I am a nursing assistant at a hospital. Yesterday was my first day off orientation. I was working on a Telemetry unit, and it was insanely busy (I had 11 rooms by myself). P.T. got one of my clients up to walk, and as they did, she urinated in the bed. Since she was already up, I decided to change the bed right then. As I was walking back to the room, linens in hand, a nurse stopped me to tell me that another pt. had been discharged and needed to be wheeled downstairs. I explained to her what I was doing, that I needed 2 minutes to change the bed, then I would wheel the pt. down. In the middle of the hallway, with nursing students whom I have to see at school everyday, Physical Therapist, and the patient who urinated watching, she screamed at me that I needed to learn to prioritize and that there are patients waiting to come onto the floor, and the discharge was more important than cleaning up urine. I stood there, mouth agape, and just walked away and did what she said. Another person who saw what happened changed the bed while I was wheeling the pt. out.
Was I wrong in this situation? I have only been a nursing assistant for 6 weeks, so maybe someone can explain to me why the discharge pt. would be more important?
Specializes in psych, addictions, hospice, education.
I have trouble with jumping past talking to the offender to report her to the manager. That could be one sure way to insure negativity in the future. I think the nurse should be talked to though, to set things straight. Getting the manager involved at this point might be overkill. As a former manager, sometimes in such situations, I really felt like saying, "please settle these things yourself."
I probably would have pulled the curtain to hide the dirty bed and then wheeled the other patient down.
Where I work, PT would have spent like 20 minutes with the patient, and I would have had time to come back up and remake the bed before they came back anyway.
Was I wrong in this situation? I have only been a nursing assistant for 6 weeks, so maybe someone can explain to me why the discharge pt. would be more important?
Thanks for any input!
The nurse in the situation explained why the discharged patient would be more important; because there are other patients waiting for a bed. Tele units can have high patient turnover rates. On my unit, the beds don't even have time to get cold before the next patient arrives. Another thing you're going to have to learn to prioritize is being ready to assist with admitting new patients, watching for their arrival, getting the slider board, helping transfer them, and whatever other responsibilities CNAs have with admits, like getting a water pitcher, toiletries, food (if the patient has a diet order), applying telemetry, and a first set of vitals.
That being said, she shouldn't have screamed at you. I'm sorry that happened.
You were in the middle of a task, so it makes sense to finish it before starting another low-priority task.
As others stated, what if the pt became dizzy during PT and needed to lie down? Or what if there was some urine on the floor and the pt slipped and fell? Taking 2 minutes to change the linens so the pt would be comfortable is no big deal. How does it look to leave someone with a urine-soaked bed and no place to sit down? A-B-C's come first; definately. But what about a pts comfort and avoiding undue embarassment? To me, that takes priority above a stable pt who is discharged and awaiting a wheelchair ride out the door.
The discharge pt was fine, and taking 2 minutes to change linens is acceptable. If you would be tied up for 10 minutes - now that's another story. The "yelling" nurse had a priority to get the pt out the door asap since admissions are never-ending. But, 2 minutes? Give me a break! If 2 minutes was too long to wait, then the nurse should have said "I'll change the linens for you so you can take the discharged pt out with the wheelchair".
Its all about teamwork, baby! Don't stress out - you did nothing wrong. Thank you for trying to make the pt more comfortable, as many people would just throw a chux on the bed or "get to it later" once their break was finished, or delegate it to a CNA (which irks me if the primary nurse isn't busy).
I'll admit, I've put a fabric pad on the bed before, but this is when I had a new ambulance coming through the door, or an unstable pt, or something else going on. I run on 5-minute "surprises", as my flow can change from one minute to the next ("you're getting a new ambu", or "guess what - room 15 is now going to surgery, OR is on the phone for you", or "room 10 is vomiting all over"). I try to anticipate interruptions so I'll provide an alternative (ie fabric pad on the bed) until I can complete the task. For example, if I have orders to give 1000mL of 0.9%NS over one hr, followed by 0.9%NS at 25/hr for TKO, I'll run the 1000mL as a secondary and have the 25mL/hr kick in as the primary - that way, when the 1000mL bolus finishes then the pump won't be beeping - because god knows I'll be tied up somewhere and won't be available that very minute; and the pt will be on the call light stating "something's wrong with my IV".
Perhaps you could try to incorporate some "temporary" fixes in your routine? The pt that had urine in the bed: place a fabric pad (if they're available in the rooms) on the bed to cover the urine, and leave the room to get new linens right away; as you came back and were interrupted by the "yelling" nurse, you'd be able to discharge the pt with a wheelchair since the linens were covered temporarily. Then in 10 minutes you'd be free and available to change over the full set of linens. There's nothing wrong with doing that - because if the pt couldn't tolerate their PT, they'd be able to get back in bed and not be soaked (even if you were going to change the linens right away; people can get dizzy in 1 second, so its always good to temporarily "fix" the situation until you can complete the task).
Yelling at you was inappropriate. As I said, if it was that important to discharge the pt, then the nurse should have offered to change the linens for you so you could complete the new task that she requested of you.
Linen change would have been my priority. Pt being discharged could have waited another few minutes. As far as the nurse, sounds like she was under a lot of stress. But, no excuse for belittling you in front of others. I always try to treat my NA's with dignity and respect. Basically because I can't do my job well without them.
I definetely would have changed the bed! That pt may have been so exhausted after walking that they may not have wanted to wait in a chair until the bed was finished, then transferred into bed. I would have told the d/c pt that you are finishing up with a pt and then you'd be right in. That nurse was unprofessional to yell at you. As a nurse, if my assistants are busy and I have a few minutes I would have taken that pt out myself.
Hmmm. Well The pt could have sat in the chair when they got back. My response to the nurse would have been " I will be happy to as soon as I am finished making this bed or you can make the bed now for me so this pt can get back in bed and I will take this pt down." lol. When i was an lvn I had the same thing happen just different circumstances. The RN had asked me to do something and as i was heading to do that she told me to do something else. I don't remember what but both were priority and my response was "I will be more than happy to do that but you need to do this" My manager was standing right there watching and nodded her head at me. There is no reason for this nurse to talk to you that way. Pull her aside and tell her you don't appreciate being griped out in public and it is demeaning, if she has a problem with you then she needs to take you aside and explain her problem and reasoning so that you know the rationale behind what she is saying." Sure its important to get pts out as quick as possible but there is no reason she couldn't go make that bed herself or even say "listen this pt is ready to be discharged and i have another one coming to her bed so its pretty important that they get out pretty quick, I can go change the linens for you so you can do this. That is teamwork....make sure you talk to the nurse. I wouldn't go to the manager unless after you talked to her it happens again.
Specializes in Telemetry, ICU, Resource Pool, Dialysis.
What a petty argument. I mean, SERIOUSLY. DA314 - trust me, the world would not have ended if you had changed the bed before wheeling the discharge downstairs. How was the patient waiting to be wheeled downstairs holding up the next admit?? Is 5 minutes REALLY going to make a difference?????
You are dealing with a person (who is unfortunately also a nurse) who has serious power issues. She wanted X done, you suggested doing Y before X, causing a very minor (what, less than 5 minutes?) delay. Although this is LOGICAL, it wasn't what SHE wanted, therefore, you needed to be humiliated. This had nothing to do with prioritizing, and everything to do with control. The bed got changed, and the pt got discharged. Her tirade did nothing to solve either one of these problems.
Develop a thick skin during this period of your career, there are more like her around every corner. Just remember this when you are the nurse delegating tasks to the people who support you. DON'T end up like her! Lead with your head, not with your fist.
Can you tell I'm just a LITTLE fed up with this kind of behavior??????? Some people really need some good medication.
Any professional who is yelling at a co-worker, is not a priority! You did have your priorities straight, and hers was to get you rattled, get her way (using child-like behavior), and show you she was to be obeyed.
That type of thing is not appropriate or good for retention of employees. You might go to the nurse manager of telemetry with a solution (it's always good to be part of that). An inservice program regarding prioirity setting, using that situation for everyone to resolve will start productive discussion, enlighten you about what the manager considers important, and instigate team work (which the bed maker did). If the manager doesn't want things improved (which he/she'd indicate by not acknowledging your suggestion), that's not a good place for you to begin your work, especially since your assignment of 11 rooms appears unrealistic.
So the issue isn't really who was right, but rather what type of leadership there is and that teamwork is possible without resorting to screaming.
Good for you, for putting your dilemma out there!
My experience has been that the auxilliary at acute care hospitalas (which yours seems to be) take discharged patients out to their transportation. Just because the patient was in a w/c doesn't mean that all her belongings were on a table, ready to go with him/her, and doing that can be time consuming.
To defuse the atmosphere of crisis you were quite right to walk away. However by doing the screaming nurse's will, you could have let her know that strategy works. Wrong! As a new staff member you don't want to be anyone's whipping boy/girl. You deserve an apology, so for heaven';s sake, if she offers one, don't share the blame! Thank her for her desire to make things better, and let her know you'd like to have more positive experiences with her, as she has a lot to teach you......
I personally would have voted for quick finishing the job you were in the middle of, and then discharging the patient. That being said, when I am in the middle of something and my nurse needs me, I say something like "I'm just finishing this; do you want me to finish or come and do that?" and then it is their choice which is more important; and if something is left undone because I am pulled from a task they know I am not done with it.
Anyway, you sound like a very caring CNA who is working to be efficient and I hope other coworkers don't talk to you like that! I would advise against going to a supervisor (gotta pick your battles!) but if she talks to you this way often, maybe you need to talk with her.
Good luck! Hospital experience is great experience!
I think the priority was to tell this wench to lower her voice and don't EVER speak to you that way again.
Prioritization with things like this is personal. You could make an argument either way, as long as you have a good rationale to argue your choice. I probably would have thrown the linen in the room and asked PT to make the bed while I took the patient downstairs.
I am sure others are saying this, but patient care comes before a d/c. Since you were already doing the linen change, it would make no sense to stop what you were doing and wheel. A d/c client is an administrative priority, and as bedside nurses and assistants, our priority is to the patient and patient care. Soiled linens are harmful to the client in terms of skin integrity, and embarrassment.
I would confront her on this. If you get no satisfaction, move up the food chain. Get witnesses if you have to. She needs to be taken down a peg or two, for sure.
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Whispera, MSN, RN
3,458 Posts
I have trouble with jumping past talking to the offender to report her to the manager. That could be one sure way to insure negativity in the future. I think the nurse should be talked to though, to set things straight. Getting the manager involved at this point might be overkill. As a former manager, sometimes in such situations, I really felt like saying, "please settle these things yourself."