What more can I do as a nurse?

[Mis228]

I've been at my job now for 4 months and it's my first nursing job. I feel like I was "thrown to the wolves", so to speak, as I'm sure many, many new nurses feel. I work in a group home for medically needy individuals who have developmental and intellectual disabilities. 15 to be specific with 1 nurse per shift. We have 6 clients with G-tubes/ Mic-Key buttons so as you can imagine I have my hands full between charting, assessments, treatments, med pass etc... I digress. Unfortunately my care staff are not CNA's but they do all the work of CNA's without the training. I came into my house as the old manager was leaving but no replacement in sight. Because of this my direct care staff have basically run wild. They come in late(sometimes hours),they leave any time they want, they steal from the house/clients and neglect the individuals. At first the staff seemed to like me "you're one of the only nurses who do client care... " and I feel like they've taken advantage of that. Sometimes I'll be running around and see a client saturated so I'll stop and ask one of the workers who's sitting down "so and so is completely soaked would you mind or could you change them real quick" they say okay but an hour later they haven't moved and the client is still soaked. I started out trying to explain why I need them to do these things, I dont want to seem like "the bossy nurse". This month we've gotten a new manager and I've taken it to her and she said "well there are no consequences"...... okay so make some? I've gone to my nurse manager who oversees numerous houses and told her I'm conserned as a nurse. At risk for skin breakdown, decub ulcers from not being repostioned and frankly it's neglect, she said the house manager oversees the direct care staff. I'm absolutely at a loss. The company was just cleared by APD on abuse charges. So short of calling them and reporting I really have no idea what to do. I've started to look for a new job but I'm still a new nurse with less than 6 months experience. Completely aside from that, I care about my clients. I'm worried if I leave who will come in and advocate for them? Or will it be a lazy nurse who doesn't care? Management seems too busy to be bothered and ignores the situation. I'm absolutely at a loss and I literally feel sick to my stomach going to work I absolutely dread my coworkers. What do I do?

[mtjoanna]

You may need to start developing a more authoritative role within the home. You have the training and knowledge that has earned some respect and your willingness to help is greatly appreciated. Now you need to step into the role as manager. Make your requests politely worded instructions and if the staff doesn't respond, start with disciplinary measures such as writing them up. There will probably be some push-back, back-talk and such, but you are not asking the aids to do something outside their scope of practice, but to simply do their jobs. That's what they were hired for and what they should be doing without you goading them. It's not always fun to be the "mean" nurse, but your first job is the care of your clients-not catering to staff who are unable to exert self control. Once they learn that you are in charge and will maintain certain standards, you will probably be able to settle into a comfortable working role with them. I learned, the hard way, during my first job as a nurse that there are some drawbacks to becoming friends with the aids--c/o favoritism and other such issues occurred. Any place you work, unless perhaps home health (home health nurses can correct me if I'm wrong), you will be expected to "manage" the aids in your area.

[Mommavik, ADN]

Report this immediately to your company compliance officer or to the state; this cannot be allowed to continue one more day! These people show no respect for you as a nurse or the company they work for and no regard for the people they are supposed to be caring for. You should not be responsible for the discipline of this unit unless you were hired as a charge nurse (which doesn't sound like that's the case ) and as a new nurse you aren't capable of it. Frankly, without the backing of your nurse manager and corporate; no one would be able to get this place back under control