Friday, September 2, 2011

Nurses and Nursing Assistants: Can’t We All Just Get Along?

The working relationship between nurses and nursing assistants can be touchy – in practice and in discussion.

I remember some years ago, as both a student and a new grad, that directing nursing assistants (also called patient care technicians or associate care providers), was a job for which I was probably unprepared. Most of the NAs were older and had been on the units much longer than I. Although their education levels were lower than mine, the NAs were long on experience in many areas. They knew how to be efficient and sometimes I interpreted this as being uncaring.

Another difference: I was young and single, and like most of my fellow grads, had few responsibilities. Most of the NAs, on the other hand, were older than I by a decade or more and had families to support, often alone. (All were women.)

I could sum up the whole situation by saying that, early in my nursing career I was pretty uncomfortable being in charge. I tried to hide my insecurities, and don’t know whether I was successful or not (probably not). It took perhaps a year or so before I developed enough confidence and gained enough of their trust to be an effective team leader.

I’m sure I wasn’t the only new nurse who felt that way, but none of us ever admitted our feelings of inadequacy or discussed the RN–NA relationship or how to make it better. I’m not even sure that we could have articulated the problem, but from what I’ve heard and read from other nurses like Palma D. Iacovitti, MBA, BSN, RN, “building strong professional relationships between these two roles remain a tussle.”

“Nurses have always felt, and still do, that their counterpart, nursing assistants, can't do their job,” writes the nurse manager of Transplant Surgical Services at Mayo Clinic Florida in Jacksonville, whose article appeared recently on “The flip side to this debate is nursing assistants have the impression that nurses don't want to do theirs. Here the battle begins.”

Iacovitti suggests that an open dialogue between the two groups is the first step to changing the RN–NA relationship. The dialogue must take place in a safe environment and RNs must understand that the NAs seek encouragement, guidance, acceptance and trust. She also points out that nursing assistants want to be part of the solution, not the problem.

As a postscript to this blog, I’d like to note that some years ago I was a patient for more than a month on an orthopedic unit. The best care I received was from a nursing assistant who I mistook for an RN because of her skill in caring for me – and her confidence in doing so. I requested that she be assigned to me and worried on her days off. It was a good lesson on how important experience can be.

What is the RN–NA culture like at your workplace? Do you think it is as good as it can be or is there room for improvement?

What are some of the positive and negative aspects of the RN–NA relationship at your workplace?

If you held an RN–NA “summit,” what would the agenda look like?

Tell us what you think.

1 comment:

valerie-kowal said...

Hi Eloise. I think the relationship between CNA and RN are strained at best. I agree that there should be a talk about this so we can all work better together.