Having problems with NA's and PCT's

natsfanrn · Aug 12, 2006

Okay - Natsfan - if you can not ask - it just means you are a rude person. Nurse or not. If you want someone to do something - asking them and using the words please and thank you are just plain descency and good manners. Asking, using Please and Thank you still fall under the category of delegating.

I ALWAYS use please and thank you, and make a point to thank my aide/tech every day when they leave work as well for all of their help. But I certainly don't feel a doctor is being rude to me because he "tells" me to run a unit of blood, rather than "asks" me to. I don't have the option to say, "sorry doc, can't do it, I'm too busy...maybe next shift." And while I certainly understand if my aide/tech can't do something right away because of something of higher priority, I do expect them to be able to complete the task within a reasonable amount of time, barring extenuating circumstances.

Just because you tell someone to do something (that is well within their job description) rather than ask them, doesn't mean you're barking orders at them. I do use tact and understanding when delegating, and have NEVER been accused of rudeness!

Marie_LPN, RN, LPN, RN · Aug 12, 2006

I honestly can't wait until you are a nurse.

Boy that phrase was beyond old when i was an aide (when is was meant as a you're-clueless remark).

My perspective on how busy a nurse is, etc., didn't change one bit after i became one, since i knew just how busy a nurse was before being one. Yet that certainly didn't stop the droves of "i can't wait till you're a nurse.":stone

cardiacRN2006, ADN, RN · Aug 12, 2006

Well, good for you. I bet you didn't sit back and say, "what do nurses do all day?" either.

Daytonite, BSN, RN · Aug 12, 2006

Hi, heather1999. . .sorry to be responding to this post so late, but I just read it this morning. I feel your frustration and went through it many years ago myself. You are embarking on a career-long journey to master how to deal with difficult people. One of the first things you should put on a "To Do" list for yourself is to look for and take a one day seminar in "How to Deal with Difficult People". It will put into a nutshell some of the things I will also tell you in this post. It will also give you a chance to pick the brain of the seminar leader with some of the problems you've come across for real solutions.

First of all, your nurse manager has a problem with dealing with this as well. From what you describe, she doesn't seem to recognize or understand the scope of her authority and power. Writing someone up is pretty much what is relegated to those who don't have much else authority-wise. Writing up is powerful, though, because it gets documentation into the record. The manager has the power to turn those write-ups into disciplineary actions.

Second, on your "To Do" list you also need to add a seminar or a course in assertiveness. You have to learn how to confront people who are not doing what they are told. The problem is that you are the one backing down from them and not the other way around. I promise you, the first time you don't back down is a flag waving day. Your heart is beating a hundred miles an hour and sweat will be running down your back, but it gets better and easier each time you stand up to these little toads.

Two books that I keep in my library for reference are:

Managing Difficult People: A Survival Guide for Handling Any Employee by Marilyn Pincus
Working With Difficult People by Muriel Solomon

Now, ideally, you want to be kind with difficult employees and initially you want to educate them to the proper way to do things. However, in your case things have already gone far beyond that. Things have to be stopped and stopped immediately or discipline applied.

Often they "disappear" off the floor without telling us.

You have to take each employee aside, question them as to where they were. If they have a legitimate answer (were with a patient) what can you do. So, word your question carefully. If they are lying and you know it, you need some proof and you need to confront them with it (that should shock them!) and tell them that (1) they are not to leave the floor with your permission (give them the rule) (2) If they do it again you will have no choice but to report them and tell them it will be either by reporting them to the supervisor, manager or writing them up (the consequences) (3) follow through if they "test you" or you'll lose face and legitimate authority with them. If you see them missing again, call the supervisor and tell them you can't find them. Get the supervisor in on this. Never hurts to have a second witness to an employee's wrongdoing and I don't think the supervisors are going to be happy about employees roaming about the hospital when they should be on their units. The supervisor might know of busy places in the hospital where an idle employee can be made useful. I was a supervisor and I sure would know this.

They sit around and gossip.

Not much you can do about this unless they are trashing other employees. I stop gossip that is not productive or about other employees or about the facility You can ask them to help with some tasks if there is other work to do.

They act "put out" when I politely ask for their assistance.

This is just childish behavior that I would ignore for now.

Some just "skip" 2 am vitals signs. One of them makes up vital signs even (I know, because I suspected a patient was running a fever- this tech documented a normal temp and when I followed behind her 5 minutes later, the patient had a fever of 101).

This is insubordination and falsification of hospital records. You handle the failure to do the vital signs the same as leaving the floor. Insubordination is usually reason for disciplinary action. (1) quote the rule (I gave you an order) (2) what happens if you don't follow the rules and (3) follow through. Falsification of records is usually grounds for immediate termination and if the person has a license or is a CNA can be reported with written documentation to their agency and will most likely lose their certification. Don't leave it to your manager. Threaten these people right to their face that you are going to report them to their nurse registry. It requires, however, that you write (document) your evidence. You clearly could have had this person out the door. You have to think about how the patient could have been injured.

I have even had a Tech question my nursing decision to put a patient on fall precautions!

This is just something that you have to deal with. People will sometimes question your decisions to your face.

That is my advice. Over the years I worked with many of the types you've listed. The problem here is that your aides have been allowed to carry on like this for some time, so it is going to take some time to bust them. It also took me a good many years to get proficient at dealing with difficult aides. It's like any skill in nursing. You have to practice it over and over. My best practice came in nursing homes where there were some real tough cookies to deal with. It's harder when they are all together in a group. It's easier when there is only one or two to deal with. Concentrate on one or two at a time. Usually (not always), once you bust one, the others start to fall into place--kinda--at least, when they are in your presence. They'll talk about you fiercely behind your back. So what. My feeling always has been that as long as anyone working with me does what they are supposed to do for the patients while they are on duty with me, I don't care what they think about me behind my back. And, I'm not a mean person, but I can be if I think someone is mistreating a patient or cheating at their job. I will "ride" a bad aide until they either ask for a transfer off working my shift with me or quit. Makes my job a whole lot easier and I don't apologize for it. If my manager can't stand up and do her job, then I just have to find ways to help myself. Remember, I've been a manager before and I know what a manager is capable of.

You did say you were on the night shift, didn't you? I would talk about these problems with each of your supervisors. They are your substitute nurse managers during your shift. I was a nursing supervisor long before I became a manager and, believe me, if I knew what was going on with your aides, I would be red-faced and spending a lot of time hanging out on your unit during my shift. Part of your supervisor's job is to help you with your problems and this certainly qualifies. If you can't get that help from them then I would have to say the problem lies with the entire hospital staff being blase about letting employees like this run all over them.

wonderbee, BSN, RN · Aug 13, 2006

I want to know where nurses get time to sit around cuz I'll fax my application today. Two of my last three 12s were 14s. The lunch from home I brought in for my first shift was still in the freezer for my last shift. My bladder has developed an amazing capacity for capacity. I would love to have a nursing assistant for our ICU just to help us turn and bathe, and assist with hygiene if nothing else.

nathan777 · Aug 16, 2006

I have worked as a CNA, dialysis tech., and Mental Health Tech. all of these jobs are very hard at times and frequently underpaid. However they also carry a professional liability. I have found now that I am an LPN I have to be firm when needed but also stand up for my staff when they deserve it. Once I gain their respect and they give it back things work much better. I was a mental health tech. at my current job while waiting to sit for boards. So I have been on both sides, now I am a charge for the same folks I used to work with. At first they challenged me until I got respect from them. Good Luck

TXNurseBSN · Aug 17, 2006

I have been a nurse for about 6 months (still so much to learn) on a 66-bed Med/Surg/Oncology unit at a community hospital (it's hard work, but I believe it's God's work). We have team nursing-10 patients with 2 RN's and a Patient Care Tech or Nursing Assistant. I work nights. There are several techs that we work with that are just plain lazy! Often they "disappear" off the floor without telling us. They sit around and gossip. They act "put out" when I politely ask for their assistance. Some just "skip" 2 am vitals signs. One of them makes up vital signs even (I know, because I suspected a patient was running a fever- this tech documented a normal temp and when I followed behind her 5 minutes later, the patient had a fever of 101). I have even had a Tech question my nursing decision to put a patient on fall precautions!
So this morning, at 6 am, there are 4 techs sitting around at the nurse's station (doing nothing!) while we were scrambling to not only get our final charting done, morning meds passed and our other morning tasks done, but also giving baths and making beds! And I don't mind giving baths (Great time for skin assessment and skin care), but this morning I had a pre-op patient, 2 patients having pain issues and I was awaiting a call from an MD.
I am a passive person anyway (yes, I need to work on that) and I've never had to delegate tasks before becoming an RN. I haven't said anything to the techs (none of us have) because we're under-staffed for techs as well as RN's. We feel like we have to handle our assistive personnel with "kid gloves" because we are under-staffed. Nursing is difficult enough dealing with patients, families, catty co-workers, and MD's....please don't tell me I must also deal with lazy techs!
Has anyone had similar experiences? Any advice?

Wow, are we working at the same hospital? I barely get 10-15 minutes to inhale my lunch and the techs are on breakfast break, coffe break, lunch break, snack break...or cruising the internet! My patients never have water, I always have to fill that up so I can give my meds. I am not too good to do any of these tasks. However, when i do, it takes away from things only a nurse can do. If we had time for all of these things, the techs would not have a job. They just don't seem to get that concept!

Hellllllo Nurse, BSN, RN · Nov 15, 2006

I was a CNA for years, then an LPN for years, now an RN for years. Good CNAs are rare as diamonds and even more precious.

The majority of CNAs are awful. Not picking on anyone here. Just giving my opinion. I have left more than one job for the simple reason that the CNAs/techs made it hell.

You must have the full backing of mgmt to change the situation with problem CNAS. If you don't, trying to change things will never work.

LADY55902 · Nov 15, 2006

I have had several cna burn my butt to many times now at the start of the shift i tell the cna iw ill do my own vitals ,finger sticks and empty my own foleys that way i know its getting done and done right.

bethin · Nov 15, 2006

If the aides are treated with kid gloves by nurses, managment, etc then they are going to act like that. Their thinking is probably along the lines of: "they can't fire me, we're short staffed already, so I'm just gonna sit down. They won't do anything". First, stop treating them with kid gloves. Personally, I take vitals very seriously. Many pts are on BP pills, heart meds and nurses need REAL vitals on patients. If you have evidence that a tech didn't take vitals, I would take it up with the NM. By evidence I mean more than she said, he said. Also, I would write up aides and techs if they didn't do their job such as baths and vitals. Write them up each time they do it and maybe management will get the hint that these aides need a serious talking to and some may need to be fired. Patients depend on us. I think it's a disservice to the patients the way these aides and techs have been behaving. When we walk into work it's all about the patients. Come to work prepared to work.

RNKay31 · Nov 16, 2006

I know how you are feeling, because I am being faced with a similar proble, but I calm myself down and treat them with respect, but they look at me with scorn, try to do the best you can for your patients

Kinjo · Nov 19, 2006

You know when I get to work in the morning and I get my asingment for the day and I can almost tell how my day will go depending on what CNA is on my team. I know when I don't have to worry and I know when I will be retaking my own vitals and have to take my fall risk patients to the bathroom on my own coz if I delegate it it will probably never get done. I feel your pain I wish I had an answer , I think it sucks being a new grad.....