RN views on Intern/Externs, Sitters, and CNA/Techs

proudnurseRN · Dec 21, 2009

Okay, I admit that generally our floats...whether it be RNs, LPNs, student externs, aids, secretarys or whatever, are treated like crap or ignored. It's not something I like or promote, but I'll be the first to admit its truth.

That being said my view on "float" CNA/Techs: sometimes they don't know unit specific policies, but they are usually the harder workers. You can ask them to do anything without an eye roll or comment. The majority of our float aids though are students...the majority which are trying to prove themselves and generally want to help and learn. The unit specific aids are not students, older, and while they are knowledgeable sometimes they are downright lazy.

Sitters- whether it be an aid or a nurse sitting with the patient, most often that assignment is given to a float and they are usually ignored. Out of sight, out of mind mentality. Sitting is often boring (not always, but often), and I try my best to check in on the room every couple of hours as I have a chance to see if anyone wants to get something to eat, drink, use the bathroom, etc. I'm the only one that does that.

As for the float RNs/LPNs, it's like it us against them. They won't answer call lights that aren't their own. We don't answer theirs. This is a generalization, and not all floats are like this, nor are we like this with all floats.

Externs in our hospital can serve as a nurse with LPN type privileges or can be an aid. They can be whatever we need them to be, pretty much like your hospital. I remember being an extern and getting the bad patients. It was scary. Frankly, it was dangerous, and I strongly believe that someone that isn't licensed shouldn't be performing licensed duties independently.

roser13, ASN, RN · Dec 21, 2009

I think you'll get as many different views as you do answers. All nurses are just people too and have different ways of dealing with co-workers, be they equal in "rank" or above/below.

Personally, I value a conscientious sitter/CNA as much as I value my fellow nurse. If they are doing their job and I know that I can count on them to do their job, then they are an equally important part of the health care team.

You will always have someone who feels obligated to express their superiority. They're the same ones who do major sucking-up when they interact with those who they feel to be their superiors.

Virgo_RN, BSN, RN · Dec 21, 2009

I'm wondering what your view as an LPN or RN is on the various ancillary positions such as CNA's, Techs, Sitters (I guess a better word would be nursing support staff?) and why you think what you do.

My view is that they are all individuals who bring their own individual levels of knowledge and skill into the picture. Until I get to know them from having worked with them frequently enough, I don't know what their level of knowledge or skill is, so I can never assume that they know what I need them to know. So, if I explain something that they already know, I certainly hope they don't feel that I'm talking down to them or being patronizing. I have an obligation to make sure that whatever task I delegate is within that person's scope and skill level to perform safely.

Past experience can shape our views as well. Maybe some of those nurses were treated badly when they were aides, or maybe they never were aides, or maybe they've had so many bad experiences with aides that they've generalized their low opinion of some aides to include all of them. Also, some people are so insecure that they try to make themselves feel better by putting others down.

Maybe, because you're a float, you don't see the daily unit politics that happen, since you move around. My old unit had horrible CNAs who were never held accountable. It was BAD. If I based my opinion of all aides on the experience I had on that floor, I would have a very low opinion of aides. Fortunately, I recognize it as an example of poor management, and realize that not all units are this way. But it could be that there are things like this at play on the units that you are floated to.

RNandRRT · Dec 21, 2009

work ethic, not job title, earns my respect.

Virgo_RN, BSN, RN · Dec 21, 2009

work ethic, not job title, earns my respect.

Me too. Yesterday there was a tech looking at Craigslist on the computer. My phone rang, and it was CT calling for my patient. I looked over at the tech, he looked at me and saw me looking at him, then stood up and started walking the other way. I caught up with him about four feet from the corner. Better luck next time, buddy!

cardiacmadeline, RN · Dec 21, 2009

I'm wondering what your view as an LPN or RN is on the various ancillary positions such as CNA's, Techs, Sitters (I guess a better word would be nursing support staff?) and why you think what you do.
When I'm wearing the nurse hat, it seems I get along with everyone and have no problems. When I wear the tech hat, it depends on where I work. Some people treat me like I don't know a foot from a hand and some people treat me more like I have the education that I do (I graduate in April so I by no means know it all, nor will I ever but I do have SOME education behind me). It seems like more than not, I get treated like I don't know a foot from a hand as a tech. Then, as a sitter, forget it! I feel there is no respect there at all from a nurse to a sitter. When I wear the rare sitter hat, I feel like I get treated like a second class citizen.
Why/how do RN's get these views from?

My view on CNA's and sitters is this-I couldn't do my job without them. I am blessed to work with wonderful CNA's (with the exception of a couple you have to watch a little more closely) I was never a CNA prior to being a nurse, but I knew from my first day as a nurse that I would treat the CNA's with respect. Now, when we have a float CNA come to our unit that I have never worked with before, I don't know them, I don't know their work ethic, I don't know what they do know or don't know about our unit. So when I give them report, I may go into a little more detail of what needs to be done with our patient. I certainly don't mean it as an insult and don't want to make them feel bad, but as the RN I need to make sure they are aware of what is expected of them.

On the other hand, there are always those nurses that treat the CNA's like crap. They won't do "CNA duties" like emptying ostomies or putting on ted stockings. I have seen RN's talk to CNA's like they have no clue. It is unfortunate because like I said the CNA's on our floor are wonderful. I have experienced this when I have had to work as a CNA because we were short staffed. It is interesting how some nurses treated me as an RN working as a CNA, some of them were downright insulting.

When I have a sitter with my patient, I give them a little report on the patient and what needs to be done with the patient such as vitals, blood sugars, turns, etc. There are nurses that don't really talk to the sitter about the patient and what is expected of them and then they get upset when something is not done. As charge nurse, when there is a sitter on the floor, I always try to stop in and see if they have questions and make sure they get a lunch break. I will admit I am not very good at stopping in the room a lot to see if the sitter needs anything. Maybe that is one thing I can work on improving!

So to answer your question, why do nurses treat the CNAs the way they do? I don't know, because I am not one of those nurses. As far as I am concerned there is no excuse to treat the support staff the way some nurses do. Some nurses just simply feel they are better than the CNA's because they have RN behind their name. Maybe they should try working a shift without a CNA, maybe they would appreciate them more.

RNperdiem, RN · Dec 22, 2009

If you float to many different departments, you will find that in some areas the RN's are heavily dependent on the CNA to survive. There is more potential for CNA -RN conflict in these areas.

I work in ICU. Our unit survived for years without CNAs. Now that we have one a shift, we are happy for the help.

Virgo_RN, BSN, RN · Dec 22, 2009

If you float to many different departments, you will find that in some areas the RN's are heavily dependent on the CNA to survive. There is more potential for CNA -RN conflict in these areas.
I work in ICU. Our unit survived for years without CNAs. Now that we have one a shift, we are happy for the help.

That's a very good observation, and I think there's a lot of truth in it.

On the floor, I could not provide all of the care for my patients single handedly, and when the CNAs were unreliable, it wasn't just inconvenient, it was downright dangerous. A realistic example actually happened to me one night. I had a confused, fall risk patient climbing out of bed setting off their bed alarm while I was in starting a Cardizem gtt on a new admit who was in A Fib with RVR. The CNA felt that I could go check the bed alarm since she was busy passing ice water. :angryfire

Another time, I had spent nearly all of my time in the room with one patient (fortunately, my others didn't need as much attention) writing down frequent VS on the flow sheet, offering a urinal, sips of juice, and doing groin checks on a pt. with an arterial sheath in. Finally I was able to remove it, achieve hemostasis, and continue to go in and do all my VS and groin checks. I did not see the aide in that room ONCE all shift. Finally, it was time for the patient to get OOB c assist and take a walk. I was behind on my med pass and all of my documentation, and shift change was in 30 minutes. I respectfully asked the CNA to get the patient up and ambulate him, and she said she couldn't because she was busy emptying garbages. :angryfire :angryfire

And yet another time, I was watching a pt. for another nurse who was at dinner, and the pt. wanted to shower because she had soiled her bed and felt really nasty. I changed the bed and helped the pt. to the BR to finish up, and asked the CNA to please shower the patient. The CNA said "She had a shower on day shift. I'm going to dinner." and proceeded to bounce down the hall on her merry way. :angryfire :angryfire :angryfire

Enough of these types of experiences, and you get to the point of not asking respectfully or nicely anymore, but just telling. These were daily occurrances on my old unit, and the CNAs would have told you that "The CNAs do everything! All the nurses do is pass meds and start IVs." The nurses would have told you that they spent the majority of their time doing the aides' jobs, causing them to work through their dinner breaks and get out late most nights. Yes, CNA-RN conflict was very high on that unit.

I think the key to preventing that starts with clear expectations and consistently holding people accountable. Occasionally we would get float aides from the Med/Surge floor, and those aides had their routine down like a well oiled machine. You could count on them to do routine VS in a timely fashion, get pts OOB for meals, ambulate pts, and answer call lights, all without having to be asked. Aides who floated to our floor would comment that they couldn't believe the behavior our aides got away with, and float pool RNs were refusing to float there because of it.

Now, my example may be extreme, but I think it bears some consideration in thinking about how people interact with one another in the OP's facility. There may be some things that the OP is unaware of, because she floats. When you float, you don't have a "home" unit, so you're a bit of an outsider and may not know everything that's going on.

JB2007, ASN, RN · Dec 22, 2009

I have done many jobs RN, tech, extern, sitter, both in the hospital and the nursing home. It all boils down to this do your job, do you job properly and in a timely manner, treat me and the patients with respect and I will view you in a good light no matter what your job is. However, if I have to continuely "remind you" of what your job is I will view you as lazy and worthless no matter what your job is.

With this statement I do not mean the workers that need a little extra instruction, but are hard workers. I mean the people playing around on the computer or hiding out in rooms talking when there is work to be done. Sorry to tick people off, but there is always something that needs to be done.