Attitude Adjustment - page 3

Over on the nursing issues/patient safety forum there is a good post from a new nurse. This needs more comments. OK? Read More

  1. by   nightmoves
    In my experience aides fall into four categories: 1) Ball of fire--need minimal supervision, show initiative. Very rare, indeed.
    2) Fairly good employee--show up, listen to report, and do routine tasks with minimal prodding. Will allow the assigned work to fill available time (i.e., takes 2 1/2 hours to obtain and chart vital signs) and tend to resent what they perceive as "additional assignments." 3) Zippy the Wonder Slug. Enough said. You know the type. 4) Dishonest, dangerous, or abusive aides. I hope you NEVER know the type.

    The last category needs to be written up and reported to nursing administration stat, obviously. Categories #2 and #3 can in many cases improve their performance with not much more effort than you are currently expending.

    I have found that people tend to perform up to or down to their perceived levels of expectation. Note that I said THEIR perceived level of expectation, not YOUR perception (or management's, etc) of what they should be doing.

    When I was a staff nurse I had a meeting of the aides assigned to my unit and told them the following: "It's not just giving baths. It's not just getting outputs. You are an extension of my eyes, my ears, and my hands. I can't be everyplace. I need you to tell me if a patient looks funny to you when you are doing his bath, I need you to tell me if a patient hasn't voided in four hours, I need you to tell me if you hear or smell or see something that looks odd to you. For that, I need you to be in the rooms, not at the nurses' station. I don't begrudge breaks to anyone. But I answer call lights and pick up bedpans, and I expect you to do so, too. I have to write care plans" (back then) "and I need your observations when I do this."

    I had a meeting with them because I wanted everyone to be on the same page. A few days later, when they started coming back to me with their observations, I gave them the courtesy of listening to them, validating the observations (by observing the patient, usually with the aide who told me about the problem) and thanking them for their input, and gave them a short synopsis of what I planned to do based on what they had seen. When we had patient care conference I had each aide attend and offer appropriate input. In short, I involved them as full-fledged team members.

    It's no secret that many times a patient will tell an aide (or a housekeeper, for that matter) things he won't tell the nurse. We as nurses need to capture that data by involving the aides more in the data collection, not just in performing tasks.

    Think of it, for a minute, from the aide's standpoint. You (frequently) are not well paid, and you are being asked to perform minimal tasks. The professionals are hard working, but you see them sitting doing paperwork. It's still sitting, though. And for a second put yourself in the manager's shoes. He or she may have several units to cover and does not necessarily know details of day to day performance of an individual aide.

    I hope that you don't think of this reply as preachy or condescending. It's merely an approach that worked for me.
  2. by   wenkin
    Originally posted by P_RN
    Over on the nursing issues/patient safety forum there is a good post from a new nurse. This needs more comments. OK?

    You said that there is one nursing assistant per ward. How many RNs are there that are leaving tasks for them to do. If each RN gives enough chores to do, is the workload too heavy for the nursing assistant. If the work is too heavy for you, think about how much you are asking the assistant to do in conjunction to the other nurses.

  3. by   KangaRN
    As a foreigner who worked in the US for several years I was quite daunted by the Nursing assistant system as it was totally new to me at the time.

    I certainly tried to be as nice as possible yet felt like I was under constant surveillance and literally being tested. It did take me a good few months to really build up the rapport and respect of these team members, through being consistent, "participative", setting and maintaining high standards in collaboration with them and educating them as I went.

    Acknowledgement of an individual's hard work and effort is always appreciated, even if they don't show it - keep it up but you must be SINCERE and honest.

    Eventually you will become confident in your practice and they will respond to you accordingly - speaking from experience - it is best not to lose your cool - this leads to a lack of respect from all staff and exposes your vulnerabilities.

    There is nothing worse than a bossy RN who treats assistants with contempt - they are a team member!
  4. by   Thunderkat
    Carol.... I just read your post and girl... you rock!!!! I have to say that teamwork is the answer. I work in a field where we have to be a team or some one's going to get seriously hurt I just wanted to tell you... Well said, my dear!!!!
  5. by   shannonRN
    wow, i can't believe the array of comments. i am new to the forum and think this is a wonderful thing for nurses!
    i agree with almost everyone has posted. yes there are good aides and bad aides, just as there are good nurses and bad nurses. we need to work together. i find that on my floor some of the nurses think that the aide is their personal assistant. i constantly remind myself that while i have 4-9 patients they have the whole floor to care for and are being pulled in different directions by all of the nurses on the floor that shift. when i ask them to do something, it is usually something that i really need help with. and usually i offer to do the work with them. i find it also helps to ask the other nurses what they example would be if something is needed from central supply like a gomco or a late dinner tray. ask your fellow nurses if they need anything from those places, this will cut down the amount of time that the aides spend off of the floor and hopefully increase their productivity while they are on the floor.
    hope this helped...happy nursing to all!!
  6. by   not-nancy-nurse
    My situation has improved--not because the NA's have gotten any better, but because I'm on 7p-7a and don't need their help as much! On nights, the RN's have a little more time to help one another and we don't rely as heavily on assistants. During the day, when you have doctors and families in the unit, and you're sending people for tests or surgery, it gets way hairy when you're trying to do it all. We generally don't have that at night, so I get along just fine.

    The night nurses seem to do a better job functioning as a team--ie, not minding being asked for help--which I'm sure is a function of how busy we are. We're still busy, and we still work our butts off, but its a different kind of busy than you get during the day.

  7. by   mattcastens

    No, you don't need an attitude adjustment. You have every right to expect things to be done that you ask of a nursing assistant, and if they aren't done, you should expect a valid reason.

    That being said. Before I became nurse, I was a nursing assistant for three years. I often found that nurses had an unreasonable expectation of what could be done in what amount of time. Look into what you're asking the nursing assistants to do. Remember, too, that just because you can delegate, doesn't necessarly mean that you should. Especially in an ICU setting, I would never delegate something like vital signs.

    Try to see yourself, too, from their point of view. Are you reading magazines or making small talk in your down time? Charting is of course necessary, but are you spending more time talking than writing? I remember one unit I was in as an NA where the nurses would do nothing about complain about how busy they were, while reading magazines!

    Remember to be diplomatic, but firm. Let the people you're working with know that you expect either results, or an explaination.