my techs are STILL walking all over me! help!

If a tech refuses to do an appropriately delegated task, you could write an incident report. Much as I don't like extra paperwork, a few of those should get some attention. At my facility, an incident report is to be filed over any occurence outside the normal course of practice, but yours may have a different policy. In any case, you should document the refusal, if only in a nurse's note. Refusing to help you is pretty inexcuseable, in it's own right, but even more grave is that it deprives the patients assigned to you of appropriate care.

I consistently phrase my delegation to my aides in the form of a request: "Would you please...", "Do you have time to get ..." It seems more considerate, and while I might use the term "my aide," in a conversation like this, I truly am thinking of them as "the aide I'm working with," and they know it. But if that approach didn't work, a more direct order such as, "Get a set of vitals on..." might make it clear I was serious.

Finally, I think it's appropriate to go to your manager with your concerns as often as it's necessary, and if your manager won't back you up, it's time to find yourself someone else to work for.

One good hint my manager gave me is to provide the rationale for your request to the tech as much as time allows. "We need to get a 2nd set of vitals on room 255 BECAUSE he was just found tachycardic and it's really important we re-assess him" or whatever. That way, the tech knows you're not just being bossy or ordering around -- it's about the patient, not about either one of you.

If I do this, I usually get an, "oh, Ok -- I'll do it after i do this" and we can both feel like we're working together. I'm sure it makes them feel more respected, part of the care -- which they are. They are an integral part of it and should be included.

I also will let them know that Mrs. So and so isn't going to survive today if she doesnt' get her teeth brushed, and I try to joke about it. I sort of put it on the patient also so they know the request isn't always coming from me.

Thankfully most of our techs don't even have to be told to do much in the way of baths and cleaning up -- it's the being there when patients want to get to the bathroom .. ..they NEVER seem to be around for that.

Some also "forget" to do vitals, and nothing is worse for me to have to deal with than a missed set of 4 p.m. vitals on a tele patient.

I'm a CNA, and as a soon to be RN, I understand first hand how busy a aide can get...However, I do not use that as an excuse. My JOB is to get vitals on everyone 3x a shift, do the one touches, set up the surgeries, get patients stable and help them however I can.....

I can imagine that I may encounter some resistance to my new job catagory...but my job is clearly defined....it's about the patient, not me....

and also? If you haven't pooped in a day...you don't need 2 enemas.....just take a few prune juices

Make it clear that they have a CLEAR job to do...if they won't do it, then that is the definition of "insiborination"....sorry, can't spell....

i think people that have worked from the ground up have a good sense of leadership. transcend your perspective and assess their goals and find unique value (older=reliable, younger=inquisitive energy). i have worked with some awesome techs that other nurses call "worthless" or "lazy". and i have over heard the techs say the same about these nurses. i try to involve them, as previous posts mentioned, in my assessment of patient care as much a possible. sure your limited on time, but you save time in the long run when you have developed a productive relationship. everyone wants to get more out of work than just a paycheck, be treated with respect, and use as much of their talent and abilities as able. by potentiating and capitalizing on their abilities, everyon ends up better in the long run.

thx -ben

One good hint my manager gave me is to provide the rationale for your request to the tech as much as time allows. .

agree that this is important, I also usually say what I'm doing aswell. example "Could you please take Mrs A to the toilet, whilst I get painkillers for Mr B" To show them that I'm not doing it because I'm lazy but because I also have something important to do.

Here I am posting advice, and yet yesterday I had one of my toughest days yet, much of it due to a tech who just was unavailable to me at every worst moment.

I tried it all -- involving her, explaining things and rationales -- she just didn't even want to pay attention was the main problem. She was there about half the time. We'd never worked together before, and I think I had her at some moments, but maybe she was getting used to me or something.

She also would make faces about certain patients if we needed to clean them up or whatever -- it was very annoying. I'm sorry -- it's not my fault Mrs. so and so just messed in her bed again for the third time. I've GOT to do my paperwork now that I'm 4 hours behind on because you failed to help me today, so would you PLEASE get in and try to get her cleaned up? I WILL help you if I can get my job done, but I can't get mine done if you don't do your part.

She also missed a set of vitals which really, really makes me mad. That is HER job -- I get the first set -- criminy -- why is it so hard to remember -- isn't that their job ?

I'm going in tomorrow and I will specifically remind my tech -- #1 is to get all the vitals you are assigned to get. I cannot miss sets of vitals, because by the time I figure out you've missed them, the time has passed to get them.

On our floor it's really crucial, with blood pressures all over the place, temps, telemetry/heart rates, etc. Just makes me nuts.

I think one strategy I'm going to use is to try to set time frames if I can. I don't know -- I'm just tired of folks who won't do their jobs or sit around while I haven't stopped moving in 12 hours. PLEASE, if you're going to just sit . .ask me if there's anything I need help with. Better yet, take the initiative and just do it.

LOL -- famous last words!

sound of music, i feel so bad for you. that must be really frustrating to be spread so thin. i think it is good that you expect a level of professionalism (faces...ability to perform basic job description (vitals).

sound of music what follows may not be for you, your looking to help her get up to speed... if i had just come in to the discussion, it would make me really annoyed to read so if *the reader* doesn't want dr.phil all over in *the reader's* personal situations, please don't hate...i got a lot of love to give. i believe that we all have an ability to see 'better' with perspective and that we are not always able to step back for that.

ok serious time: i think parents or maybe people who have been the "boss" of a business can really do the whipping best (when it is needed...aka sound of music's situation ). that's because they know you can't throw people to the side like trash (not talking about you sound of music)...you have to love your kids or worker bees because it will 1) cost too much to adopt or 2) they might never have someone take the time to teach them what they need to know. yes you’re not their parents, yes they may hate you for it if their not in the right attitude (receptive), yes this will probably not work.

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in a previous post, i mentioned the other side to maintaining authority in professional relationships...empathy and the personal experience as the low man on the pole. reaching people where they are at to find what motivates them, selling the job to them, and setting them up for success.

fact of the matter is, some people are too immature for the responsibilities they have been given. for some people, you can work with them to get them there; ie. do they care that they are compromising the lives of others (patient, your career, etc). assess that first right?...what do you have if not that! do not pass go...do not collect $200...send directly to incident report.

ok...the boss needs to crack the whip. like teachers give tests...parents lovingly provide direction (not tests :) ). we provide feedback to guide and empower others for positive change. there is always risk that it could burn us...trust them and they have a kegger while you’re on vacation or the aid slacks while we're tied up in an isolation room. we have hope that that change is possible and realize/prepare ourselves for the risk mentioned.

to sum it up...sorry! is a parent that is too stressed out at work to play an active role in their child's life really being a parent...spouse? we all gotta do what we gotta do... but sometimes we just think that and fail to realize the best for our lives. a nurse is s t r e c h e d, but we are kind of the boss/educator: we are the last link for patient safety...we are possible potentiators of positive change.

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assess your patients...assess your crew. some help may be older than you, but age does not always confer wisdom.:yeah:i applaud those that think that would be easy/quick fix...in a cheesy- chester the cheetah smiley face kind of way. ...good luck sound of music, et al, i hope things get better.

.......I WILL help you if I can get my job done, but I can't get mine done if you don't do your part.

She also missed a set of vitals which really, really makes me mad. That is HER job -- I get the first set -- criminy -- why is it so hard to remember -- isn't that their job ?

.....

I think one strategy I'm going to use is to try to set time frames if I can. I don't know -- I'm just tired of folks who won't do their jobs or sit around while I haven't stopped moving in 12 hours. PLEASE, if you're going to just sit . .ask me if there's anything I need help with. Better yet, take the initiative and just do it.

LOL -- famous last words!

As a student nurse, I had experienced a lot from techs - from positive, like showing me the ropes, eg, how to deal with quirky equipment - to negative, like showing how to do a disappearing act in 10,000 ways and still get away with it.

Coming from a different discipline, my first impulse was to look closely at what incentives there were for techs to deliver, and deliver well. Hardly anything, I guess, aside from a smile and a thank you from the RN. How adequate this is for the tech is anybody's guess.

At one hosp where I rotated, techs get a chance to get into an on-site RN training program. I believe this is the way to go to provide them visions of a better future in their job. Besides, hosp management has to design a way to screen the techs who deserve further training, and so somehow monitor the performance of techs; thus the burden of managing techs no longer rests that heavily on the rns, overloaded as they are.

But how many hospitals have this kind of program? 1 in 10 as my experience suggests.

At the end of the day, it looks like it is up to us to find the good side of every tech we work with and how to do this and maintain quality of care AT ALL TIMES remains a challenge. It would be real nice if the folks who do the hiring and the firing of techs take the time and effort to make sure the techs deliver their end of the employment deal.

Besides, hosp management has to design a way to screen the techs who deserve further training, and so somehow monitor the performance of techs; thus the burden of managing techs no longer rests that heavily on the rns, overloaded as they are.

These are words to think about. I feel very strongly that I am way too new to try to "manage" these people. Many of them just seem to come and go, don't like being there, don't like working hard -- I didn't hire them and would NEVER recommend keeping many of them. Why is it I have to deal with them for the 12 hrs and why does management not "huddle" them

together and give them the pep talks they need? If I dare blame something on one of them, it's always reflected back to ME -- like I need to find a better way to deal with them. Sometimes there IS no way to deal with a person who is unhappy and unmotivated in any job they do.

I had a fellow nursing student get some 'lip' about asking for help to move a pt when the student was pregnant.

I'm sorry...if you don't want to help, if you aren't caring enough, get out of healthcare!!!

I couldn't imagine not helping, especially when certain tasks are in my job description!!

The reason why they are flat out telling you "No" to your face is because they don't respect you. Also, they know that they can get away with it too. It also depends on the way you ask to them. People will treat you as horrible as you allow them to treat you. You have to write them up and speak up in an assertive voice. Because you are so young, they probably see you as a kid not an adult nurse.

Thankfully I have had the luck to work with some really GREAT aides, who are an important extension of myself. They are my eyes, ears, & nose when I don't always have the time myself... I always try to explain my rationale... I never run from cleaning up one of my patients either, and that is a big deal when working with staff in general... It doesn't even need to be my patient, if you need help & I'm available I'm there. Of, course turnabout is fair play. If I cannot rush to help right that moment I explain myself... I need to reassess so & so, or so & so needs meds right now, etc... If I will be busy for an extended amount of time I tell them so... if it'll be quick I'll say get such & such supplies & I'll meet you in 5 minutes... I work 3rd shift, so we tend to be tighter knit anyhow, but everyone has a really bad night now & again & if you consistently work as a team it pays off big when you need it... Not to be funny, but it may be a matter of how you approach the techs... or how you appear to the techs... maybe they see you as someone who is not a team player.... I'm only speculating as I'm not in your shoes here... try to make a greater effort to become more proficient at time management, which may in turn allow you more time to be available to assist the techs at times...I've always found that if you shock them a little by being genuinely willing to help, they tend to see you in a whole different light & may actually attempt to work with you, instead of against you. Just try to remember the work of a tech is never beneath you... it's all part of an assessment.... what better way to assess than be right there in the trenches wiping someone's behind...or assisting a pt to the bathroom you can assess their LOC & gait & oh so many other things.

Like I said I don't know your whole story, but a more hands on proactive approach may benefit you, whenever you are able, it may peak your tech's interest & you may find you have just gained an irreplaceable priceless coworker. Good luck to you!!