Nurse coworker won't help with patient care

[thenursebabe25]

Alright everyone, I need some advice. I work at a small long term care/assisted living facility. Small as in my floor literally always under 10 patients. Our ratios are unheard of. On my shift, we always have 2 nurses, and every now and then 2 CNAs. That's amazing for such a small group of patients. They are trying to get away from having 2 CNAs, and just have 1. Here's where the issue comes in. Although it's not a lot of patients (currently 9), they are total care but 1. Even though our CNAs are amazing and will work alone, I don't let them on my watch. I help with checks and changes (q2 hours), answer call lights, do my own vitals, etc. My nurse partner on my shift NEVER helps out. She does her meds, and that's about it. Again, we each literally have 4 and 5 patients. It's ridiculous. She will come get us while we're changing someone about another call light going off and all. It's not fair that on top of my meds, assessments, and other nursing duties, that I'm the ONLY one EVERY shift helping with patient care. I don't know what to do. Telling management will be obvious that it was either myself or my CNA which will make for an uncomfortable work environment. I do have a great relationship with my DON and have known her for like 5 years, so I've thought about asking her for advice and asking her not to say anything. She's super understanding and will hear you out, especially when she knows you're a great worker. I love my job and my patients, and its literally a dream to have such few patients especially in long term care. I do agency work on the side, and it's not abnormal to have 20-40 patients alone! This work is a breeze compared to the norm! It's nothing personal to my partner, as a person she's actually really sweet. I hate confrontation, and I'm not comfortable saying anything. Technically she's a "charge" nurse. But I do all the work, as well as her judgment not being the best which is also concerning (she's been a long term care nurse for 20 plus years). Example: not knowing that a med being pulled from an ekit has to be accounted for. Another one of the nurses at my facility has a similar issue with her partner, and brought up how she asked her to just take both med carts, and pass all meds, while she works the floor with the aid and does patient care. This seems like a good possible idea as well. I just feel like patient care shouldn't be on me every shift. Please please help!

[LibraSunCNM, BSN, MSN, CNM]

Few people enjoy confrontation.  But the situation you're describing truly cannot be managed in a healthy, mature way if it doesn't start with you having what we call at my job a "courageous conversation."  You need to approach the other nurse directly, in a calm and professional way.  It doesn't have to be as scary as it seems, especially you're saying she's otherwise a sweet person.  Ask to talk privately at a convenient time.  Use "when you do ___ I feel ___" statements and ask curious questions.  Only if it doesn't get resolved then do you then go to the DON.  I feel like our society is completely losing the ability to have civil discourse and communication these days.

[Been there,done that, ASN, RN]

Patient care is not on you every shift. You are CHOOSING to help the CNA's. You cannot expect the other nurse to do what you do. Enjoy your breeze job. Stop looking for trouble.

[ponderingDNP]

I am one to work with everyone if I have the time, especially in the morning, so that we all can leave on time. I don't care what the job is, I've even been known to grab a broom from the housekeeper. That's who I am. TEAMWORK!!

That being said, as for your coworker, I don't blame her. If management is "looking" to downsize to one CNA for 9-10 total care patients, then your CNAs will soon start calling out. When they do, it will be the expectation that you 'time-manage' better so that you can function as a CNA with every free minute you get. Management is not taking into account that stable patients become unstable unexpectedly.

If I were you, I would explain to the CNAs (because they deserve to have the help needed to do the job), that I won't be helping as much until management comes to their senses about cutting staff. And they DO need the help. You prove that fact every night. Think about it...?