Opinion Please...problem at work

[chenoaspirit, ASN, RN]

I had a 2 year old little girl as one of my patients yesterday. She was in with vomitting and diarrhea. She was dehydrated, hadnt voided all day, etc. The parents had been up with this child all night long. Apparently it was a form of virus because on shift yesterday the dad vomitted over and over into the floor, the parents are sick too. Now, housekeeping refused to clean it, said it was our job and after we cleaned it then they would come and sanitize it. Problem was, I hadnt even seen 3 of my patients, one had a CBI running wide open. I was trying to take care of the CBI between my assessments and med passes, my assistant was finishing vitals and wouldnt take the time to address the CBI at all. I asked her to help me clean the room, her response to me was "he can clean it himself, Im not cleaning it". Now, Im frustrated because Im so far behind as it is. I went to the charge nurse and before I said one word, her response was "let me guess, Kim wont help you". The charge nurse helped me clean up the vomit, which took around 15-20 minutes. I was livid. If I am willing to stir in vomit, what makes my assistant think she is better than I am and refuse to? The charge nurse was behind also, she had admissions/discharges that were needed, orders that hadnt been taken off, etc. My patient with a CBI had a PCA ordered for pain and I didnt have the time to get it set up, the doc was mad at me, etc. I have had the worst 2 weeks at work and Im miserable. This same assistant refuses to tell me when a patient has a high bp, one time a bp was 200's/100's and she didnt tell me. I went to her and told her that she needs to tell me when a bp is that high so I can address it, she keeps the vital board and unless she tells me I will not know. My butt was chewed out by a doc for that incident also. And the assistant REPORTED ME!...stating that I had chewed her out in front of patients, families, etc. I did not do that, I said it nicely but firmly and no one was around when I did so. I find this assistant in empty rooms doing homework, downstairs eating breakfast. She didnt even tell me yesterday when she was leaving the floor to go to breakfast so that I would know that she wasnt going to be around to help me with the CBI (she wasnt anyway though). How would you guys handle this if your CN and NM are unwilling to do anything? I need my assistant to do her job so that I can do mine.

[litbitblack, ASN, RN]

write up an incident report each time and then they have a paper trail and HAVE to take care of it. KEep notes when you do, that way if after a few times the manager doesn't do anything you can take it above her head.

[caliotter3]

General rule of thumb: first offense, verbal warning; second offense, written (or verbal, depends) warning; third offense, written reprimand, further action. Even if you think you won't get any action from above, do your part. Tell this person that you will not accept behavior of this nature and that you are documenting disciplinary action. Then do it. Take the third step to your supervisor. Keep copies of all write ups. Keep a log. Have witnesses, licensed nurse or supervisor, for counseling sessions. Just build and build your book. At some point your hard work will pay off. You may have to go one step further up the chain but someone will listen to you. This assistant needs to be reprimanded and suspended on her way to being terminated, if that is what it takes. You can't have this happening around those who are conscientious about their work. She will poison their attitudes and they are watching how you handle her and whether or not she can push you around. And the worst consequence of all, the patient care is suffering because she is not doing what she is paid for. I guarantee you there is a person out there who would be very happy to have an acute care assistant job. When I was an assistant I would have killed to work in a hospital and I was a good worker. So even though it seems to be fruitless, keep up a disciplinary paper trail on this person. Good luck.

[Ginger's Mom, MSN, RN]

I would also talk to the nursing assistant, if this was the first time I would not report to the nurse manager. If this is a continually behavior then report. It sounds like the assistant was having a bad day too but she needs to tell you that she is overwhelmed. It is her job.

[leslie :-D]

hmmmm...

i'm sensing the assistant is a piece of work.

not reporting abnormal vitals?

doing homework, being dismissive?

i could feel my adrenaline pumping just reading your post, chenoa.

i definitely agree w/taking charge of her, her responsiblities, her attitude and your patients.

and even if your disciplinary chain includes verbal, written, suspension etc, i would still write that incident report...

since it resulted in delay of care and ticked off md's.

however you proceed, do put it in writing and do not let this asst push you around.

she needs to know you mean business and her attitude will not be tolerated.

have another nurse/witness w/you in event asst goes running back and causing trouble.

if my asst had told me "i'm finishing up vitals", i'm thinking i would have responded, "that can wait, i need you now".

this lack of cooperation is only going to bite you and possibly, your pts in the rear end.

time to take a stand.

best of everything.

leslie

[bluemalibu]

How would you guys handle this if your CN and NM are unwilling to do anything?

The CN is apparently well aware of the slacker, as per your description of the vomiting incident.

I can empathize with her, as I myself would choose to complete chores myself... even as distasteful as cleaning vomit, rather than constantly nag another individual to do the job that they're being paid to do. But this person has gone beyond the pale.

You could either have a quiet one-on-one with the NM, or drop an anonymous note to the top administration, but either way, just explain that you realize that forcing someone to toe the line is an unpleasant task, but that this individual is compromising the health of your patients and is an outright liability... a negligence lawsuit waiting to happen... and that she needs to either be written up, or that the administration needs to be prepared for a negligent homicide suit.

Once notified of the sub-par performance of this person, inaction on the hospital's part can result in large compensatory damages should any future malfeasance by her result in the harm to a patient... the administration is acutely aware of this, and you can be assured that action will be taken.

[Batman24]

First off...shame on your CN for knowing Kim wouldn't help and not making her do so right then and there. The tail is wagging the dog and it needs to stop.

You are going to need to establish a new set of boundaries and they will be good and ticked. As stated above you need to starting writing these instances up every single time they happen. If there isn't a paper trail they can avoid it but when it's in writing they can't do that so easily.

You need to start doing this with your very next shift. You also need to assert yourself. She's there to assist you in caring for the patients. If she's not willing to do that you need to get the ball rolling towards her being reprimanded formally, etc.

[workingmomRN]

I agree that you should do an incident report each time something like you described happens. Keep copies of the reports for your own records & document when & who you turned it in to. This assistant is a disaster waiting to happen, so when it does you will have yourself covered by showing that you did report her repeatedly. Also if you do have any type of discussion with her when she is doing what she needs to be doing, have a witness & document it as well. It will be time-consuming for a while, but it will be in your best interest.

[SweetLemon]

Why is it people refuse to do their jobs the ones they apply for and comit to do... I don't get it. Sounds like as the Nurse you were more then willing to help out as long as she was willing to pitch in. Frankly she signed up for this job no one forced her into it! And while cleaning up vomit is never a pleasant experience it is part of overall patient care... making a comment that the patient can clean it up himself is really absurd...

[chenoaspirit, ASN, RN]

Well, I tried to write her up, apparently there is no "write-up" process on our floor! Can you believe that! All we can do is complain and hope for something to change. I need to talk to someone about our rights to have write-ups and a form to do it with.

[Blee O'Myacin, BSN, RN]

I don't understand why the patient's father continued to vomit on the floor. I don't think I would have been too charitable about it after the first incident. He would have gotten some towels and a basin and I probably would have asked him to either go home or to the ER to be seen. While that doesn't address the other major problems with the NA on your floor, expecting her to clean up after a patient's visitor is above and beyond. Your charge nurse should have addressed this particular instance - along with the other behavior. I agree with the others, keep a paper trail and cover your own behind.

[chenoaspirit, ASN, RN]

He couldnt stop vomitting. He was trying to make it to the bathroom, but was vomitting on the way there. He felt horrible about it. He had been up all night with his child and its rule that the parent has to stay with the child in the hospital. No ped can be left alone. I would never have expected him to clean it up, he was sick and his child was VERY sick. i dont think he would have even been able to do so.