New nurse needing advice

nurse2033, MSN, RN · Nov 19, 2010

Are you the highest ranking nurse? If so perhaps you should have a quick meeting with everyone and lay out your expectations and their roles and responsibilities. You need to set the tone ASAP or things will slide into a zone of mixed messages, disappointment, and repressed anger. You don't want to dictate but you should explain that the reason there are CNAs is that you are there to do things they can't, like hand out meds. Sure you could do their jobs too, but not all at the same time. They need to handle the tasks within their scope of practice. Make sure you are acting within the protocols of your workplace and hold them to the consequences if they are slacking, or whatever the problem is. Not everyone has the best intentions and some people simply have to be held to the standards of their job under the threat of institutional "correction". Best of luck.

mkahnlpn · Nov 19, 2010

I am the night shift 6p-6a nurse on the entire unit that I work on (its a multi unit facility) I care for about 40 residents and have 4 cnas and 1 QMA under me. I believe the absolute main problem is that I am the youngest one there! I am 22 and one of the cnas is 55! I think that is why they are having a hard time wrapping their mind around taking orders from me. I have already spoke with my supervisor about dealing with them, and she handed me a stack of write up papers and counceled me about this issue. I am such a new nurse, and I dont believe I took into consideration how big this responsibility really was! I am considering making an "expected to-do this" for these girls to set the standard. thank you for your reply :)

NightNurse876 · Nov 19, 2010

You are a leader : ) Never think less of yourself. I'm sure you carry yourself in a way the exemplifies who you are..and if you are a nurse, you are able to delegate and prioritize and critically think!! Set up your leadership style, have a meeting with them. Let them know what's up, what's expected, what wont be tolerated but that you are still the amazing you- you've always been. I ahd a horrible day today but I think I've learned from it and you are learning from your experiences as well. But you have it in you, just let it come out ; )

Ginger80 · Nov 19, 2010

I'm a new grad LPN as well and I work in LTC with 4 CNAs on my shift (nights). I felt very incompetent as well in the very beginning, but now, 4 months later, I feel like they trust me. I have never had to "discipline" anyone yet, but I do make it clear that I know what's going on in every one of my units ( I have 140 residents under my care at night!).

Just make sure you are aware of what needs to be done by the CNAs, and don't let them intimidate you. You're there to supervise them.

LJNZRN · Nov 19, 2010

read your state practice act- you are the leader! outline your expectations remember YOU the LPN are responsible to ensure they are doing what is required by policy for the patient under your care. Dont be a dictator but also dont allow poor care or insubordination. Good books to help ones by John Maxwell and QBQ. Find a LPN/RN mentor to help learn these valuable skills

Davey Do · Nov 19, 2010

mkahnlpn:

Yours is a common situation: "do not feel as I have had enough training on being the 'boss'...not a dominant person...not a leader...forced to be...not one to deal well with confrontation."

We take some courses, do some clinicals, pass a test, get a license, and are expected to know and do everything right. The first time. That just ain't how it is. We attempt. We stumble around grasping in the dark. Sometimes we get what we're after. Sometimes we don't.

"If at first you suceed, try to hide your astonishment."

Previous Posters have given some sound facts and advice. Now, you have to make the attempt. It ain't easy. However, "Practise provides opportunity for possible improvement".

Many times, we have an expectation of ourselves which is outside of the normal realms of who we are. So, I say to you, don't be dominant. Don't be confrontive. Be who you are. Approach others as you would want to be approached if the tables were turned.

And TRY not to take rebuttals personally. Remember that the rogue CNA's are human beings with the same kind of feelings and shortcomings that you pocess. They may express theirs in a different way than you do, but we are all generally the same: Tryin' to deal with life the best we can.

If you can't dazzle them with your charmingly brilliant outgoing personality, or your self-assurred leadership qualities, then merely furnish them with the facts. As your Peers have pointed out.

The best to you in your endeavor, mkahnlpn.

Dave

FrogKissingNurse · Nov 19, 2010

remember back to grade school when there was a substitute teacher and the entire class would walk all over them... well you gotta be smarter than that teacher :)

have confidence in yourself, that is the number one! always add a please and thank you and offer to help the cnas when ever you have a chance. don't be one of those nurses who can't ever get their hands dirty and change a patient or roll them over. that is one way to get on a cnas bad side real fast. remember, never ask a cna to do something you yourself would never do.

[color=#483d8b]you do have to lay down the law every now and then. make sure they know what your expectations are and always communicate with each other. a friendly enviornment makes work so much easier.

[color=#483d8b]once every gets to know each other things will run more smoothly and mutual respect is key!

[color=#483d8b]good luck!

Kooky Korky, BSN, RN · Nov 20, 2010

first, a hug and congratulations to the new nurse on her first job.

now, down to biz.

younger though you are, the law says you are in charge. awkward or not, you didn't make the law. but you will definitely feel the wt of it against you if you don't take charge and fulfill your obligations. one of them is to effectively supervise.

that means, for example, that, if a pt is harmed because an aide does something wrong or doesn't do what she is supposed to do, like feed the patient, toilet the pt, something like that, your boss might wonder why you didn't make sure that the feeding and toileting didn't happen. if a patient falls, someone might wonder why you didn't prevent it. obviously, you are not responsible for orienting the aides. obviously neither they nor you can be everywhere at once. but if it is known that you routinely allow the aides to take extra long breaks, extra breaks, breaks when patients are needing care, or if you routinely do not see to it that they lock wheels on beds and chairs and put call bells within reach - well, you might have some explaining to do. while your job is not to mother hen aides, you do need to cyrearend and go behind them to a degree to make sure that the patients can reach their remote, kleenex, and h2o, and make sure that aides chart vs and i&o's. yes, they are supposed to do all of this, yes, they often do. but i have seen plenty of times when they don't. to protect myself, because i am ultimately in charge, i must correct or get them to correct these things.

being young, it's very hard. being new as a nurse and on your job, not a born confronter, and inexperienced over all makes it even harder. one solution is to picture yourself giving testimony in a courtroom. you are being held liable for damages because your aides restrained someone without an order. the patient was restless and confused and rather than get vs and have you see her to see if maybe she was ill (uti, lytes off, adverse med reaction, prodromal seizure, mi, stroke, glucose off, whatever), they just restrained her so she wouldn't fall - and after she stroked out, they said you told them to do it). that mind game will likely motivate you to self-protect, self-protect, and self-protect. how? by riding herd on your staff. by utilizing the write-up, the verbal counseling, the incident report, the team meeting, the 1 to 1 meeting, the coaching, the team-building techniques you are going to study up on and put into practice on the job.

i am currently in a similar situation in that i am new on my unit. i am older, though, male, and experienced, and have a reputation for being very fair and a hard worker and that i take no guff. none. unless you are passed out, hemorrhaging, or quit breathing, unless you just got word of a terrible emergency at home, you are responsible for doing your job, mr. or ms. or mrs. aide, and doing it courteously, completely, and correctly, on time. if you need help, get it. if you need information, don't know how to use a certain piece of equipment, ask. but no excuses. you accepted the assignment and you have to do it in a manner that you would want used on you or on your mom if you all were the patients. period.

in your case, you must start with your own outlook. 22 or 52, the law says you are the boss on that shift. period.

realize that you likely have a couple of good workers, devoted and honest. and you likely have a couple who are the laziest aides who ever lived. one has 7 kids at home, never sleeps, means well but is always too tired to give her best effort. you know what? her personal troubles are not your responsibility. nobody told her to have a large family, nobody forced her to be financially strapped. she just didn't think. and if there were other circumstances that are beyond her control and not her fault (her mom is ill and she has to care for her, too), it still is not your responsibility and you cannot afford to give her a break on the job. she comes to work to work, not to sleep or shirk or put you in a trick bag. another aide might have some equally sad or difficult story. it might or might not be true. it might be a complete falsehood, designed to make you feel sorry for her so she can then borrow a couple of dollars now and then, take extra breaks, and not do her share of heavy lifting. in other words, develop a lot of skepticism. do not let anyone fool you. see people for what they are. do not feel sorry for them and let them slack off on the job. do not do the work they are being paid to do. yes, it's low pay, but that's not your fault. let them find a way to make more money thenmselves. not saying you can't give a little christmas gift if you are so inclined, but really think about the message you are sending. make it little. and make it equal.

if i sound hard or bitter, i guess i am. i've seen enough shenanigans over a long career to make me that way. i'm sick of smokers taking extra breaks and longer breaks as they've had to walk further to smoke. i'm tired of people making a million cell phone calls home - while working with patients. their attention should be on the patient, who just might need to say something! i know working parents need time to talk to their kids. it is heartbreaking what american workers go through. not my problem. hang up your cell phone and do your job. call home on your break.

always couch it in terms of policy and safety. "policy requires no cell calls while on duty. when you put your attention on your phone call, the patient feels she can't talk to you, feels like you don't care enough about her to hang up the phone. how would you feel? old, sick, and you're getting half the attention you need. you've waited an hour for bedtime care and now your aide in on her cell phone talking to her boyfriend. and the patient is afraid to say anything to you, therefore, i have to be the heavy and remind you that policy is..." be for real with your aides. they might not all see anything wrong with this, btw. they might think it's perfectly fine and that you're being a stick in the mud or that it's racial, if you are of different races. too bad what they think. that's why you go with policy.

you have to lay down the law - not the don,not the owner, not the administrator. they pay you to be in charge. do not look to them except for backing you up. but they are not going to be present every time every shift. that's why they hired you.

don't come on too strong. but not too easy either. you are not anyone's friend. you are their boss - whether any of you like it or not.

be prepared to do write-up's - but don't make them your first approach. a lot of things can be just talked out. and then, if the problem recurs, you will need to start writing. do it sooner rather than later.

keep a written log of your own, at home, tell no one about it. record any problems you encountered each shift - who was involved, what happened, just a few brief words that will jog your memory. if you make it known that you have this log, it might be able to be subpoeaned. (no legal advice intended, i just think this might be true. not sure. ask a lawyer.)

trust no one. there really can be no friends on the job. do not tell your personal business - any of it. unless you like being betrayed, embarrassed, and talked about all over the building, keep mum about your personal life.

do not share your views on politics, religion, or anything else even remotely controversial or that might offend anyone with a different view.

i know these make work sound like work. well, that's what it is. i wish you all the best. the sooner you accept reality, the sooner it will start to get easier.

one more gem - if anyone threatens you and you think they are even remotely serious, get the police there. do not ask your boss if you should or may call cops. just do it. you have a right to be safe from threats or actual attempts to harm you. and you don't need anyone's permission, even the owner's, to call a cop.

i forgot to say - get used to the fact that there a lot of really mean and nasty and evil people in life. some are so lazy, some love to see what they can get by with, some think they're older than you so they should be the boss. too bad. they can go back to school if they want to be boss. until then, ride them, write them up, make sure you've "got their number".

Kooky Korky, BSN, RN · Nov 20, 2010

remember back to grade school when there was a substitute teacher and the entire class would walk all over them... well you gotta be smarter than that teacher :)
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have confidence in yourself, that is the number one! how can she do this when she is brank new? new nurses usually lack exactly that - confidence.
always add a please and thank you and offer to help the cnas when ever you have a chance. don't be one of those nurses who can't ever get their hands dirty and change a patient or roll them over. that is one way to get on a cnas bad side real fast. remember, never ask a cna to do something you yourself would never do. what? never ask them to help someone while you do your meds, chart, admits, discharges, process doctor's orders? what?????
[color=#483d8b]you do have to lay down the law every now and then. make sure they know what your expectations are and always communicate with each other. a friendly enviornment makes work so much easier.
[color=#483d8b]once every one gets to know each other, things will run more smoothly and mutual respect is key!
[color=#483d8b]good luck!

mutual, yes. she should not have to do aides's work to earn their respect. courteous, yes, but remember that the aides are there to work!!! yes, actually pull their load. why must they be thanked all the time? the aides need to learn to buddy up, not come get the nurse every time they need to pull somebody up in bed or get somebody up or cleaned. let them help each other. she can help occasionally, but the hands-on, bedside, direct care is not on her. it's expected to be done by the aides while she does her piggybacks, meds, incident reports, etc., all the stuff only nurses can do.

carolmaccas66, BSN, RN · Nov 20, 2010

I work as charge nurse in a LTC sometimes. I have no problem with those under me, because I told them all at the beginning 'I'm the charge nurse on this shift, can u please report anything to me, any problems come & see me.' I work with all the carers etc to get the work done & pitch in when I can. They think we RNs don't do any manual work like they do, I explained one day that is cos we are worrying re meds and other priorities. They are not the same roles. I'm older as well but have had some older, dominant carers who don't like u telling them what 2 do. I had to organise staffing one night & told the carer I couldn't help her turn patients etc. She was not happy! But staffing takes priority.

When ur young & inexperienced it's hard acting confident. U could speak to each person individually, but maybe u could find another job where ur not in charge? It sounds like this role doesn't suit ur personality. U can act confident, and just tell the other staff things in a firm tone but I think u need more experience as well.