PunkinNoir

"No, you still have to get vitals on our Covid patients". This was how the whole conversation went. I told my oncoming nurse that I'd been monitoring our Covid patients, and got a full set of vitals on everyone during the night. She seemed very excited and replied, "Oh! So, I'm good then? I don't have to get them!". A full set of vitals Q shift is protocol for our Covid patients. I guess she thought my vitals counted for all day? I mean, it's not like vital signs change in sick people....

My work environment is beyond hostile. I am both infuriated and incredibly sad at work now. I was just wondering if anyone else is having these same issues. Where to begin? Covid has helped make things incredibly worse. Not sure of the rules everywhere, but you used to have to be certified to work in long term care in my state. Well, Covid made the rules bend and now I have a bunch of uncertified nursing assistants. Don’t get me wrong, some have their heart in the right place and try to do a good job. Most though? Most don’t care at all, have a terrible attitude and do NOTHING. When me, my supervisor, or other nurses write these awful workers up or inform management- nothing is done. There is a staffing crisis, after all. I work 11-7 shift. Most of my nursing assistants sit on their phones all night, and only change the patients once a shift- starting at 5am. I start my morning medication pass at 5am, so imagine how much I appreciate issues just being brought to my attention for the first time at the end of my shift. I literally just had one of my lovely NAs inform me at 6:00am, “Oh, by the way.... so-and-so has a skin tear on their arm. It happened on afternoon shift, but I guess no one addressed it.”. Seriously?! No one gets turned and positioned. How could they when they get changed once a night? Beds are left sky high in the air, fall mats are not placed on the floor, and call lights are at times purposely not given to patients. If a patient puts on their call light a few times, my NAs will threaten to take their call light away! As I have learned, this is not an empty threat. I have seen the aides clip the call light to the wall of “troublesome” patients! This has been reported, with nothing done. Oh wait, my director of nursing told the NAs not to do that, with no punishment. Back to the changing people once a night. When you only change the patients once a night, they will clearly be a mess. If the NA is working a double shift, they will put multiple briefs on the patients and stack blankets under them to “set themselves up”. I think the record number I’ve seen is 5 briefs and 3 bath blankets.... all soaked with urine. It’s no surprise we get a lot more wounds now. My favorite lazy NA complaint is when someone is working a single shift, and says this during their first/last round at 5am- “Look at how afternoon shift left this person!”. They even think I’ll try to get afternoon shift in trouble or write them up! Maybe they’d be in trouble if this conversation was happening at 12am, but at 5am, afternoon shift is not to blame. My NAs will grab random creams from the treatment cart and apply them during incontinence care. When I witnessed this, I asked the NA to please not go into the treatment cart- you can’t just put whatever cream you want on people. I then informed her that most people had zinc paste ordered for incontinence care. Her response? “Yeah, I use this and I’m going to keep doing it.” She was holding up bacitracin-zinc ointment. I told her that was not the same as plain old zinc paste, and that some people are allergic to bacitracin. She walked away with the bacitracin. I then locked the treatment cart and was called a ***. The NAs also try to do treatments. I stopped one just in time when she was about to apply a DuoDerm to someone who had no order for that. I asked where she even got the DuoDerm from, and informed her that was totally the wrong thing to use (not to mention that she was not to do treatments!). Guess who’s a *** again? One of the night shift duties for nursing assistants is to pass fresh water cups. Again with the laziness.... they will only do this once a night as well. They are SUPPOSED to place the fresh cup at around midnight, then pass ice at 4am. But why do your work? They place the new cups at 4am, to only have to do the work once. If someone is out of water at the beginning of the shift, my aides will tell them they have to wait for water. That’s right, wait until 4am! Oh, and if the patient drinks all of their water after it is passed at 4am and rings for more? Again, they are out of luck. The aide will NOT give them more. “I just gave you water”, they’ll say. Another huge problem is the absolute refusal to take care of certain patients. If a patient says something racially inappropriate or sexual, my NAs will just flat out refuse care to this person.... forever! No incontinence care, no water, they will not step one foot into that room ever again. I mean, come on! I try to tell my aides you just have to be firm. You tell the patient that behavior is not appropriate, and that they are not to talk that way to you. I will also talk with the patient and write a behavioral note. Makes no difference. You can only imagine how many rooms my NAs refuse to go into, because I can’t even count how many times I’ve been hit on, cursed at or been called something offensive by a patient! The thing that broke my heart and infuriated me the most though, is the following. We had a red zone for Covid positive patients. ALL of the 11-7 aides in the entire facility refused to work that unit. I am already in charge of two units during the night. I had to be the red zone nurse, the nurse for a non-Covid unit, and the red zone CNA. The red zone was covered in trash, everyone was soaked, and no one had any water. Oh yeah, I was also the CNA for the non-Covid “offensive” rooms that the aides also refuse to go into. In all, my NA had 13 patients to care for, some of which can walk and take care of themselves. I had around 30 patients to be the nurse and CNA for, most of which had Covid at the time. The NA had the nerve to complain about how it wouldn’t be “fair” for her to have to take care of more patients, and stated that’s why she was refusing to do so. When I asked how it was fair for me to have to be the nurse and aide for all those patients, she just simply ignored me and went back to texting on her phone. And before I get a lecture- I worked as a CNA for years before I became a nurse. I have no problem changing people, answering call lights, etc. I DO have a problem doing all the work, while my NAs sit on their phones and flat out refuse to do anything. I try to be understanding, and realize many of my NAs never worked in healthcare before. However, when I try to teach them things, they generally don’t listen and don’t care. I get many eye rolls. The patients deserve so much better. I do change as many people as I can inbetween my medication passes/vital signs, since I know they won’t be touched otherwise until 5am. I also pass out water as early as I can. I'm exhausted and the nursing "management" does nothing. I wrote my DON a letter on how my NAs refuse to do their work and the response I got? I was rudely questioned by an employee who shouldn't have been involved about how I stated that the aides didn't even do their charting, yet the charting was done. I stated the truth, I did the CNA charting since I was the one doing the CNA work. I was even more angry, because I'm sure they saw that my initials were the ones noted on the CNA charting. Might I also add... some of my NAs work for staffing agencies. They get paid the same hourly wage that I do. They refuse to do their work and refuse care to the patients, while I am running around like a mad woman. We get paid the same amount and it makes my blood boil.

In my experience this is usually a no win situation. I work midnight shift in a rehab unit and have to wake residents up at midnight to give them scheduled sleeping medications. This usually angers the residents meaning sleeping pill or not, they are staying awake (and a lovely bonus, they are resistant to vitals being obtained). If the sleeping medication was PRN that could work but only if it wasn't requested before midnight (our PRN sleep meds just say as needed at HS). Some of my residents do take their PRN sleep meds between midnight and 1am and they sleep through the night. I guess it just depends on the mood of your patient/resident. Some you can talk to and reason with, some will curse at you for waking them up.