labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Monday, January 21, 2008

Problems With The Help

I know this isn't going to go over well with some, but I have reached a level of fed-up-dom that I can no longer remain quiet. So what the fuck is up with lazy ass nursing assistants?

We have several nursing assistants on our unit. They function as nursing assistants on postpartum, such as vital sign taking, bed making, call light answering, and general nurse assisting. Or so their job description entails. Some of them also are cross trained to scrub in on c-sections which is the only task they actually do completely and thoroughly.

There is a pervasive feeling amongst the nurses that we can't really ask for assistance from our nursing assistants, because, frankly, they won't help. They come up with a million and one reasons why they can't do what you are asking for. For the most part, I never bother asking. But there are times when I've worked postpartum and really needed help. Bed making is really low priority when you have other issues to be dealing with, like breastfeeding, fragile mothers, fainting mothers, discharge, pain control, you name it. That being said, I really want to get fresh sheets on the beds. Nursing assistants are supposed to take the liberty of initiating bed linen changes, or so I'm told, and so I should be able to assume that it will get done. And yet it never does. I have to purposefully ask one of them to do it; and many times it still doesn't get done. The other thing that gets me is their refusal to bring babies out of the nursery to their mothers. I mean, how difficult is that? Oh! And the other thing is if a mom calls out for supplies (like diapers) and the secretary knows the nurse is busy, she will bring it herself.... because she knows the assistant will say, "Ask the nurse to do it. I'm busy."

My first nursing job was no different as far as the attitude but it was a different environment. The difference was it was in a sub-acute rehab and long term care facility so those nursing assistants worked their butt off. But if you asked them to help out with something outside of their normal routine of feeding, toileting, and bathing forget it. Some of them would even accuse the nurse of being lazy and sitting on their ass for most of the shift. And there was no explaining that the reason you are sitting is because you have 20 Medicare style (AKA very long and drawn out notes so that the place would get paid) notes or that we were doing back to back med passes on those same 20 people (not sitting, but they saw the "standing around" as laziness).

So all of this flack for asking an assistant to do tasks within their job description has made me gun shy, believe it or not. I feel apprehensive asking for some help; and most of the times will just somehow do things myself.

I've even seen a nursing assistant say "Yes" very nicely to a nurse asking for help, and once the nurse walked away to go back to what she needed to get done the assistant says, "What the hell does she think I am? Her slave?" I pointed out that the nurse looked like she was busy, and what she was asking was fairly simple (walk out a discharged patient). She did end up doing what was asked, but really. Was that needed?

I just don't understand why nursing assistants get so put out by having to actually do their job. I have wanted to point out that their jobs on maternity are the cushiest nursing assisting there is. There are no bed ridden, helpless, incontinent, confused, combative, sickly patients for them to have to give bed baths, toilet, and ass-wipe. The crux of what they have to do is vital signs, bed making, handing out supplies as needed.... you get my point. It's not physically grueling work like a med-surg or nursing home can be.

* disclaimer- I know there are good nursing assistants out there. I have come across a rare one or two in my career.

16 comments:

puppybraille said...

I ran into that as a patient after my surgery. I needed a lot of help because it's really challenging hopping around and staying orriented as a blind person. And I needed to get up frequently because I was on IV fluids which was really filling up my bladder. The nursing assistant helped me some, but didn't even want to tell me where the sink was (this was the second nursing assistant, the first one I worked with was wonderful). She also complained about having to wheel me down to my mom's car. As a patient, I wanted to say "I don't enjoy needing your help, but I want to recover well from this surgery and falling face first isn't going to help with that."

AtYourCervix said...

Sing it sister! I can't tell you how many times the OB techs/aides on L&D have outright refused to do a transfer to postpartum, or bring a baby up to the nursery, much less do ANY other kind of assistance that's in their freaking JOB DESCRIPTION!!

While I'm at it, why does it take 2 ancillary persons to clean and remake a room? They make such a big flippin' deal if we try and take one of them away from "cleaning" a.k.a. watching TV while cleaning -- to do some assistance with patients on the floor.

Believe me, the patients also realize when the nurse is not being helped. I've often had patients ask me why no one was helping me while I push them up in a wheelchair to PP, along with their baby and their many belongings.

LeosMama said...

My first child was born in a hospital. The nursing assistant on the ward was wonderful. She was always right there to help out, bring supplies, give advice (she showed me how to diaper a newborn baby and helped me to dress him), and take my vitals. Her care almost made me want to go to a hospital for my next childbirth, as well. Almost. ;)

I don't really know what the nurses thought of her, but I was very impressed with her hard work, compassion, experience, and attentiveness.

Labor Nurse said...

Leosmama, I have a feeling that the person you had a great experience with was a nursing student! Many times the good ones who are working on a unit they hope to be as an RN.

puppybraille points out how this hurts patients...

mommymichael said...

"no. slaves don't get paid to do what they're asked. you do."

i had to type that out. it was bugging me.

Labor Nurse said...

Mommymichael, it took me like 5 minutes to get what you were saying there....

too bad you weren't there!

OBRNinNE said...

I'm glad to know it persists in other healthcare systems as well...our unit can't seem to find the solution. I actually had a new hire call me this weekend and say "there are five of us on and I'm not doing anything, can I go home?"....I only wish I had the authority to say..."Yes, and please stay there permanently...we don't like that attitude around here". No one holds them accountable...

Jennifer said...

Labor nurse, I wonder if you've ever been a CNA? I'm a nursing student right now, and I've also worked as a CNA (both at a nursing home with 10+ patients and the worst nurse in the world, and at a group home) for the past 3 years. I find this attitude about CNAs somewhat alarming coming from an RN. I realize that the relationship between an RN and a CNA can be a little tense sometimes - who really likes taking orders? But there's things nurses can do to make delegation to assistive personnel go easier. I found some great articles about delegation and the RN/CNA relationship while writing a research paper for a nurse leadership class.

Good luck with your midwifery studies. In a couple of years, I'll be looking at grad school for midwifery myself.

Labor Nurse said...

Jennifer, as a matter of fact I have been a nursing assistant. While I was in nursing school.

The issue I have isn't "taking orders"; it's with doing your job. It is the nursing assistant's job description to be responsible for certain tasks like vital signs, bed making, etc. When the nursing assistant decides that they don't want to do those certain tasks, and the RN has to continuously ask them to do it, and the assistant either never does it or gives major attitude is the problem I have.

My point here was that the assistants in this environment have a very cushy job as compared to a nursing home or med-surg unit. In my opinion those assistants work their butts off! The assistants I have worked with in the maternity care field like to sit around and maybe get some vitals signs after they eat their breakfast.

Ali said...

Don't get me wrong, we have some very good health care aids on my floor, but sometimes... well, you have to wonder about people.
Sometimes I am convinced that there is a method to their maddness...
At times we get health care aids from companies which the hospital contracts their services out to. Their skills and knowledge are often questionable. It is sometimes easier to do things yourself than to ask them to help you. But maybe that is their plan... if they act incompetent, then we won't ask them to do much, and we won't have high expectations from them. Then they don't have to work as much.

RN Someday said...

I know where you are coming from. I am a cna right now while I finish nursing shool and the people I work with are awful. They are so surly with terrible attitudes, no teamwork. I usually have to rely on the nurses to help me if i need help because the cna's i work with are not interested in helping anyone out, even the patients. It's really sad. I can't wait to get away from the place.

hucknjim said...

Between the nursing home and a surgical unit I've been a CNA/tech for over 20 years. Most of us do work our butts off, and I thank you for saying that. On the other hand, I've seen some lazy nurses as well as techs. They cut corners. They hide. A fellow tech and good friend even had an RN tell him to his face, "I only do enough to get by." That attitude should be enough to get someone severely reprimanded if not fired, whether it comes from a nurse or a tech.

Lest you think I'm bashing nurses, I've trained many techs. The first thing I tell them is that our job is to make the nurses' lives easier. Anything we can do within our scope of practice to accomplish that is our responsibility. Then I go about teaching them the basics ... vital signs, bed making, bed pans, ambulation, etc.

Sorry for the rant, but I get a little tired of RN's who think they are the be all and end all of health care. Thankfully, there are very few of those on my unit. We work well together. My friend deals with them every day. He runs his butt off while they sit. And no, most of the time they aren't charting. They're reading magazines or chatting. Okay, enough. Thanks for letting me vent.

John

Amanda said...

I have worked with both types of nurse assistants. One particularly bad one comes to mind, even 15 years later. I can't tell you how many times I was busy doing 6 pm. IV meds, taking vitals on an admission, and cleaning up a bed someone vomited in... while "Mary" was nowhere to be found. And whenever I did ask her to do something... because I was busy, not because I was "above" making a bed or whatever.... she gave me attitude.

I worked 8 and 12 hours shifts without getting lunch or bathroom breaks sometimes, but people like "Mary" always get their breaks.

Labor Nurse said...

I'm really surprised more people didn't disagree with me on this post, which I guess is good and bad. Good because I won't gain any haters, and bad because it means this problem is universal.

I also agree with some of the commenters here that noted that nurses are not immune of this attitude and work ethic either. I've worked with some (ie, Lazy Ass Charge Nurse comes to mind) that are just as bad.

Margaret said...

Had my first adult hopitalization couple of years ago (having babies don't count -- I wasn't sick! LOL), broke hip in the leg most severely affected by childhood polio. Those early hospitalizations were traumatic, so I've avoided hospitals and doctors as much as possible, and fortunately am extremely healthy.

While in the hospital there were three women I saw/noticed most, and reading your blog, LaborNurse, I wonder again what their job titles were. There was one older woman (probably mid-forties) I took to be an RN...she reminded me of my momRN! Just totally professional and competent and kind but seemed to see and notice so much, just very in-charge (I was just resting and doing as asked so I could go home!). It was she who asked me to rate something or other on a scale of one to ten and I had no clue what that was about, but I liked her so much I always gave her a number, and tried to vary it so I wouldn't bore her (later I learned it was about pain, and I never felt any pain!) Then, there was a very sweet young woman who gave me more water when I asked, changed the catheter bag, etc. And then there was a woman who was surly, for no good reason that I could see. She even asked me why I was having my daughter come in from another state to take me home when I had two daughters in my city to help! How did she know anything about my family? I talked about nothing. The two nearby daughters both were whiners who wouldn't lift a finger to help another person if their lives depended on it. I suspect one of them filled her ear with how they weren't loved as babies or some such rot. And it was this third woman who came in with the discharge papers. But I will tell you for sure, I felt so blessed with the surgeon doctor and the care I received in the hospital. I didn't stop holding my breath til I got home, but I really had NO complaints.

Angry Nurse said...

To all the techs that responded: Until you're a nurse with crappy techs...don't bother...really. Save the ragging on nurses for another post. This one is about crappy techs.

Some techs are really good and I love working with them. There are others that should be ashamed of the work they do (or in this case, don't). I don't know how some of them can sleep at night knowing they haven't turned one patient all day, or cleaned any up until the end of the shift, or wait to get the DFS AFTER the patients eat.

I see the techs eat their breakfast, lunch and dinners. I see them lolligag around, no hussle in their terminology and I also see them disappear at 7pm, while myself and the other nurses are still working long after giving report.

It's one of my biggest gripes about being a nurse. If we aren't going to have effective ancillary staff then get rid of them!! It's not worth the headache on a daily basis fighting with them to do their jobs.