Some days it just stinks to be an aide

[bethin]

I'm feeling really guilty about something that happened at work 2 weeks ago.

I'm an aide that primarily works on med surg but if ICU is open (really small hospital) I float up there as I'm the only aide with the most experience there.

We had 1 pt(the only one) who was post op bowel resection. On a PCA. While the nurses were in report I got a set of vitals. BP was low, sure the guy wasn't moving around much but a BP of 70/30 is cause for concern. His RR were only 8 and his pulse was irregular (checked radially) and in the 130's. I prompty notified the nurse of his vitals. He was responsive to a degree but he had just had surgery during the night and this was at 0700. I knew that low RR could be d/t the PCA and that our protocol is that any RR below 12 means that the PCA is immediately dc'd and the dr called.

The nurse shrugged her shoulders. I repeatdly checked on this pt during the time I notified the nurse and the time we called the code. Thankfully, we never lost a pulse but he was reintubated.

I don't know why I feel guilty. I notified the nurse immediately of the problem. Management has issues with aides charting anything in nurse's notes that doesn't deal with how far a pt ambulated. And I don't feel that as an aide that I can chart these kinds of observations. I guess I should have gotten in her face and yelled at her and told her to take a look at her pt. I have to follow chain of command.

I charted the vitals so there is a record of that. But, if the nurse comes back and says she was never notified, what could happen to me? I don't plan on becoming a nurse. In fact my major is political science but that doesn't mean I don't care about the patients and my certification. And I always notify the nurse of abnormal VS, BS, etc but usually I get a shrug as if to say "so what, I see that all the time". I work weekends only so we are a close bunch and I know who is going to do something about an abnormality and who isn't but that doesn't change the fact that I tell them.

It sucks being an aide because when you do notice something is wrong with a patient some nurses (and not all) just don't listen. Sometimes you know what should be done but you can't do a darn thing about it because you are just an aide.

Is there anything else I could have done in this situation?

[emmycRN]

I think the best CYA option for you is to write an incident report. The form may be called something different where you work, but every hospital has them. This will notify the appropriate individuals of the nurses possible neglect of patients. Also, your appropriate response to this patients needs will be officially documented if there is ever a question.

[Tweety, BSN, RN]

She confided that she feels frustrated by the lack of "work ethic" shown by some of the nurses on the floor. That many a time she sees the techs running their butts off while the RNs just sit and chart, chart, chart and not do anything but pass meds.

cheers,

Sorry Bethin, but I have to address Roy.

I've gotten the "all you nurses do is chart and pass meds" from techs before, I hope you set her straight that it's a bit mroe than that. Yes, I do chart and pass meds duh. Not that your co-workers aren't lazy, or the techs aren't doing a lot of work either, but that statement burns me up when I've had it said to me. Unless she's a fly on the wall watching every move of every nurse, she really doesn't know what they do. Lazy nurses that don't get up off their butts and help their kicks burn me up too.

End of rant.

Thanks.

[Roy Fokker, BSN, RN]

Sorry Bethin, but I have to address Roy.

I've gotten the "all you nurses do is chart and pass meds" from techs before, I hope you set her straight that it's a bit mroe than that. Yes, I do chart and pass meds duh. Not that your co-workers aren't lazy, or the techs aren't doing a lot of work either, but that statement burns me up when I've had it said to me. Unless she's a fly on the wall watching every move of every nurse, she really doesn't know what they do. Lazy nurses that don't get up off their butts and help their kicks burn me up too.

End of rant.

Thanks.

I realize this is an "ancient post" to respond to. But:

Yes Tweety, I did tell her those things - among others. :)

Such as the oft missed part about how as nurses, we are ultimately responsible for all aspects of patient care. In other words - if the tech didn't do "this or that", it was upto me as the nurse to make sure that "this or that" did get done.

Merely claiming "I asked the tech to do it and s/he didn't" us no good as a defense.

I also made it point to explain why they are "nursing assistants" - not "floor assistants". That while this did have a degree of hierarchy to it - it was also reciprocal.... that while nurses delegated tasks to techs, we were invaluably dependent on them to carry them out to precision and satisfaction.

I told her an anecdotal story of how I caught a particular nursing tech (who was going through nursing school) misrepresenting the vital signs she was doing - she would simply "write down" what respiratory rate she estimated/thought the patient was doing rather than actually count them! Understand that I work a surgical floor - where patients often come back post-op under heavy sedation! She would also take blood glucose checks at times "deemed" by her rather than at times reqested by the nurse. Said "tech" no longer works anywhere in the hospital or our hospital system.

I commiserated with her frustration regarding staffing (and I agree with her on the regard. We're the worst staffed unit in the entire hospital... be you a nurse or a tech, despite being the largest unit!) and I told her that anytime she felt overwhelmed, she was free to approach me with regards to her concerns.

And whether a tech was going through nursing school or not - I tried to explain "nursing rationale" to them. E.g.: Our techs would do vitals on patients and simply tell us any "abnormals". Typically they would only point out just the abnormal BP or the abnormal u/o. I've patiently explained the relationship between BP, HR and U/o - as in: "it's difficult to arrive at a complete picture based just on the heart rate alone. What's the BP? What's the u/o look like?" etc. I'm not trying to substitute nursing assessment and judgment here - but I also realize that many of my techs have been doing this for years now (while some are spanking new).

Giving them a process can't hurt - I'm going to reassess my patient anyhow based on any abnormals... but after I've started this practice, I've had all my techs come in and tell me their "fears" or "worries" about a patient, along with pertinent objective readings! Many times, it's a false alarm but many times it has also saved my bacon.

After all, isn't "teaching" one of the primary goals of a nurse? We teach patients all the time - why not also inform and coach our assistants? Surely an extra pair of "alert minds" can't hurt! All I lose is 2 minutes investigating a false alarm ...

I dead depend on my nursing techs during my shift. I'd be utterly lost without them! Especially on my floor, where some of them have been at the job for years.... when they tell me "I don't think patient in so-and-so-room is doing so good", I make it a point to follow up pronto! They may not have the initials and credentials behind their name - but boy can they smell smoldering trouble!

Good post Tweety! :)

cheers,

Roy

[Ms Kylee]

You did the right thing... reported it to the nurse. You're not responsible for their attitude.

What I always do when I get an abnormal vital, when I tell the nurse, then when I chart, I make a note "Reported (abnormal vital) to Nancy Nurse." That way my butt is covered.

Most of the time, the abnormal vitals are covered in the report, and I've had several say "this is normal for them", or "they run tachy". I usually just say Ok, but I had to tell you because we have to report abnormal vitals.