will willingly help with the "menial"tasks if they have time.

Now, you don't sound to me like the first kind of nurse, so I have to assume that the attitude you are getting is because of a preconceived judgement that nurses don't do these tasks and think they are above doing the "menial" jobs.

Having been on both sides, and having experienced that same attitude from NA's, I can only say that I have favorite NA's that I like to work with, because thay are on their game, understand how busy we nurses are, and if they need me, I know it's something I need to check out. I also see when they are swamped, and will help if I can. Besides, what better way to assess skin than to help clean up a pt, or look at stool or urine.

It took a while, but once the NA's saw that I would help if I can, their attitude changed towards me.

Amy

[DeLana_RN, BSN, RN]

(((( Hugs ))))

Been there, dealt with that crap, first on a med/surg floor and later in a dialysis clinic. It's difficult - like pp have said, there are jealously issues, age, and of course they're testing you right now to see how much they can get away with. And although you are an RN, and clearly their superior (and they know it!), it can still be difficult to assert yourself and ask them to do their jobs. After all, they can make your life miserable, and they know it.

All I can say, hang in there. Treat them with respect, ignore some things (pick your battles), help them if you can, but don't overdo it. Eventually, it will get better. Do not make enemies (if you have a real problem with one or more, insist that your manager deal with it, while keeping your confidentiality!)

Best of luck,

DeLana

[Okami_CCRN, BSN, RN]

Everyone loves bashing the NA's because its so easy to do. but we do so much and get such little recognition. There are days when I have 15+ patients and I change everyone, pass out water, do my glucose testing, draw blood, organize the rooms. and RN's still want more. Today I had 28 patients and I still had RN's asking me for glucose results when I have 28 patients to take care of. I find it extremely unsensitive and disrespectful for them to not ask but demand I do that for them. RN's need to understand that yes they have to chart and pass meds but they must help the nurses assistant because we're not there to chat and gossip but to take care of patients. It really pisses me off when RN's talk about us being jealous because we "couldnt pass Nursing School" not all of us want or went to nursing school. Im going through nursing school right now and I will never be a lazy RN because my patients need me. *sigh* Please guys just help our ur NA cause we're swamped and tired and the smell of stool gets to our head.

[holdensjane]

dar15 said:

Did you say that you worked with these staff previously as an aide? That they orientated you?

It does sound like sour grapes! Suddenly you have gone to the next level, and they don't like it!

Question...Were they like this to you before you became a new grad?

No i wasn't treated like this before thats why I don't understand where all this is coming from. I've had other aides that have been wonderful and I don't meet the this kind of resistance. I always tell them to let me know if they need my help. Its not like I boss them around or anything. what is difficult for me is that I see the way these seasoned aids act and it appalls me because when I was an aide I would NEVER act like that. I would didn't care if I had to get ten bps on one patient, IT WAS MY JOB. and I noticed that anything this particular aide has to report about my patient she will ONLY report to my preceptor like weight discrepancies, even though i'm nearby and am more accessible. She WILL WAIT until two hours later to report it to my preceptor. I only found out because I overheard her saying it to her. which btw, it wasn't anything to worry about because she was comparing the wrong weights, and I already calculated weights earlier and they were fine. But it was just the idea that I she obviously noticed an issue and instead of addressing it to me when I was available, she waited TWO HOURS just so she could report it to my preceptor and not to me. I keep telling myself to pick my battles because I'm still struggling just to keep my own head above water. whch on another note, please tell me I will get better at being a nurse. I always feel bad when a multidisciplinary member asks me a question about the patient that I don't know the answer to but my preceptor is able to answer without even thinking about it. How does she do that?!

p.s I don't think its jealousy because two of these aides are in their fourties and fifties and have lives established for themselves so i don't think there would be reason to be envious of me who just graduated college.