Need advice...New RN working LTC

[kimberly_1878]

Hello...Thanks in advance for any advice you can give me.

I am a New RN, have been at a job for almost a month now. 2-3 weeks of training to replace the RN on that wing. When she was training me she mentioned how she doesn't ask her CNA's to vitals because they have an attitiude. But, that being said there is no way she is getting vitals and doing her job description as well. I would assume and witnessed her just punch random vitals in....not good! I know.

That being said, when I have time to get a set of vitals or even two I will. Well this week was the 1st time I wrote on the CNA's sheet that I needed vitals on 2 pts. Neither of them were completed. We had a fall, and therefore I did them the 1st hour Q 15 - just because I want to make sure the patient is stable. Vitals every hour on the patient were written on the CNA sheet...nothing.

So, I approached the CNA's the next day. I said I know you guys are busy, and I appreciate that you work your butt off, but I need vitals from you guys. She said "well if they arent on that sheet in the morning, I dont look at it " I said well you know Mrs.....blah blah had a fall. And I needed vitals on her. I wrote this at 10 a.m.- shift is over at 2p.m. After that she walked around all day with an attitude. I had one person with a set of vitals needed, one of the CNA's got it and put it on the sheet and I told he thank you. But the same "leader" walked around all day with an attitude and when I was doing my morning med pass she was in the dinning room and said "I can tell today is going to be a great day"...in a very saracastic tone. I replied...Her name, its going to be the type of day that you choose to make it. She is the one that the previous nurse said she has an attitude. I gathered that within the time of training...they were feeling me out. I am very polite, kind, and go out of my way to do anything I can if I have the time. At one point in the day, I asked how Mrs...Blah blahs stools are because there was an issue and she said " i dont know" and just walked away.

That being said, I am not one of those where I can't get my hands dirty, I dont think I am better, and have told them what a good job they do. But, I am meeting resistance with expecting them to get vitals. I dont have time to get them, and I am jsut not going to plug numbers like the other one did. I am meeting resistance...and I figured she would get over it soon. I work tomorrow and I hope she drops the attitude. If not, what should I say? I want to have a good working relationship. We should be a team, but she is making it hard....before I asked for the vitals we communicated, she was happy, going about her day the prior week. I know they were waiting to see how I was going to react to them not getting vitals, and probably expected me to be like other nurse but that is not the case.

I have a backbone...the other one didn't. The CNA's are resisting the change.

Advise please. If she is still coming at me with an attitude with no communciation either how should I handle it? This is not good for the patients if she is just going to cut off communication. I want to approach her in a respectable but firm manner where she knows I mean what I say.

Thanks for any advise.

[guest358111]

Make sure the vitals are on the sheet for the CNAs in the morning. Assign vitals to the CNA by name clearly. If routine vitals aren't done by the end of the shift, or by the time specified (maybe by 2 hours) write up the CNA. If they are definitely not done by the end of the shift, write them up. Give them a warning halfway through the shift. If they still aren't done, disciplinary action needs to be followed. VITAL SIGNS ARE NOT AN OPTION. If they are trained to do them, they can get them.

Fall vitals are up to you. If the aides seem really busy after the fall, don't involve them and just do it yourself. But you should not be doing the vitals unless it is your facilities' policy to be doing them or if you feel the patient is unstable enough where you have to do it. Someone not getting vitals on 2 patients is nonsense and totally unacceptable. Go above to your supervisors if you need to if you can't solve it. But do not allow it to continue. Like I said, the aides not doing vitals if it is in their job description is not an option. They need to get them or not work there. Period.

[withasmilelpn]

I do my own vitals - trust mine more anyway.

[anniern2010]

You're the RN, you're the boss. I would be sure to announce to the staff (clearly with eye contact) who needs to do the vitals and when they are expected. I would also respect that employee's demand to have the vitals up on the sheet at that specific time. Usually the staff has a strict routine and get very upset if it's disturbed (especially by the nurse). I feel that as a nurse I have the option to be a little more flexible and keep the unpredictables for myself unless I need help.

That is all you need to do on your part. They need to know their job and do it when asked... Never mind the attitude, I would just ignore it and be as polite as I can be all the time. You're all there to work aren't you?

[hope3456, ASN, RN]

I think this is a problem widespread in LTCs. The cnas almost have the upper hand on the nurses, in my experience. I reported one for constantly disappearing- I caught her outside when I had an urgent situation once. Yeah the DON talked to her but she was also a favorite because she would work for them 60+ hrs a week. The crap she pulled on me - honestly I wish I had not reported her. I also think it is easier for them to find jobs than it is us. I've seen several working at subway, Walmart ect so it isn't like they have a lot to lose. And the ones that did a good job IMO font get credit for it. I'm sorry I don't have better advice.

[Nola009]

Wow, your colleagues are resisting you too, in a covert way by not expecting their CNAs to get their vitals. I would bring this up in meetings where the DON or ADON is present. You need to be united when it comes to what's expected of CNAs. Then, the one nurse who doesn't 'make her CNAs' do it will be the exception, not the rule.

If honest, open sharing of concerns / ideas in your workplace is not an option (yikes!) I would get myself a portable BP cuff, pulse ox, and whatever else you need. My goodness, they should at least have thermometers in clear view. It's not ideal, but I have a friend whose a LPN who told me that's what she does.