Working as a team

night owl · Apr 24, 2002

I hate the bull----too. I work in LTC and I often ask myself, "Where is the team work?" It seems to get worse every day. We are always short. If we have a day where there is good staffing, they pull from us. Who suffers? The residents because you just can't give decent care when you don't have the help.

Team work is the only way things can get accomplished and I can't stress that enough to our staff. People just aren't dedicated to the job like they used to be. Too many call outs and on my unit, they just don't call out one day, it's three days or a week which makes it even harder on the people who do come to work. If they don't send the help, then the rest of us have to pick up their assignments. Everyone gets so darn tired that they call out because let's face it, we're not getting any younger. 20 years ago I could handle 20 residents without any problems. Now that I'm pushing 48, I don't move as fast and when I move, things start to hurt! But I do what I can. I started out being a NA, so I've been there and done that. When I push my med cart for 22 residents and there is one CNA working my hall, I will stop to help her/him because I would hope they'd do the same for me. It's just too much work for one person and I hate to see someone struggle. There are those however that would turn their backs and keep on going...Team work makes the job easier on everyone. The nursing shortage isn't going to get any better anytime soon, and eventually people are going to realize that team work is the only way go.

I commend you for your excellent observational skills and reporting what you see to your nurses. It's amazing how you report things to people and three or four days later the problem still isn't addressed. I hate when that happens! I would strongly recomend that you document what you find and who you report it to. That way you CYA! That nurse who stated, "I don't care what you do...it's your oxygen...turn it all the way up!" Then when you turned your back told you to turn it up to 5 certainly wouldn't fly with me. Can you imagine how that poor lady felt??? How rude can you be? That nurse shouldn't be a nurse. Where's the compassion? the caring attitude? I'd be documenting like crazy as with the nurse who told you the edemetous feet was probably arthritis. Document, document, document it's the only way to save your butt God forbid you were ever involved in a lawsuit. Always go with your gut feelings. If something you feel is terribly wrong and you get no help from your nurses, call your supervisor and tell her/him your dilemma. Those nurses could lose their license if they aren't careful! Then document it all in the chart or the computer.

When things get rough, those smiling faces, the squeezes, the hugs, the winks and the "Thank yous" most definitely make it all worth it indeed and they remind you why you chose this profession in the first place. Good CNA's are hard to find. Thank you Vicki for being so caring :kiss

Paprikat · Apr 24, 2002

I agree with the above. I also stress to DOCUMENT! It will save your butt and reassure you that you did your part. Also chart "RN/LPN aware."

As a charge nurse, I have the utmost respect for my care aides, 97% of them are dedicated professionals, who truly care for the residents and they have good observational skills, as it seems, so do you. Keep your head up high, and be proud of the work you do.

ComicRN · Apr 25, 2002

I am the Clinical Coordinator (sort of like assistant nurse manager) on a 46 bed LTC floor. Our unit would not run without the CNA's. And.......the nurse manager, the other nurses, and I make sure that we tell the CNA's this often. They certainly have the most physically demanding jobs and usually have to put up with the most grief from residents. On the other hand, they are usually the first to get the hugs and kisses for all of the "little things" they do for our folks.

Yes, they truly are the eyes and ears of the floor. We do depend on the CNA's for alot. I don't mind it when I see a CNA sitting down taking an "unscheduled" break. I know she (we don't have any male CNA's on our floor!!) has been working hard and deserves it.

I agree with documenting. Our CNA's only have one form of documentation to fill out at the end of the day and there is not a lot of space for them to write notes, but I encourage them to write as much as they can.

The CNA's on our floor will do anything for us when asked, and in return, we try to accomodate them when they need something, like an unscheduled mental health day!!

momrn50 · Apr 25, 2002

I also work in LTC and cannot praise the CNA's enough for their hard work. You better believe that... the CNA's are the eyes and ears of any facility. At our facility we have a CNA book to write down any observations that they have. The nurses have to read it and sign off that they checked out what the CNA 's had to report. True, some nurses just don't give a damn, because they aren't on the front line of hands on patient care. God bless all you CNA's out there...you have a hard job and not enough respect.

jones58 · Apr 25, 2002

Hi Vicki, I was a CNA for 15 years. It is a very hard job, and I worked my butt off. I know what its like. I work in a LTC/Rehab unit. I worked there as an aide, and now as the LPN. There is much stress in long term care. It is busy for the aides and the nurse. Some of the nurses you described don't sound like they care very much about their work. #1Nurse should have checked that lady on o2 and you never turn up a copd pt. to 5. #2 Swelling in feet sounds more like edema then arthritis. All nurses are not like that. Hang in there. You are right to point out changes in pts. status to the nurse.

robinrdrn · Nov 6, 2002

How to work as a team?............First, you have to have a DON that sets an example..........next you need to follow suit.........and so on and so on............Our DON has been with our facility for 6 years and that is very unusual in LTC. Much of our staff has been there years too. In fact, our facility has the best longevity rate in it's chain. Why? Our DON doesn't allow complaining or tattleing and I mean doesn't allow it. She rarely ever writes someone up and we rarely every write anyone up and so on and so on. Seems like the place would be full of goof offs hey? Well anyone who starts "b-ing" is short lived. They usually leave on their own because our team turns a deaf ear to it. The complainer usually feels isolated and either stops complaining and pitches in or leaves. Anyway, our work environment is fun and it reflects in our patient and family care. ...and the lack of b-ing rolls over to the physicians and to the surveyors. We aren't perfect, things go wrong at times and someones bath might get delayed but, for the most part the work gets done. I consider myself very lucky to be working for this DON....and believe me I've worked for some that seem want to point out everything wrong with your unit. And in following suit........I'd start pointing everything wrong with someone else's care....and so on and so on. Corse, I ain't working there anymore and the facility is now out of business with the "State's" help. All I know is when ya focus more on working and less on complaining the day just seem to go by a lot nicer with a lot of smiling faces....and the work gets done too.

Care Assistant · May 26, 2003

I would like to reply to this post as I am a Care Assistant. In a Care Home in England. The thing about getting them up in the mornings is just th same where I work. I hate that. I feel that we have to rush so much they are not getting the proper care and attention that they so deserve.

We too have the 15 minute timing and I am sorry but I dont agree with that some residents have to be hoisted and that takes longer.

At the monent I am thinking of changing my job in the home for another job in another care home as we are rushed so much it is really starting to annoy me. I have people *training* me up. This I know has to be done, BUT I have done care work before and KNOW what I am doing. At the moment I have a 18 year old training me up and she is always moaning at me and i am so loseing my temper with her. SHE IS 18 YEARS OLD I am 27 I have been doing Care work for 10 years. Then she comes along and starts telling me how this and that should be done. I DONT THINK SO.

I am not standing for this much longer and am looking for another place to work.

jschut, BSN, RN · Jun 10, 2003

I absolutely love the CNA's I work with! I would be NOWHERE without them. They deserve a heck of a lot more respect than they get....

The CNA's are my eyes and ears for the patients.....

I really depend on those ladies and appreciate everything they do.

Yea, there are some that get on my neves, especially when they sit at the desk, talking on the phone when call lights are going off, or neglecting to pass nourishments until I say something, adn huffing and puffing when asked to do something, but most of them are the best and I couldn't work without them right by my side!

mek50 · Jun 17, 2003

As an RN in a LTC facility, I hear you loud and clear. In my observations of the CNA's role, I often think your job is a thankless one and if it weren't for the patients/residents thanking you for your hard work you probably wouldn't survive. In our facility we are hiring new CNAs and losing them just as fast. We have a new DON who is very hard on the CNAs and at most times does not give them any respect, but demands respect for herself. I try to work well with my CNAs on the LTC side on the day shift. I recognize their hard work and compliment them as often as I can. I give them the respect that they deserve and speak to them kindly. In return they cooperate with me and are my eyes and ears for things that I do not observe with the residents. Communication and team work are two of the most difficult issues in any institution. How to improve it is a big concern. It takes people as a responsible group to work well together and rather than criticize all the time, try giving some credit where it is deserved. I don't know if this helps at all, but I can tell you I respect my CNAs very much.

Dr. Kate, BSN, RN · Jun 17, 2003

Back in the dark ages when I was a new RN a very wise supervisor told me that the CNAs knew more about taking care of patients than I would ever know and that I would be well served to listen to them. I took her words to heart and in the process those CNAs taught me to be a nurse and a good charge nurse.

From the bottom of my heart, thank you all for being the great care givers and teachers you have been to me.

wif411 · Aug 14, 2003

Boy, I fully agree with you. CNA's deserve respect. They are the ones that make the nursing homes look, smell, and feel like home. I respect my CNA's and am very protective over these ladies. On other shifts where I work they have problems (per the nurses) with the CNA's. Personally I think it is a joint problem. The cna's do not do things in a timely manner and the nurses listen to the lights go off. I mean listen....I realize they are charting...but I feel they could do as some others of us do. At least check and see that the pt is not in the floor, having pain, etc. If it is something that the cna can do while I chart, I let the pt know someone is on their way, turn off the dang light, and find the cna and tell them what is up. The cna's on my shift know that if I am not busy I will take care of it myself...but if it is something that can wait til they can get there, I let them do it. This way I do not spend my charting time, med pass, assessment time filling ice pictures, bedpans and changing clothes. The cna's know I too want to go home in a timely manner. And if when I answer lights I take care of every little request, I will never get out of there.

I was a cna while in school. I have walked in those shoes, changed those dirty bottoms, given that bath, cleaned poop out of eyebrows and other crevices 10 minutes before shift ends. I sometimes think all nurses should have to experience the cna position. I also think that every cna should have to shadow a nurse for a shift. Yet the cna cannot take home the burden of did I do the right thing?. make the right decision. ALthough they make decisions about pts everyday...it is somewhat different as a nurse.

Maybe a joint meeting would help. But the DON must buy into this too.

Good LUCK...hang in there