So Who Runs Your Floor, You or the Aides?

Jelli_Belli · Feb 29, 2008

I was a tech at my prn job not to long ago (like 3 mon.!), so when I am the charge nurse it can feel a little weird. Lucky for me though, the techs and LPN's I work with are great, we work together wonderfully as a team and everyone knows their job and does it without me having to ride their backs all night. I work on a psych unit though, and personally, I feel that teamwork is better on psych floors vs. your typical medical floor. There isn't the same emphasis placed on hierarchy.

There is one tech where I work that drives me crazy sometimes. She's a really hard worker but she always wants to be helping out with nursing duties and therefore ends up leaving the floor with no one watching it.

The other night she was the only tech and I was in the nurses station (it's separate from the rest of the unit and sealed in by glass walls) and she came up there and started printing out paperwork for the next day (normally my job but something that she knows how to do). The next thing I know I'm getting all the drinks and cigarettes, and I'm out in the milieu helping people to the bathroom and showing them where to do laundry. Suddenly I realize, She's up there doing my job and I'm back here doing hers.

So basically I swallowed a big girl pill, and went up there and told her I appreciated that she was trying to help but there were phone calls that I had to make and it would be more helpful of her to stay out in the milieu with the patients. She was mad, and it sucked having her mad at me, but sooner or later she'll get over it and I had to do what I had to do.

I try to be as helpful to the tech's and pitch in where I can, and while I can do all of the techs job, there are parts of my job that only I can do and if I spend my whole night doing the tech's work then nobody is doing mine.

That was one of the hardest lessons to learn post nursing school. Sometimes you just have to delegate (whether they like it or not).

Valerie Salva, BSN, RN · Feb 29, 2008

I have worked at a number of facilites (both LTC and acute) in which the aides run the units, mgmt knows and does nothing, and nursing complaints fall on deaf ears. This is pretty common in health care.

This has also been a major factor in why I have quit a number of jobs.

longjourneydream · Feb 29, 2008

Do you ever clash with your aides?
What about?
Who "wins"?
Do you have friendships among your subordinate staff? What about with other coworkers?
Have you ever had an aide tell you she's refusing your direction to do this or that? Have you ever called your supervisor for back up? What happened?
How did you cope with it? Were you made to feel at fault somehow?
Are you in a long term setting or acute care with quick patient turnover?
Is your staff pretty stable or do you have a frequent load of new staff who don't really know the job yet?
Thanks for sharing.

Hi,

I myself was an aide for 17 years before becoming an RN.

When the staff is new and still has to learn the routine;yes it can be difficult, but you try to teach the staff, what they need to learn.

Some staff refuses to learn and refuses to do the job and the director does nothing, but just talk to them.

I moved from ER to the medical tele floor, the aides seem to run the whole floor, it is out of control...

1. Foley bags are not getting emptied. I&O is not getting put in the computer.

2. Baths are not assigned, and many are not getting done for days at a time on the same patient.

3. Night staff states they are not there to do baths.

4. Much socializing is going on while nurses are doing it all!!!

In the ER the girl techs all did their job, the boy techs sat and talked, disa-peared, when patients needed transporting, and dictated what they were gong to do, or not do...

All out of hand.

Maybe the solution is to have more nurses no techs, then do it all with no complaints, I don't know...

When I was an aide/ tech I had 14-16 patients, Did q4 vitals, 8-10 baths, I&O, computer input, answer lights, relay messages, and did what I was told, even when I did not like to do it. It was my job...

In the ER I did what I could do in the crazy frenzy, but I did help the nurses, and did what they asked me, again , even if I disliked the job.

So I have a difficult time watching all this stuff going on right now, at work.

Any ideas!!!!! :madface:

racing-mom4, BSN, RN · Feb 29, 2008

do you ever clash with your aides? just one

what about? about her not wanting to do anything but sit, and god forbid you ask her do something . the huffing puffing and eye rolling begins

who "wins"? ultimately she does, because if she does have to do something for you, count on her hiding out the rest of her shift

do you have friendships among your subordinate staff? what about with other coworkers? yes and yes

have you ever had an aide tell you she's refusing your direction to do this or that? have you ever called your supervisor for back up? what happened? never refused, just huffs/puffs then hides

how did you cope with it? were you made to feel at fault somehow? i have told mgmt about it, and they nod and say "yes that is how she is"

are you in a long term setting or acute care with quick patient turnover? acute care

is your staff pretty stable or do you have a frequent load of new staff who don't really know the job yet? pretty stable, a few new hires---including me. but i was a cna for 4 years prior to becoming a nurse, so i know the cnas role well.

Ms Kylee · Feb 29, 2008

We have two aides that love to run and hide. One is on light duty, which means she can't turn or lift. She is supposed to take the vitals, pass water pitchers, I&O, etc. What does she do? Takes the blood sugars, the first set of Q4 vitals, and the I&O's at the end of the shift. She does not do the end of shift vitals even though she is supposed to. In between the tasks she does do, she's in the computer room, online, hiding while the rest of us work. Management is aware and does nothing because she's a pet. This is why I'm leaving in May when my year is up and I'm heading for greener pastures.

racing-mom4, BSN, RN · Feb 29, 2008

I would like to add something positive to this post...I think everyone has aides that run and hide, but I am sure we also who have come across aids who are dedicated and kind. We have an aide that works at our hospital that is AMAZING with the patients and staff. She really give the patients a good bath, lots of soap, lotion and back rubs. She makes sure if she is feeding someone, the food is warm and the pace is slow and consistent. She tidys every room she enters, she waters the patients flowers, she fetches coffees and sodas for the families.

She keeps the nurses constantly updated on the patients conditions. She makes sure all of her patients know her name at start of the shift and that she is there to help them until 3pm. At 2:30pm she tells them all she will be leaving but tells the name of the CNA that will be replacing her and asks if they need anything before she leaves. She then tells them when she works next ex: I will be back tomorrow or I wont be here again till Thursday.

One time she was giving a patient who had her knee replaced a bath and she discovered a lump in the womans breast, she reported to the nurse who reported to the Dr, test were done, the woman had breast cancer. Had it not been for the CNA who knows how long it would it would have gone unnoticed.

I could go on and on about how wonderful she is. I make sure I ask her through out the day if she needs any help from me.

I could only wish others would rise to her level.

gonzo1, ASN, RN · Feb 29, 2008

I have had many aides over the course of time tell me no and walk away and when I report them management always says "that's the way they are".

At my last gig there was one aide who spent hours on the computer playing no matter how busy we were.

I feel that no one should be sitting unless everyone is caught up and can sit. But who am I?

Needless to say I have also worked with awesome techs who were better at everything than me. They have my undying gratitude and they know who they are because I always thank them.

jjjoy, LPN · Feb 29, 2008

The problem isn't the aides... it's the managers who allow them to get away with not working and a bad attitude. So what's the reasons managers seem to let this happen so often? Is it that it's so difficult to find a replacement aide that someone's better than no one? Is it 'favoritism'? Why are some managers allowed to play favorites with clearly inferior workers? Did those managers get THEIR position through favoritism as well (as opposed to their ability to manage)? Why is it that in too many places, there's no recourse to take complaints against a poor co-worker if one's immediate manager won't take action?

There will always be a few bad apples at every level. Sometimes we're just venting but appreciate that most of our co-workers are good to work with. Other times, it reflects a toxic work environment that it may very well be best to just get out of than to try to change.

wearingmanyhats, RN · Feb 29, 2008

ACKKKKKKKK...... were you guys hiding in the woodwork last night????

I did an 11-7 last night as an agency LPN in a LTC -- I had 2 facility CNAs.... one is fairly new ( and did a decent job) the other...... where do I start?

On her cell phone (texting I presume), took a 45 min break.... minimal rounds "sometimes it's ___o'clock, sometimes its___o'clock" --- sleeping at the desk (was sitting with eyes closed...wearing her coat... I tiptoed around then made a sudden noise and she "jumped".... when I said "if you are going to sleep, I suggest you find something that needs doing....",she stated "I'm not sleeping" and when I said "your eyes were closed" she said "No, my eyes are in my coat".......

I would have said something to the DON, but when I left (almost an hour late... at almost 8am......) she had not come in yet....

Faye

longjourneydream · Feb 29, 2008

As RN's I belive we would need to make a difference.

Maybe we can ask our manager/director to try different things?

Incentive reward programs for aides/unit clerks.

Specific documentation for those who do not do thier work, to eliminate them and replace with others that will work.

Training programs for techs/aides, with specific competentcy training.

The problem with many of these things, are the hospital has no money in the budget to provide this kind of training.

Any ideas out there I would love to hear it...

ACKKKKKKKK...... were you guys hiding in the woodwork last night????
I did an 11-7 last night as an agency LPN in a LTC -- I had 2 facility CNAs.... one is fairly new ( and did a decent job) the other...... where do I start?
On her cell phone (texting I presume), took a 45 min break.... minimal rounds "sometimes it's ___o'clock, sometimes its___o'clock" --- sleeping at the desk (was sitting with eyes closed...wearing her coat... I tiptoed around then made a sudden noise and she "jumped".... when I said "if you are going to sleep, I suggest you find something that needs doing....",she stated "I'm not sleeping" and when I said "your eyes were closed" she said "No, my eyes are in my coat".......
I would have said something to the DON, but when I left (almost an hour late... at almost 8am......) she had not come in yet....
Faye

racing-mom4, BSN, RN · Feb 29, 2008

As far as ideas to encourage aides to do their job I have a few.

1) pay them more. I dont do payroll so that is easy for me to say, but I think if we raise the bar and make being a CNA a more desirable job, we will get better applicants.

2) respect them --treat them as an extension of your self. Ask them their opinion and then listen to it. I have seen nurses dismiss what an aide has to say, do that enough and the aide will stop reporting changes to you.

3) we have staff meetings that are mainly geared towards the nursing staff, the aides should have aide staff meetings. Many aides have great suggestions, they just need to be heard.

4) offer incentives or rewards for exemplary performance, maybe cafeteria dollars, or even something silly like a star pin to wear on their name badge. Some small token that shows we appreciate them.

5) get rid of the ones that drag the others down, we as a staff should not tolerate rude behavior. If an aide is not doing their job and a new aide is hired and sees that "old" aide is not working nearly as hard, yet is getting the same $$, do you think new aide is going to bust her butt? No, they will soon see they can get away with not doing as much and still collect the same pay check for half the work.

another suggestion I have and this I am sure no one but the aides will like, dont make them work holidays. Let them have holidays off and have just an RN staff on those days. Lets face it, they make at least 1/2 if not a 1/3 of what a nurse makes and the good ones work just as hard as the nurses do. I would be willing to bet if a facility treated their aides with respect and gave them perks such as Holidays off and other incentive programs, we would retain the good aides and qualified CNAs would be beating down our doors to get a job.

Since I am not in management, I can not make those changes. But I can provide the respect part of the above suggestions.