Trouble adjusting to my new unit

[Melanin]

I just transferred to a new unit, and yes, I realize it takes a while to fit in and maybe I'm being tested, I don't know.

Anyway, one (of many) incidents stands out - I came into a room during morning med pass to give a patient a bunch of medications. I try to prioritize so that I can get everyone's meds out on time, especially those with time-sensitive medications such as antibiotics, so I'm usually pretty squeezed for time first thing in the morning - but I do my best to cover all the bases. Anyway, as I was preparing the medications & the CNA was in the room delivering a breakfast tray, the patient mentioned that he really wanted to take a shower. The CNA then left the room. I acknowledged what the patient said about showering & finished up with the medications. The patient again said that he really wanted a shower NOW (he was ambulatory - just needed supplies, IV wrapped, IV unhooked, etc.) I unhooked his IV and called the CNA to ask if she'd mind bringing towels and wrapping the patient's IV while I continued with my med pass. Over the communication device (which broadcasts everything, unfortunately), she told me that she doesn't wrap IVs, so I would need to do that myself, and that I could get the towels and have the patient waiting in the bathroom until she got to the room, then she hung up before I could reply.

I was surprised to hear that a CNA doesn't wrap IVs. To be fair, just the previous month a CNA had called me from a patient's room to tell me to come empty that patient's ostomy bag. Before starting on this new unit, I had always worked on units where CNAs are able to empty ostomy bags & do it pretty regularly. But the charge nurse (who I checked in with at the time, thinking that maybe I was being taken advantage of) confirmed that on THIS unit, CNAs don't do so. SO I went to the charge again, this time to confirm that a CNA also couldn't wrap an IV, because wow, that just didn't sound plausible.

Long story short, CNAs DO wrap IVs on my new unit, but this one CNA refuses, so the charge said that I would have to do it myself. Which I did, after first making sure that my patients with antibiotics got them within the required time frame. No big deal.

Except for some reason, this kind of thing is really starting to bug me. And I can see that I'm rubbing some of my coworkers the wrong way by asking about behaviors such as these. I wonder if I need to wait it out and see if I can get used to things on my new unit, or whether the place is sort of dysfunctional, or whether I'm being too rigid, or what.

Any thoughts?

[JKL33]

It would bug me too...

But, you know, you'll run into people like this randomly - lots of nursing units have one. Some people would say to write up these incidents...definitely one option. Personally I try to develop a rapport over time and have found that very successful. What I won't do (which is probably why the write-ups never seemed like a great option to me) is engage in a power struggle or play any kind of games whatsoever.

I wouldn't be thrilled if that's the accepted overall culture on your unit.

[nursemike, ASN, RN]

It sounds to me like you're handling things about as well as you can, but it isn't hard to foresee the need for a serious talk in the near future. Taking your account at face value, it sounds like the CNA was more or less giving you orders: "You can get the towels..." Maybe her tone was different, but I can easily believe it was just as I inferred. Aides will test new nurses (even experienced nurses new to the unit). I don't actually blame them, and I think some don't even realize they're doing it. Anyway, one way or another, they want to know whether you are someone they can trust and respect, and a very few want to see if they can get you to do your job and theirs, too.

I think you'd be well within your rights to insist that the CNA bring the linens, and promptly. I think it would be entirely right to make it clear that hanging up on you is unacceptable. I think it's essential that when you ask her to do something, it's not a request, it's an order. If you're like me, saying these sort of things will make you anxious. Thank goodness it isn't often necessary, but in my case, I've started making a point of addressing this sort of thing early on, before I really start getting angry about it. Anger is a motivator, but I'm a tad too inclined to revert to my carpentry days. (On a construction crew, "horizontal violence" can mean one or more parties ends up horizontal.)

What I use to motivate myself, what makes it necessary to do so, and how I try to frame my discussion, is that it ain't nothin' to do with titles, or egos, or anything else but the patients' care. Over time, I have come to the decision that, within my scope of practice, my patients are MY patients, and if it comes down to it, I'm the boss. If my charge nurse doesn't like it, he or she can relieve me of my assignment. If my manager doesn't like it, she can fire me. If my assistant or a fellow nurse doesn't like it, tough. As long as a patient is assigned to me, I call the shots. But I also try very hard to include the assistant, to make it OUR patient. I know what I respect in a doctor, so I try to project those qualities as a nurse. But I often tell my patients, and practice as a nurse, what I learned when I was a patient: It's nice to be nice, but it's important to be heard. If you have to chose one or the other, be heard. (Then I work my butt off not to make them chose.) Good luck.

[sevensonnets]

I think your first mistake was in asking her if she'd "mind" bringing towels and wrapping the IV site. It is your responsibility as an RN to delegate a task to assistive personnel. Your license allows that. I'd have said, "I need you to bring towels to Room 16 as soon as possible so the patient can take a shower." Then follow up when you can to make sure that was done.

[Melanin]

Yeah, I'm pretty bad at delegating & dislike having to do it when I don't have a relationship with the person yet but sense that they are testing my boundaries.