am I missing something

[tenexe]

Try to be to the point. I was an aide, patient care tech, when I was in nursing school. worked my butt off.
Finished nursing school, took a job at a level 1 trauma center to get some experience to start traveling. (been there 7 months).
Lately I've been leaving work miserable, don't feel that I'm getting any better experience at this hospital in developing my nursing skills than I would have in a smaller community hospital.
I've realized that a vast majority of my shift is changing diapers, doing ekg's transporting noncritical patients, getting patients into gowns, putting all the orders in the computer, putting patients on the monitor, drawing blood and starting IV's. Oh and yes we have aides, they do almost nothing and when you ask for help you get blatent attitude so most of the nurses don't bother any more.
I'm not against doing these things in principle but I am finding that while I'm spending 25 minutes changing the diaper on a morbidly obese patient I have another patient with chest pain sitting in the room not seen yet. then I run in to do a quick workup on that patient, and theres another one in another room. While this is going on one tech is sitting reading a newspaper and the other is watching a basketball game. TRUE STORY
i feel like my job as a tech is infringing on my ability to not only provide basic nursing care but it is inhibiting my ability to refine and work on my skills as a nurse. I don't feel this job is much different from my job as a tech except that now I'm a tech who passes meds and documents.
Oh and forget addressing the poor performance of the techs, one of them was disciplined and cried rascism so the administration won't touch them with a ten foot pole. I think this situation is ridiculous and unsafe, but this is my first job as a nurse. Is this what I can expect in the future or should I start looking for other options. I'm also afraid that If i leave this job before I get my year of experience and work in a smaller community hospital I will find it hard to get a travel assignment.
Any feedback would be appreciated.

[Ricu]

Try to be to the point. I was an aide, patient care tech, when I was in nursing school. worked my butt off.
Finished nursing school, took a job at a level 1 trauma center to get some experience to start traveling. (been there 7 months).
Lately I've been leaving work miserable, don't feel that I'm getting any better experience at this hospital in developing my nursing skills than I would have in a smaller community hospital.
I've realized that a vast majority of my shift is changing diapers, doing ekg's transporting noncritical patients, getting patients into gowns, putting all the orders in the computer, putting patients on the monitor, drawing blood and starting IV's. Oh and yes we have aides, they do almost nothing and when you ask for help you get blatent attitude so most of the nurses don't bother any more.
I'm not against doing these things in principle but I am finding that while I'm spending 25 minutes changing the diaper on a morbidly obese patient I have another patient with chest pain sitting in the room not seen yet. then I run in to do a quick workup on that patient, and theres another one in another room. While this is going on one tech is sitting reading a newspaper and the other is watching a basketball game. TRUE STORY
i feel like my job as a tech is infringing on my ability to not only provide basic nursing care but it is inhibiting my ability to refine and work on my skills as a nurse. I don't feel this job is much different from my job as a tech except that now I'm a tech who passes meds and documents.
Oh and forget addressing the poor performance of the techs, one of them was disciplined and cried rascism so the administration won't touch them with a ten foot pole. I think this situation is ridiculous and unsafe, but this is my first job as a nurse. Is this what I can expect in the future or should I start looking for other options. I'm also afraid that If i leave this job before I get my year of experience and work in a smaller community hospital I will find it hard to get a travel assignment.
Any feedback would be appreciated.

Hi there,

It sounds like you're getting top quality, first hand experience in one of the most difficult nursing processes. Patient advocacy. Your hospital, like many I've worked at, definitely has some serious staffing issues too, I readily agree. If they were to be addressed, many nurses would have to approach human resources and complain and it would require a lot of time to work out. Nobody is doing that. Meanwhile, let's go back to advocacy for a minute. This issue goes above everything else because it protects the patient and the nurse. You worry about leaving your job prematurely and it having an impact on your record but imagine what a legal fiasco you would be in should a patient sue because under your care, he suffered a catastrophic event like a stroke or heart attack. You missed it while changing a diaper because your aide didn't want to put the newspaper down and you didn't enforce yourself. What happens if your aide didn't check or checked and didn't report a dangerously low blood sugar, blood pressure, heartrate? You would be liable. Yes, the aide is licensed and liable for his or her actions but you are the licensed nurse overseeing the aide therefore, also liable. Your obligation like it or not is the proper use of assistive personnel which includes the delegating of and supervising of tasks. The nurse is burdened with more and sicker patients who have a multitude of everchanging needs. This requires the nurse to constantly assess and prioritize the tasks needing to get done. Nursing aides are extentions of the nurse, are there to be intuitive and anticipate needs and changes, report any findings especially "something just isn't right..." all while carrying out assigned tasks. Their job isn't easy and a good aide is priceless. You know because you've done it. Take a minute and review your RN scope of practice as defined by your license. You will find it all spelled out there. Yours is a very hard job. There is much more to it than bedside patient care and documentation of same. Your greatet responsibility is to protect your patient whether from himself, medical negligence, abusers, or incompetent staff. If you are always acting in the best interest of the patient and find yourself having to go to bat, you will not be penalized and your license to practice will be protected. I know this is hard to think about and fortunately, having to enforce yourself this way is relatively uncommon but, it is still your responsibility to do so. While thinking about your future, keep in mind that travel assignments will frequently put you in facilities where there are staffing issues. In short, you could end up in a hospital like the one you work at right now. Hospitals that don't have major retention problems generally don't undertake the expense of contracting with travel companies.

Best of luck,

R

[tenexe]

thanks for he response, it was very helpful. The funny thing is that our ratio isn't actually that bad. generally no more than 4 patients. Its the fact that we have to do every single task with that patient from the moment they walk through the door with almost no help. I appreciate your feedback though

[irishgrl@ameritech.net]

Excuse me, but didn't you say that you're working in a Level 1 Trauma Center, and you have FOUR patients? Isn't this a critical care area? If you're doing critical care, you should have no more than 2 patients.

I understand your frustration with the nursing assistants. This is a classic, age-old problem, one that seems to be ignored consistently by management.

If you continue to jump in and do the job that the asst. won't do, you are "training" your assistant to do exactly what they're doing now: nothing. You are reinforcing their bad habits. You are a new grad, and this aide is "testing" you to see what you'll allow them to get away with, and what you won't tolerate.

Change your tone. You are not asking for help. You are directing the aide. Erase "do me a favor" and "would you mind...." from your vocabulary. Simply say, "I need you to change Patient X." firmly, and in a business-like tone. Repeat is as often as you have to, and don't engage in arguments with the aide.

If they resist, simply ask, "Are you refusing to do your job?" If they say, "yes," tell them that you will have to call the nursing supervisor. Then follow up and DO IT. If they say, "no," then follow that up immediately with, "Then do your job and change the patient now. Not later. Now."

Don't worry about being villainized by the aide(s). Remind yourself that you're not there to be her friend, but to be her supervisor. You're going to have to develop some real backbone, and stand up for yourself. This means you have to put yourself to the test, and put the aide to the test, and don't back down. Never yell, never show that you're upset. Help her if you must, and thank her when she's completed the task.

Do not be distracted by anything the aide says. Ignore and do not respond to everything else they say, and continue to repeat your directive to the aide and continue to repeat, "Are you refusing to do your job?"

Don't be afraid to "write up" the aide if they take too many breaks, take too long on breaks, "disappear" without telling you where they're going or how long they'll be gone, etc. Warn the aide that you will take whatever steps necessary to involve management in ensuring that they do their job. Then follow through. Never threaten unless you intend to follow up on your threats to seek disciplinary action for the aide.

When you document the aide's failure to perform their job, you are protecting your license and protecting the patient. This also puts management on notice that the ball is in their court. While management may choose not to do anything, you have still documented that you notified management of the problem. That makes them responsible, instead of you being solely responsible for the aide's failures and irresponsibility.

Best of luck.

[stillearning]

The Irish Girl gave you some great advice.

In my estimation, what you're missing is a manager!

This response may be more suited for your manager, who is, I presume new at his/her job too!?! If you had a seasoned, competent manager you would not have to argue with assistive personnel about doing their jobs.

Any nurse manager worth his/her salt knows that it is MUCH TOO EXPENSIVE to have nurses tending to the chores you mentioned and at the same time have assistive personnel sitting on their buns. Sooner or later, the unit budget will bleed red and you'll see some change. However the changes may not be geared toward genuinely improving work-life on the unit OR patient care.

Carolyn A. Martin, PhD, wrote in a recent article (Nursing Management. 36(9):38-45, September 2005) about managers who simply don't manage -- anything. Her prescription is pretty simple (and this I found on her website): managers need to ASSIGN the work, ASSESS whether and how well it gets done and then hold workers ACCOUNTABLE.

Apparently that just doesn't happen where you work.

I might suggest you add to your documentation efforts a little bit of a TIME STUDY to help your manager (or the administrator) do the math on the lack of productivity evident on your unit. Time is money, and sometimes money talks louder than anything.

You need to manage your practice (as Irish Girl suggested) but not take on the management of the unit, unless they offer you the job, the pay AND the benefits that accompany it! Good luck.

[usnrjim]

Sounds like you are not utilizing your patient care techs right. I realize that you are a new nurse who is probably working with techs who have years of experience. My solution is You are the Nurse and must delegate them to do their duties. This is your license.

[Ricu]

You all make good points but let me point somehting out. Many of the recent posts blame the management for problems that are the responsibility of all of us. While it's true that managers are to hold workers accountable, it is everyone's job to help enforce that. The manager cannot be everywhere 24/7. Nobody is hired into any healthcare job without first being indoctrinated in the facility policies and the responsibilities of the job itself. Finally, we all sign on the dotted stating that we understand and agree to follow the rules. If you are working with a slacker and want the manager to change that, document actual events using the facility paperwork and report the problem. This empowers the manager to actually charge the offending worker with the offenses and hold him accountable. Just going into the office and ranting about "what a slacker that person is" doesn't empower your manager to change anything. Evidence is needed, not allegations. If you would rather address the problem directly saying "hey, can you help me with this please," you will get further than griping or copping an attitude about the person. Such behavior creates dissent among the staff and makes the environment hostile. Not everyone readily fits into the team right away and sometimes a little friendly help does the trick. This makes the environment friendly and sets the stage for teamwork. People can be disengaged for a variety of reasons and unless you try to involve the worker, you will never know what can happen. A surly disposition may be off-putting but a genuinely friendly approach can melt that away. In an ideal world, we would all come to work every day and do the jobs we are hired for perfectly well. In the real world, where we all live, we are real people who occasionally have problems and carry baggage. We can be turned on or turned off. Lets try to treat our coworkers a little more like we treat those we care for, with kindness and patience. It works for me.

Been around for awhile and in different levels.