I was training a newer RN on the pm shift yesterday. He will not be working on my unit, just cross-training per policy. I did the same when I started and have never gone off of my unit. He has no experience with psych nursing and is ending his training. I knew he wasn't pleased to have to come shadow on my unit but managed to keep up appearances most of the shift. Towards the end, I was busy with a new LPN in training and the supervisor came along for rounds.
I came into the nurses' station on the back end of a conversation in which he was asking if "this is normal and allowed". Although I was wondering, I had enough to do and had to leave the station again. Report was complete so I didn't need to be there for the supervisor. When I was able to come back, the super asked me to deliver a taped note to one of my staff, which I did. But, I had an awful feeling I missed something with this new RN.
I asked him if I just delivered a very negative note to one of my cna's and if so, could he explain. He stated he saw her eating crackers and had a book out during a 1:1, which is against policy. He never came to me with this information so I never had a chance to correct the bx. It was a very busy night with 2 admissions (which never happens), physical altercations, family drama...in short typical nursing evening, lol. I could have screamed I was so po'd. I discussed this with him regarding giving staff a chance to do whats needed before going to the next level and he just didn't get it.
It was a very busy stressful night and to top it off with a new orientee who I just wanted to get off of my unit and never see again. I spoke with other staff that float to the other unit and was told he's been writing up employees there. I'm just sick that someone with no experience in their new field would be so blind to chopping off their other hand. I did tell him to be careful because those same staff members are the ones that should have his back when pts become assualtive. I think he had no idea. I was new just over a year ago and understand how hard it is, but jeez was I frustrated. I just needed to let it out :)
I suspect it has as much to do with the fact that he is new and not even a permanent member of that team. He has no knowledge of this person's prior working relationship with the floor, which should always be considered in disciplinary measures. One day of crackers and a book for an otherwise exemplary employee isn't the same as someone being unsafe, insubordinate etc. Part of the yardstick when measuring something should be the person's history and the depth of the offense. He has no point of reference for that. All people need reinforced boundaries sometimes. That doesn't have to mean big guns.
1. I agree that's it's likely because he is new. It's a whole nother sorority sister bullying thing in nursing. You have to be jumped in, for sure. Again, not what I would choose to do but that doesn't reflect well on our profession either. We shouldn't be keeping quiet until we make nice nice on the unit.
2. The point of Reference is the unit policies which both nurse and tech clearly know. There really isn't any reason not to tell the big guns so to speak (though again I would have said something to the person FIRST and waited till I had observed more and perhaps spoken to the charge nurse) If the person is an exemplary employee, this incident will mean nothing to the manager. It really isn't the staff nurses job to measure the offense at all. That's up to leadership: charges, supervisors and managers.
3. Lets be real. The book didn't magically appear. It's likely a chronic behavior, isn't it?
Specializes in Critical Care; Cardiac; Professional Development.
I am not sure I agree with you about staff nurses not being responsible for leadership of a CNA's performance. Why else would one be permitted to write one up? And I would put forth that part of the staff nurse's ability to critically think would be in making a judgement call regarding what is a truly infraction worthy of the time/attention of charge/manager/supervisor etc and what can be handled person to person. Even you said you would have probably talked to the person before taking it to the supervisor.
I disagree too about making an assumption that the book is a "chronic behavior". There is no mention of how long this CNA has been on the floor or with the company, whether they are PRN and work seldom or full time and are there all the time. I do think one has to be very very careful before making assumptions, particularly those to the negative. I know I would prefer people give me the benefit of the doubt and I am sure you would like the same...we all hope for that. :)
You are correct on the technicality of reporting said behavior, but one does have to bow a bit to social norms and social intelligence as well. Being a float shadower for crosstraining and reporting permanent staff to their supervisor without talking to the staff nurse who is the first level of leadership over the CNA is pretty much socially ignorant and a bit insulting to the staff nurse. She should have the ability to monitor/manage her assistant on a basic level and to make the judgement when what is needed goes beyond her ability/authority - that is part of her job I think.
We may simply differ on this. Some folks are very rigid when it comes to rules and others are more flexible. Finding the line of how flexible to be is a challenge in any level of leadership I think. I feel the crux of the issue here is more that it was not within the scope of that guy's role at that time. He should have defaulted it to the staff nurse over that particular CNA if he was concerned.
While I subscribe to "betty by the book", we all know, socially and professionally, that is NOT a good way to treat employees. People always respond better when given a chance to improve. I can count on my index finger the number of write-ups I have given over the years, one to be exact.
He thinks he's earning brownie points. He is only messing it up for himself. Karma baby.
The other consideration is, if some random person I don't even know writes me up, it really won't have much effect on me. If my regular nurse does it, holds a lot more weight as does her/his spoken word.
Sounds like a couple "protocol happy" nurses I work with.
I was "written up" by one of 'em and so was my pod partner over "inappropriate overuse of propofol". Basically this person claimed that 'protocol was violated' because 'pt. was given over the limit amount of sedation'. This person arrived at this conclusion based on the number of bottles of Propofol that were used on the patient within x amount of hours.
Never mind the fact that this person wasn't assigned the patient (pts. primary RN was my pod-partner. I was helping out where I could. This person got called in to "verify dose with 2nd RN" because pod-partner was hanging a new bottle of Propofol... and that's where this person started talking about "you've used too much Propofol. It's against protocol. This WILL BE an incident report!")
Never mind the fact that the ER doc, the admitting doc AND the ICU intensivist doc had no problems with the dosages. Never mind the fact that during this entire episode, pt. was hemodynamically stable (which if any of y'all who has ever used propofol knows it's not always easy).
This is what happens when people pay too much attention to "protocols" and forget about "critical thinking" (the pt. in this case was morbidly obese. Usual doses of meds won't work as well in this case. Besides the fact that the pt. WAS hemodynamically stable!!!)
As uncharitable as this may sound, I'll borrow a quote and say: "We all got a job to do. And 'This Person''s job is to be an *******. Just so happens that 'This Person' excels in it".
- Roy
Is the protocol meant to be followed or not? Who will be in trouble for giving more than protocol allows? The nurses, not the docs who ordered it. Bet they were verbal orders, too, which the docs would probably deny ordering.
it's fine that the pt tolerated, even needed, the higher doses, but I have to wonder about the foregoing question I asked and wonder why protocol doesn't cover this exception. I would like to have something in writing - orders and rationale and approval from my supervisor - to cover myself.
I know what everyone is saying - he should not be writing people up so quickly. He should have talked to the aide directly and given her a chance to do right or he should have gone to the mentor, the OP.
However, the CNA who was eating and reading while she was supposed to be watching the 1:1 - is she new? How come she was violating policy? How many other nurses have let her get away with this? Why? Laziness? Fear? Not fair to her, to the patient, to the employer, to the new nurse, to anyone. Don't nurses realize that they can get in big, big trouble for not effectively supervising other staff?
There are always 2 sides to every story.
And maybe it's more important to him to keep his license than to fit in.
Specializes in ED, ICU, MS/MT, PCU, CM, House Sup, Frontline mgr.
and maybe it's more important to him to keep his license than to fit in.
true, however, i have never ever read, heard, or known of any nurse to lose his/her license for not writing up an aid. i agree with the perception of many of the others, this new rn has no common sense in the work place. if he/she had any common sense, he/she would try to fit-in. the real world of nursing dictates some level of team work. when the new rn wrote up the aid rather than speaking to him/her first (making expectations clear or letting him/her know that he/she was to be written up) the new rn used the system of write-ups incorrectly. the system of write-ups is to make the environment safer and effective. it is not to be used to snitch on or bully fellow co-workers.
op: the new rn is definitely poison in the drinking water.... i seriously doubt this nurse will be around very long unless your work environment is already toxic.
I am not sure I agree with you about staff nurses not being responsible for leadership of a CNA's performance. Why else would one be permitted to write one up? And I would put forth that part of the staff nurse's ability to critically think would be in making a judgement call regarding what is a truly infraction worthy of the time/attention of charge/manager/supervisor etc and what can be handled person to person
I disagree too about making an assumption that the book is a "chronic behavior". There is no mention of how long this CNA has been on the floor or with the company, whether they are PRN and work seldom or full time and are there all the time.
We may simply differ on this. Some folks are very rigid when it comes to rules and others are more flexible. Finding the line of how flexible to be is a challenge in any level of leadership I think. I feel the crux of the issue here is more that it was not within the scope of that guy's role at that time. He should have defaulted it to the staff nurse over that particular CNA if he was concerned.
It isn't about critically thinking. I see the same behavior here as I do on the unit. Saying someone should critically think is like saying there was no thinking in deciding to report the cna. Actually, there is a thought process here and its called boundary setting and nurses suck at it. They justify and justify and call it critical thinking. It's not. It's excuse making.
There is no doubt in my mind that everyone's orientation includes that you can not eat or read books in front of patients. I said I would have talked to her first because I don't want to be bullied by people like the folks on this thread who make it clear they are here to enforce negative codependent social norms against people who report obvious infractions. This nurse obviously doesn't care about the social norms on nursing units which doesn't make him socially ignorant as other posters have suggested.
It isn't a challenge to find that boundary for people who know how to set healthy boundaries with other people in their lives whether that's at work or at home. I don't own other people's behavior. If they break the rules, I assure you I would lose no sleep over it when they break them enough times that they get fired. It's why we have rules, to provide some order, especially when it is basic rules like don't eat in front of patients or read books.
The nurse has his own license to be accountable for and no reason to report it to the orienting nurse who has no position of authority over him. So yes, we disagree.
1. Speak with the nurse about any issues that arise.
2. If it continues to be an issue, speak with the charhe so they are aware of the situation.
3. Bring it to the attention of immediate management.
I argue that it is actually unprofessional and exhibits a tendency towards lateral violence and creating a hostile work environment when someone goes straight for #3 over minor incidents. Something that compromises pt safety or causes a major mishap, I can potentially see that going straight to management would be a legitimate avenue.
Going straight to managent over an outdated IV (which is one example from my floor) the first time it happens is idiocy.
It isn't about critically thinking. I see the same behavior here as I do on the unit. Saying someone should critically think is like saying there was no thinking in deciding to report the cna. Actually, there is a thought process here and its called boundary setting and nurses suck at it. They justify and justify and call it critical thinking. It's not. It's excuse making.
There is no doubt in my mind that everyone's orientation includes that you can not eat or read books in front of patients. I said I would have talked to her first because I don't want to be bullied by people like the folks on this thread who make it clear they are here to enforce negative codependent social norms against people who report obvious infractions. This nurse obviously doesn't care about the social norms on nursing units which doesn't make him socially ignorant as other posters have suggested.
It isn't a challenge to find that boundary for people who know how to set healthy boundaries with other people in their lives whether that's at work or at home. I don't own other people's behavior. If they break the rules, I assure you I would lose no sleep over it when they break them enough times that they get fired. It's why we have rules, to provide some order, especially when it is basic rules like don't eat in front of patients or read books.
The nurse has his own license to be accountable for and no reason to report it to the orienting nurse who has no position of authority over him. So yes, we disagree.
I agree about nurses being generally not so good at setting boundaries. I do believe the orientee should have reported to his trainer, who, I am pretty sure, did have authority over him in that situation or orientee/trainee.
I definitely think it is good to fit in at work and have all the "friends" one can have. However, these friends will turn on you in the blink of an eye if trouble comes. That's why it's better to follow rules, make subordinate staff follow them, and play by the book.
It's much more vital, then, to hold everyone accountable for all the rules, as the nurse can then never be accused of not following policy and won't have to explain why he or she did not effectively supervise - the latter being called into question if some tragedy strikes.
I will say that, if an aide is mandated for OT and has had no proper break and can't get one, and is maybe falling asleep, I will probably not see if she is eating a quick snack while on 1:1. The reading is different, as it takes her eyes off of the patient.
1. Speak with the nurse about any issues that arise.
2. If it continues to be an issue, speak with the charge so they are aware of the situation.
3. Bring it to the attention of immediate management.
I argue that it is actually unprofessional and exhibits a tendency towards lateral violence and creating a hostile work environment when someone goes straight for #3 over minor incidents. Something that compromises pt safety or causes a major mishap, I can potentially see that going straight to management would be a legitimate avenue.
Going straight to managment over an outdated IV (which is one example from my floor) the first time it happens is idiocy.
I don't think it's lateral violence or unpro or creating a hostile work environment. I think it shows that the nurse is concerned about a problematic situation, perhaps fears it will come back on him or her if not reported.
I would not say anything about an outdated IV to the boss if the person responsible to change it actually changed it if I mention it to her.
This is a serious problem - we have rules but no one wants to enforce them. Then someone comes along and does expect the rules to be followed and that person is seen as being the problem. yes, I know it's about what to say, to whom, and when, but, gosh darn it, guys, if we all enforce all rules all the time, pretty soon everyone will be following them. Stop being afraid to enforce the rules.
as far as i am concerned, if the new orientee took me out of the loop by going to the supervisor with concerns/write-up then one of two things should occur:
if i'm responsible, then the supervisor should have redirected orientee back to me.
if i'm not responsible, then supervisor can deal directly with cna with regard to counseling/notification of write-up etc.
don't use me as your middle man to pass notes and "the buck".
nursing is famous for delegating responsibility without any authority.
VICEDRN, BSN, RN
1,078 Posts
1. I agree that's it's likely because he is new. It's a whole nother sorority sister bullying thing in nursing. You have to be jumped in, for sure. Again, not what I would choose to do but that doesn't reflect well on our profession either. We shouldn't be keeping quiet until we make nice nice on the unit.
2. The point of Reference is the unit policies which both nurse and tech clearly know. There really isn't any reason not to tell the big guns so to speak (though again I would have said something to the person FIRST and waited till I had observed more and perhaps spoken to the charge nurse) If the person is an exemplary employee, this incident will mean nothing to the manager. It really isn't the staff nurses job to measure the offense at all. That's up to leadership: charges, supervisors and managers.
3. Lets be real. The book didn't magically appear. It's likely a chronic behavior, isn't it?