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.
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.
Being a subordinate doesn't mean that you have to do WHATEVER your superior (for lack of a better word) tell you to do. What it does mean is that if there's a judgement call to make, it's the superior's call and not the subordinate's. If it's clearly a bad judgement, though, you have the right and responsibility to question that order and follow the chain of command if need be.
"Do it because I said so and I'm the boss" are words of misused authority. That is more appropriate in a parent/child relationship with young child. If you are behaving maturely and someone pulls this line on you, THEY are acting inappropriately. If, on the other hand, you are refusing to do what your superior tells you to do simply because you disagree or don't like it (versus it being unsafe or unreasonable), then you are being inappropriate, because it's your job to do what's delegated to you.
It CAN be tricky in regard to job roles in nursing. Is the CNA responsible for vitals, baths of patients A, B and C? Or are they responsible to Nurse X who then delegates vitals, baths, etc of patients A, B and C? When this relationship isn't clear, problems occur. And problems DO occur.
It CAN be tricky in regard to job roles in nursing. Is the CNA responsible for vitals, baths of patients A, B and C? Or are they responsible to Nurse X who then delegates vitals, baths, etc of patients A, B and C? When this relationship isn't clear, problems occur. And problems DO occur.
At my facility the day shift PCAs (med-surge unit) are to do all vitals, baths, assisting to the toilet, ambulate post ops, accuchecks, turns and repositions, assist the transport staff, pass meal trays, answer call lights, etc. The nurses don't have to delegate any of those tasks, it's in my job description so it is crystal clear as to what is expected. I can see where the waters can get muddy if roles are not clearly defined and communicated.
I will gladly help anyone out and, like anyone, I appreciate being treated with kindness and respect. Even if someone is not so nice I still help out because I'm doing it for the patient. It's truly not an issue on my unit, I've yet to see anyone with a "superior attitude" even when they are in a position of authority.
The water is murky, though, because in most environments, it's ultimately the nurse's responsibility that the NA's tasks get done. That is, the nurse can't just say "well, that was the NA's responsibility" and leave it undone. So if the nurse is too busy to complete the NA's work, he/she is held responsible for it not being done and yet doesn't really have the authority to discipline the NA or to choose to not work with them in the future. Some NAs (not you, I'm sure!) will get annoyed if a nurse DOESN'T help them with their tasks (understandable if the nurse truly isn't busy.)
I'm sure that's not a problem with you. I'll bet you're a great NA who can be depended on and who works as part of the team without getting into turf battles over who is responsible for what. But there are many different personalities out there that we have to deal with and clear job roles can help keep relations smooth. And when both NAs and nurses are responsible for more than they can humanly get done, the overlap in responsibilies seems to lead to finger-pointing at times (encouraged by management, sometimes, it seems - so as not to admit they need to hire more staff).
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.
Regardless of semantics, teamwork is key!
I hear you saying that the nurse is not in charge. I hear you saying that the nurse has no authority to tell you that priorities have changed or that the plan has changed and you are needed to stop doing A and now do B. It sounds like you are saying that you are your own boss and no one is really LEADING your team.
Here's a simple analogy.. Beauty shop. Licensed cosmetologist can do it all - shampoo, cuts, sets, etc. Shampoo person cannot do cuts, sets, etc. Shampooer is important, of course, saves cosmetologist from having to do her own shampoos, stock towels, keep the bowl clean, etc. Who will be liable if something goes wrong with the client?
Think down the road to when you will be the nurse in charge. How do you think you will feel if you are the RN in charge and the aide tells you "no" when you tell her such and such is needed now, even though it disrupts her plan?
Let me tell you, you will not like having to explain, beg, plead, thank her 1000 times, or deal with her reluctant or even ugly attitude. No, I am not saying you should have no concern for her feelings, plans, needs, or frustration. I am not saying to be rude. But the aide who does not consider you her boss is going to be a thorn in your side. The aide who sees you as the leader and who respects and trusts you will be a blessing to you.
I'm telling you, someone has to be in charge, be the boss, lead the team, have the authority to actually lead. I think it is a huge mistake for aides to think they have their own practice, independent of the charge nurse, which is, it seems, what today's aides are taught. Again, I am not disparaging any level of personnel, nor glorifying any other. I'm simply saying that someone does have to be the ultimate leader, boss, the buck stops here person. And that person is the licensed nurse.
It's like parents and kids. Who is in charge? Who should be in charge? I know this changes as they get older. But I think our society is in a mess because parents do not lovingly guide and discipline their children as parents used to, generally. Whether from fear, ignorance, weariness, parent's absence, illness or worries, our society is really having problems because the family structure has been so weakened.
Good luck in school. Reminds me - we used to have what was called "Leadership" as our very last clinical rotation. We learned to make the assignment and perform other Charge functions. A big part of that was learning to feel and be competent as the nurse in charge and dealing with subordinates (yes, those who were not licensed, who were legally subordinate to the RN, not inferior as human beings).
We were taught how to be courteous yet authoritative, how to lead strongly without being ugly to people, how to assist physicians (it was a long time ago :nuke: and we would get their charts ready, making sure to have a fresh order sheet and progress not available, we'd have suture removal kits and dressing materials ready, have labs, consult reports, and x rays ready, round with them, stuff like that - now they have to fend for themselves, except that the wise nurse rounds with doctors as often as possible to chaperone, build relationships, and to know what's going on with q patient - hard to do if there is more than one doctor rounding but we should try for our own and the patients' benefit and because it really does help the doctor, which helps the patient. If you're with the doctor, you can also get an interpretation of any hieroglyphics he has written - maddening to have to do but timesaving).
Maybe schools don't teach this any more? Maybe I'm a relic, best put out to pasture - I really wouldn't mind. Just can't afford it. :nuke:
BTW - we'd even get coffee for our favorite doctors or, really, for any who asked. Call us sexist, call us dinosaurs, that's just how it was way back when.
I hear you saying that the nurse is not in charge. I hear you saying that the nurse has no authority to tell you that priorities have changed or that the plan has changed and you are needed to stop doing A and now do B. It sounds like you are saying that you are your own boss and no one is really LEADING your team.
No, not saying that at all. The thread title is "subordinates", all I was addressing is my view of who I am working for (the patient). Believe me, whenever anyone asks me for help, whatever they need, I jump right in even if it's not a patient assigned to me. Today a nurse at the far end of our unit asked me for help getting a pt out of bed. I said sure and went with her to help. The nurse decided, after we got in there, that it wasn't a good idea to get her up right then and decided an air mattress would be prudent so I ran and got the pump and set it all up. The nurse is making all the decisions and I'm carrying out her plans for the patient but I still view the relationship is one of me working for the patient, not the nurse.
Maybe that muddied the waters even more, hope it cleared them up though!
The thread title is "subordinates", all I was addressing is my view of who I am working for (the patient)...
Maybe that muddied the waters even more, hope it cleared them up though!
I worked as a nursing assistant for several years before I went and while I was going to nursing school. I don't think there was ever any question in my mind that I was under the authority of the nurse - that, as I understand it, is the meaning of the word 'subordianate,' semantics and social connoatations aside.
In the past, I have worked with some excellent nurse managers and nursing administrators (not many), and I have worked with several weak managers and administrators - as I am now. Like it or not, I am subordinate to the director of nursing where I work now. I have to do what she tells me to do and go where she tells me I am supposed to do - if I want to keep my job, that is. I expect to be treated with the respect I have earned and will not be treated otherwise. When I have to float to a unit where I know more than likely I will have a really bad day, I don't complain, I don't argue, and, unlike some of my colleagues have done recently, I would not refuse.
I have a BSN, so there is nothing stopping me from taking a job as a charge nurse, nursing supervisor, or nurse manager, but I don't want that job. I've seen what they have to do, and I don't want to have to do it. I want to put in my 12 1/2 hours, walk out the door and not think about it until I have to come in to work again. That's my job. If I wanted to do something else, I know what I would have to do - and in fact, I am doing so.
Specializes in LTC,Hospice/palliative care,acute care.
:yeahthat:
I work *for* my patients and *with* my nurses. QUOTE]
Your comment is spot on in my opinion. And every good team has a good leader -one who encourages that kind of attitude.
One of my pet peeves is nurses calling aides "my girls" I find that demeaning-but the term "subordinant" does not bother me. I say "our crew" First-they are not "girls"-most are women and are my contemporaries and they aren't "mine" Just my thing,what can I say?
I work *for* my patients and *with* my nurses. QUOTE]
Your comment is spot on in my opinion. And every good team has a good leader -one who encourages that kind of attitude.
One of my pet peeves is nurses calling aides "my girls" I find that demeaning-but the term "subordinant" does not bother me. I say "our crew" First-they are not "girls"-most are women and are my contemporaries and they aren't "mine" Just my thing,what can I say?
And I thought I was the only one!! My pet peeve is a supervisor, or RN, or just plain boss referring to as"my LPN" or the aide as "my HHA". Excuse me, I don't belong to you and I'm not your personal possession!! I don't think it's being "PC", it's just obnoxious!
And I thought I was the only one!! My pet peeve is a supervisor, or RN, or just plain boss referring to as"my LPN" or the aide as "my HHA". Excuse me, I don't belong to you and I'm not your personal possession!! I don't think it's being "PC", it's just obnoxious!
mc3
It certainly CAN be obnoxious, especially if said in a demeaning manner or by someone you don't like to be associated with and wouldn't work with if you had any choice about it. WHO says it and HOW they say it is what can make it offensive.
Saying "Pat is my aide today" or "Let me ask my aide" does not, by itself, necessarily imply possessiveness. If I talk about "my colleagues" you don't assume that I'm inferring possessiveness over them, do you? And if you *like* working the person who says that inadvertently, you probably won't take offense to it (if you even notice it) and might tell your fellow aides without thinking about it that "I like my nurse today!"
Saying "Pat is my aide today" or "Let me ask my aide" does not, by itself, necessarily imply possessiveness.
I doubt that addressing someone as "my partner" would be considered offensive by most people, but 'partner' implies equality.
More often than not, I suspect that it comes down to economy of wording - it's easier to say "my aid" that to say "the aid working with me today." I seriously doubt it's meant as a slight
Just can't afford it. 
:nuke:
jjjoy, LPN
2,801 Posts
Being a subordinate doesn't mean that you have to do WHATEVER your superior (for lack of a better word) tell you to do. What it does mean is that if there's a judgement call to make, it's the superior's call and not the subordinate's. If it's clearly a bad judgement, though, you have the right and responsibility to question that order and follow the chain of command if need be.
"Do it because I said so and I'm the boss" are words of misused authority. That is more appropriate in a parent/child relationship with young child. If you are behaving maturely and someone pulls this line on you, THEY are acting inappropriately. If, on the other hand, you are refusing to do what your superior tells you to do simply because you disagree or don't like it (versus it being unsafe or unreasonable), then you are being inappropriate, because it's your job to do what's delegated to you.
It CAN be tricky in regard to job roles in nursing. Is the CNA responsible for vitals, baths of patients A, B and C? Or are they responsible to Nurse X who then delegates vitals, baths, etc of patients A, B and C? When this relationship isn't clear, problems occur. And problems DO occur.