How to enhance cohesive working and communication

UM Review RN, ASN, RN · Apr 4, 2008

I would ask the aides to volunteer for the committee -- at least one to represent each shift. If their input is truly valued, they will be able to come to an agreement with you about what their duties should be for each shift, and will lead the others to compliance.

GratefulHeart · Apr 4, 2008

I am working on a task force team on my floor to enhance the communication between RN's and nurses aide's. I love my aide's and ai appreciate what they do but a lot of them do not do their job and they are lazy. I feel like we have to walk on eggshells around them when ultimately we as RN's hold all responsibility for patients. Even to ask to get a set of vitals is like asking them to run the boston marathon. So i made an entire list of tasks that they shoudl be doing every shift and i brougt it to my nursing managers attention. She loves it and wants me to be a part of a taskforce with another nurse who is more experienced on the floor. DO you guys have any ideas of how to help show the aide's OUR point of view?? (one idea was to have one PCA shadow an RN footstep by footstep an entire shift and explain what we are doing and what we have to think which takes a lot of energy but I think if the rigt person did it then it would be successful). ANy ideas or suggestions that i can bring to my floor? Thanks!!!!
New grad :)

How about pulling out a job description for the nurse's aide job and discussing item by item why what they're doing is so necessary for patient care and reminding them that they're each being held personally accountable for what's in their job description (including their attitude/lack thereof re team spirit). It's a little unclear to me why you feel like you have to walk on eggshells around them. Who's responsible for overseeing their work? Shouldn't that person be documenting the incidences of laziness, etc, and dealing with them on an individual basis re their job performance?

In any case, be ever so careful! Anything critical you're ultimately responsible for, make sure you personally do (even if the aide is supposed to do it), especially VS. I've always thought it's a little crazy that RNs hand off that piece of assessment...

NYCRN6 · Apr 4, 2008

thanks for the response. Well our hospital believes in shared governance, and we have had meetings that let us discuss our feelings about the floor verbally as we wrote everything on the whiteboard. We summarized everything at the end but it ended up being everyone feeling negative at the end. The nurse manager is responsible for the whole floor I guess, and i had spoken with her about this a few weeks ago about how PCA's are extremely lazy with some things.... and they do not realize the importance of their jobs. I just want everyone to feel like we are working together, and every patient is all of ours and to not have the mentality "that is not my patient". I brought up the "job description" issue... and this is what i did i just mad ea list of daily tasks of what they should be doing and my manager agreed 100%. This other nurse and i are probabl goign to have a meeting together about this. We were thinking about appointing a PCA for each shift as like a "head PCA" that will implement these ideas and keep everyone focused. What do you think?

One of my ideas was to put those daily tasks and parameters of what to report to the nurse like "Report to RN if HR >100 or 150, etc" on a clip board so they could use the clipboard for organization purposes and to also be reeducated on what to report to the RN.

PBAJS · Apr 4, 2008

I brought up the "job description" issue... and this is what i did i just mad ea list of daily tasks of what they should be doing and my manager agreed 100%.

And I agree, too.

This other nurse and i are probabl goign to have a meeting together about this. We were thinking about appointing a PCA for each shift as like a "head PCA" that will implement these ideas and keep everyone focused. What do you think?

I disagree. Our LTC facility did that several years ago.

One of my ideas was to put those daily tasks and parameters of what to report to the nurse like "Report to RN if HR >100 or 150, etc" on a clip board so they could use the clipboard for organization purposes and to also be reeducated on what to report to the RN.

Good idea!

medsurgrnco, BSN, RN · Apr 4, 2008

Suggest you have a list of normal VS, BS, urine output, etc. along with the parameters for reporting abnormals & add that they tell the nurse timely. Also cover delegation as it seems like many aides think they should only have to do the expected assigned tasks for a shift. And cover getting updates from RNs each shift, adding that both the CNA and RN are responsible for making sure this gets done early in the shift. After you pull the info together, you could have a meeting to present the info to CNA's along with the reasoning behind the info.

barefootlady, ADN, RN · Apr 4, 2008

No suggestions just wishing you good luck. This is an issue at many facilities, and one that rears its head all too often.

pebbles, BSN, RN · Apr 4, 2008

I would ask the aides to volunteer for the committee -- at least one to represent each shift. If their input is truly valued, they will be able to come to an agreement with you about what their duties should be for each shift, and will lead the others to compliance.

I agree with this. It might also provide more insight into WHY they aren't jumping all over their work and get seen as "lazy" - if they are invited to give their own perspective. Truly asked for their opinions, not in a "why don't you do your work properly, what's wrong with you" type approach. I've seen many CNA's completely shut down all communication when things like this are tried because they know they are going to be "told" what to do rather than asked honestly for opinions on change.

RNperdiem, RN · Apr 4, 2008

Try advertising your vacant CNA positions at area nursing schools.

I find nursing students to be very motivated and hard working. Add a few good nursing students as CNA to your staffing, and see if it helps.

NYCRN6 · Apr 5, 2008

Well we aren't necessarily looking @ hiring new positions or firing anyone; we are looking to work with the people that are here now. thanks though for the suggestion!

zuzi · Apr 5, 2008

DO you guys have any ideas of how to help show the aide's OUR point of view??

OK Boston nurse... first of all your attitude from my point of view is WRONG!

OUR POINT OF VIEW.... is not a nice definition, is not US "superior staff level" is about THEM also. Pinpointing OUR you separte starting to the beginning the floor in "US" and "YOU "(CNAs). Is normal that them react like that, they fell EXCLUDED!

Only one advice for YOU, do whatever you want to do but make them to feel part of your facility and you will do everythink with them, because they will do by pleasure not by constraint!

Love YOU ALL! :yeah: :yeah: :yeah: :heartbeat:heartbeat:heartbeat

NYCRN6 · Apr 5, 2008

I am not wrong in the fact that I was a PCA so i know how it is on that aspect. Some people on the floor are rather resentful because some nurses treat them in the way that you were just stating. I, on the other hand LOVE my PCA's i introduce them to every patient if we are in the room together by name and tell them how wonderful they are. Some are resentful because they see us sitting on our computers typing away; and they have stated this before "All you guys do is go on your computers" when they do not realize that a lot of our job is documenting (well at least our hospital we have crazy system which makes us document what seems like double). Some dont realize that we dont take breaks; we eat and document; we eat and run. I would love to take a PCA and bring them on a journey of my shift so they could understand the nurses role AND the PCA role together, and in that way they would be apt to understand when being asked a favor. So i dont think i am wrong, i think i may have worded the previous statement in a different way then what i meant.