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16 month old nurse needs advise / help on managing aids

Posted

Specializes in Geriaterics, RN Student.

sorry for the post, I very obviously gave the wrong impressions and am sorry to have upset and offended.

TheCommuter, BSN, RN

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 14 years experience.

If you're a 16 month-old nurse, you're making history. :)

Or, do you have 16 months of nursing experience?

Think back to when you were an aid. How would you have responded to how you're acting?

People respond to a positive, "We're in this together" sort of attitude.

And it sounds like you're going in with a "me against the aids" sort of attitude. Staffing is bad. That is NOT the fault of the aids. They're getting thrown out on the floor all alone before they're ready. They need to be coached what to do, not threatened after the fact. Think of it as you and the aids against the world. Not the aids and the world against you.

nrsang97, BSN, RN

Specializes in Neuro ICU and Med Surg. Has 19 years experience.

I am thinking you only have 16 months of experience. However being new takes time go get up to speed doing things. Some of the aides you are talking about only have 1 day to 3 weeks of experience. Maybe you are being too hard on them. I am not there so I am just going by observations I am making from your post. Maybe give them a list of things to be done by a certain time and check to see if things are done after time is up. I have worked with a lot of aides good and bad, but it takes more than 3 shifts to be a good aide especially if they have just come out of training and have never done this kind of work before. So really I don't know how else to advise you but with the list and time frame thing. Are there other dependable CNA's they could work with for a few weeks to be shown how things are done? Am I reading it right that they don't work side by side with a exerienced aide and are let out onto the floor with only class room training?

If they aren't working side by side with a experineced aide then that is where the problem is falling. You worked side by side with another nurse for a period of time right? Same usually applies with CNA. When I worked at a LTC as a aide I was working side by side with an experienced aide for 2 weeks. So I really think this may help them.

greenergrass, BSN, RN

Specializes in Wellness Coach, ICU, PACU, OR, Mgmt. Has 13 years experience.

O.k., I love the 16-month-old nurse thing. Welcome to nursing.

Sounds like you work in a Nursing Home....Hard for me to give advice, because I lasted about 2 weekends working extra shifts in one. I left for the very reasons you're stating.

  1. You are TOTALLY responsible for the care your patients receive
  2. You are TOTALLY responsible for the lack of care your patients receive
  3. You are the NURSE

Sorry. That's the rule.

Please document your conversations with everyone. Document all conversations with the CNA's. Document your conversation with the DNS. Follow your institution's policies exactly. Consider another position if you must.

  • Are your staffing ratios appropriate?
  • Do the CNA's have too many pt's to provide appropriate care, or do the just not care?
  • Are they appropriately trained?

Sorry I can't be of more help. It sounds like a big problem that's been going on at this institution for a while - maybe bigger than one person can solve.

Best of luck.

RazorbackRN, BSN, RN

Specializes in Pediatrics (Burn ICU, CVICU).

Personally, I think you sound like you're on a power trip.

Get over yourself and give these aides some guidance rather than being the "postal" nurse you have self-described.

crazdmomof4

Specializes in Geriaterics, RN Student.

I am thinking you only have 16 months of experience. However being new takes time go get up to speed doing things. Some of the aides you are talking about only have 1 day to 3 weeks of experience. Maybe you are being too hard on them. I am not there so I am just going by observations I am making from your post. Maybe give them a list of things to be done by a certain time and check to see if things are done after time is up. I have worked with a lot of aides good and bad, but it takes more than 3 shifts to be a good aide especially if they have just come out of training and have never done this kind of work before. So really I don't know how else to advise you but with the list and time frame thing. Are there other dependable CNA's they could work with for a few weeks to be shown how things are done? Am I reading it right that they don't work side by side with a exerienced aide and are let out onto the floor with only class room training?

If they aren't working side by side with a experineced aide then that is where the problem is falling. You worked side by side with another nurse for a period of time right? Same usually applies with CNA. When I worked at a LTC as a aide I was working side by side with an experienced aide for 2 weeks. So I really think this may help them.

They are getting training however, the problem is they aren't being trained well enough or long enough. Which, I have told the ADNS, tomorrow I approach it with the DNS. I would have no problem not writing them up, however when I am flat out being ignored, what do I do??

I have tried the encouragement, I was even working side by side with them last night as an aid. Charting didn't get done till the very wee hrs in the morning. I have told management repeatedly they need to train them longer. But my full time aid has 8 + months @ an out of state facility and at our facility for over 2 weeks. I am worried about my license. We were hit with a neglegence fine 2 weeks ago. Lastnight we were 3 aids on my hall, the 3 day aid being trained by another full time aid, however, management had no clue she was short shift, 2-8pm and left with no notice to me. The trainee informed me that no one had the middle run, and it wasn't her responsibility. This 3 day trainee also has experience as an ER tech, aid, Phlebotomist so I'm not dealing with completely new. I like the list with time frame thing though. Any other suggestions?

crazdmomof4

Specializes in Geriaterics, RN Student.

Personally, I think you sound like you're on a power trip.

Get over yourself and give these aides some guidance rather than being the "postal" nurse you have self-described.

I am not on a power trip or do I need to get over myself. I have tried encouragement, my aids normally only have 7-10 residents, which is below most LTC standards. I have warned, encouraged, helped.

I do not have time to care for up to 23 pts, meds, treatments, and train aids to do their job. That is a management issue. I have asked the nurse manager for help with staffing / training, the ADNS who is in charge or the aids, the CNA instructor, and tomorrow will talk to my DNS. However when care isn't being provided most of a shift, residents are being left on bedpans for over 1 hr and staff tell me a run of 7 residents isn't their problem what am I as a nurse who is responsible for care supposed to do?

JB2007, ASN, RN

Specializes in LTC, Med-SURG,STICU. Has 5 years experience.

Think back to when you were an aid. How would you have responded to how you're acting?

People respond to a positive, "We're in this together" sort of attitude.

And it sounds like you're going in with a "me against the aids" sort of attitude. Staffing is bad. That is NOT the fault of the aids. They're getting thrown out on the floor all alone before they're ready. They need to be coached what to do, not threatened after the fact. Think of it as you and the aids against the world. Not the aids and the world against you.

That is a great approch if the aids have team sprit and care about their work. Sad to say, but alot of aids (and nurses) show no pride in their work. When I was an aid, it was reward in of itself, for someone to notice that your residents always smell clean or your resident's rooms were always tidy. Anymore, most (I will not say all) do not care. They are there to collect a paycheck and nothing else. They will mouth off to the nurses (if we let them), walk by call lights, and ignore alarms.

I say write them up if they are not going to listen to what you are telling them. It is your lincense if something goes wrong because of their insubordination.

Sorry if I sound negative today, but I had to deal with aids just like you described all day long. It is exhausting having to follow them around all day making sure that they are doing their work. It has put me in a melt down kind of mood.

I've worked with a couple of the "aides just in it to collect a paycheck," and I think they're rarer than people think. Because some of those work well with me. Recently a tech at the hospital came to my shift, and she had that kind of reputation. But I'll work with her any day. Because from day one with her, I told her to let me know if SHE needed help, I knew the transition to days was tough for anyone. She's always taken spectacular care of my patients, and will watch my back just like I'll watch hers.

I've had plenty of days working with frustrating people. And I'm going to sound soooo Pollyanna-ish here, and a few years ago, I'd have never believed it. But the old adage about you being the change you want to see in others is actually true (even if I often think it's a pile of poo). If you display an attitude of teamwork (that doesn't mean doing someone else's job, it does mean being willing to help with their job) then they'll be more likely to display that attitude towards you. Will it work 100% of the time? No. Will it work if you're just faking it? No. But if you make a genuine effort, and really do try to keep in mind that the people working the floors WITH you are really trying to work with you, it helps.

It's advice that you can take it or leave it. A couple years ago, I'd have really left it. But I'm really finding more and more that it's true.

oslogirl

Has 12 years experience.

If I were an aid, I would'nt want to work with you, either. Please allow me give you some advice: Threats don't work. How much time and energy do you think you WASTE running around ranting; threatening to write people up? Aids, and everyone else for that matter, will be much more willing to work with you when you are friendly, courteous, and provide encouragement and positive reinforcement.

If the situation is so bad, I suggest you calmly meet with management to discuss your concerns.

crazdmomof4

Specializes in Geriaterics, RN Student.

obviously I gave the very wrong impression. I have dealt with these issues for over 3 months. I have also worked 36 hrs in the last 3 days. I have been called a good nurse by most of the aids I work with. I have asked management for help and better training because I don't enjoy having to trail after my aids making sure care is being given.

When a dying patient goes 5 hrs with no care there is a problem there that needs to be addressed. I talked to the particular aid who did this 2 x's about this problem and never wrote him up, I encouraged, told him and others that if they had any problems or needed anything they needed to let me know so that I could address it or help them. I don't normally write anyone up, or yell or harass. There are better way, but when this is continous, with management turning aids out without adequate training, or you are being told what care the aid will and will not provide, there comes a point when you have to say something or do something. I was hoping for suggestions on how to encourage and motivate, but obviously my frustration over 3 months of poor training and staffing is coming out with me being a less than favorable person. But lastnight when I had to revamp the runs for 19 pts between 2 aids and was told by one with 30 some years experience that if she didn't her run she would just tell me to go to heck, what is my response supposed to be?

I can totally understand the frustration you have. And when you've just gotten off a few long shifts, I can understand not being able to express it in a manner totally congruent with how you're feeling.

But I still think you're frustration is focused in the wrong direction. The aides aren't coming in saying, "Hey, I'd like to work with no training and inadequate staffing just to stress out the nurse!" I think if you just keep in mind that they're having a rough time too, and remember that THEY aren't the enemy. Unfortunately, you probably feel pretty powerless over the enemy (the short staffing) so you're frustration is going to end up aimed at who you have a bit of power over, the aides, UNLESS you make a conscious effort to not allow that to happen.

Talking to management is your best bet. The aides aren't the problem, your delegation skills aren't the problem. The problem is short staffing and lack of training. Neither of which you or the aides can fix. You can just all work together to get through.

oslogirl

Has 12 years experience.

My response was not personal. It had nothing to do with whether or not you are a good nurse/person. I am sure you are both. I was merely trying to give you some advice with the info. you had provided.

I hope things improve for you.

JB2007, ASN, RN

Specializes in LTC, Med-SURG,STICU. Has 5 years experience.

It sounds to me like you are trying to work with your aids, but they are not in the mood to work with you on the problem. I do not know what is causeing the poor attitude (short staffing or not feeling appreciated), but it sounds like something needs to be done. Try talking with the aids and asking them what is going on. If you can not get the answers you need there go to the DNS and talk to him/her about your concerns. Whatever you decide to do, it is going to require some honest communication on everybody's part.

greenergrass, BSN, RN

Specializes in Wellness Coach, ICU, PACU, OR, Mgmt. Has 13 years experience.

Please remember that advice is worth the $$ you pay for it. Every one of us has an opinion & it's a lot easier for us to express it in the comfort of our computer screens instead of the pain of your situation.

I've found this one thing to be true:

Most people come to work every day wanting to do a good job.

Unfortunately, systems, processes & negativity quickly get in the way of some. The more mature worker (in any job) has learned to manage their reactions to this.

I would imagine that a vast majority of CNA's are more prone to allowing systems, processes & negativity to effect their daily outlook & performance.

Our job as mature & responsible professional leaders is to set up systems so their jobs are as pleasant as possible - allowing them to continue their day providing the compassionate care we expect.

This can be accomplished through:

  • Design
  • Staffing
  • Leadership
  • Self Control

Good luck...you've got a really difficult situation on your hands. It sounds like a deep moral problem as much as anything else.

Remember Tinker Bell & never let them steal your light!! :tinkbll:

bluegeegoo2, LPN

Specializes in LTC. Has 11 years experience.

Do you help your aides? Answer call lights? Toilet people? Help with transfers and repositioning? I know we're busy, but I try to help my aides whenever possible, and they seem to respond very well to the effort. In fact, I can pretty much ask my aides to do anything and it will get done. They don't feel so overwhelmed as they know they can ask me to help for a minute and I will. It puts me behind some (most) days, but it's worth it to me to know my pts are being taken care of. They respect me for my efforts and they know I respect them. I also allow them to be imperfect, as we all have our "off" days. Being an aide is very hard work, the hardest in the facility, I think. And ususally being the lowest paid they can easily feel unappreciated. I thank them for doing their job. It may sound funny, but they need to know I appreciate their efforts. It's nice to hear "atta boy" once in awhile.

crazdmomof4

Specializes in Geriaterics, RN Student.

Do you help your aides? Answer call lights? Toilet people? Help with transfers and repositioning? I know we're busy, but I try to help my aides whenever possible, and they seem to respond very well to the effort. In fact, I can pretty much ask my aides to do anything and it will get done. They don't feel so overwhelmed as they know they can ask me to help for a minute and I will. It puts me behind some (most) days, but it's worth it to me to know my pts are being taken care of. They respect me for my efforts and they know I respect them. I also allow them to be imperfect, as we all have our "off" days. Being an aide is very hard work, the hardest in the facility, I think. And ususally being the lowest paid they can easily feel unappreciated. I thank them for doing their job. It may sound funny, but they need to know I appreciate their efforts. It's nice to hear "atta boy" once in awhile.

I do put residents to bed, toilet, answer call lights etc. I was an aid for 10 years and know how hard and unappreciated their job is. I always start with "if you have time" or "if you need help let me know" Its just that lately we are getting hit with aids who either can't manage their pts and want you to do it for them, or they flat out tell you they won't. Sunday one actually said to me if "I don't want to do it I will just tell you to go to heck" completely serious. I replied "yes, you can say that, but then I would tell you to go home."

I have talked to my DNS and went and bought several books at barnes and noble about team building and motivation. I took a week off, will be back to work this Friday I could see it if it were just me having this problem, I would then question my attitude, but its all the nurses on my wing, which has lost all regular staff to the VA home which pays much better. We have 2 potlucks a month which the nurses host between the 200 and 100 (my hall) we do pizza fiests or such just to let our aids know how very much they are appreciated. I just don't know what to do to motivate them to do their jobs competently. I defentately don't want to be the nurse who trails after her aids nagging them to do their job. I am hoping my books will help. I have already gained several ideas. Will implement them Friday hopefully with good results.

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