I'm writing this post because I'm a new graduate nurse seeking some advice regarding PCA's (or CNA's) on my unit.
I've been on my unit for 3 weeks now as a nurse. Before, I had worked as a float PCA & had worked on my unit a few times, & I did my leadership/preceptorship clinical on this particular unit during school. The staff is pretty familiar with me.
Anyway, I have been taking patients with my preceptor & doing primary care with the patients as the nurse. For whatever reason, the PCA's do not report critical results or questions or updates on my patients to me. They will ignore me & report to my preceptor. I feel that they don't really respect me as the nurse or view me as being in this position.
I guess my question is, how do I change this? How can I earn respect from them and other nurses so that they see me as a competent RN?
Sorry, I just realized I didn't really answer your question. Respect from PCTs should not have to be earned (where is NOADLS when you need him?) but in reality, it is. From the perspective of a long time PCT, let me tell you how RNs got it from me:
-Ask for me help, don't ever TELL me to do something.
-Thank me for helping you with YOUR patient.
-Please don't call me from another task to do something that you could have done while you were right there in the room. Unless you are in a critical time crunch, this is not cool. If you do, be prepared to justify it.
- Similar to the last: If I am in a room, and need the NA to clean a pt, toilet, whatever, I always have a good reason, and share it: "Hey, Lucy, could you help Mr J to the bathroom while I get his meds together and call medicine for this critical lab? I have to hang blood next door, but when I'm done with that, I can help you get him in a chair."
I don't "use" unlicensed assistants when I don't want to do something, I ask for and appreciate their help when I have stuff to do that is timed or they can't do. I think/hope most of them realize that. Maybe I'm delusional, and they all think I'm a lazy cow.
-Don't ever, ever, ever ask ANYONE to do ANYTHING if you have been on your phone in the past 2 hours. Or if you just went out to smoke. Or if you took a 45 minute lunch and I haven't peed in 9 hours. I'm a pretty nice person, but you will NOT like my response.
Nursing needs to be like the military, not namby pamby could you please, if it isn't too much trouble for you to actually work while you're at work, dear little PCT. Do you really keep track of who peed when?
What if you have a sick child at home and are checking on him? You have to wait 2 hours from that call to ask a tech to do something?
I know what you're saying, I just think a nurse should not have to justify to a tech.
Good Morning! Sorry to hear you are experiencing a communication barrier with your nursing assistants, but congratulations on your new position!
When reading your post a couple of things you mentioned need clarification:
"I've been on my unit for 3 weeks now as a nurse. Before, I had worked as a float PCA & had worked on my unit a few times, & I did my leadership/preceptorship clinical on this particular unit during school. The staff is pretty familiar with me."
If you did your preceptorship on this unit, how did you get information from the nursing assistants before? Did they not pass information about your patient's during your preceptorship, if they did, why are you now experiencing a negative change?
I agree with all of the posts, you should be talking with your preceptor and have consistent redirection to your nursing assistants that they need to be updating you. In addition, you do have a responsibility to be updating them about the patient's care plan. If you are updating them at the being of your shift they will have a better understanding of the care being provided and will show them the "respect," of being part of the patient's treatment team.
You know as a nursing assistant, they will have at times more information about the patient then nurses may have. Are you checking in with them during the shift. Are you educating your nursing assistants?
The statement, "the PCA's do not report critical results or questions or updates on my patients to me. They will ignore me & report to my preceptor," is significant. What is the context? Are they calling abnormal vital signs? If they are getting lab results, ( I am surprised they are getting the results first and not you), did they know in advance that you are waiting for results? Have you specifically educated them, what is their response.
If you are in your third week, take it easy, it will get harder, and the intent of your nursing assistants may be to help you from getting overwhelmed, or if they themselves are busy and the first person they see they will tell (they are human).
If you are still able and willing to get down and dirty, just like every nursing assistant does, you should not have a problem earning and maintaining their respect. You need their breaks and they need theirs!
It will change when you are actually on your own. Right now, your preceptor has the last word and sometimes it is just a matter of "trust". They don't want to be going back and forth repeating same things to two different nurses. Relax. It will change when they actually have to report to YOU.
I don't think this means they respect you any less. They have super busy days too and they may find it hard to give detailed reports to two nurses throughout the day. It's more time efficient to give report to one (and even though I'm sure you're capable as a nurse, the NAs know the reliability of your preceptor, and will naturally give their report to the one who they're familiar with). Hopefully your preceptor includes you in those details.
As an orientee myself, I check charts often. I'm looking at flowsheets at least every couple of hours on each patient to make sure they're eating, peeing, having their vitals and weights in, activity...you get the picture. I of course also ask be patients about this too or document it myself if I see or do it. I also try really hard to make sure I update the NAs I'm working with every 2-4 hours at least. This does NOT always happen because I'm still working on time management lol. I ask them how they feel they're handling their patient load, what they may need help with, what they've noticed about their patients, and then I give them my little Update on our patients and ask them to report certain things to me when they see them. I've had such a good rapport by doing this! One thing to remember is that as nurses, it's our job to make sure stuff is getting done and it's our job to reach out to people for updates. It's awesome when other staff members reach out to us, but it doesn't always happen.
Nursing needs to be like the military, not namby pamby could you please, if it isn't too much trouble for you to actually work while you're at work, dear little PCT. Do you really keep track of who peed when?
What if you have a sick child at home and are checking on him? You have to wait 2 hours from that call to ask a tech to do something?
I know what you're saying, I just think a nurse should not have to justify to a tech.
I see what you're saying and I've thought this before too. Sometimes I really do wish everyone would just come in knowing what their job is and that they would just do it. On the other hand, as a person who has loved ones in the military and has heard their stories: the military can be dehumanizing. You're a number. Your superiors often don't care what's going on in your life. It can be depressing to some.
I think of it this way: when I'm a restaurant, obviously the waiter's job is to get my order in, bring my food, keep up on my drinks, etc. I absolutely expect them to do their job, but I'm still polite and I still say, "Could I have the chicken please" instead of saying, "go get the chicken, and when you're done with that make sure my water is full." But, if at the end of my day, my waiter is horrible and the manager happens to walk by and ask how my experience was, I might just tell the manager that the waiter was horrible. Same with the nurse/NA relationship. I'll be polite, but if the NA is not doing their contractually agreed upon job, I would let the charge know after trying to address it myself. Haven't had to do this though, and I honestly don't think I'll have to in the near future. The nurses and NAs at my hospital all have a fantastic relationship. I'd go out for drinks with most of the NAs I work with.
Nursing needs to be like the military, not namby pamby could you please, if it isn't too much trouble for you to actually work while you're at work, dear little PCT. Do you really keep track of who peed when?
What if you have a sick child at home and are checking on him? You have to wait 2 hours from that call to ask a tech to do something?
I know what you're saying, I just think a nurse should not have to justify to a tech.
She was saying when she, the CNA, hasn't peed in 9 hours. Used-to-be-CNA anyway.
Kooky Korky, BSN, RN
5,216 Posts
Nursing needs to be like the military, not namby pamby could you please, if it isn't too much trouble for you to actually work while you're at work, dear little PCT. Do you really keep track of who peed when?
What if you have a sick child at home and are checking on him? You have to wait 2 hours from that call to ask a tech to do something?
I know what you're saying, I just think a nurse should not have to justify to a tech.