I dont handle lazy aides well

Nurses General Nursing

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Maybe I am not cut out for hospital nursing, I dont know. I cant seem to handle lazy aides well. Again I was assigned to the other side' on my unit, night shift, 2 rn's with one aide, 12 pts (6 patients each rn). If there is not a good aide, you drown at some point, usually later in the shift.

This float aide we had last night did his vitals, sat down in the hall with a portable computer for an hour or hour and a half. I got an admit, he balked at doing a sling weight (she is asleep, that can wait for days') (me: no it cant). Then he took over an hour break, when it is posted that they can take 2 15 min breaks and one 1/2 meal break. But that is the standard.

The night charges dont care. They dont give support. They just dont want trouble'. I told the aide upon his return of the above policy on our floor.

Then he started 0400 vitals, didnt answer call lights. I was trying to chart. I asked him to answer a call light. He did not, finally I went to answer it. I asked him why he didnt answer it, he said I could have answered it instead of coming to tell him to answer it. I told him I was charting, and that he was on the floor. He said he was in an iso room'. It seemed to me he took 15 minutes of so in that iso room to get VS, and was just waiting for ME to answer the call light. He got loud when I asked him this (about not answering) and argumentative. Then he went to the charge nurse to complain about me.

The chrage nurse said he's generally been a good guy'... I wrote my nurse mgr stating I am frustrated dealing with certain aides who seem to want to do only the minimum. I called insick for tonight. I am thinking of requesting not to be put back in this section especially if there is a marginal aide.

I left this morning with not enough time to do notes, ect. I just was so upset and wanted to get out of there.

I dont know what to do. Please advise.

Specializes in LTC.

I used to be an aid and couldn't stand when a nurse would walk ALL the way down the hall to find me and tell me to do something. And it's always when I'm in the middle of doing something(I could see if I wasn't busy). The job could have already been done considering the amount of time it takes to look for me and tell me. I literally said to a nurse one time, "uhm, you walked all the way down here to tell me that?" I was in the middle of changing a bed with pee in it(also cleaning patient) and was the only aid on the whole floor with a ton of other things to do(and she knew it). She could have easily put patient "x" on a bed pan but had to walk down the hall to tell me to do it. Lazy!

Yes and some aids are lazy too.

Specializes in School Nurse.

I agree with darkangel: every RN should work as an aide at some point. I have been an aide for 1.5 yrs and it's been a great experience. I work with the RNs and the other aides as one big team and we all get along really well, as we all respect each other. If an RN ever said something remotely similar to what Romie said, I would have been in shock. We just do not treat people that way.

I start my new job as an RN on Wednesday, and I intend to go in knowing how busy aides are, and how much they want to be treated like human beings.

L.

Specializes in LTC.

The aide you described sounds awful. But if you're having a problem with all of them, then maybe it's your approach. In your other thread (the one someone linked here), it seems like you didn't give any thought to what the aides were actually doing. You expected them to understand how busy you were, but didn't afford them the same consideration. You had many things to do at once, but the CNAs were "leisurely checking blood sugars... dragging them out," etc. Maybe this is true. Or maybe they were doing BS because it's their job, and they were taking care of the patients' other needs as they went along. I'm a CNA and when I'm doing vitals or rounds it can sometimes take forever because I'm cleaning up after incontinence, straightening up the room, repositioning people, etc. Or while I'm in there someone will want to go to the bathroom or ask me to get them a box of tissues or whatever.

I work in a nursing home. I've never worked in a hospital so I can't say I know what it's like, but at the nursing home I'm really busy. And so are the nurses. I know what their routine is and I know a lot of their individual preferences and peeves. I try to be accommodating. Most of them are nice too. There's a big difference between a nurse who finds you up to your elbows in diarrhea and says "I need you to weigh Mrs. X right now" and gives the impression that you're supposed to drop everything and run to do it that second, because the nurse has 3-5 more important things to do and you can't be trusted to do it later; and the nurse who pops her head in and says, "You're going to weigh Mrs. X, right?" That would be like the difference between me going up to a nurse and saying, "Mrs. X wants her pain meds right now" and standing there staring at you, vs going up to her and saying, "Mrs. X just rang for pain meds- what do you want me to tell her?"

I know that ultimately it's your license and that your job is more important than ours, but if you're automatically looking down on CNAs and it's coming across in your approach, then you're not doing yourself any favors. Have you talked to the other nurses where you work about your issues? Maybe they have a better understanding with the CNAs about what is expected and what the other side is like.

Specializes in Flight, ER, Transport, ICU/Critical Care.

Wow - what a thread!

To the OP - You are CORRECT in that you do not handle things well. I think that you may have legitimate issues, however - I am not too sure that your "methods" of resolution are working out too good for you, your patients and are certainly not effective for team building.

It seems to be a YOU (RN) vs. ANYONE (CNA, PCT, RT, etc). Conflict seems to be the rule of most days.

I get it - this seems to be a big issue with you. Before I get too far along - what makes you think that you have the right to an aide that you deem above "marginal"? You have been upset by this matter and have even called in for tonight and are considering refusing assignments based on your support staff. Geez, I hope that I am just reading this wrong. Sure, there are folks that just do not get on well - but, when you have problems with most - I think that you may need to look for the common denominators (you, delegation of certain tasks, etc).

I think that you were at the desk charting, got a call light and then (instead of just going to the patient call light room), you hunted down the aide that was doing another task to go answer the light. I hope I got that wrong. Charting may be important, but those call lights involve patient care and are job #1 - and taking care of any patient need always comes before charting. I promise if I was charge and you came to me with this issue - I'd listen to everything and talk to those involved - I do not really care about a trouble-free shift - that is not what I was hired to expect. Regardless, if I ever caught an RN that was doing desk work fail to answer a call light, yet get up and hunt down the busy "aide" to inform them to answer the call light - I'd make sure immediate corrective action would be taken (if you know what I mean!). ;)

I'm guessing that at this point the "aides" have figured out your M.O. and seem to be getting the better of you. You may not think so, but I am reasonably certain that you are giving this far more traction that it needs - it wastes your productivity, leaves you upset and does ZERO to make the situation any better. Guess what - if this is a battle they are winning! The real loser is ANY PATIENT that you are entrusted to care for.

There is NO RN or PCT or CNA in TEAM. Team-building is difficult at times and there will always be some "personalities" that just will not work well in tandem - that is just reality. The mark of a professional is being able to do that which is difficult and ensure the best outcomes.

It seems that there is a lot of interest in a "pecking order" and even Chocobean outlines "prestigious" tasks (sorry, that one really made me laugh - except, you seem to be serious and then that is so not funny!). Well, folks I'm sorry to have to let everyone in on it that has missed it - but little of what we do is PRESTIGIOUS and any nurse that thinks in all manners of rewarding support staff with the prestigious jobs or delegating the "worst" tasks to one "aide" vs. another, or adopting the attitude that a task is "aide" work - is SETTING THEMSELVES UP FOR A MISERABLE, FRUSTRATING, AND QUITE POSSIBLY DANGEROUS STINT AS A REGISTERED NURSE.

To be fair - I get it. You worked hard and went to school and are on the bubble of responsibility - so, there are tasks that I can delegate. I think where the concept gets broken in the I MUST DELEGATE.

For the sake of argument - I'll stick to the RN and aide issue.

I think there are folks (RN's and support staff) that do look for the easy route. I do not think it is just a sympathy issue from RN to aide or a perception issue - I think it is just a RESPECT ISSUE. There are some unenlightened RN's think that an aide is there to do EVERYTHING that is not a direct RN task. That reasoning is flawed - sure they cannot do RN assessments, IV's, give meds, dressing changes and such - neither do they have the legal responsibility of the RN - but even so, they cannot be expected to do everything else. It is not only not reasonable - it is impossible given most staffing patterns. Lets agree that our jobs are different - but we need to remember that our jobs are really about the same thing.

TAKING CARE OF PATIENTS THAT DEPENDENT ON US.

Effective delegated practice takes a professional - not a tyrant. If a nurse is having trouble understanding the realities of one "aide" for 15 patients (RN ration 5:1 and aide ration 15:1) and the limitations that will be encountered you are either new, do not care or have some other type of denial that impacts perception of reality. This ration is fairly common. Think this over for a minute - VS every 4-6 hours, baths, ambulation, turning, toileting, glucose checks, comforting, nutrition (water, feeding), I/O's and assisting with RN in certain tasks - you know that is a busy day too. Often they have to document as well. Now add call lights and other duties as assigned - whew! It is impossible to except that any aide will be able to do everything that you ask. Just as you can do one thing at one time for one person - well, they have the same limits.

I encourage you to contact your facility HR and see if EAP is available. A counselor will be able to help you work through your communication style, suggest ways to team build and work on conflict resolution and if there is any way to salvage your career - this would be a good place to start. I think you are in real danger or not being able to find professional nursing a career that you can function at - good communication is essential to success and you seem to be floundering.

Good LUCK.

Practice SAFE!

Specializes in Med/Surg, Home Health.

I too had problems with a few aides I worked with at the hospital. I was the one doing everything, even taking half the aides' lab draws to help them out. But when I needed help I couldnt get it. One aide left a tourniquet on a patient's arm (pt had blood clot and had already lost other arm). One was caught faking vital signs on the vital board. There was one aide who was mad at a patient because he was incontinent, she was cleaning it up while saying "Im tired of cleaning up sh$t, thats all I get to do is clean up sh$t". She made the patient feel humiliated and was literally slinging poop on the wall while attempting to clean it up. I told her to leave and I would clean it, she refused. She later was mad at me, and for what? I was trying to help, while trying to save the patient's dignity. I finally quit. I am now doing homehealth and I dont have to depend on anyone else to do their job before I can get mine done. I like it alot better. I dont work well with lazy people who expect me to do their work and mine too. I agree that nurses should be an aide before becoming a nurse, but the aides also need to realize that they need to prioritize and try to understand the nurse's perspective too. When I have someone whose O2 sats are in the 70's, I expected my aide to take care of the medial things while I stabilized the patient, etc. Then I would help aide get caught up. I had to chart, the aides would get mad and say things like "the nurses get paid big bucks to sit on their butt and chart". Now, I understand how it "looks" for me to sit and chart, but its something that has to be done. If the phone rang or the call light went off, I did answer them, but if the aide was doing nothing while I was charting, then they needed to answer it. I had to stay over so many nights to finish charting because of this. I had to turn patients by myself, finally hurt my back doing this. The good, responsible, team-playing aides are worth their weight in gold, but you get one lazy one and your shift is awful. I dont miss floor nursing at all.

Specializes in Cardiac Telemetry, ED.
Maybe I am not cut out for hospital nursing, I dont know. I cant seem to handle lazy aides well. Again I was assigned to the other side' on my unit, night shift, 2 rn's with one aide, 12 pts (6 patients each rn). If there is not a good aide, you drown at some point, usually later in the shift.

This float aide we had last night did his vitals, sat down in the hall with a portable computer for an hour or hour and a half. I got an admit, he balked at doing a sling weight (she is asleep, that can wait for days') (me: no it cant). Then he took over an hour break, when it is posted that they can take 2 15 min breaks and one 1/2 meal break. But that is the standard.

The night charges dont care. They dont give support. They just dont want trouble'. I told the aide upon his return of the above policy on our floor.

Then he started 0400 vitals, didnt answer call lights. I was trying to chart. I asked him to answer a call light. He did not, finally I went to answer it. I asked him why he didnt answer it, he said I could have answered it instead of coming to tell him to answer it. I told him I was charting, and that he was on the floor. He said he was in an iso room'. It seemed to me he took 15 minutes of so in that iso room to get VS, and was just waiting for ME to answer the call light. He got loud when I asked him this (about not answering) and argumentative. Then he went to the charge nurse to complain about me.

The chrage nurse said he's generally been a good guy'... I wrote my nurse mgr stating I am frustrated dealing with certain aides who seem to want to do only the minimum. I called insick for tonight. I am thinking of requesting not to be put back in this section especially if there is a marginal aide.

I left this morning with not enough time to do notes, ect. I just was so upset and wanted to get out of there.

I dont know what to do. Please advise.

I know how you feel. The aides where I work get 8-10 patients. The do not do VS unless asked. They do not tidy rooms. They do not keep accurate I&Os (even on CHF patients who are diuresing, or ARF patients on IVF). They do not get rooms ready for admits. They do not get patients OOB for meals. They do not ambulate patients. They do not turn patients. They do not toilet patients. They minimize going into iso rooms, only doing so when absolutely necessary. They huff and puff when you ask them to do anything. They "hide" from the nurses. One has been caught texting in a patient's bathroom while there were call lights on. I am not exaggerating.

Some of them are just inexperienced aides, but not all of them. It's a culture that has been allowed to continue for years. Our floor even has a reputation for having the worst aides; other aides who float here are amazed at what ours get away with, and other nurses have asked to not be floated to our floor specifically because of the aides.

It is effing ridiculous.

I agree with those who say that nursing care is teamwork, and that RNs are not above doing "aide" work; that "aide" work is basic nursing care, and we are all accountable to the patient to meet their needs. I agree, in theory, that bedside care trumps charting. However, the reality for some of us who labor under conditions that I have described above is that we are hounded by management about our documentation, and get no support for UAP to meet the patients' basic needs, and so we do total care with a full patient load plus all the redundant paperwork that goes along with it, missing our lunch breaks and staying late to finish, while the aides never miss a break and always get out on time.

I have been a part of the effort to effect change on our unit, choosing to do something rather than just complain. At first, things did improve, but then they went back to the way they've always been. I would be absolutely in favor of getting rid of aides on our floor, if the nurses could have fewer patients.

So, for those of you who want to blame the OP for their problem, I just want to say that you could have a point, but also be open to the idea that there really are units like this, where the aides get away with murder while the nurses are held accountable for everything.

To the OP, I want to say I agree you should be open to the idea that you may contribute to this problem in the way you interact with the aides. I agree that you should find some resources related to effective team leadership and delegation and learn what you can to improve this aspect of your practice. At the same time, I understand what it is like to work with sub-par aides and have management not do a thing about it. If this is the case, that the unit you work on has allowed poor performance and has not held poor performers accountable, I wouldn't expect to see things change any time soon. You'll have to decide if you're going to just suck it up and work under those conditions, or find somewhere else to work where everyone pulls their weight.

Can I work with you?? I am an aide and I agree with you :yeah:

Specializes in LTC/Behavioral/ Hospice.

I have found that even the "lazy" aides usually can be encouraged to work and be part of a team by investing some time into them. What really works for me is enlisting the aide to help me. I have been known to go and do transfers, change bed linens, and pass trays with an aide who I thought might need a little bit more encouragement to work. I will answer a call light, even though it might cost me time at that moment, asking the aide to come with me to see what is needed and then we teamwork to help the resident. It pays off because you get to see the aide working and may be able to correct some techniques or thinking that may have been off. It has worked almost every time. Yes, it's an investment of time, but it's also an investment in people, which pays off almost every time. :)

Specializes in Cardiac Telemetry, ED.
I have found that even the "lazy" aides usually can be encouraged to work and be part of a team by investing some time into them. What really works for me is enlisting the aide to help me. I have been known to go and do transfers, change bed linens, and pass trays with an aide who I thought might need a little bit more encouragement to work. I will answer a call light, even though it might cost me time at that moment, asking the aide to come with me to see what is needed and then we teamwork to help the resident. It pays off because you get to see the aide working and may be able to correct some techniques or thinking that may have been off. It has worked almost every time. Yes, it's an investment of time, but it's also an investment in people, which pays off almost every time. :)

This may work well for new, inexperienced aides who just need a little direction. It does not work with aides with 20+ years' experience on the floor who are informal leaders that the other aides look to as an example.

Specializes in LTC/Behavioral/ Hospice.

Hmmm. I disagree. I have seen it work very effectively with leaders as well as followers. When we are all on the same page, when they see that I am willing to work with them, rather than just give them orders, I have found that the aides who initially couldn't stand me have become my strongest supporters. I think they are great aides and I believe (at least they've told me) that I'm a pretty good nurse.

Specializes in Cardiac Telemetry, ED.
Hmmm. I disagree. I have seen it work very effectively with leaders as well as followers. When we are all on the same page, when they see that I am willing to work with them, rather than just give them orders, I have found that the aides who initially couldn't stand me have become my strongest supporters. I think they are great aides and I believe (at least they've told me) that I'm a pretty good nurse.

I take offense at the implication that those of us who work with the type of aides I have described are in that situation because we just give orders and do not show a willingness to work with them.

Specializes in LTC/Behavioral/ Hospice.

Please don't take offense. I never said that it works with every aide. I simply making a suggestion for the OP that she may not have already thought of. She did ask, after all. I am speaking from personal experience and what worked for me. Obviously, there are some aides that will only listen when disciplinary action is taken. My experience has been that they are few, though. If that is not your experience, then I am truly sorry. That is very difficult and I would not want to deal with that day in and day out.

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