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.
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.
Nurses also need backup from their managers as well. If nurses have little say in the disciplinary actions against personnel that work under their leadership then their leadership is essentially undermined. Of course, those who work on nurses' teams also need to have recourse if they have valid issues about a nurse.
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!
Hugs Zuzi
Interesting quote from the gymnast - about labels not being for people. I wonder what she was thinking, why she said it.
It's a standard joke among residents in my program when we have to rotate through one particularly junk hospital.
"You don't write orders, you write suggestions. Sometimes the nurses accept your suggestions, most of the time they don't."
I also have worked with nurses who picked and chose which orders to follow and which not to. Part of it had to do with surgeons always being scrubbed and orders being needed right away. They'd sort of do what needed to be done and get the orders later. Eventually, that service learned to leave an intern unscrubbed at most times.
Other times, though, nurses thought an order was stupid or inappropriate, dangerous or wrong and just didn't do it. They'd snag an attending eventually to correct it and the writer of it.
Of course, some residents just will not learn and are forever putting the nurses in difficult positions. There is a way to handle them, too. It's called "the attending".
What was it that made the particular rotation you refer to so hard?
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".
Doctors bring business to the hospital. Hospitals, including smart Nurse Managers, bend over backwards to make doctors happy. They provide great parking spaces for them while nurses have to park far away and deal with the elements and allow a whole lot more time to park than doctors do. They have a separate dining room, a cloak room, and lots of other amenities, possibly gym and country club memberships for at least some doctors, tickets to symphonies, whatever. (Of course, the doctor must live up to expectations, bring in business, live conservatively, not rock the boat, and generally fit in with the status quo.) When was the last time a nurse had all of that and more? It's about money. Just try being as rude to doctors as some of them are to us and you'll learn rapidly who is boss and who's not. I know these things because I have a couple of nurse friends married to physicians and they keep me abreast of such matters.
Doctors bring business to the hospital. Hospitals, including smart Nurse Managers, bend over backwards to make doctors happy. They provide great parking spaces for them while nurses have to park far away and deal with the elements and allow a whole lot more time to park than doctors do. They have a separate dining room, a cloak room, and lots of other amenities, possibly gym and country club memberships for at least some doctors, tickets to symphonies, whatever. (Of course, the doctor must live up to expectations, bring in business, live conservatively, not rock the boat, and generally fit in with the status quo.) When was the last time a nurse had all of that and more? It's about money. Just try being as rude to doctors as some of them are to us and you'll learn rapidly who is boss and who's not. I know these things because I have a couple of nurse friends married to physicians and they keep me abreast of such matters.
And therein lies my problem. I was unaware this existed until recently. I am fortunate that I work in a teaching hospital that values EVERYONE!
No one I know has God-like attributes. We work as a team, to aide the patient during their stay. The few surgeons, or residents that act that way catch on quickly-sugar gets you soooo much more than vinegar, and truthfully attendings will not put up with their crap!
Of course the ER is different, I do see a bit of an attitude change on the floors. The doctors are not as responsive to phone calls, which is not acceptable in my book.
My FIL experienced a horrible end in my local community hospital due to nurses fear of "bothering" the doctors, and nurses having zero empowerment or autonomy. Even the hospitalist told me he couldn't get involved. What a misguided culture of care! As you might imagine, this did not sit well with me. I actually had a physician tell me that nurses where I work are aggressive and he'd never work there, I told him with his attitude he wouldn't make it!
Currently, I am on a one woman mission to bring this place down! I have a plan, slowly but surely it will happen. Since some of these nurses are newer, or my graduating peers...I have had a hard time understanding how we could be SOOOO different in our skills and work ethic. As you might imagine, one of the things I did was contact my former instructors....I described in detail what occurred and that their emphasis needed to be on nurses knowing their rights and documenting like crazy when a doctor does not react to their phone calls, and or, requests for medications or procedures. They also need to go over cultures.....and how to be assertive. Truly I was disgusted with their attitudes, yet I know this is all they have ever seen.
In this hospital NURSES and the PATIENTS were truly subordinates.
Who knows? Maybe it's easier to take NO RESPONSIBILITY for the patient's outcome....and blame it all on the doctor.
When we all work together for the common good, bad things can happen, but at least you know we did what we could.
When you have a culture of Doctor worship....the patient comes second....bad outcomes can and DO happen....because of fear, intimidation and selfishness.
BY THE WAY, WHO PAYS THE BILLS....PATIENTS OR DOCTORS?
Sorry for the rant, everytime I see something like this mentioned I can't help but bring up this "abortion" of care that he received.
You don't go to Nursing school to "LEAD" OR to gain "POWER" attitudes like this is why our profession is suffering (shortage). "RESPECT" is earned not awarded at the end of graduation.
This was in response to Shenanigans post on the first page. Forgot to hit the quote button.
you don't go to nursing school to "lead" or to gain "power" attitudes like this is why our profession is suffering (shortage). "respect" is earned not awarded at the end of graduation.
unless you are being funny....we agree to disagree.
otherwise, i see your attitude as the reason nurses aren't seen as professionals, but as the maid-or nursing is just a job. i am not satified to accept the way things are, they can always be better.
just because things were always done that way, doesn't mean it should be the status quo! tasks will always need to be performed, but who is with the patient 24/7? nurses. who makes the difference in their care? nurses. who assesses, evaluates and updates interventions? nurses. who is responsible for the physician receiving all of this information and more? nurses. and so on.......
we are suffering from a shortage because thinking people see there is a problem in the healthcare system that needs to be addressed. until that is done, the shortage will continue! continous short staffing, danger to our patients and our licenses, danger to our person(injury and threat), and whatever else a nurse encounters that threatens them and their patient during a shift...that's the problem.
nurses should lead. we need to be at the forefront, with ideas, evidence based practice, and as patient advocates....otherwise, what's the point?
this isn't a union speech, but a get involved with outcomes speech.
it's up to all of us to make sure the system improves and the desired outcomes are reachable.
it's okay to just do your job, but understand that your job impacts peoples lives in a way that no other does! you can be the difference between life and death.
i think all nurses are important, as are every professional that adds to a patient's quality of life while hospitalized and beyond.
maisy
ps how is respect earned by a nurse or any other healthcare professional, if their input is not valued? good decisions, common goals and outcomes, and providing good information and options to the team is what earns respect.
now i have to correct too! diva rn quoted on someone else's quote oops! anyway still feel all of this too!
Nurses who attempt to stand up for better nursing care and demand to be listened to are more likely to simply be pushed out or to eventually give up and quit. I can see why nurses would be reluctant to unionize or to strike, but individually, nurses have little power. Look how many nurses HAVE left bedside nursing already! This exodus of nurses has raised the wages in many places, but has NOT improved working conditions nor given nurses more influence in how their workplace is run.
Doctors bring business to the hospital. Hospitals, including smart Nurse Managers, bend over backwards to make doctors happy. They provide great parking spaces for them while nurses have to park far away and deal with the elements and allow a whole lot more time to park than doctors do. They have a separate dining room, a cloak room, and lots of other amenities, possibly gym and country club memberships for at least some doctors, tickets to symphonies, whatever. (Of course, the doctor must live up to expectations, bring in business, live conservatively, not rock the boat, and generally fit in with the status quo.) When was the last time a nurse had all of that and more? It's about money. Just try being as rude to doctors as some of them are to us and you'll learn rapidly who is boss and who's not. I know these things because I have a couple of nurse friends married to physicians and they keep me abreast of such matters.
The hospital I work for is a nonprofit, teaching facility with a strong nurses' union. Yes, the doctors may bring in money, but they are accountable for their behavior. We have the authority to write an incident report should a doctor treat us badly. I have never had to do such a thing, as I am fortunate to work with doctors who are very polite, even when I've made a mistake.
I've also noticed that the hospital is frequently implementing new polices and procedures for the physicians to follow and that we, as nurses, are expected to remind them of these.
I've read a number of comments about the legal responsibilities of the RN, but I think what's more important is the recognition that RNs have to prioritize. When I'm in a crunch I don't want to have to explain why I see something as having a higher priority at the time.
In "From Novice to Expert," Patricia Benner describes nurses acting on what appears to be instinct, even to the point of breaking the "rules" for reasons that may not even be apparent to the RN at the time, but after the fact, the RN can usually explain why she or he responded to a situation in a particular way. Sometimes the only answer is, "Because it seemed like the right thing to do at the time."
As I've written in other threads, I can remember times when I was trying to convince another nurse or a doctor that a patient was bleeding out and the only thing I could say at the time was, "LOOK AT HIM!" Only later could I explain, "he's pale, tachycardic, and restless, those are textbook signs of hemorrhagic shock" - at the time it seemed so apparent to me I couldn't understand why someone else would question my judgement. (I think well on my feet, I just don't speak well when the adrenalin is flowing)
In short, RNs are trained to use the nursing process: we continually assess, evaluate, and revise our plan of care.
I've found that the best way for things to go very wrong is for me to allow anyone else try to tell me what my priorities are. So, when I decide that something takes priority over anything else that might be going on at the time, there is a really good reason - and I'll be more than happy to explain it after the fact when the dust settles.
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.
:yeahthat:
I'm a PCA right now, headed to nursing school in the fall. I work *for* my patients and *with* my nurses. Much like docs writing orders for nurses to implement, nurses write care plans (well, maybe not write them out nursing-school style) and the nursing staff (aides, RNs and LPNs) implement those plans. So yeah, I'm being delegated to by nurses but I'm not doing it for the nurse, I'm doing it for the patient. Subtle difference? Yep. Most of the nurses I work with get it.
I have a BM!!! (that's a bachelor of music degree, much less useful than a real BM
What's the difference between someone with a music degree and a 12" pizza?
A 12" pizza can feed a family of 4.
FWIW, I dropped out of music school to spent ten months hitch hiking in Africa then, with a strong desire to return to Africa, I decided to become a nurse.
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jjjoy, LPN
2,801 Posts
Nurses also need backup from their managers as well. If nurses have little say in the disciplinary actions against personnel that work under their leadership then their leadership is essentially undermined. Of course, those who work on nurses' teams also need to have recourse if they have valid issues about a nurse.