Drama / Write Up

Nurses Relations

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Specializes in Rehab, acute/critical care.

Hi, I work in LTC and before my shift I walk in every room of my patients to check they are alright and breathing. One resident in particular has been off oxygen and when I checked the resident - was not on any oxygen whatsoever (she was fine!). During the shift when I had to give a scheduled medication, I saw the resident was on 2L oxygen via nasal cannula. The previous nurse didn't say anything about the resident needing oxygen and I asked the aid, who said he put it on basically because he felt like it and I could take it off if I wanted to. I got upset, he never told me he did and he isn't licensed to do that. He basically walked off after those couple of sentences he spook and I spent a couple hours during my shift tapering it down so that I could take it back off without her O2 sats dropping horribly. When I talked to the aid again, I was nice but he was all defensive and saying I owe him an apology and made up all these excuses to make what he did alright. I kept telling him, if he has to do something like that, he needs to tell the nurse. He kept blowing off what I said and goes "It's just oxygen." I was really mad. I talked to my supervisor and I wrote the aid up.

At this moment in time, he doesn't know I wrote him up. And I am worried about the tension thats going to go on at work. I am a new nurse who looks like a teenager, so I guess people don't take me seriously or they think because they've worked as an aid for 10+ years that they are more experienced than me. But aid's aren't licensed or trained to assess and give oxygen or meds. And at least if they sense something is urgent, they need to tell the nurse. This resident was perfectly fine without oxygen. So I guess I'm just worried how work is going to be from now on... this is my first time writing someone up.

:confused:

Anyone else write people up? How do you deal with someone who thinks they are always right?

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Not a nurse yet, but I think you did the right thing. The patient was not harmed, but CNAs who know it all and are disrespectful to their superiors need to be reprimanded. I hope that he doesn't make your life miserable, but takes the write up as a lesson learned.

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Number 1.. oxygen is a drug.

Number 2.. the assistant's response constitutes insubordination, they are acting in a nurse role and refused your direction.

Number 3... WHY was it necessary to wean off 2 liters of O2? 2 liters is bascially equal to room air. Was the resident presenting any respiratory diffculties?

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I have been in your shoes not long ago. I work in LTC as well and it is my fIrst job as an RN. I have been there for about a year now. I am 27 but look about 16. I have dealt with aides just like that many times and seen many come and go. Most important thing is, you are your resident's biggest advocate! As long as you are looking out for their best interest, following the state regulations, and being responsible and professional, you have nothing to worry about! Your supervisors will see that you are only doing what is best for the resident and will respect you more for it. I speak from experience, after only 7 months, I was promoted to unit manager. This meant I was now the supervisor over many nurses who had decades more experience than I did. My DON and administrator told me they chose me for the job because i advocate for my residents, wasn't afraid to speak up and take action when I thought the care they were receiving was not up to standards, and I made sure to follow through until I was satisfied with the results. It is also very important to keep an open line of communication with your supervisors so they know what is going on and why you are doing what you're doing. If state were to walk in and there was no order for O2, you as the nurse would be the one responsible. The aides work under your license! So, you did the right thing!

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This has been something that has befuddled me for 32 years as an RN. Why in the god name would any nursing assistant, Med Tech or unit secretary would ever think to take on a responsiblity/action that falls under a licensed nurse's domain in this legal focused healthcare system of ours. I have seen them do this countless times over the years and then turn around to the RN and act as if the RN is out of line. Are they not afraid of hurting some one? Do they even think that their action could hurt someone? What goes through their mind when they do these things?

Anyone, out there in cyber space, please, give some answers. i would kinda like to know myself after all these years, what goes through a CNA's , MT or unit secretary's mind that prompts these acts?

I'm 56 and I don't look 16. I don't think it has so much to do with how old the RN looks. I think it's more the personality of the nurse's aid. I had a unit secretary tell me she knows how to triage because she has been in healthcare for 10 years she just doesn't have the nursing license. Oxygen today, medication tomorrow, and alot of them do it. I've seen hundreds of central lines placed, does this mean I can pick up a central line try and just start inserting them when "I" feel one is needed? Some principal.

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Specializes in LTC and School Health.

You did the right thing. First of all: kudos to you for taking the time to do rounds. Nurses rarely take time to do rounds in LTC ( or atleast the ones I worked with). I was the same as you when I worked in LTC. No matter if I had 20 or 60 residents I liked to lay eyes on all of them.

One time I went to assess a resident who was having trouble breathing. This resident felt like she was suffocating. She had a dx of COPD. Her sats was in the low 75, when normally she is in late 80's.

I then looked at her 02 concentrator.... turns out an aide turned her up to 6 liters of 02. :eek:

Aides are not licensed to initiate 02. It is a drug. You did the right thing. If the aide felt like the patient was in distress he should have notified you first.

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Specializes in Rehab, acute/critical care.

Thanks for the support. The aid is furious and won't look me in the eye, and I had to work with him again but the supervisor told us to remain professional and both of us did. We both did our job and went home. I think the aid took it personally but I don't mean it that way, I would've done it to any aid who would do that. It's just that were I work, some aids there have been aids for a really long time and they *think* they know what they are doing and can do it.

To answer the question - I had to wean the resident off because when I turned the oxygen off, the O2 sats dropped to 76% so I had to turn it back on then do it slowly. The resident also had heavy breathing too when I turned it off.

But just from being a working RN for 3 months, I have noticed it's the workers (nurses and aids) that boast how long they have been a health care professional are the ones that do obvious things wrong. There was a nurse that claims she's been doing this for 30 years and I caught her doing putting an IV line the wrong way in a pump. And the same with this aid, he brags how he's been an aid for so long yet it seems he forgot what he is licensed to do.

But I am standing up for myself and not going to let aids think they run the show. There are some good and bad ones where I work but I'm not going to let them get away with doing things they aren't licensed to do. I am the one that has to save residents if they code or talk to their family members, the aids don't, they get to leave when the time comes but I can't if something happens.

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Specializes in ER, ICU.

Congrats on doing the right thing. If he doesn't like it, tough. He might take you more seriously from now on, if not- doom on him. Do the right thing for your patients and protect your license.

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Specializes in Medsurg, Homecare, Infusion, Psych/Detox.

I don't know you, but I am so proud of you I wish I could hug you. You are serious about your responsibilities as a nurse and that is a good thing. It will serve you well in years to come. Get used to people being mad at you for standing up for yourself. Eventually you will develop a thick skin and none of what they think will matter. But try they will to trip you up. Like not alerting you to issues and problems. Just be on your guard as always. Even friends of this person may try to get back at you, on his behalf. Some may even pretend to like you. You are new, they have been there longer than you, their loyalty is with each other. They know now what you are capable of, they will respect your authority.

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Specializes in Rehab, acute/critical care.

I agree and one of the other nurses told me also to watch out for something being taddled or made up about me. But I'm watching my back, only trusting myself, and documenting everything. I am an extremely nice person but I don't go to work to make friends. I noticed some people will try to be "buddy-buddy" with each other, this aid tried to with me (prior), but I'm not going to let stupid stuff like this go on and do nothing about it.

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Specializes in Psych.

Two thumbs up to you for standing up for yourself and your residents! Ultimately it is your butt and license on the line. You did the right thing by bringing this to attention.

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