Nursing Assistants (NAs) accountability

[Kayleigh Stanley]

I have been a nurse for over 15 years, and a lot of it spent in icus. I recently took a position as a team lead at a new hospital (new for me), on a surgical pcu and medical surgical floor. I have recently realized that the NAs are struggling to know what and when they are supposed to do certain tasks, and which shift is responsible for which tasks. Baths in particular are a big question mark. I recently found out that some of our NAs will mark a bath as refused, and then the next shift is supposed to offer them a bath again, and come to find out they were never offered the first bath... how do other places assign their baths to make it fair, and how do you hold your NAs accountable for following through or not following through on completing these tasks? My suggestion is do divide the baths by days doing the odd rooms and nights doing the even rooms, along with creating a dry erase bed board to make a visual of which baths got completed, and which ones did not. Currently, my night shift na is looking through the charting to find out who did or did not get a bath, because what she gets in report does not match up with what is charted. Thank you in advance! 

[JKL33]

Out of curiosity, what number of patients do the NAs cover on their respective shifts?

There are likely issues beyond just whether or not there is confusion about whom is supposed to be doing what/when. It will help everyone if you review expected duties and make sure there isn't a discrepancy between expected duties and staff available.

Not sure about your odds/evens idea....I suspect that will go right off track as soon as Rm 220 requests a full bed bath at 0800 and Rm 217 is annoyed that no one has even offered a washcloth all day. Then the NAs may have disagreements because so-and-so had to help a room that they weren't supposed to have to help.

It seems like you will probably need to come up with a plan where each shift is offering supplies and/assistance as needed to wash up/bathe. Each shift is responsible to follow up if the care was declined (marked refused) on the previous shift. You will likely need to do some rounds/close follow up at first on the refusals. Actually visiting patients if you suspect that refusals are being marked without patients being asked.

[heron, ASN, RN]

^^^ What she said. ^^^

One of the hardest things I had to learn as a nurse was how to supervise a team. The last thing in life I ever wanted was to be somebody's boss.  I worked most of my career without the help of nursing assistants. Then I got a job on 3-11 and 11-7 in LTC for the final 10 yearsbefore retirement. I got the opportunity to work with an amazing ADON who taught by example. Is there any such person in your organization? And do your managers have your back?

[makima]

heron said:

One of the hardest things I had to learn as a nurse was how to supervise a team. The last thing in life I ever wanted was to be somebody's boss.  I worked most of my career without the help of nursing assistants. Then I got a job on 3-11 and 11-7 in LTC for the final 10 yearsbefore retirement. I got the opportunity to work with an amazing ADON who taught by example. Is there any such person in your organization? And do your managers have your back?

That's a thoughtful question! Having supportive leaders and mentors can really make or break your experience in any workplace, especially in healthcare. I've found that some organizations are lucky enough to have managers or ADONs who truly lead by example—people who step up, guide their teams with patience, and aren't afraid to get their hands dirty when things get tough. When you have someone like that, it's easier to learn, grow, and feel confident even when supervising others doesn't come naturally.

In a good organization, managers not only teach by example but also have your back when things get hectic or challenging. They'll advocate for you, listen to your concerns, and help you find solutions instead of just pointing out problems. Not every place gets it right, but when they do, it makes all the difference. So yes, those people are out there—and when you find them, it's like having a rock you can always rely on!