Bratty little bitches!!

[brandtrn]

Well! I'm a couple of weeks into the new job and not certain, at all, that I like it! I'm now a clinical instructor for Nursing Fundamentals and am dealing with first-year nursing students (while still doing PRN at my "former" place of employment). On one hand, it's a GREAT time to get hold of nurslings before they learn some nasty bad habits from somebody else! On the other hand, it's irritating as f**k, because a few of these said nurslings have some seriously ill-conceived notions that, because they'll have an aide to do their "scut" work, they shouldn't *have* to learn the basics! Believe it or not, I even had one of these little snots say to me "I don't understand WHY we need to learn all of this. I'm not spending all of this money to learn how to do AIDE work!" Grrrrr! Did I have some news for her, and yes, she will, in the next few weeks, have to have one serious "attitude adjustment" if she hopes to pass through MY little section of the nursing program!

I explained the following things to her: first, that we nurses are capable of doing many things that our aides CANNOT (and are not qualified) to do. But, the most "basic" needs of our patients are NOT going to just "go away" because we have more technical "busywork" to do. This is why we NEED our aides and why, if we hope to survive as nurses, we need to RESPECT what they do, and to be capable of performing these "basics" ourselves! Yes, often, these poor folks ARE relegated to doing the "scut" work for us -- which is often difficult, back-breaking work like bathing confused, combative patients, transferring dependent patients from bed to chair and from chair to toilet, etc. It can also be "messy" work, like providing incontinent care, or fairly mindless (but necessary) work such as procuring vital signs, emptying catheter bags, emptying drains, making beds (often while the patient is still IN said bed!), emptying trash containers, etc. etc. BUT...these aides are working under OUR licenses, which means that WE are the ones who are legally responsible for whatever care is (or is not) provided by our aides. And, with that in mind, shame on us if we are NOT equally capable of doing such work ourselves! There is NO EARTHLY REASON whatsoever for us not to be just as capable as our CNAs of performing this so-called "aide" work. And, as I continued to explain to the spoiled brat who took me to task for trying to teach her how to do "aide" work -- in MANY nursing environments, one does not even HAVE an aide to dump on! That's right, people...in certain patient environments (critical care would be one), the nurse does EVERYTHING for his/her patient(s). This is what is known as "primary care" nursing. Also, there are times, even in an environment where aides do a majority of the "hands-on" care (such as the ECF environment), it often happens that one or more aides either call off for a given shift OR your facility has a shortage of aides to begin with due to ongoing staff turnover, etc. and the nurse has NO CHOICE but to "help" with this work him/herself! I put the word "help" in quotation marks because, even among my seasoned nurse colleagues, too many of them, while sitting upon their high horses, assume that they are "helping" their aide if they take a patient to the potty. WTF???!!??? As I indicated earlier, as the nurse, it'll be YOU who's responsible for whatever care your patients do or do not receive, and it is YOUR license which is on the line. With that in mind, it'll be YOU who'll be held accountable when your patient gets up to try to toilet him/herself and then, perhaps, falls and fractures a bone because your aide was in another patient room when the call light went off and YOU couldn't be bothered to answer it! Honestly, get a grip, people! Toileting a patient, feeding a patient, transferring a patient, changing his/her bed linens, providing incontinent care, obtaining vital signs, etc. are things which ALL nurses should be capable of performing...and we SHOULD be capable of performing these tasks just as well as (if not better than) the CNAs who are working under OUR supervision and under OUR licenses! These tasks are NOT "aide work," THEY ARE NURSING DUTIES!! And shame, SHAME on you if you believe that, because you've managed to be admitted into a nursing program, that you are somehow "above" performing these most basic of nursing tasks!!!

Some of these obnoxious little brats are in for a huge surprise, it appears! There is positively NO WAY that I'm going to even CONSIDER teaching such people invasive procedures (such as catheter insertion, injections, IV insertion, tube feedings, etc., let alone a MEDICATION pass) until they've managed to learn (and to become proficient in) the "basics" of nursing care. Lesson number one, for all you spoiled brats out there: you are NOT "helping" your aides when you grab a set of vital signs, take a patient to the toilet, get him/her a glass of ice water or make a patient's bed. Your aides are there to help YOU to do YOUR job!!! That's right, YOUR job! This means, that when the call lights are going off like popcorn, and every single aide on the unit is tied up in another patient room, it's time to get up off YOUR spoiled, lazy ass and to ANSWER some of those call lights, maybe TAKE a patient to the potty, help him/her into a more comfortable position, or to change his/her linens and clean him/her up if he/she has soiled him/herself. If you EVER think that you're somehow too "special" to have to actually put your hands on a patient -- guess what??!!?? There's no freaking WAY that you'll EVER pass my "fundamentals" class, which means that there's no WAY that you'll be able to go on to learn bigger (and supposedly "better"), things. Trust me when I tell you that a good nurse does NOT dump on his/her aides, nor does he/she EVER neglect the "basics" of patient care....grrrrrrr!!!

[Icey]

I agree with everything you've said.

Keep at it Cindy. Your job's new yet, and you're bound to get some snotty kid who thinks they're above the "menial" tasks, but you're absolutely right, it's all part of the nursing procedure - and a vital one as well.

Instill some sense of obligation, duty and compassion into the nurses-to-be, otherwise they're never going to make good ones, and let them know that they either listen to you, or fail miserably.

[pilvikki]

well, that's why you're there; someone has to tell these wee princesses what its all about! and from what I've gathered, if you ride them hard in the beginning, they'll either learn or bail. either way it's a win. maybe a few pep talks about the facts of life every few days for the entire crew, rather than individual tutoring?

also tell them they can expect shit dished out by some doctors, who think themselves above a 'lowly' nurse... plenty of those jerks, too, and do not kick it down the line!

here I thought i'd tell you about a friend who went into nursing... on her floor she had an old man, who always had his equipment hanging out of the fly (years and years ago). she decided to once again tidy him up and tuck it all back in. however, there was this long black hair there, so she grabbed it to toss it into the garbage.

unfortunately it was attached - and bled like a war wound....

[Icey]

Oh dear, the poor man, but that was a total accident.

[brandtrn]

Pilvikki, you may be certain that I have a lecture planned, to take place during my next "post-clinical" rotation, to point out ALL of these things to my students...not only the evils of "dumping" upon one's aide staff and the tendency for nurses to try to "blame" their aides for things which THEY are legally responsible for, but also, for the tendency of Docs to bitch us out for calling them when we need their help (and our need to stand our ground when we DO, because we DON'T tend to call them for our own amusement!), the tendency of senior nurses to "eat their young," etc. Yes, these nurslings have a LOT to learn!! And I have no doubt that many of them WILL "bail," once they realize that nursing IS a freaking HARD job and is NOT what's portrayed in television dramas (i.e. cute nurse hooks up with handsome, rich Doc...not AT ALL likely in the "real" world!). And what better place for them to get their first taste of it than in their "nursing fundamentals" class??? As discouraged as I might be with some of my "nurslings" in certain matters, I have no doubt that SOME of them may possibly be trained, not only to advocate for their patients, but to stand up for THEMSELVES, as well! If they're not capable of doing so, they're freaking OUT!!! So, we shall see...

[Icey]

It sounds as though it's all about getting these trainees on your side, and telling them just what you've said above. They WILL listen and learn, or they won't make the grade - simple.

However, there are some people who go into the profession without realising the basic but hard work which's necessary, and some just don't have the nature to make a good nurse. They might gain the qualifications, but it takes a certain attitude and compassion mixed with taking the job seriously to produce nurses which we can all be proud of.

I think you'll be a dab-hand at all this a year from now Cindy. If you're warm and approachable, but demand the right things of your underlings, I think you'll find that once they qualify, you'll be proud of what you've achieved, and they'll thank you for it.

[brandtrn]

I hope so, Icey. I still have all kinds of gratitude and warm feelings for one of my first instructors in nursing clinicals (I'll call her "Janie," even though that's not her "real" name). Anyway, Janie was one tough old bird...tough, but also fair. She was my "role model" as I formed myself to be a nurse and, now that I'm actually an instructor myself, all these years later, she'll ALWAYS be the standard which I'll measure myself against. If I can only be HALF as good as Janie, I will have done an awesome job...

[Icey]

Wow - that's a lovely compliment to your instructor, and shows that she did her job, just as you will.

I have the fullest confidence in your ability to tackle all this. I know from how you've written in previous posts that you're good at what you do, and you've gone the extra mile to achieve it.

Some of those who're not paying attention to what's necessary, might be alright in the end. It's new for you, new for them. Sometimes we have to handle different personalities in different ways, and I don't write people off from the start.

Although it's in a totally different way, I've had to deal with all sorts of staff - their problems and their training. I've took chances on people to turn out fine, which they thankfully have, but I appreciate that some're so half-hearted or intent on doing things THEIR way, that they might as well not bother. The point about any job, is that you learn it from A to B and use that experience to keep things running as they should. This doesn't mean that new ideas and approaches can't be listened to, but in the case of medical staff, I'd think that it was best to learn right from the bottom up (no pun intended!), including all the boring or unpleasant tasks. If any of these trainees ever find themselves needing care themselves one day, they'll be glad of being surrounded by dedicated people who they can trust and talk to. One or two of your underlings may end up as instructors themselves, so carry on - lay down the rules, and get on with them. You'll soon notice the ones who don't make the grade, or who carry out their jobs irresponsibly. This won't be due to any fault of yours, but to their lack of interest or a precious manner.

[pilvikki]

another thing, don't forget to tell them also that after some years they will know more about some things than many doctors. I, for one, am alive because I had nurses who knew what they were doing.

the trick is to the doctor to see it.

[brandtrn]

THAT is more true that you'll ever know, pilvikki. I STILL fume, all these years later, over a situation which I ran into when having to "float" to a medical unit in a hospital many years ago (at the time, I was working critical care). A patient I was caring for had been admitted with "pneumonia," and the nurse reporting off to me had informed me of an increase in patient edema (i.e., fluid accumulation and swelling of the extremities) as well as an increase in adventitious breath sounds, but had NOT called the Doc, because it was Sunday and this particular Doc had a tendency of bitching nurses out who called him on the weekends. I took ONE look at said patient and, after noticing all that edema AND, after listening to that poor guy's junky-sounding lungs, STOPPED his IV fluids (he was getting 125 ml./hr. AND was obviously in fluid volume overload, undoubtedly as a result of congestive heart failure) and paged the Doc, multiple times before I finally got an answer. When he called back, I gave him the results of my assessment, informed him of what I suspected, and ASKED him for orders to stop the IV fluids (which I'd done, already), along with a few tests (i.e., some labs, a chest x-ray, etc.) to confirm my suspicions, and for some IV Lasix to help get some of the fluid out of this poor guy's body. THIS bastard did everything he could to ream me a new a**hole, called me names, insulted my intelligence and went out of his way to point out that, since I am NOT a physician, I was in no way qualified to mess with his diagnosis (i.e., the so-called "pneumonia" which the patient had been admitted for). I basically informed him that there was NO WAY that I was required to take such verbal abuse from anyone over the telephone and, if he did not want to give me any orders, I was going to hang up and call the medical director because, perhaps, HE might actually be interested in delivering "quality" patient care. I then hung up on him. He immediately called me back, GAVE me all of the orders I'd asked for and, after the test results came back confirming my suspicions (yes, the guy WAS in CHF!) AND after the patient had peed off more than a gallon of fluid in the meantime and his breathing became much easier, actually came into the hospital and offered me an apology...

[pilvikki]

yikes! the poor guy would have blown up - in more ways than one!

it's bloody annoying that so much money, time and work has been put into becoming a healer, and then have one turn into a deity in their own eyes. one who cannot do anything wrong and shall not be questioned. I HATE it when I run into one of those!

of course... scraping and kow-towing is quite against my nature, so...

[Icey]

After having been in hospital for several days, I was pleasantly surprised by how even our consultants listen to their patients, but sometimes feel as though it's alright to talk down to "lesser" members of staff. It's not right at all, and in the UK at least, there's now a drive on for those qualified to teach, who deliberately place mistakes before their students, to see who questions them - or who might even dare! I think this's a good idea.

We all praise those who manage to help us, but these top doctors and surgeons aren't the little gods which they once saw themselves as. There WAS one gross person a few days back though. He was supporting our junior doctors' strike, but likened his underlings to "trolley tarts", which was totally out of order, and very offensive to those starting out in the profession. That sort want to find work more suitable to their egotistic personalities - maybe as MPs? : )

[pilvikki]

can't stand snooty people regardless of their profession, but those in the "helping" professions, doctors, cops, clergy really ought to behave with some dignity.

but it doesn't matter as they'd be the same in whatever career they chose...

MP's... a good one!

[Icey]

I think you're right, but certain professions seems to draw a certain type of person into their ranks. Until recently - doctors, judges, even some teachers. Just because they have the intelligence to pass the necessary exams for their jobs, I don't think it makes them superior beings, but they like to think so.