Whose responsibility is it to discuss expectations of the nurse aide?

[emptyboxcars]

I am a student who will be interviewing soon for a nursing position. In order to correctly compile my answer to a potential interview question, I'm wondering if you could answer this for me. If I hypothetically as the nurse had a nurse aide who was chronically shirking their responsibilities, is it within my job description to handle the situation? That is, can I sit down with the nurse aide and discuss their job description and problem solve together to set realistic goals for them? Or do I need to report the nurse aide's chronic lack of responsibility to the nurse manager and let them handle it? I'm not clear on the hierarchy in this situation. Please let me know asap -- my interview is tomorrow! Thanks.

[Maybaby8]

That depends. The CNA answers to the LPN and RN. The LPN answers to the RN. If you are working in a nursing home, whether you are a LPN or a RN does not matter. You are ultimatly responsible for the people working under you, so it is your job to ensure they are doing their job. That means you delegate to the CNA to ensure that the patients are being properly cared for. In the hospital setting the LPN can delegate to the CNA, but ultimatly the responsibility is on the RN.

[vintage_RN, BSN, RN]

It depends on where you live..where I live, unregulated health care workers are delegated by registered staff (RPN & RN). RPNs don't "answer" to RNs...the pt is the responsibility of whichever nurse is assigned to them. At least where I live, either RPN or RN are always ultimately responsible for their own pts care and delegate unregulated staff to make sure proper care is given. It's different everywhere though (I'm in Canada)...but I would say the responsibility is on the assigned nurse.

[KelRN215, BSN, RN]

If it's a chronic problem, IMO, it's the supervisor's responsibility to handle it. If it's an issue that specific shift, you can deal with it. If, say, the nurse's aide assigned to your patients hasn't done vitals by 10 am or didn't report to you that your patient had a temp or a low BP or something of that nature, I'd discuss it with them. "Suzy, it's 10am. I noticed that there are no vitals in the computer. Have you done them?" "Jane, I just noticed in the computer that my patient's temperature was documented as 101 this morning. I need to be notified of this immediately." Don't accuse, but address the issue. Suzy may have done VS on your patients but just hasn't had time to document them yet. If she hasn't, then you can review expectations that vital signs need to be done and entered by 9am and if the patient/family refuses, the nurse needs to be notified.

[tyvin, BSN, RN]

Yes, you can sit down and counsel...be sure you know what you're talking about though. CNAs and the like know their limits. It's up to you as the charge to know their job as well. Only when the situation of shirking duties in light of already being counseled by the RN would I write them up and get management involved. Know the facilities p/p on all of that because every state is different and well as every facility. So yes; you handle the situation and counsel when needed. Know the DON's thoughts on all of it too. They might have a policy already in place. Know the rotation schedule and the assignments of the CNAs as well (you might be scheduling the assignments). Be up and informed on delegating duties as well.

RN's have a responsibility to know everyone's job. If bodies are there and working and you are charge you need to know the limits of what each individual can do (that includes LPNs as well). Especially in light of the different levels of CNAs, PMAs, etc... Some are certified to do many things like tube feedings for instance; you need to know what their scope of practice is, and it's different in each state and each facility and each person (goes for LPNs too). On a final note please know your own states Nurse Practice Act as it applies to RNS...it's different in each state and each facility (the facility might modify the NPA as well).

If hired I would arrange a sit down with each person you will be working with if possible. Know what they think their strengths and weaknesses are. They need to know you will take charge and be fair. It's often more difficult in some situations replacing an RN in a facility. It's good to know the history and what they were experiencing before. Talk with the DON about the CNAs and LPNs and their thoughts about the staff. Ultimately, it is the RNs duty in my state..

Good luck on your interview

[classicdame, MSN, EdD]

clarify with the co-worker about expectations to see if you are on the same page. Then, if policies are not being met or if patient care is impacted, bring to attention of manager.