By Sheena Jones, who attends Dutchess Community College and lives in Beacon, NY
hourglass 4/graymalkn, via Flickr
So I’m a young nurse, one of the youngest in my facility. I used to be a nurse’s aide; now I’m an LPN in training to be an RN. It’s very difficult when the aides are either the same age as me or old enough to be my grandmother.
What do you tell a 19-year-old aide who just got mandated for a second shift on a Saturday evening and who is texting all shift but getting her work done? Do you tell her to put it away, knowing that you would be doing the same thing if you were still a young aide and had already gone the extra mile to check that all the patients were safe and happy?
What do you tell the 57-year-old aide who is always the last one struggling to finish her assignment because she can’t keep up? She can’t get her two baths done plus get the other eight residents washed and in bed by 10 pm, even though everyone else is done by 8:30 pm. Do you tell her to hurry up and finish? Do you send the frustrated younger aide to finish her assignment, and call it ‘teamwork’? Who wants to do extra work?
This is the situation I face every couple of weekends. I’ve tried changing the aide assignments to make the older aide’s workload easier, but she just can’t seem to work fast enough no matter what I do. I have a frustrated younger aide who always finishes her own assignment and half of the older woman’s. I even help put some of the older aide’s patients to bed, and then I’m behind on my medication rounds. As a facility, we’re short on help most weekends, snowstorms, and holidays—and everyone is frustrated when they arrive and learn they are mandated by law to stay another shift for the safety of the residents.
As a young nurse, do I tell the 19-year-old who is doing her job to do extra, or do I tell the lady who is old enough to be my grandmother and has been working as an aide longer than I’ve been alive to work harder?
These young supervisors and aides need to realize that someday they will be in this older woman’s shoes. Respect the experience, have her be a trainer or split the workload differently so that the older woman has more patients but less physical work, with the younger one doing the physical work. Have them work together on some of the patients this way. Put her to work shadowing new hires and training as they go. Perhaps she could assist the younger one in countless ways as the younger one is moving the patient, simply by steadying the patient, locking wheelchair wheels, etc. These types of solutions must be looked into more and more with an aging population of employees. Replacing them with newer ones is NOT the answer, especially for patients who lose the benefit of experience and common sense from aides who have forgotten more than these new aides (or supervisors) know about nursing care.
GET OFF YOUR CELL PHONE while on duty. You aren’t paid to be focusing on anything but PATIENT CARE. Nurses who lie to themselves and think they are above it all in being able to multi-task, aka texting while working, are fooling themselves. In NO way is anyone fully focused on patient care when you are consumed with chronic texting to your boyfriend or friends while on duty as a nurse. There is ALWAYS something to do while on duty. Your patients may need a bath. May need toe nails clipped. Hair washed. Charts reviewed. Notes reviewed. You could be doing research on what better ways the patient can be treated and suggest this to doctor. You can give the patient a massage. MONITOR pt’s for side effects of drugs and if you don’t know what they are get on your cell phone and look it up instead of chatting with your buddies or boyfriend. Offer a drink of water. THINK about patient, get off that damn cell phone. A nurse who will go far and stand out above all others is one whose mind is focused on the patient, not defending their use of texting because they’re young, hip and well, can get it all done. Oh please.
I managed w/this difficult situation. The older aide was 80 years old, and w/obvious medical issues such as shortness of breath, forgetfulness, and she was unable to keep up w/tasks. The younger aides and nurses loved her dearly, she was a wise and wonderful woman w/many years of experience, but she was no longer a capable worker. The other staff members had to do extra work during full shifts that were regularly exhausting. A 20 year old providing similar work would have been fired. There was no happy ending. She eventually fell and sustained a fracture that prevented her from returning to work.
I might also add this occurred in a hospice inpatient unit. I am surprised to see a number of comments assume hospice work is easy. It is backbreaking. While thorough tender care is the expectation it often comes at a price for the professionals that give above and beyond. I sent many a perspective employee away from a job interview when I heard them say they were looking for a low stress job. Anyone who thinks hospice and home care are low stress jobs has not worked in such positions.
I learned my basic nursing skills from an older nurse’s aide back in the mid 1970’s. I was twenty years old, newly married and earning $1.76 per hour on the 11-7 shift. I was lucky enough to be placed on a floor who was staffed by aides in their 50’s and 60’s. We had one LPN who covered the entire house of 186 patients. I was expected to learn everything I could from these ladies and I certainly did. I learned how to turn and position patients without breaking my back and hurting the patient, I learned how to do a bed bath and bed shampoo that left the patient sleeping deeply. I learned to observe the patient from one rounding to the next-Is there something different? What is different? I learned nursing skills from these ladies, that I use every shift. Sure I was much younger, and you might say with fresher legs and stronger back-but I absorbed or tried to absorb everything they thought I should know. This young CNA is missing valuable learning time with the older nurse. Why can’t they work together as a team ? Both would benefit, sure the younger aide may be faster with physical work, but the older aide may be able to teach her how to position, how to observe her patients. She has experienced a lot more in her years of nursing than the young aide and she should be willing to share and teach. Texting and using cell phones while on the job is not professional-how does the patient or family know that the aide is not photographing or laughing about the patient. That happened locally with two aides photographing nude patients and sending to friends-they both lost their crediatials and the nursing home was fined. I recently had a student nurse texting while I was trying to teach her how to stage pressure ulcers-I sent her back to her instructor.
There is not need to contact a person at work unless there is urgent need for a person to be contacted. If there is, then call the place of work and ask for the person, explaining it is urgent. Calling to ask someone to bring home a qt of milk is not. Turn off the phone and leave it in your purse or pocket until the end of the shift-then you can check to see what all you have missed in 8 or twelve hours.
The women in questions are aides, not RNs. That is definitely going to affect options – these are jobs that are primarily physical. I think Carolyn has the right idea that this older aide should probably be transitioning to lighter work in home health or hospice where her experience would be valuable and her body less taxed. My guess is that she wouldn’t want to take the cut in hourly wage, but don’t we all face not getting paid for jobs we can’t do?
As a RN for more than 25 years and a owner of a medical company I am willing to put my 2 sense in here. I think your young aide does not show as much compassion as she could be showing under the right direction/ guidance. There are so many TLC things that she could be doing for her patients as well as co-workers. One day she may need the return help or TLC. I do not pay my employees to text during working hours and at 19 she should not be managing kids homework and things so I would assume it is friends. There are many things that the older nurse can do if she can no longer keep up but if she gets her job done by the end of her shift and patients are well taken care of then I don’t see a problem with the timing. You can always make the suggestion of caring for patients in a different scenario where the work load is lighter like home care and hospice areas. It takes all of us working together to care for the elderly who are sick and do so with compassion.
I guess if we acted this scenario I’d be the 50-something RN w/ health problems who misses a lot of work (legitimately, due to serious health problems) but cannot afford to retire yet.
I’m less concerned about the texting if the young aide has done all her work and gets up as soon as she is needed. What is difference between that and nurses, aides etc I knew in the past who read, crocheted, talked on the phone, did crossword puzzles etc after their work was caught up? I think some of shock/horror about the texting is out of proportion, and it’s because it’s a young person’s “thing” and strange to many of us.
Back to the older nurse….I have found out, using both our Union (thank God we have one) and a lawyer: a person CANNOT be fired for health issues. And why can’t administration try to find her something that uses her brain and experience and not her muscles? Just curious. So much in nursing is locked in a box. Because “its always done this way”. I bet the older nurse put in many years of hard backbreaking work, “paid her dues” so to speak, whether in that facility or others….why not use her in a new creative way. Patient teaching…case managing (they CAN be RN’s, not just social workers) etc so she can keep her dignity and a job and still be useful to the facility, but not as a lifter/puller/pusher/ transporter just because “otherwise it’s not fair”.
She should be advised by friends to look into the ADA (American Disabilities law), the union, if there is one, and a lawyer as a last resort….she should NOT be mistreated, harassed, gossiped about, and made to feel old and useless because she is now older and likely has health problems, often work related ( I have bulging discs, etc as well as some medical issues).
We had a YOUNG RN where I worked previously, who developed cancer. People fell all over themselves, as they should have, to donate leave, to “wink” at her coming in late/ leaving early etc while she was undergoing chemo (she had young kids too). I think part of that was that the other younger nurses could IDENTIFY w/ her, and her kids, the fact she might die, etc. However, its harder to identify w/ a 50-60 yr old nurse w/ health issues that may be invisible. More and more RN’s will be “older” soon, as the whole demographic changes in the U.S. Facilities HAVE to learn how to work with them, and not just try to get rid of them.
In 1977 when I was 19, I had aide training in a geriactic hospital. We had to do full a.m. care on 8 to 10 patients. We had to have our patients up & out of bed by 10:30 a.m. & everything else done by noon. That meant passing out the food trays, feeding the patients, dressing, giving bed baths, putting on topical medications, giving suppositories, bladder medicine instillations, positioning, making every bed everyday, regardless if it needed it or not, transporting patients to different hospital departments, paper charting, etc. etc. etc. Any way, I had a hard time keeping up & I did not get help. Guess what-I got one warning to get it together or I was history. Well, I just could not keep up with the work & I was let go. I was devasted. Now I am a nursing student & I volunteer on a cardiac med/surg ward & am so glad to see the RN’s & aides working as a team & that many of the jobs I did as an aide are now done by different hospital departments. The aides & RN’s are not ran ragged everyday & I feel the patients are receiving better care because of it.
i thing were should be learn all think as a nurse although were still young
Texting at work!!! Not allowed where I work. You’re being paid to work, not to socialise with mates via text messages. But we don’t chat at the nurses station either. Obviously where this happens there are higher nurse-patient ratios than we have.
Team work is about working together. The first thing I’d do is ask the older aide why she is having trouble doing her allocated duties. At least it will give you a chance to talk about it in a non-confrontational way.http://shadesofgreynursing.blogspot.com/
Sheena’s post has us considering how the actual physical, time-consuming labor is divided. Not long ago, I was charge nurse on the evening shift in the healthcare center of a retirement facility. I’m putting myself right now into Sheena’s shoes. I can picture it all: the snowstorm, the short-staffed weekend, the mandate, the double shifts. I’m putting a face on the older, slower-moving aide: She’s the one with forty years experience who taught me a great deal about what we used to call “P.M. Care,” and one thing she taught me is that it takes time to do it right. I’m also putting a face on the younger one with the cell phone: She’s the valuable hard worker, doing double shifts not only because she’s mandated, but also because she has the energy for it and needs the pay, because she has kids (It’s the kids she texting all evening, until they get their homework done and go to bed.) I would like to encourage Sheena, and praise her for thinking about these two aides as individuals. Because the real issue here is the short staffing and the de-valuing of the physical labor. The shortcomings of these two team members have come to light in no small part because they are under stress: lots to get done at the bedside, too little time. As for the patients, waiting for P.M. Care (It once included a good backrub, an excellent time for assessment), I can picture them too. With regrets.
The solutions mentioned above seem like great ways to lose a really productive young worker. There are plenty of places who would love to high an effective aide who goes the extra mile for her patients. Asking her to pick up the slack for another employee who can no longer perform her core job functions isn’t fair. Teamwork certainly is a value but it requires that all employees be giving and taking. What is the older aide bringing to the table that balances her foisting her assigned work onto others?
At 30 I’m somewhat on the generational fence with this, but I’m not sure why using her cellphone is significantly different than chatting with other nursing staff at the nurses’ station – something I’m pretty sure is allowed.
Editor’s note: we should have clarified this up front, but since the time of writing, the author no longer works at this facility.
“You should talk to them together to determine a solution. Hopefully the younger nurse will work more closely with the older nurse and vice-versa. When I was an aide, I made sure the older nurses were ok bc the work load is tough and I knew I could handle it better. Nursing is a job that require compassion. If you don’t have it, don’t do it”
I second that Lily I can’t say it better. And for a 58 year old nurse bathing 2 and washing 8 patiënts before 10 is a lot. So more work closey is very much wellcome here.
Texting during your shift?? Not possible. Only when work is completely done.
Nora ( The Hague,Netherlands)
This is a performance evaluation issue, not a personal, age-related issue. If the facility has a policy preventing the use of cell-phones and texting while on duty, simply enforce the policy. If it does not, your hands are tied. Request one from the administration as it will become an issue if a resident is injured or expires and it can be tracked back to employee distraction while using a phone or texting on duty.
Annual performance appraisals are not the time to inform an employee that he or she is not working up to standard. In this case, setting a monthly improvement goal and evaluation may be more appropriate. If the employee can not meet the short-term goal, use the facility-approved guidelines to keep the employee informed, as well as supervisors and Human Resources that he or she is not meeting the standard.
The important thing to remember is that this is not a personal or personality matter. This is job performance. Take a deep breath. Get advice from Human Resources. Document clearly what you have said and done. Be polite to the employee and explain clearly the steps in the process, in writing. Leadership is a tough job, but treating each employee fairly and with respect will earn you the respect you deserve, no matter anyone’s age.
Correction… nursing is a profession…although some days it can feel like a job 😉
You should talk to them together to determine a solution. Hopefully the younger nurse will work more closely with the older nurse and vice-versa. When I was an aide, I made sure the older nurses were ok bc the work load is tough and I knew I could handle it better. Nursing is a job that require compassion. If you don’t have it, don’t do it.