Unsupportive 'team' members

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Im a new staff nurse, been in post for 5 weeks on a very busy hectic orthopedic surgical ward with mainly post op patients and i have 14 patients under my care. I have been working the morning shift 7-3pm with two supports (CNA/CSW) for the past three days. I have run into problems with one of these CSW's, i shall call her CSW J.

1.on day one i was discussing a problem with the unit secretary regarding a discharge that i had done the previous day as pieces of paper were missing and she was unable to file his notes due to this missing so i was trying to sort this issue out when a patient rang his bell, i continued to deal with the problem regarding the patients discharge as the unit sec was due to go home in a few minutes for the weekend and it needed sorting. CSW J decided to bellow up the hall from where she was sat at a desk playing on her phone for me to answer the call bell ' Staff nurse there is a bell going behind you ya know!' in a really nasty tone. i explained that i was busy trying to sort a discharge out, that i didnt appreciate being interrupted and could she please get the bell as she was not busy. She huffed and puffed and muttered under her breath about lazy nurses.

2. day two, i asked the two CSW's to pair up and sit the patients up whilst i started the medication round, i get half way round to discover that the patients are not sat up so unable to take their tablets or ready for breakfast. I had to hunt for the CSW's to ask them to help me sit the patients up. i found them in the kitchen doing nothing.

3.whilst i finished the medication round i asked the CSW's to pair up to do the double washes and i highlighted which patients were singles,doubles and who was independent.i then had the dr's round to do and prep three patients for theatre and escort two of them down to theatre as well as wounds to dress,etc. I come back from theatre after the 2nd patient to find a dr wanting to talk to me about a patient and whilst i was discussing the issue with him CSW J started moaning about how i havent had done any washes and that im lazy and not doing anything. She then went on to say that as i was sitting there doing 'nothing' (i was charting and on the phone to a dr) then i could do the care plans-its a rule here that if you do the wash then you do the care plan (as you saw the pressure areas/skin condition)

4. I had a patient on hourly urine measurements and after handover that morning i highlighted the key things to the CSW's which were the hourly obs/urine measurements and who they were on and i asked them if there was a problem to please let me know or if they were unable to do the hourly because they were busy to let me know so that i could do it. Well it got to midday and i was checking the patients drain site and i went to document the drainage when i noticed that the hourly had not been done since we started shift! the patient had passed next to no urine in this time.

Im sick of her attitude and having to check that she has done her job. She refuses to communicate with me and tell me how the patient is doing ie did the patient assist with their wash, refuses to listen to anything i say,for instance this one gentleman is self caring-he just needs a bowl given to him and he washes himself-but she went in there and washed him.

What can i do? How do i go about solving this problem? i cant do everything myself, i was the only nurse down this end of the ward and i had a whole list of things that had to be done and because im new to nursing i often have to find another nurse to raise a query or to clarify a question (as well as having to hang my fluids for me)

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Write them up, objectively, each and every time.

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Specializes in ICU.

Before you start writing up you may consider discussing this with management first. Good luck, it is hard to work with someone who won't do their job, esp. when it effects your ability to do your job.

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Specializes in Surgery, Tele, OB, Peds,ED-True Float RN.

I sympathize with you! Had the same problems when i first started on our surgery unit. Also, I can't believe that you have 14 pts to 1 RN... that's nuts! I had a pt go septic and the doc comes up to me and says that the pt's is to be in the OR in the next hour. I go to work getting the pt ready and by the time I get him dropped off to the OR the aid comes up to me with her coffee cup in her hand on the way to break and says, "I left room 103's care for you... since you did nothing all morning!" She gives me a look and takes off to her break. Luckily there were several incidents around that time and they were "spoken to" by management. That didn't really stop the abuse 'cause a week later while i was in the supply room getting dressing supplies, I was cornered by a few of the aids saying that they wanted to know who reported them and that they had a right to know. I wasn't me, but now I wish it was! At that same time the only other RN on the floor was calling out to me 'cause her pt was about to code. Of course when she found out about THAT incident, she reported them AGAIN! Can you speak to your manager?

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Specializes in cardiac, oncology.

I would try asking them what you and she need to do to get along. You are her superior and she is probably testing you. If that doesn't work, go to your manager. 14 patients and two techs and she expects you to help with baths? And wow you have 14 patients? Wow.

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We are a very short staffed unit (we are supposed to have fewer patients on the ward than other wards due to an ongoing staffing issue but if a+e get busy then they shift them to us) :( There is a float nurse but she is down the other end as they are even busier due to having the full care patients,etc.

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Specializes in Rehab, LTC.

Yes they are definitely testing you. I would sit each one down seperately and professionally discuss the issues you are having. Have your examples with you so you know what you want to speak about. Let them know there are 2 of them and you are always willing to help them do their job, but a CNA/CWJ cannot help you do your job and there are things you must complete in your shift. Let them know that speaking with a doc, doing a discharge, ect takes presidence over helping them sit patients up, helping with a bath ect. ESPECIALLY since there are 2 of them and only 1 of you.

Be sure that you remain in control of the coversation, but always stay in a calm voice and allow your team member to voice their opinion. Nothing is worst then losing control, starting to yell, getting emotional, ect. You will lose even more respect.

If you feel you need to, let your unit manager know that you have had this conversation to the CNA and CWJ and how it went, the outcome, ect. If things do not get better after that (even though I think they will) then go to your unit manager and speak to them about writing them up, ect.

If you go directly to writing them up before speaking with them, you will not gain their respect and they will only resent you and things will get worse. There are a whole lot more CNA jobs out there than RN jobs, and they know they can always get another job.

Good luck, and I hope things get better for you, hang in there!

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Specializes in ER/ICU/STICU.

I would also talk to the manager and find out what kind of authority your position has, if any. Can you only write them up? Or can you send them home if they aren't doing their job or for insubordination? If you are the only nurse there and have the ability to send them home, their attitude might change when it starts effecting their pay. It may leave you short handed, but it doesn't sound like this aid is doing all that much anyway.

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Specializes in Rehab, LTC.
I would also talk to the manager and find out what kind of authority your position has, if any. Can you only write them up? Or can you send them home if they aren't doing their job or for insubordination? If you are the only nurse there and have the ability to send them home, their attitude might change when it starts effecting their pay. It may leave you short handed, but it doesn't sound like this aid is doing all that much anyway.

I really don't think sending them home is going to solve the OP's problem. What happens the next they work together? You think all of a sudden the CNA is going to start working because she got sent home? Wrong. The CNA/CWJ is going to make the new grads life even harder!

Be professional, and have the guts to speak the CNA and discuss the problems. Sending him/her home is only adding fuel to the fire.

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Specializes in LTC.

You have 14 patients? Ouch!

And what is CSW?

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You have 14 patients? Ouch!

And what is CSW?

care support worker, its our version of CNA/nurses aides

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i would have kept personal notes...

then after 3, i would have written her up, reporting the 3 incidents of insubordination.

and, would have had a verbal 1:1, reminding her that she has a job to do, and further incidents of insubordination will be dealt with.

begin that paper trail, it's your only weapon for now.

leslie

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