I need to vent!!!!!!

macawake, MSN · Jul 12, 2017

I am a nurse aide and soon-to-be 1st semester nursing student. Although I am a nurse aide, I am a floater and usually spend most of my time as a sitter (while still performing NA duties).

Thank you everyone for reading this lengthy rant. I hope no one hurls any stones at me for being too uptight. I realize that I may give off an uptight "vibe," but it's for a good reason. I treat my coworkers like family, but I cannot condone laziness, as it risks impairing the health and safety of my patients.

I realize that you wrote this as a vent but I'd still like to offer you some advice. It's my hope that you can use this advice to decrease workplace friction/tension and the internal stress you seem to be experiencing. I sense that you are a bit of a control freak. Being one myself, I can relate. I think that it would help you to realize that the only thing you have full control over, is how you do your work.

Nonetheless, I am growing tired of NAs arriving late. Leisurely walking in with a Starbucks coffee 5 minutes after I was *technically* supposed to clock out does nothing to soothe my nerves. I understand that life happens, and I am a very understanding person.

This is honestly one of my pet peeves. The person who habitually strolls in five or ten minutes late, is not a hapless victim of "life happening". It's not some unforeseeable circumstance that made them late. They are clearly signaling that their time is more valuble than your time. It's disrespectful, and these people only do it because someone lets them get away with it.

I've had coworkers who behaved like that. I'd just put my foot down, and tell them that from now on, I'd expect them to be on time so that I could leave on time. If that hadn't worked (it did), I'd have brought it up the chain of command the next time it happened.

NA: "I don't take the vitals unless the nurse tells me to!" (chit chats with buddies)
Me: "But you know that they're q4!"
*Checks care activities*
Me: "Um... why haven't you turned this patient in 3 hours?" (me to sitter)
*Checks vitals*
Me: "You realize that their vitals were due 6 hours ago, right?"
Sitter: "I bet they're not diabetic, they're just paranoid about their blood sugar!"
Me: *checks EHR* "Um... they take humalog."
Nurse: "Oh crap! Accucheck them!"

You are not in a supervisory position in relation to the other nurse's aides and sitters. If the other aides/sitters fail to carry out their duties during their shifts, that falls on the patient's nurse to address. If you're there eight hours in a day, you literally have no control over what happens the other sixteen hours. Another aide might chart that the patient has been re-positioned while not actually doing it and you'd have no way of knowing. At least now with the missing documentation it is obvious that it hasn't been done (or charted at least), and the nurse responsible for the patient can review this and take appropriate action.

If you observe things that causes your patient harm, you should definitely take the appropriate steps to report the observed risks/incidents through the proper channels and advocate for and protect the patient. But if I were you, I'd leave the "policing" of your fellow aides/sitters to their supervisor.

The "I HATE MY JOB, JUST SHUT UP AND LEAVE" employee
Me: "So, this is what went on, this is what you should watch out for--"
Them: *cuts me off multiple times* "Okay, okay, okay." (with an attitude)

The "why are you giving me such a detailed report, you're JUST a nurse aide" employee
Me: "Blah blah blah, important info, blah blah blah."
Them: "Why are you so detailed? It's not like you're a nurse." (laughs)

Me: "Blah blah blah blah, misc. info, misc. info, important info (x10-20) blabbity blah blah blah. Any questions?"

Okay, what I think you should ask yourself is what your motivation to give lengthy and detailed verbal reports is. It's not my intention to be mean here, I just think it might be helpful for you to figure out why you're doing it.

Is it because you've been taught that this is the way that it should be done?

Is it because this is the type of verbal report you yourself prefer to receive?

Are you scared that if you accidently leave out some detail that it would reflect poorly on your professionalism or that harm might come to your patient if you omit some small detail?

Do you do this to bolster your self-image as a dedicated, conscientious aide?

Regardless of why you're doing it though, I think that you need to change your delivery a bit. It's obviously annoying some of your coworkers and the risk is that they miss the important information you are trying to convey, because they're busy sitting there internally rolling their eyes and criticizing your style of delivery. You can't change them, but you can attempt to tailor your delivery so that the communication becomes more effective. You wouldn't be altering your style of delivery for your coworker's sake, but rather for your patient's benefit. A good, concise report that actually gets through to your coworker is in the patient's best interest.

Once you become a nurse, you might be giving verbal report to the oncoming nurse on six or eight patients in an acute care setting. I think it would help you if you already started practising giving a succinct and to the point handover. You simply can't include all the miscellaneous information and the blah-blahs. Time management and efficiency matters and I think that you'll find that an extremely lengthy and detailed report will annoy many of your future coworkers.

When giving report, I like SBAR (S=Situation B=Background A=Assessment R=Recommendation) If you're not familiar with it, you can find a lot of information on Google. Nurses and physicians use it, I'm not sure it commonly used by aides though. However, that doesn't really matter, because I think you can use it as a base for a brief, well-structured handover. Now you wouldn't believe it considering the lenghty blah-blah posts I make here on AN, but in real life I give very short, concise reports. Most coworkers appreciate this and if they want the extra (non-vital) information about the patient they can either ask me for it or read up on (charts) the patient in more detail at a later point.

â€¢My inner thoughts: No offense, but it's not like I want to remain a nurse aide for the remainder of my life. NAs and RNs go hand-in-hand, but I will expand my opportunities and become a RN someday.

A piece of advice. Be careful so that you don't convey this attitude to your coworkers. It's bound to be perceived as arrogance or condescension on your part and it might either annoy or hurt someone who for whatever reason isn't planning on becoming a nurse. Nurse's aides are valuble members of the healthcare team and they deserve respect for the job they do.

To sum this up, advocate for your patients and continue to provide the quality care that you are providing :up: Try to accept that you have limited capacity to change other people, so try not to waste valuble mental energy on things that are beyond your control (and in this case area of responsibility). Do your job well and derive satisfaction from that :)

Take care!

livelovelaugh22 · Jul 12, 2017

I definitely agree that I am somewhat a control freak. I wouldn't say that I'm always policing people though, because although I may remark on what should've been done, I don't take it upon myself to chastise people. As you said, I am not in a managerial position.

When I gave the examples for my report, I almost always stick to the pertinent information (I read everything off my report sheet to the oncoming sitter/NA). The reason why I gave "misc. info" as an example is because I didn't want to risk disclosing PHI on the Internet. My goal is never to waste anyone's time or bolster my ego. I just want to leave work knowing that my patient(s) are taken care of.

Oftentimes, sitters don't bother to read the report sheets (let alone reference them) and they act as if they didn't just spend 8 or 12 hours with them. I also interact with everyone with a smile and I keep the snarky comments to myself, although it's hard at times. I try to seem like an easygoing individual, because if I show everyone how uptight I am, then I probably wouldn't have any work friends lol.

I should also add that I not only checked care activities, but verified with the sitter that the patient hadn't been turned for three hours. I was very nice about it, but this patient was extremely emaciated and weak, and was unable to reposition themselves without significant assistance.

When I first got this job, we were always told to speak up. I realize that I might be a PITA at times, but I'm reluctant to report anyone. I just provide occasional feedback and I'm kind about it. If I were to make a mistake (which I have), I would expect to receive constructive criticism.

My particular ways didn't arise because of an inflated ego. I have witnessed my mother suffer from the effects of serious chronic illnesses, and viewed the nonchalant attitudes of some health care providers that resulted in (nearly) grave consequences for her. I just want to give everyone a shot at wellness. Perhaps I care too much .

macawake, MSN · Jul 12, 2017

OP, I've read your response carefully and I'm looking for signs that you're hearing me, and I'm not sure I'm seeing them.

Don't fight me on this, work with me here I'm trying to help :)

When I gave the examples for my report, I almost always stick to the pertinent information (I read everything off my report sheet to the oncoming sitter/NA). The reason why I gave "misc. info" as an example is because I didn't want to risk disclosing PHI on the Internet.

Me: "Blah blah blah blah, misc. info, misc. info, important info (x10-20) blabbity blah blah blah. Any questions"

(my bold)

Well, you included both important information and miscellaneous information. The fact of the matter is that your fellow aides/sitters think that your reports are too detailed and long-winded to the point where they interrupt you with "yeah, yeah" (as in "get on with it already"). Here it doesn't even matter which one of you who is "in the right". The style of your report has become a communication barrier. They simply aren't paying attention to the information you are trying to pass on.

Listen, I work as a nurse anesthetist (not in the U.S.) and if the surgery I'm working isn't expected to wrap up within the next thirty minutes or so at the end of my scheduled shift, another nurse anesthetist from the next shift will take over. I do mostly trauma surgeries which is different from most elective surgeries where the patient is often in a more stable condition. With trauma patients there can be a lot of things going on during the surgery, and it's vital that I give a good report to the oncoming nurse. Despite this I hardly ever have 10 - 20 separate important things I have to report.

I really believe that you are getting entangled in minor details when you're giving report, and you're losing your audience. Clarity and brevity should be your new best friends! Trust me, it will help you as you embark on your nursing career.

My goal is never to waste anyone's time or bolster my ego.

My particular ways didn't arise because of an inflated ego.

I specifically didn't use the word ego (which to many has a negative connotation and wasn't what I meant), but self-image. It was only one of several possible explanations that I suggested as reasons for your long and detailed reports.

This was the question I asked you: "Do you do this to bolster your self-image as a dedicated, conscientious aide?"

The reason I included this as a possible explanation is that it is something I often see in perfectionists and high achievers. Don't regard it as potential criticism, but rather as a matter of fact observation. The reason why this might be helpful to identify in oneself (if indeed one does it), is that this mindset can generate a lot of anxiety and also make you behave in a way that can easily alienate people, including coworkers.

I just want to leave work knowing that my patient(s) are taken care of.

I understand your feeling here. What I'd like to know is whether you can buy into the idea that you can make your report more condensed without negative consequences for your patient? Remember what I said earlier, despite what you may want, you have no control of what happens when you're not there.

I wouldn't say that I'm always policing people though, because although I may remark on what should've been done, I don't take it upon myself to chastise people.

You don't have to outright chastise people. To the target/recipient of the comment "Um... why haven't you turned this patient in 3 hours?" or "You realize that their vitals were due 6 hours ago, right?", the criticism is clearly implied.

Look at how you labeled your coworkers. "The "I HATE MY JOB, JUST SHUT UP AND LEAVE" employee" and "The "why are you giving me such a detailed report, you're JUST a nurse aide" employee". There is disdain there for your coworkers. You might be right to feel that way. Perhaps they have the crappiest of work ethics or maybe they fail to see the importance of blood glucose check in diabetics and regular repositioning of emaciated patients due to lack of training/understanding. I don't know. But the message I'm trying to impart is that you can only control how you do your job. Letting them get on your nerves won't help your patient, might make it harder for you to get along with coworkers and it likely adds stress to your life.

I realize that I might be a PITA at times, but I'm reluctant to report anyone. I just provide occasional feedback and I'm kind about it.

As I said before, if you observe/identify real risks to your patients you need to speak up, utilizing the proper channels. Everything that isn't exactly up to your personal standards isn't necessarily a reportable "offense", but when patients are harmed or at risk of being harmed it is our ethical duty as healthcare professionals to bring it to the attention of the proper authority.

I have witnessed my mother suffer from the effects of serious chronic illnesses, and viewed the nonchalant attitudes of some health care providers that resulted in (nearly) grave consequences for her.

I'm very sorry that you've experienced this. It's so very hard to watch people we love struggling with serious health issues.

I just want to give everyone a shot at wellness. Perhaps I care too much .

You do that by being the best nurse's aide and the best nurse when the day comes, that you can be. You don't have to be and won't be perfect all the time because you're human, just do your best. You should always advocate for your patients but you can not shoulder the responsibility of the entire world. It's the fastest way to burnout that I can think of.

Good luck OP!

livelovelaugh22 · Jul 12, 2017

You're right. Forgive me for not understanding your point the first time (it's been a long day for me). Now when I think about it, I tend to be long-winded when I give report. I routinely place too much on my shoulders and think that the patient is still my responsibility once I clock out. For now on, I will try to give more concise reports. I know I have it in me :).

Labeling my coworkers is wrong, and so are my micro aggressions. I need to realize that some of them are stuck in their ways and move on with my life, as I will never be happy if I don't.

But I was never trying to undermine the importance of nursing assistants-my own profession. I know that we play an integral role in our patients' well-being. I just don't want to do that all of my life. We are underappreciated and sometimes overworked. However, I feel bad about complaining about this aspect of CNA life to a CRNA, as I know that you have to work under much higher pressure than I; plus, I'm sure that you also have days in which you feel underappreciated. Ironically, I wish to become a CRNA someday.

I will try to "go with the flow" more often at work and trust that my coworkers are doing their part. I will allow the RN to redirect the aide if needed. Regarding the tardy coworkers, I will be more firm with them and speak to management if the behavior persists. To be honest, I had become accustomed to being mistreated at my former jobs and failed to realize that pointing things out could be considered rude. I guess my smile makes me seem more condescending, but that's not my intention. When I worked in a research lab, I was physically assaulted and berated by my lab manager. When I worked at my college, I was embarrassed in front of my coworkers by a supervisor, and much more. I guess what I'm trying to say is that I was used to much worse behavior, hence the reason why I thought I was being "nice".

And thank you for empathizing with my mother's situation. Whenever I take care of someone with a complicated medical history (like my mother's), I unfortunately become WAY overprotective and envision bad things happening if I neglect any little thing. If I see a code, my heart drops and I envision my mother on the stretcher, fighting for her life. I need to detach myself from my personal life. Nowadays, my mother asks me if I think that I have chosen the right profession. Honestly, I don't envision myself doing anything else, but this job is so emotionally demanding.

Thank you kindly,

Livelovelaugh22

NightNerd, MSN, RN · Jul 12, 2017

I think a lot of important things are addressed in the above posts already, so I will just throw this out there. Probably every facility is different, but when a task or med or anything is due at change of shift, my hospital agrees that it will be the responsibility of the offgoing shift. I understand that sitting is a little different from being a floor tech, an RN, etc., but it is still a rush to come in, meet your patient, get supplies, and complete a time-sensitive task. I always pass my 0700 meds during the 0600 hour, as we have an hour before and an hour after to give them. You never know if a behavioral issue, rapid, or code will come up and throw off the shift report, so it just makes sense to get as much done as possible.

I hear what you're saying: when you're tired and just done with your patient and want to go home, the last thing you feel like doing is "someone else's work." But it's not. Vitals are something you do for your patient; it's not about helping out the next shift. Maybe try to see your work this way.

Believe me, it is awful to with with people who are so burnt out they don't even come in on time. Part of the reason I left my last job was because that was the culture there. It's good that you're not stooping to that level, but just don't let it make you bitter or distrustful of everyone you work with. I now work with amazing techs who take terrific care of our patients together. I would let them care for my family anytime. :) If it gets to that point, reconsider the fit of this organization, or see if there's a specific unit that fits you best and try to work there.

livelovelaugh22 · Jul 18, 2017

I would like to thank everyone for their helpful feedback. Since last week, I have had a different outlook about my job. I try to obtain vitals early, no matter what, because I want my patient's care to be the best possible. I am also spending less time giving report, and I am able to overlook my rude coworkers. Even though I've had 2 people insist on me giving them the report sheet to read, versus allowing me to give any verbal report, I didn't take offense to it.

macawake, MSN · Jul 19, 2017

I would like to thank everyone for their helpful feedback. Since last week, I have had a different outlook about my job. I try to obtain vitals early, no matter what, because I want my patient's care to be the best possible. I am also spending less time giving report, and I am able to overlook my rude coworkers. Even though I've had 2 people insist on me giving them the report sheet to read, versus allowing me to give any verbal report, I didn't take offense to it.

You just put a smile on my face :) Thank you for coming back with an update, many posters don't. I am genuinely glad to hear that we could be of some help.

I just wanted to share that I'm impressed by your ability at introspection and it really sounds like you've used the advice you received in a constructive way.

I routinely place too much on my shoulders and think that the patient is still my responsibility once I clock out.

You know I had a feeling that you did that

Having an almost obsessive attention to detail and fearing that even missing the smallest detail will have catastrophic ramifications will generate a significant amount of anxiety, which will drive people away and take a huge emotional toll. The suspicion that you might have this tendency was what had me most concerned and what motivated me to try to get through to you.

Before I started in my current specialty I precepted a decent number of students and also new graduates. A few would concern me because they were overconfident, didn't know what they didn't know and because they didn't really seem to grasp the responsibilities that comes with the job, but on the other side of the spectrum I've had a couple of students who almost cared too much about their patients.

Whenever I take care of someone with a complicated medical history (like my mother's), I unfortunately become WAY overprotective and envision bad things happening if I neglect any little thing. If I see a code, my heart drops and I envision my mother on the stretcher, fighting for her life. I need to detach myself from my personal life.

From reading this, I see that you are aware of the risk involved here. When we experience serious health issues or watch a loved one struggle with them, it can leave us a bit raw and vulnerable, even defenseless. I'm not advocating that you stop caring for your patients, on the contrary I think it speaks volumes regarding your emotional intelligence, empathy and ultimately character that you do care and that you realize that your patient, is someone else's loved one. Just be careful, because we really do need to put up a bit of a protective shield. Both for our own sanity and longevity in the profession but also for the sake of the patient.

I've definitely never viewed one of my patients as a "thing" or reduced them to a diagnosis, I always see the human being. But if I instead would see them as/imagine that they were a loved one, that would simply destroy me. It would cause tremendous anxiety, might paralyze me in situations where I needed a cool head and the ability to rapidly come up with a solution/course of action and it would definitely affect my objectivity. There'd be a very real risk that I would be transposing my own feelings and experiences with the patient's feelings, instead of actually hearing and seeing him or her. That's wouldn't be beneficial for the patient, or me.

Gosh, I seem utterly incapable of writing short posts :facepalm: I set off to write a short thank you for your thank you :) and here we are. Another post rivalling Tolstoy's War and Peace (in length that is, hardly in literary quality )

Anyways, I think you're doing really well and I wish you a long and happy career in healthcare!