Learning to assert self with NCP's/PCT's

Lynx25, LPN · Jan 14, 2012

They tried this on me the other day. I'm like you- I know they are overworked, and underpaid. I don't call them unless I need assistance, and I'm certainly not the type to go hunting them down for stupid little things.

HOWEVER... last Monday I had a patient go downhill- had to transfer him out, do a pile of paperwork, call 50 million people... So I asked his aide to get me a set of vitals.'

She ignored me.

Just straight-up, no apologies ignored me.

Yeah, OK- great. Guess who got to take all of the patients out for smoke break, clean out the pantry, and bleach the fridge? :heartbeat

I would have written her up- but we have no support from the higher ups when we do that, so I prefer my way. I have straight up told them exactly what you said in your post.... "I do your vital's when you're busy, I don't bother you with stupid little things, and I don't micromanage you...When I need help, I expect your help."

Nebby Nurse · Jan 15, 2012

It's tough being fairly new. These folks know their job and mostly do it well. It is imperative over time, in addition to your often impossible responsibilities that in order to take control of your assignment is to befreind them and earn their trust. In addition to attempting to satisfy the needs of the patients and families,not to mention management this sounds impossible. But take heart. If you go the extra mile, lend a hand (time which you don't have!) these often angry underpaid workers will surprise you. Lead by example. Show them a strong work ethic and it takes time often months. They will grow to love and respect you for sure. Best wishes!

Been there,done that, ASN, RN · Jan 16, 2012

Write them up.. each and every time they refuse YOUR direction. They are working under your license and direction. They need to be reminded of that.

kxvc · Jan 23, 2012

I also struggled as a new grad. I was shy and quiet, and most of the techs I worked with knew me in my previous position. I had little to no respect at first. For the most part I did lead by example. I helped out and was as understanding as I could be. I remembered what it was like to be a tech; I didn't want to be "one of those nurses." Respect goes a long way, but it is a two way street. Sometimes I have to pull out my "big sister voice." I did have one tech laugh in my face (no joke) when I delegated something to her as she was chatting up her buddy. I was in a bit of a panic with a pt who wasn't doing so well, and I didn't appreciate her response. I looked her in the eye and sternly said, "I need you to do this NOW, please." We eventually became friends, and she turned out to be one of my best techs. No write ups were needed, and she never did that to me again.

finallyfound10 · Jan 29, 2012

This is most likely a leadership problem of the unit more than anything else. People (yes, us included.) will do what we are allowed to get away with. Either the boss doesn't know this goes on and they need to be informed for it to change OR the boss does know and whatever crazy reason, lets it continue. If you wrote the details down go to the boss and show them the timeline. Even if you don't have the documentation go to the boss. They will ask, did you ask the NA/PCT again? Basically, you delegated-it didn't happen-how did you try to remedy the situation with NA/PCT- did you remind? Was the NA/PCT involved in a Code or something so major that the vitals could not be completed? I didn't think so. You will know if the boss took care of the situation if it changes if not then the NA/PCT is being insubordinate to the boss or the boss didn't really 'go there' when talking to the NA/PCT or the boss didn't even address at all. If so, talk to the boss when it happens again because it 100% will and then most likely nothing positive will come out of it and RN's will continue to be ignored and you may need to make the call on going up the chain of command. None of this is fun and I've been there in other industries that I've worked in.

GOOD LUCK!!!

DixieRedHead, ASN, RN · Jan 29, 2012

7 AM: "I need vitals completed by 9 AM"

In the above scenario "Get the vital signs"

"I do not appreciate, nor will I tolerate your attitude or your tone. Now, will you do what I ask or do we consider this insubordiantion?"

CompleteUnknown · Feb 17, 2012

There's some good advice here. Leading by example is so important, make yourself someone you would like to work with and people will like working with you and 'have your back' as they say.

The other thing I would suggest is don't wait until you're at drowning/boiling/screaming point before you ask for help. As you point out, everyone is busy, and unless someone is going to die unless whatever the task is gets done right now this second, no-one can just drop everything.

This may not be the case, but it sounds like you're waiting until you absolutely must have help right now and hardly interacting with the aides until that point. Practice asking when it isn't critical. Practice asking when it's only something small that you could do yourself but it would help immensely if, this time, you didn't have to. Don't assume that others must be able to tell you could do with some help. You don't have to fall over yourself being grateful when someone does their job, but do show appreciation for a job well done.

You shouldn't have to 'prove yourself' to the aides but unfortunately often you do. If they're older, they've seen it all including the RN who treats them like dirt. If you're consistent, fair and gracious but firm when you need to be, you'll set the tone for the shift and everything will go much more smoothly. You'll get there!

tigrbuttrfly · Feb 17, 2012

Thank you. I think this makes sense and does completely describe what I am feeling.

tigrbuttrfly · Feb 17, 2012

Okay so I am almost and old new grad.. been working for about 6 months now. I am having a hard time asserting myself to the PCT's/NCP's on the unit. Most of them are older in their 50's and sometimes I feel that I am being taken advantage of because I am a new nurse. I know that they are busy. I know that they are stretched to their limit. I don't ask for help unless I know I need more than one person to lift, reposition, or give a bath. Whenever I ask, I always get the I am too busy attitude/tone, I can't do it right now and sometimes they are outright sitting at the nurses station telling me that they can't.
I absolutely don't call them almost for the entire day... when I do, I get this attitude, I've done vitals for them on my patients, glucose checks, entered their vital signs, been more than accomodating. But it's become a regular thing. So what I'm asking is what have you found that helps? i.e what to say?
I need advice!

Thanks for the replies and input! I am starting to feel a little bit better and I do try to plan the day with the NCP's when I see them. I set an approximate schedule for baths and have found that the day does go by much smoother, I will take all suggestions and lead by example and do what I can for the patient. Because that is who I am there for!

Gold_SJ · Mar 26, 2012

I had a similar experience as yourself back when I was a new grad. It initially frustrated me beyond believe and I struggled greatly with being assertive it felt too awkward to be trying to dictate to a person who was far more senior and had worked decades more years on the floor than myself.

So I tried to do most work myself (This is a bad idea! Your time management becomes hideous).

Instead after a while (realising the above concept did NOT work) I than tried to learn what things each individual liked. Example some EEN's (LVN) preferred to give medications while others hated it, some prefered to feed patients others to shower them. I tried to delegate work they liked to do and do things for them that they didn't like, I also met with them at the beginning of the shift and would ask when should we start showers? Would you do this? While I do this? So they were involved with the plan too and knew what we were doing. So we became a team.

It worked waaaay better. Eventually we were on a complete role as a team and they went out of their way to help me, because I helped them and respected their individuality on likes/dislikes etc etc.

Some might think this way lets you be taken advantage of. I however found this wasn't true, for tasks we both didn't like so much we just shared or took turns. You'll always find a person or two you clash with though so have to work harder to have a smooth run with.

I think respect can also take some time to grow, you haven't been there long so they'll be learning about you, as much as you about them.

In dire situations or crazy/busy situations, you do have to just delegate with little consideration to preferences though.

Just 'X can you please do 'abc' for me while I do this and this? Thanks so much.' Smile and walk away and do your work, you were polite and to the point. I've never found someone ignore me/refuse in this approach.

Thanking those working with you at the end of the shift is another good thing to do. Shows all their work was appreciated. Even if during the night/day you could of been ran off your feet and barely spoke to them.

I hope some of my experiences can be of some help.

All the best!!

BostonTerrierLover, BSN, RN · Mar 27, 2012

I would gently(the first time), remind them that we all have a part to play on the Nursing Team. I too only call them when I am desperate, as a male, I try to assist everyone with lifting and up to BSC (even other RNs/LPNs patients). Often, this effects my time management, and nothing is done in return for my patients.

So, I have a very small stomach for being ignored, or turned down for assistance. It's not like I ask them if they are running 90mph to keep up, they are generally nested somewhere when I ask. I love the ones that play hide and go seek too at the same time the Code Brown of the Week occurs.

I know there are the CNAs, PCTs, Aides, and Orderlies that I would say are invaluable to our team, but that's not the ones we are discussing here. I don't have to "prove" anything to any staff member because they have been here half a century. And, being here half a century does not entitle you to act like a complete care patient as I have seen in numerous facilities. If the assitant gives me a tude' after all I do to "Not" call them for help, they get a special reward, they get to go home early.

We are all here for the same reason, and I am not interested in making someone elses paycheck for them. If they don't like their plight in life, there's other jobs, education, or the "door."