The grumpy aide ... And how to stop us vs. them

[ixchel]

I'm not sure how to go about writing this without coming across as us vs. them, but it's been on my chest for ages and I would really like to make some sense of this, while maybe also sharing some thoughts with others who may feel the way this aide does.

Aide co-worker ("A") is fantastic at her job. She's normally in the ICU, which is total nurse care but staffs an aide each shift to assist. Whenever she is pulled to my floor, she is grumpy. She does a great job, but she complains constantly. Among A's pet peeves - aides get 9-11 patients while nurses only get 4-5. (This is an ICU step down unit, I should mention.) Also, nurses are offered a bonus to sign a contract to be scheduled an extra day to cover shortages. It bothers her that aides don't get offered the same contract because A doesn't want to get pulled. Perhaps if aides had the same contract possible, there would be less shifts when someone is pulled. I should mention, though, all last minute staffing needs get bonus pay, including aides.

So basically, every shift with A on my floor feels like us vs. them. It's frustrating. My first shift with her, A was having a meltdown about her patient ratio vs. the nurses'. I tried to talk to her about it. I tried to walk through all the nurse does in a shift, what we're responsible for. She wanted nothing to do with it. I tried to remain understanding, because until I went to nursing school and then orientation, I really didn't understand how much we do in a shift either. But as polite as I tried to be, as much as I tried to emphasize our job without putting down hers, the more disrespectful and frustrated she got. The conversation turned to how much time we "just" spend at the computers, how she feels we expect the aides to do stuff that we just ignore. I reiterated the fact that if things are not documented, they didn't happen, and that takes a long time to get through in addition to making sure we are up to date on orders and notes. She then goes into, "we have to document a lot, too!" And how do you tell someone that there are times we HAVE to ignore things (aka "delegate") if we are to get through what we are responsible for and CAN'T delegate?

I stopped at that point. Really, what more can be said? How do I emphasize the volume of our workload without making her feel I am minimizing hers? Our aides really work their butts off, and in no way do I ever want to display a lack of respect for that. And as for the contracts with the bonuses.... Maybe it wasn't offered to the aids because we haven't had an ongoing shortage of aides? Or, maybe it's because administration seems to not mind dumping the extra load on us nurses if we are short on aides. We can do their jobs if they don't show. It can't happen the other way around. Maybe that's still not fair to them. I don't know. But to have someone so hot-headed over this notion that we are simply lazy at her expense bothers me. It shouldn't, but it does.

How do you break through this mentality? Or is it even worth it? In stark contrast, I was pulled to ICU a couple of weeks ago, and one of her fellow aides over there was orienting a new hire. Part of her orientation? "I've seen nurses here past 8:30 just charting. We can help make that not happen. I always do my best to lighten the load on them because at the end of a shift, we all just want to go home." I could have kissed her squarely on the mouth! It's true, though! If we all help each other, we all get out on time. That 5:00-6:30 window will either make or break your path to the elevator!

Any of you have any thoughts on this? How is the relationship between nurses and aides at your facility? Are there any team building activities, or educational activities that your facility has tried that help build a better, more understanding relationship?

My gut feeling on this is if they knew exactly all we do, maybe they'd understand and be less frustrated by our perceived laziness. But how can that be approached without seeming condescending?

[jadelpn, LPN, EMT-B]

Coming from someone who was once an aide--they are worth their weight in gold. However, should anyone start harping on things that are out of your control, "I am hearing what you are saying. However, there's patients to take care of. We all have jobs to do, so let's begin, shall we?" End of story.

You should not have to justify/attempt to explain/make excuses......it does nothing but delay patient care. And I would say that "I think you need to rectify that in whichever way you see fit to, however, now is not the time. There are patients that need to be cared for."

And the "spending too much time on the computer" stuff...."well that you have time to observe so intently, I am not sure that the "too many patients" complaint is going to fly......" (

Just a general "I need to concentrate, medicate a patient, do my job" and disengage. I repeat-- disengage.

Even in a step down ICU, ain't nobody got time for a peeing contest.....

[BrandonLPN, LPN]

It sounds like she's just being willfully ignorant. I'm not sure there is anything you could say to make her understand. She doesn't want to understand. There's a very strong attitude amongst some aides that nurses simply sit at the computer and pass meds, while they (the aides) do all the real work. They're convinced that all that separates us is a "piece of paper", aka license, and nurses are overpaid and aides are underpaid, etc. etc.

And I say all this as a LPN who used to be a NA on a med surg floor.

You could try pointing out which are the staff members who always seem to get their 15 breaks in, and which staff members get to just go home on time more often. (Hint: it's not the nurses). But this probably will only make her imply nurses are too slow, or something.

Really, trying to explain these things will probably be counter-productive. When she says it's unfair that she has 15 patients, while you only have 5, you're best bet would be to just grunt non-committally, and make some general statement about how you wish the hospital would hire more NAs or something. It will save you a lot of grief.

Grunting non-committally and making vague statements in response to stupidity has kept off many a stupid person's S-List.

[macawake, MSN]

A was having a meltdown about her patient ratio vs. the nurses'. I tried to talk to her about it. I tried to walk through all the nurse does in a shift, what we're responsible for. She wanted nothing to do with it. I tried to remain understanding, because until I went to nursing school and then orientation, I really didn't understand how much we do in a shift either. But as polite as I tried to be, as much as I tried to emphasize our job without putting down hers, the more disrespectful and frustrated she got. The conversation turned to how much time we "just" spend at the computers, how she feels we expect the aides to do stuff that we just ignore. I reiterated the fact that if things are not documented, they didn't happen, and that takes a long time to get through in addition to making sure we are up to date on orders and notes. But to have someone so hot-headed over this notion that we are simply lazy at her expense bothers me. It shouldn't, but it does.

How do you break through this mentality? Or is it even worth it?

Any of you have any thoughts on this? How is the relationship between nurses and aides at your facility?

My gut feeling on this is if they knew exactly all we do, maybe they'd understand and be less frustrated by our perceived laziness. But how can that be approached without seeming condescending?

I've worked with some wonderful CNA's and some really annoying ones.

There's one CNA in particular that I'll always remember. When I was a brand new nurse I worked on a med-surg/intermediary/step-down floor. It was extremely stressful with high acuity. It was sheer Hades for a newbie. A CNA veteran of more than thirty years saved my behind (and my patients) more than once. She was one of the most hard-working, efficient and good-natured people I've ever met and her excellent critical thinking skills and vast experience were invaluable to me. She gave me many helpful hints and suggestions and I was smart enough to listen to her. She always anticipated what I might need her to help with even before I realized I needed it.

She would have made an excellent nurse or an excellent physician or an excellent pretty much anything, had she decided to pursue another career, but she loved being a CNA.

At on time when we talked about this she explained; "I get to care for patients and help them heal or keep them comfortable when we can't and I only have to answer to one person, the nurse that I'm assigned to on a given shift. Nurses on the other hand have to juggle a million tasks and coordinate with numerous physicians, patient's family members, pharmacists, laboratory staff, physiotherapists, dietary, housekeeping, social workers, home healthcare staff, transport etc. etc. etc. Add to that you have to be on top of medications, side effects, orders, swiftly recognize change in status, patient education, nursing care plans, ethical dilemmas and documentation, documentation, documentation.... I wouldn't want your job even if they tripled my pay"

I adored and respected this woman both for being such an asset/support for me personally but more importantly for being such a such a professional and contributing so much to her patient's well-being.

Then there's the other kind... The ones who think that nurses have it easy and all we ever do is distribute a few pills and sit on our derrières. They have no idea how much work is actually going on inside a nurses' head. Honestly, I don't think that this type is all that interested in finding out either. I admit that this is a slightly misanthropical way to view other people, but some folks really seem to enjoy kvetching rather than actually trying to understand another person's situation.

I've appreciated the majority of the CNA's I've worked with and consider them a vital asset in the healthcare team and I've told them so. The ones who only complain, I've never had the desire to try to "bring around". I've always felt that it would be a futile effort and I've chosen not to spend any energy on it. Hopefully other posters have some helpful advice for you OP :)

[Pangea Reunited, ASN, RN]

Tell her you agree. Then encourage her to go to nursing school so she can get fewer patients, too.

[RNsRWe, ASN, RN]

If this CNA is accustomed to working on an ICU in which nurses do all cares for their patients, with one CNA shared by the floor to assist, that would mean to me that each nurse would have typically 1-2 patients (maybe 3, rough shift) and the aide would need to be available for ALL the patients on that unit.

So....how is that so very different from your unit, where each nurse has 4-5 patients, and the aide has to assist with twice that many? Doesn't it seem....the same, more or less? What am I missing that is so much better for her on ICU than your unit? It looks like she's busy on both units, going into many rooms all shift, regardless of which floor she's on.

[SmilingBluEyes]

STOP RIGHT NOW, justifying yourself and your workload. I like the post above mine, saying essentially:

"we both have a lot to do, let's just do our best to get it done. I will help you if you need me, time allowing. Now, let's have a GOOD DAY".

End right there and when she starts whining, smile and walk away.

Simply turn your back, and walk away, every time she starts, and ignore her. Stop justifying yourself; that only feeds her fire. Pure and simply, she doesn't give a damn how hard your job is, and no way will she understand. That's ok. She doesn't need to. She DOES need, however, to know you are not listening to her complaints unless they are constructive......period.....