Stop calling me sweetie! - How to get respect as a new nurse

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I am a new nurse of two months, graduated in June and landed my very first job in August at an assisted living facility. I love the work and the residents, but I am having some trouble finding my voice. One huge area I don't think they taught us well enough in school was how to supervise and manage other people. We did have a "Leadership & Management" component, but it was a dry course with a dry textbook. Role-playing would have been so much more helpful!

Every shift, I supervise two to three nursing assistants. There are a handful in particular who are sloppy and careless. Example - they are responsible for getting vital signs and writing them on a form that I later review and then enter into the chart. They are expected to know normals, and they are supposed to report to me immediately any vitals that are out of range. One day I found on the form a BP of 80/60 that nobody had told me about. And they go way too fast and make huge errors in transcribing the vitals to this form, like leaving a "1" off of somebody's weight, or writing "158" under O2 sat.

So I made a sheet of what normal vitals are (there is already one posted, but obviously they ignore it). I put it in a highly visible area and write that I will expect them to know this, and that I expect them to read it and initial it. No one does. I follow through and start quizzing them. "What's a normal blood pressure?" The answer: "115?" I ask, "What's normal respirations?" The answer: blank stare, then "what's a respirations?"

So I take the time to go with them to do vitals. I answer their questions. I quiz them again. They continue to make mistakes. I take them aside and tell them that if there's one more careless mistake, or one more abnormal not reported to me immediately, I will write them up. We'll see when I go back on Sunday...

I go to the nurse educator to tell her what I've already done to address this problem and ask her if there's anything else I should do. And she called me Sweetie and Dear, said, when I showed her the vitals board with all its mistakes, "I don't need to see your examples," and her final parting advice was a hurried "Did you do everything perfect when you first got here?" Ironically, we are not allowed to call the elderly residents "sweetie," "hon," etc because it is considered so disrespectful. She teaches classes about this! I couldn't believe she was doing it to me and I was too stunned to say anything.

I know I need to earn respect to get respect, but I don't know how to do it. I don't want to become a raging B-word .... that is not my style. I feel dismissed and not listened to from above and below, and it's starting to get me down.

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Hi, one thing you have to realize is that you would always be a threat to the older employees wherever you go. It's even worse with those you have control over. They have ways they do things that they feel no one should tell them about. When you start enforcing rules it creates tension in the work environment. Start by getting to know them personally, appreciating their years of experience, and explaining that your license can be affected if residents get hurt due to carelessness. Go the extra mile to recheck the patients yourself as a precaution. As for your director, they sometimes create these kinds of problems by not dealing with them and instead putting you in the forefront. Do what you have to do to practice safely and hope for the best.

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Specializes in Critical Care, Education.

I can't comment on the "Sweetie" thing - without knowing what area of the country you're in. In my neck of the woods, it's perfectly normal to refer to someone as 'sweetie', 'hon', etc....

As an educator, I am concerned about the response you received from your nurse educator. Our role (staff education) is to support and assist managers - Never to interfere with their authority. You may have to have a critical conversation with the nurse educator to clarify your expectations so that she knows when you ask her for assistance, she is supposed to provide it rather than simply disregard your concerns.

Bottom line? YOU, as the clinical supervisor, are responsible for ensuring that your subordinates are competent to perform their patient care duties.... and YOU will be held accountable if there are any quality or patient safety issues.

I disagree with PP who is suggesting that you need to double-check the work of subordinates on a regular basis. This is not acceptable. Don't enable bad behavior. They need to be held accountable for the performance of their own job duties.

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Specializes in Critical Care, Postpartum.

I'm with you OP. In the workplace "sweetie, hon, etc." is inappropriate no matter what part of the country you're from. If you can't say "hon" to the CEO or President of your facility, then it's not ok to say it to others without the big title in the same workplace. My former company (non-nursing) did a workplace sexual harassment seminar. You would be shocked and enlightened at the "insignificant things" others would perceive as harmless that are considered workplace harassment, which includes terms of endearment toward a coworker.

I'm shocked at the responses from the nursing assistances. They didn't know what respirations meant? I hope they were just giving you a dumb response to get under your skin, which still makes them in the wrong. A serious meeting needs to take place between you and the educator.

Sent via Glad2baRN's iPhone using allnurses.com

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Specializes in public health.

You need to earn people's respect. How? I don't know. Only you can figure that part out. Those CNAs got there probably long before you did. New people always get picked on, at least in the beginning. You have to figure out a way to channel your authority in your job. You are not there to answer questions and quiz them. If it's something within their scope of practice, they need to know how to do it, not you holding their hands or correcting them. I know as a new nurse it's hard to take the leadership role because real life is so different from nursing school (at least in my case I felt really passive in nursing school, because I always worked under an RN). Just allow yourself enough time to feel comfortable about your job, being an expert in whatever you do, and people will respect you and take your words seriously.

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Thank you EVERYONE - I really appreciate your helpful feedback. Great suggestions here. I will let you know how it goes :)

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Hi, one thing you have to realize is that you would always be a threat to the older employees wherever you go. It's even worse with those you have control over. They have ways they do things that they feel no one should tell them about. When you start enforcing rules it creates tension in the work environment. Start by getting to know them personally, appreciating their years of experience, and explaining that your license can be affected if residents get hurt due to carelessness. Go the extra mile to recheck the patients yourself as a precaution. As for your director, they sometimes create these kinds of problems by not dealing with them and instead putting you in the forefront. Do what you have to do to practice safely and hope for the best.

Ageist much?

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Specializes in Dialysis.

Can you write them up (you know the disciplinary steps, written verbal, written, etc) to show that you have counseled them on various aspects of care? They may not like you in the end, but in a case like this, it's about protecting your license, reputation, and residents. You are here for patient care, not to make friends. You will always have something to fall back on as far as culpability. As far as 'Ms Sweetie' educator, ask her to sign off on the nursing assistant's documentation, perfect or not. See how much of a 'dear' she is then!

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I learned a long time ago not to worry about what someone called me. If its inappropriate, it will come out and reflect on them, probably at the worst possible time for them. If it does bother me, and it sometimes does, I stop the conversation RIGHT THEN and correct that person. It rarely happens a second time. When it does, I just inform them that if it happens again, I will make a formal complaint. I have never had to do that. people respond to expectations. set your expectations and then show you aren't messing around and things will fall into place pretty quickly.

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Specializes in Medical-Surgical - Care of adults.

So, OP, you don't give any indication of your age and it SHOULDN'T matter, but it does. I've lived in parts of the country where female servers in restaurants (those of you from parts of the south will be familiar with Waffle House) who call EVERY single patron by some "term of endearment", which can be frustrating but it isn't generally demeaning because they do it to everyone. However, now that I have very gray hair, I have noticed a tendency for servers at restaurants everywhere I've been to call me "sweetie" or "hon" or "dear" and twice, in a restaurant, I've been praised for eating all of the food on my plate. This is definitely demeaning. I'm seriously considering beginning to respond in kind -- one "hon" for every "sweetie" or "dear"; however, confrontations are difficult for me so I'm still working on that.

I'm going to refer to the nursing assistants you work with as CNAs because it's convenient -- that doesn't mean I assume that they are CNAs as defined by Medicare, so please don't jump on me, anyone, in that regard.

First, and VERY importantly, look for things in this group of CNAs that they do well. Comment to them and in front of others about the things they do well as often as possible. Be honest and realistic -- but try really hard to find things -- whether it's that this CNA seems to be able to get Mrs. Jones to eat or walk or rest really well (and Mrs. Jones is reluctant to do these things or finds them difficult) or if he/she got Mr. Smith to smile this afternoon -- or any skills that are obviously well developed and practiced -- whatever you can find to be approving of, do so and do it in ways that convey respect of the people performing the activities. I get very irritated if someone does the praise as if I were barely out of high school and first learning the skill when I've been doing it for decades -- but if someone admires my skill and makes clear that I have a skill that they do not -- when someone says "I wish I was that good at getting Mrs. Rogers to drink fluids. How do you do that?", then it's truly a compliment and I can appreciate it. Look for something that each of these CNAs can teach you about the setting where you work. If they've been there a lot longer than you, there are things they know that you don't. Ask them.

I remember, long, long ago, and far, far, away, a time when the acute care hospital where I worked did NOT have a pharmacist in the pharmacy from 11p to 7a -- the night nursing supervisor got meds that were needed from the pharmacy. The pharmacists came on at 7 am, and from 7am to 8am, they did not answer the phone or dispense any meds while they caught up on stuff from over night. However, the unit aide on my unit had worked at that hospital for 2 or more decades, and she was one of the few people in the hospital who COULD get meds from the pharmacy between 7 and 8 am. This was of considerable value and was something about her (and she had many admirable qualities) that was praised. LOOK for something that each of these "difficult" CNAs can offer that is unique and valuable then comment on that when it's appropriate.

In your work environment I'd say it seems that a few of your co-workers (the assistants and the staff educator, most likely) have suffered from burn out and not recovered, or have gotten blase feeling that the important things (since all of the residents are likely to die of old age in the foreseeable future) are keeping the residents as comfortable and happy as possible (not acceptable, of course, but it happens), or have given up on trying to make a difference/sunk to the level of the lowest common denominator. It also sounds like at the level of management you currently have access to, there's little support for you as an agent of change. So, the cynical part of me is going to speak first. Do what you have to do to protect your license. You are responsible for assuring that the residents are getting appropriate care on your shifts. If that isn't happening, create your own "paper trail" (keep your own copies) of dated "incident reports" you've filed with the appropriate supervisors regarding these incidents with these CNAs. Make sure that you have recorded dates, events, and your responses. Make sure that, even though nothing gets done about what you've reported that you continue filing the reports. In the records you keep for yourself, don't include information that would identify the residents involved, by the way. That could be a HIPAA violation. Identifying the CNAs involved is probably OK, but you might limit the identifying information to their initials. Comparing that with the work schedule at a later date (like 5 years later) would still identify the specific CNA involved. If something goes really wrong and the state board of nursing gets involved, that kind of documentation may save your license. If you lose your license you lose the chance to have a future in nursing where you can influence care for residents and patients. Not to count you would lose your investment of time and effort and you would lose your career in nursing.

In regard to the CNAs, continue to state your expectations; look HARD for reasons that they perceive that make it not only OK but advantageous not to care (some places of employment make it preferable not to care, unfortunately); for now, only follow up on problems that affect resident safety; and seek to build some team spirit when you can (I vote for an occasional infusion of homemade cookies as one mechanism, but you will have your preferred mechanism for a starting point). Also, notice whether the issues are more common when members of this "handful" of CNAs work together; if they are, consider asking if they can be scheduled and assigned NOT to work together as often as possible. Lead by example and ignore the times when people state or imply that pretty soon you'll "grow up" and realize that what they taught you in nursing school doesn't have much to do with the real world. A systolic B/P of 80 in someone who doesn't usually run that low matters, no matter where you practice. You might try "nagging" that particular CNA regarding vital signs for the next few shifts after an incident like that -- in the sense of making it clear that, since you can't trust him/her to come to you with important information, you'll check with him/her frequently to see if he/she has any important information. Regarding respirations, first, unfortunately, I doubt any of this handful of CNAs has counted respirations on a resident within the last decade. So, if you have a resident on an opioid or hypnotic, ask the CNA assigned to that resident on a shift how you might know if the resident had gotten less able to handle the dose he/she is on or if, perhaps, a newly added medication has affected the resident's tolerance of the medication. Then make sure the CNA is fully aware that counting the respirations on that resident is vital - that looking to see if their breathing looks OK is not enough -- and that the CNA really could lose his/her job and ability to get another job if there were a bad outcome because the respirations weren't actually counted.

It won't be easy. If you like your job otherwise, you may find that as you continue with the employer your ability to influence practice issues increases. It isn't uncommon for RNs to "rise" (get promoted) quite quickly in companies that provide that kind of care -- you might find yourself in a position to affect hire/fire decisions within a very few years. Sometimes it is worth staying long enough to get to where you can initiate positive changes from within an organization. In my career, once or twice, I've "outlived" the person who had made my life hell and been able to promote changes that limited the affect people like that could have in the job setting. That can be rewarding because, one, a sense of schadenfreude may not be noble but it's very human; and two, seeing a place become a better setting for patients/residents/students because you did your job well can be very fulfilling.

Best wishes for a long and fulfilling career in nursing. By the way, I learned that there are some difficulties that come from being a 22 year old nurse that being a 32 year old nurse cures. If chronological youth is part of your problem, dress conservatively (no "cutesy" scrubs, no street clothes that emphasize your youth if that's what is worn where you work), and bide your time.

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Specializes in Cardiac.

I've had this problem with CNAs not reporting vitals as well. ESPECIALLY new ones. What I try to do is just reinforce over and over why it's important without being a *****. For instance, last night I heard an excuse that my aid was "too busy" to call me about 68/40 - which we all know is ridiculous. I made sure he knew that no matter what he was doing - answering multiple call lights etc - it would be his #1 priority at all times to report a vital in that range to me - btw all he has to do is call me on my mobile phone it's not like he had to come find me, so poor excuse. The rest of the night he was very good about calling me right away after the criticism. I think sometimes CNAs have difficulty prioritizing their tasks - especially when they are new - which I understand - I'm only 4 months in myself. I just try to not be judgmental and rather reinforce what my priorities are - so maybe even if they don't learn themselves what the ranges are and understand- they know what I specifically expect as an individual. Also, I constantly call this particular CNA about vitals now - which is good about getting him in the habit of just calling me so he doesn't have to bother with getting my calls! ;)

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