"Compartmentalized" support staff

BrnEyedGirl, BSN, MSN, RN, APRN · Mar 5, 2009

WOW,..I think that's when I get the BP, take care of my pt and then speak with the techs supervisor. This tech needs a bit of education, an attitude adjustment and if that doesn't work a new job!!!

RNperdiem, RN · Mar 5, 2009

I think you explained perfectly well to the tech about the need for vitals due to the change in condition. That particular tech must be very set in her ways and not very amenable to change.

A quick explanation of why to do something helps, but there is no sure way to fix the problem.

I was a CNA for almost 4 years, and my job was a checklist of tasks. Tasks were not given much thought for priority unless someone needed help to the bathroom urgently. The day started with vital signs, then breakfast trays, then baths, etc. The mindset was completely different.

Magsulfate, BSN, RN · Mar 5, 2009

I see this a lot. Along with a secretary that has the same answer for every freaking question "I don't know". Thats her answer.

I once had a Monitor Tech tell me that it wasn't her job to print out my strips while a patient was dying. She just gets the regular one at 4pm and then one after the patient dies. ... HUH???? I kinda was thrown for a loop there. I didn't really know what to say, she was so weird.

I really don't know what to do with them. Just tell them.. "Go do it, NOW. That is your assignment. It is priority. NOw." And if they don't.. then write them up for insubordination. I really don't know any other answer. Maybe I will follow this thread to get some ideas.

RochesterRN-BSN, BSN, RN · Mar 5, 2009

This tech needs to understand that there is a chain of command and there is a reason for it. That they work under the direction of the nurses ---that is if they want a job there. You certainly didn't question the docs orders to you and she should not question the orders you give to her...that is the chain of command. Yes now and again a nurse may QUESTION a request or order given by a doc but the difference is nurses are educated and LICENSED! And in the end the doc has the final call..... they may realize that they mis wrote or mis spoke or maybe you ahve a point and change their request or order but in the end they are the doc.......granted I have had a situation where I told a doc that myself and none of the nurses was comfortable giving a particular med or dose and said that --not to be disrespectful but I don't feel comfortable giving XXX would you mind giving it and being responsible for the administration--then I document that he ordered and despite my concerns the doc felt the patient needed this XXX and administered it himself. CYA!! Other then that--- its chain of command and sorry but the CNAs do NOT hold any license and are REQUIRED to work under the supervision and orders of the nurses. LPN or RN. PERIOD.

I would say some thing. I had a similar situation with one tech-- on two occasions and she got fired after the second...... the first I went in to bring a pt. meds-- an elderly pt.-- and unexpectedly found her after just trying to stand on her own and taking a few steps......looking ready to fall I was trying my best to get her back to the bed safely and she was just too heavy.....I hollered out--not like I would of if it was a code or anything but....."I need some help in here....fast, anyone out there?" Hoping a nurse or tech was in ear shot distance.....well this tech comes to the door way and stands there!! Looking at about to drop this lady and says....what do you need...that is not my patient!! I told her I needed her help NOW. She had to have heard the anger in my voice!! lol she STILL stood there and said...."she's not my patient and I have 2 minutes of my lunch." UNBELIEVABLE!!! At that point I did not want the poor patient to have to hear this but is was that or her on the floor with a broken hip....I was so embarrased at this point! I told her..."get in here now and help me get the patient in the bed....NOW!!!" Let me tell you I let into her after the fact about how every single patient in that hospital is her patient when it comes to safety!!! I said..."I don't care if you are on another floor just there to get something.....if a patient is about to fall and your asked for help YOU HELP!!!! TECH, NURSE,hell--DOCTOR!!! lol I could have died!! Then not but 2 or 3 weeks later I have a SOCIAL WORKER come up to me and say... "I just just went to see your lady in XX and wanted to let you know right away that the first thing she told me as soon as I walked into the room was that she had told some tech like 20 minutes ago that she was having 10/10 CP!!!" The tech was told this same tech and she never thought to come and tell me STAT, any nurse STAT!! The Social worker did!!! I was furious and so was the doc that I had the secretary call stat overhead!! The lady ended up in the ICU with an MI!!!!!! She was fired the next day!!!!!!

So don't let her get away with that behavior and disrespect for your authority. Her ignorance will end up killing a patient!!

Mulan · Mar 5, 2009

Compartmentalization or insubordination?

Tait, MSN, RN · Mar 5, 2009

Compartmentalization or insubordination?

Compartmentalized. With the intending meaning of "someone who can't see outside of their designated role". Insubordination is a given in health care. I am trying to look past assumed insub, and look for a deeper core of just someone who can't see the bigger picture.

Thanks for the responses btw. Just so you all know I have followed the app. chain of command on this specific instance.

Tait

lpnflorida · Mar 5, 2009

I believe if at the start of an assignment once the tech/ aide gets their report to take a moment to inform them if any vital signs are outside of the norm. I would give the parameters myself, tell them they are to inform me quickly then they are to repeat the vitals within 15 min. I would tell them this is my expectation so that we can be proactive in the care of our patients.

Last week an aide came to their nurse said" that patient with the blood pressure which was 160/72 well, I just wanted you to know that I have retaken their blood pressure and it is such and such . I did not know if it needed to be redone or not but I thought you might want to know." Their nurse thanked them, I thanked them then went on to tell them they were a great nurses aide who is actively looking out for her patients by not waiting to be told to recheck an abnormal vital sign.

Our aides and techs are such a vital part of the team. They need to know that. They need to feel it. Some have been beaten down to the point they do not do that which has not been requested of them as they have been put down for thinking independently. We need to encourage some feelings of autonomy and praise their efforts when they second guess what we might need.

Tait, MSN, RN · Mar 5, 2009

I believe if at the start of an assignment once the tech/ aide gets their report to take a moment to inform them if any vital signs are outside of the norm. I would give the parameters myself, tell them they are to inform me quickly then they are to repeat the vitals within 15 min. I would tell them this is my expectation so that we can be proactive in the care of our patients.
Last week an aide came to their nurse said" that patient with the blood pressure which was 160/72 well, I just wanted you to know that I have retaken their blood pressure and it is such and such . I did not know if it needed to be redone or not but I thought you might want to know." Their nurse thanked them, I thanked them then went on to tell them they were a great nurses aide who is actively looking out for her patients by not waiting to be told to recheck an abnormal vital sign.
Our aides and techs are such a vital part of the team. They need to know that. They need to feel it. Some have been beaten down to the point they do not do that which has not been requested of them as they have been put down for thinking independently. We need to encourage some feelings of autonomy and praise their efforts when they second guess what we might need.

This actually isn't a problem on our floor, they always inform us of abnormals. I think the majority of the issue right now is our recently resigned manager was letting a lot of behaviours slide because she was too busy with another unit she had to manage. So people go comfortable. However I expect to see a lot of change coming with our new manager.

I am trying really hard not to take this post as a "you must be a total jerk to your techs" post, because I am not. I delegate appropriately, never ask someone to do something I wouldn't do myself, and always explain why I need their support. I write them praise comment cards (we get cafe/gift shop money at the end of the year for these) and always thank them at the end of the shift.

The problem is the level of expectaion for the techs is lower than what is required by the nurses to do thier job safely and effectively.

Tait

lolalolacherrycola · Mar 5, 2009

Don't know if it would help but it seems obvious that some re education is needed. It might be worth your while to work on a short mandatory inservice on what is necessary when a patient has a change in condition.

Hope this helps...

Following is my initial reaction, before coffee and ear time with hubby...lol

Unbelievable! A tech who refused to do another set of vitals on a patient who needed them due to change in condition... :banghead:

That would be grounds for a "write up" where I work, and although I probably would just get the vital signs myself and not write them up I would be seething!!

Tait, MSN, RN · Mar 5, 2009

Don't know if it would help but it seems obvious that some re education is needed. It might be worth your while to work on a short mandatory inservice on what is necessary when a patient has a change in condition.
Hope this helps...
Following is my initial reaction, before coffee and ear time with hubby...lol
Unbelievable! A tech who refused to do another set of vitals on a patient who needed them due to change in condition...
That would be grounds for a "write up" where I work, and although I probably would just get the vital signs myself and not write them up I would be seething!!

Trust me, I rarely take work home with me, but I was so mad yesterday that I left an appointment with my chiropractor early because all I could see was red.

I guess it didn't help thatin addition to the tech issue, I waited 2.5 hours for a PA to call me back on said patient (as I checked her BP Q15 of my own accord, called Rapid Response for advice) of whom I found out was waiting on the fax of the EKG from me! Why was she waiting so long? Because after she called back with the fax number, the secretary wrote it on a random piece of paper, NEVER TOLD ME, and then went to lunch. It wasn't until the PA finally called me back looking for the EKG that I realized what had happened. I am glad I charted my butt off on this one, and I kept the patient safe through that time.

By compartementalized I reiterate, sometimes I don't think people realize in healthcare that if a step in the teamwork is missed, people can DIE.

Tait

lpnflorida · Mar 5, 2009

Tait, I do not think you are treating your aides badly at all. You mention expectation of them as being lower for patient care. I think it is our responsiblity to let our aide assigned to our patients for the day to know what our expectation is. This we can tell them at the start of the shift this way we are all on the same page.

Some of the aides I have worked with need more direction than others. This is what determines how much I have to be specific with them at the start of an assignment. We have a couple of aides who always go the extra mile, and then we have the just get by aides. The just get by aides are the ones I find I need to be creative in obtaining the best out of them. I have no fast answers in these cases. I find I have to individualize it depending on the person. Some it has been enough to let them know expectations, others I have had to micromanage more. I hate that as I do not want to have to check up to make sure one is doing what they are suppose to be doing.