New PCNA, need a nurses input/advice

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Hi, I am a new (within 90 days of orientation) PCNA on an ortho floor in Cleveland, Ohio. I received a 45 day review that said that I was doing very well and that there were no concerns at this time. The only thing the manager said was that scheduling could be an issue as I am in nursing school. I have worked in management in retail, so I realize you have to put SOMETHING down as a potential "needs improvement." So after that review I felt pretty good and have continued working as I normally do. Fast forward to almost my 90 day review and I was called into the office and I was given a laundry list of grievances from 6 RN's (which would be all of the nurses that I work with on my shift). The list basically encompassed my ENTIRE job description. I was in shock and very upset. I would say that 90% of that list was not true. They said that I didn't answer call lights (I am the first to answer a light- mine or someone else's), I don't take vital signs in a timely manner (which I take at 1500 and 1900- yes, I could get them into our charting system earlier, but I find answering call lights more important as our patients do not have bathroom privileges and I do not want to make the patient wait, so I will make it an effort to get them in the computer faster (i can work on this); I was told that I do not fill ice bags or water pitchers (which I do, but I do admit that when all of our patients are 2nd days post-ops and they all need to use the bathroom and each pt takes 10-15 minutes to toilet- ice bags can get behind...when it is not as hectic, those ice packs are filled 3-4 times on my shift- and I refill water pitchers when I come on 1500, dinnertime 1700, usually around 2 vitals 1900 and usually once more before I leave; I was told that I do not turn patients, do not do accuchecks in a timely manner, I have an attitude (this really made me upset because I do every/anything the nurses ask me to do without protest... so maybe it could be non-verbals???). Basically, I was told by management that they were extending by probationary period for 30 days and if I do not show improvement then I will be terminated. :scrying: I am very upset because I LOVE this job, the patients, and I really like the nurses (even though they are notoriously tough). I DO NOT want to get terminated and the people that I talked to about it said that I should just quit, and I do not want to do that either. I spoke to one of the RN's that night I had the talk with management and she basically said she had never complained about anything of those things and that she felt ALL the PCNAs could do a better job filling ice packs and water pitchers. That was my only advice. So yes, I will be all over the ice packs and water pitchers, but I am at a loss on the stuff that I already do but am being told that I do not do. Also, I guess that the nurses do not like it when we sit down to chart- which I do. It was recommended that I do the charting in the patient room. I am bothered by this a lot. I do not get on facebook or check my email, I am using the computer for work-related things that are to be done. I talked to all of the other evening PCNAs and they said they all have went through this as well... so I guess that makes me feel a little better, but I work my butt off all night (sometimes I don't take a lunch) and I feel like it's all for nothing. I guess my questions for all of you nurses is: What makes a great PCNA at your job and any suggestions for improving. I am open to any advice at all that will make me a better PCNA. Thanks! (sorry this is so long winded)

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I am a PCA. Are these RNs answering lights when you are doing vitals?

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Not always. Usually the secretary will call me and tell me that the light needs answered in whatever room and I tell her that I am in another patient's room and I will get it as soon as I can. The light is usually still on by the time I am done with the vitals. I am not saying they NEVER answer call lights, because that would be unfair to say. I am sure they have had to answer a call light due to me toileting a pt (it can take about 10 minutes on my floor by the time you get all of their "gear" together and get them safely to the bathroom), but I can not see how that can be considered as deliberately not answering a call light.

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bump

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Ok a few things. I am going to assume you are a sole aide on busy postop ortho floor. 1-Vitals are key and should be your main focus. Get in there, get em and get out. Docs hound nurses for these. Chart them right away lights be damned. I guarantee....the RNs would rather see a patient **** the bed over late vs. 2-Start taking your dinner break. You are legally entitled to one. 3- These people do.not want to let you go That would have happened long ago. They want you to move faster.

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So they are trying to scare you. Dont let them. 4-Only you can answer this one...when you are at work are you there as an aide or as a future nurse. If it's the former, good. Latter, step back and remember why you are there

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Can you walk through a typical shift?

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Bluemorningglory, thank you for that perspective. I always start vitals signs first, then report abnormalities, but I do not chart them right away. I think I will chart each patients vital signs in the room right away, so that they will be in there for anyone who wants to view them as soon as they are done. As for dinner breaks, none of the RNs take a break and I feel like I am looked down upon when I do take one. Their favorite PCNA does not take a break, but I do think it is important to recharge and gear up for HS care. I am there to work as a PCNA. I think this experience will be so helpful for when I do become an RN. Oddly, I do enjoy the PCNA work as I get to spend the most time with the patients. Not moving fast enough, I can see that. Especially if my vitals aren't in the computer in a timely manner. I personally feel like I never get a breather!

Typical shift:

1500: vital signs/assist pts to bathroom as needed

1600: fill waters/ice bags and again assist pts to bathroom as needed

1700: accuchecks/ usually by now I would get my vitals in and chart by hourly rounding (seeing this, I can see why they may feel I am not being prompt with vitals.)

1800: dinner usually comes between 1730-1800. I set them up to eat, sometimes I fill pitchers again and if I take a lunch, I do it when they are eating so the RNs will not have to get call lights

1900: Vitals again/ call lights are usually crazy at this time- post dinner bathroom needs.

2000: Charting of vitals and I/Os... I usually try to start HS care at this time too (we have to do full bed baths, so this takes 10-15 per bath).. if it's a knee pt they need to be put on their CPM

2100: HS accuchecks... continue with HS care...answer lights as pts need (it seems like I always have a pt on Lasix or tons of IV fluids which makes some pts need the bathroom more often)

2200: I try to get caught up on charting and fill ice packs and waters again for night shift

2300: report out by 2330

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You have to document your VS asap. Unless they are documented they never happenedAgain take your breaks. Since you have done without them you might never get them back. Are you at least getting paid for them?Are you the only aide working?

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Specializes in Medical Oncology, Alzheimer/dementia.

Why can't night shift fill the ice packs and waters at the start of their shift? I would get those vitals in as soon as you have them. As long as everyone is safe and not trying to get up unassisted, it shouldn't take long. You acknowledge that vitals are important.

You should take your break. It seems that there is enough staff to cover you for 30 minutes.

I don't understand what happened between day 45 and day 90. The last 45 days of your review sounds like a totally different person from the first 45 days. It seems like you're really on top of your job and a valuable part of the team...are you getting burned out?

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Bluemorningglory, it depends on the census. Ususally M-W (sometimes Thursday if we had late surgeries during the week)we have 2 PCNAs for the full floor. We are both extremely busy since many are just coming back from surgery and we are doing post-op vitals (q15x4, q30x4, qhrx4, then q4). Sometimes we will both have multiple patients that come back and we are literally taking vitals signs for about an hour straight. Later in the week, there is only 1 PCNA, but census is lower and you don't have the post-op VS to deal with. I haven't been getting paid for the breaks I haven't been taking, but I think I will start taking my breaks from now on.

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proud nurse, that we should do as much as we can for the night shift since there is only 1 PCNA. I do not mind helping them out at all. I am at a loss from 45 to 90 day review as well. I feel totally blindsighted, as none of the RNs have talked to me about any of this. I feel WAY more on top of everything now than I did then. I do not feel burnt out, however there are some nights where I am nonstop all night long and I am exhausted. However, I love the work that I am doing. I am going to chart vitals ASAP, so hopefully that will help. And today I bought a clipboard so that I can leave it at the nurses station so they can see all the vital signs as well without going into the computer system. I'm hoping that will help. I also made myself an hourly checklist so that I am getting icepacks and waters filled every 2 hours. However, I know that in the real world that is not always going to work.

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