This is in reference to a thread called "Re: Nurses - Leading your subordinates"
I just wanted to discuss the idea expressed there by several members that we should not view aides as our subordinates. Rather, we should look upon them as our coworkers and team members. Several people thought it was demeaning and disrespectful to view aides or LPN's as somehow not our equals.
I know we are all on the same team and have the same goal, at least we should.
However, someone leads a team. In Nursing, that is the RN. Legally, LPN's and aides are subordinate to the RN. The Charge RN leads staff RN's, too. And a Manager or Clinical Supervisor or House Supervisor or Shift Supervisor leads the Charge Nurses. In a very real sense, there is a definite pecking order. When my shift supervisor tells me what to do, as a Charge RN, I do it. She's my boss. So is my manager. So are the doctors, even though they're not nurses. So are administrators, directors of the service we're on, and probably other people. Some of our bosses are younger and less experienced. Doesn't matter. They are in charge and outrank us and that's how it is. They might be nice, they might less us know they value us, they might be nasty and unappreciative. Doesn't matter. If they're over us, they're over us. Yes, it would be nice if work were always pleasant but the bottom line is, it is work, our job, not the place to look for kudos and confirmation of our worth. Yes, I want that as much as anyone else but I've learned to confirm my own worth or get it from family and friends. At work, I do my work.
We need, IMO, to realize that we nurses are in charge. By virtue of our responsibility, by virtue of being licensed and the laws governing that licensure, by virtue of our great liability for the acts of our team members, we are in charge. Like it or not. And lots of us do not like it. Lots of us would prefer to just do our own work and give total care, not need aides to help us or LPN's to do whatever for our patients. But it doesn't work that way.
I am not saying to be ugly or imperious or rude, arrogant, or otherwise lord it over anyone. But we need, I think, to accept that we are truly in charge and that some staff members are truly subordinate to us. I think a lack of this acceptance is largely responsible for the troubles in our profession.
Other lines of work have bosses. Grocery stores, car repair shops, schools, you name it, their are bosses and subordinates everywhere. In families, this is true. When we forget it, there is trouble.
Yes, every member of a team in any line of work is important and should be treated with dignity. But, bottom line, somebody calls the shots.
well if we don't have enough threads already that enable us to chew each other up....bi-golly here comes another...
it wasn't meant to be an avenue for fighting at all. nor need it be that.
i just have a problem with nurses not realizing their true status, legally, and the authority they are expected to exercise, and the fight it can sometimes be to get everyone involved to understand and comply with the legal realities of our work.
i think it's time nurses came to grips with it and learned, as jbudd says, how to truly lead.
as i stated originally, there is no need for rudeness, arrogance, and the like, from nurses or toward nurses. respect must be shown for others, as well as appreciation for their good work and great personalities. team members should consult each other and communicate openly and clearly. opinions and views of all should be voiced and heard. ultimately, though, only one person can make a decision as to, for instance, what task gets priority #1, #2, etc. the person with the most to lose, t he one whom the employer and the law say is in charge is the team leader. how could it possibly be otherwise? and that one must not be lax in leading. think of the ship's captain. he is in charge and all the other team members do as he says or wind up in the brig. yes, there are times that orders must be disobeyed - if the captain is incapacitated, for instance, or gives an unlawful order.
think of the judge, the police, the prosecutor, the court clerk, the bailiff. judge trumps them all. they do what the judge says or else.
my aides know i appreciate them and respect them. they also know that they are not to take off for breaks without letting me know they are leaving the floor, they are not to leave when their partner is gone, as that would leave only me, they know not to exceed their break time limit. they know that disappearing is unacceptable. they know that people come first, before any task, for example, toileting is more important than getting a blood sugar or emptying trash, unless there is a terrible emergency and we need a state set of vs or glucose. then the toileting just has to wait. keeping patients comfortable, clean, and reasonably happy comes before helping doctors locate charts or answering phones, even though we desperately want to do it all.
we can only do 1 thing at once and we let phones go and leave doctors to hunt for their own charts if we have to. we used to, years ago, get doctors coffee, hang up their coats for them, get their charts ready, get supplies for their rounds, round with them. now, we're lucky if we know what our patients' vitals are and do all the care and teaching we are required to do. it's not our fault, of course, and i, for one, refuse to feel guilty about it. i digress.
my aides know i'll back them up if anyone c/o about them. but they also know i expect and need the truth and need them to be courteous and on the ball. some aides don't want to work with me and that's fine because i don't want to work with them, either, if they are going to shirk, be rude, etc. my aides are great but they can't rest on their laurels, any more than i can. every day, we must prove ourselves again. we don't carry each other but we are a great team. i hope everyone here has that or brings it about.
The only decent nurse that treated my FIL was an LPN! She was worth more than the others wrapped in gold!
Subordinate, lower down the ranks, whatever.....we all work together, but the severity of punishment changes depending on who you are if a patient is harmed.
The hardest thing about these levels, is that when we TEAM, TEAM, TEAM all of the time....some of us forget what our jobs are. Everyone has an important part of patient care. If someone doesn't like their specific role or level...IT IS THEIR JOB TO CHANGE IT! So while I agree that subordinate sounds like a "bad" term, it is the proper term according to the BON, and in hospital regulations.
Maisy
PS. I don't think any physician is my boss, unless it is my director of the ER! I am a co-worker, and collaborator in patient care. The day that ends is the day I quit! Nurses should all feel that way.
Boss in the sense that you follow their orders and submit to them, even if you disagree and they don't take your suggestions. Unless you 1000% disagree and it's serious thing and you hand them the med and tell them to give it themselves or you go to your boss and the Chief of the service - something like that.
Co laboring and collegiality are great but, still, the doctor has the last word.
The way I see it, the doctor isn't my boss, the NM is. However, my job is to implement the doctor's orders, and question any orders that are unclear or seem unsafe. I respect the doctor's greater education, knowledge base, and level of responsibility. In that way, I am their subordinate, though they are not my "boss".
Specializes in LTC,Hospice/palliative care,acute care.
No one said that we are NOT important no matter what our job title may be. Quit the contrary-it has been acknowledged that we all play an important role in the lives of our patients/residents. However someone has to be "in charge" or "lead the team" or "manage the unit" In my experience if someone is offended by the language used to describe their position it's usually due to their problem of low self esteem.This P.C. BS. is ridiculous. In nursing ,in the military,in big business -in life-someone has to be in charge.Get over it .In nursing the actions of the lower ranks are the responsibility of the subordinants/professionals/bosses or whatever you want to call them.It does not matter if you dropped out of nursing school the day before graduation-if you are cna you must be capable of accepting direction from your boss,charge nurse, whatever.Same goes for me-when my supervisor gives me instructions I follow them-without a big verbal masturbation session.
JBudd I understand that it is the "correct" word to be used but it is condescending especially when an RN goes up to you and asks you if you are her aide and then you over hear call you her subordinate. It has happened to me and it literally made me feel like crap.
So I am part of the nursing team and I am a co-worker... on my hospital ID it says Nursing Services just as it says on the RN and LPN Badge.
I'm not sure why it would "make you feel like crap."
I am subordinate to a long list of management staff, from my charge nurse who is my direct supervisor at a given moment, to my department manager, on up through the organizational chart. It doesn't make me feel like crap.
If there is an individual who is disrespectful you you, then you need to address it professionally as a team member and coworker, or resolve to not let it bother you.
My mother used to tell my siblings when they were small, "don't ever think you're the boss of the world! Everyone has a boss!"
Specializes in trauma, ortho, burns, plastic surgery.
The subordonation relationship in NURSING field is a complex one and includes many aspects and is somehow toatlly different from other type of subordonation relations (see army).
I would like to tell only about one: comunication inside the nursing is totally diferent from army communcation. You could not aplly the same communication principles working with people. Is a both way communication path. Bottom to top and top to bottom. A direct decision without a positive feedback from environment still is a misscomunication. I worked in both field civil and army, with nurses trained in both fields, what is strange is that you couldn't realize the diference just talking about, you need to see the reaction in a real nursing environment.
Transferable skills and attitudes could be usefull but not all of them. Is a special type of communication in nursing beetween team members hard to achieve and hard to cuantified to see the progresses.
Subordonates are in legal terms, in nursing field ALL are JUST parteners in the team, behaving like that. Hard to be accepeted be all, but this need to be true to a continous care.
You could not tell to a RN, LVN or CNA "respect me because I am who I am" or trying to scarre them in one way or another by power invested. is not a true way of subordination.
Is a lot to talk about subordonation special in nursing field and I like the subject... we will talk more about, later...looooool!
Just be good as you would like that somebody be with you if you will be in the same position!
I don't believe that anything was said in the original post about anyone being smarter or better than anyone else, and the distinction of who was subordinate to whom was not placed on whose salary was higher. I believe that the original post was actually well stated and respectful, except for the buzz-word of subordinant. You are correct, every job in a hospital is important and I cannot count the times when information provided to me by a CNA led me to be able to take swift action to help a patient. But the fact remains that every job has someone who is ultimately responsible, irregardless of how well the 'team' works together.
I must also disagree with your statement that the only thing that separates a CNA from a LPN or RN is the money to attain the degree. That statement discounts all of the hard work and sacrifice that it takes to earn that degree. If you don't believe that, take a look at the student threads on this board. I am not saying that CNA's do not have the capacity to become RN's, they do. The fact is that there is a vast difference in knowledge base between someone who has completed nursing school and successfully sat for NCLEX, and someone who has not. Many of the nurses on this board are previous CNA's, including myself. I would not have dreamt of considering myself as the professional equal of the RN's that I worked with until I passed boards. I know how hard CNA's work, and I appreciate the work that they do, but as long as I am responsible for the work that they do and have a legal responsibility to supervise them, I will.
Now flame me if you must, but no disrespect was meant. Semantics aside, we all do work together.
ITA, until I became an RN, I was one of those techs that thought that it was going to be so easy. Until you are in that role, you really have no idea.
I'm also in the position where I run the board at night in my specialty. I make a special effort to talk respectfully to people seeing as how I'm pretty much a new nurse(under 2 years experience as an RN) and I still get grief..So guess what, now the gloves come off. I'm not here to be liked and I've no patience for the "high school" mentality that so many people seem to have. We are all important- but this also means that people need to step up and perform the job they were hired for.
JBudd I understand that it is the "correct" word to be used but it is condescending especially when an RN goes up to you and asks you if you are her aide and then you over hear call you her subordinate. It has happened to me and it literally made me feel like crap.
So I am part of the nursing team and I am a co-worker... on my hospital ID it says Nursing Services just as it says on the RN and LPN Badge.
In my experience, I only have to remind someone that they are working under me, that I am the one in charge when the "subordinate" doesn't seem to understand that they must take orders from me. I have found that a lot of CNAs and techs feel that they are equal to the LPN or RN, and they simply are not. CNAs are an integral part of the team, but as someone else mentioned, there has to be someone in charge. I have seen some appalling behaviour from CNAs and techs. alot of them think they can tell the nurse what to do, or that they only have to do what they want. you are not equal until you get those letters behind your name. until then, you must take orders. i think that is what is wrong with nursing today. everyone is so busy trying to make sure noone's feelings are hurt, or that everyone likes them that they don't want to feel like they are bossing people. people need to learn to do what is in their job description. This mindset that the nurse is on the same level as various ancillary staff in my opinion contributes to the lack of respect experienced by nurses.
bollweevil
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