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Rookie Wit & Wisdom
Young Nurse Struggles with Experienced PCTs

I am a brand-new nurse--just two weeks off orientation. I am 20 years old but look a few years younger. I have had issues with two PCTs who are probably in their 50s, and have worked together on my floor for about 30 years. I haven't had issues with any of the other PCTs.

One issue: They feel insulted if I ask them if they did something. Of course I trust them--I'm just checking because SOMETIMES (especially with my post-op patients who need vitals a lot) things get left undone/uncharted. And that reflects on ME.

So I check nicely. One of these PCTs told me that it did not matter how nicely I asked. It was that I asked at all.

Another issue: When a pt needs medicine, they come find me and tell me and I appreciate it. But if a pt needs to be changed and another pt is crashing on me, or I just plain need help changing the pt because they are heavy, they feel insulted. Like I feel such work is beneath me and I expect them to drop what they are doing.

I clean up plenty of poop and feed patients without ever bothering the PCTs. Don't they WANT to know what is going on?

They say, "Don't you trust us to make our rounds?

I want to say, " Well, yeah, but you can't catch everything on a round.” But I can't say it because I don't want to seem like an arrogant new grad.

This hospital has a very high new hire turnover rate, and we already had a new grad on this floor quit after only three or four weeks on orientation. The hospital is always having me meet with people who ask what they can do to keep new graduates. But I really can't say that you need to ask your PCTs not to say things like "You would never make it in a big city hospital," or "If you need that much help, you can't handle your patient load so you should work somewhere else." Coming from someone who could be my mom, it really hurts.

Not sure: Am I doing the wrong things? Is it that I am young? New? White? (Both these PCTS are African-American.)

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26 Responses to “Young Nurse Struggles with Experienced PCTs”

  1. PMRN Says:

    That’s rough. At most of my clinical sites the PCTs were excellent, and it really makes a huge difference.

    I’d discuss your concerns with the unit manager or charge nurse or whoever you have around. It’s important to get feed back and learn from everybody, but you shouldn’t necessarily be expected to deal with coworkers being rude to you right off the bat, and hopefully whoever is responsible for making sure that the unit runs smoothly will be interested in what you have to say.

    Dealing with people is tricky. It’s not always obvious to ourselves how we seem to other people, especially when we’re telling people to do things.

    Trusting communication alone is tricky business. You don’t have to figure out if they’re getting their work done by asking them, you can check by helping them out and doing things along with them, and then checking the patients -yourself- while they’re not in the room. Asking them if they’ve done it or not is pointless, unless you -already know the answer-, or you’re comfortable enough together to be able to ask without the person getting offended. Doing it off the bat might not work, unless you already know the answer.

  2. Strong One Says:

    All the above!
    It’s unfortunate, but can be common.
    This is where you stand your ground and explain to them and everyone else who has this problem with you, that you are here.. you are all here to do the very best job we can to take care of the patient.
    Communication is the foundation of great team work.
    I would think they would be upset if you did not communicate with them.
    They all need to get over themselves and learn that you are here to work ‘with’ them.
    Don’t take any crap.
    Stand your ground and do the job you were hired to do.
    Best of luck.

  3. brickwall Says:

    It’s your job to check up on your patients, which means assessing vital signs, and making sure your patients are voiding, and not developing pressure ulcers after sitting in stool or urine for an hour. Please remind these people of their job description, after all it’s your license on the line, if you didn’t follow up, you wouldn’t be doing your job. It shouldn’t be an insult to them, if they fully understand a nurses job description and level of responsibility that comes along with it. As long as your helping them out when you can, they should also respectfully do their job as well, without havng to be asked.

  4. Karin RN Says:

    That kind of talk should not be tolerated at all in my mind, inappropriate. Report it to your supervisor. It seems that they do not respect you as a coworker. Also, there is nothing wrong with asking for help, checking, or delegating tasks to PCTs. As an RN, those are your responsibilities. Good luck to you.

  5. Mr Ian Says:

    Hi Rachel,
    To be honest, it sounds like they’re giving you the standard ‘breaking in’ that any nurse new to them is going to get. Partly it may be that they don’t like being questioned on their work and especially by a younger and newly graduated nurse. Unfortunately that is too bad for them.
    It could be that they’re just testing you out to see how good you are and if you’re going to go the distance.
    You say these two have worked together for about 30 years on that floor – I’d hope they know their job by now and would pretty much think they do. It doesn’t sound as if their work quality is of any concern, like they’re not doing their job, and so taking a complaint to management about two long serving PCTs who are doing their job not giving you enough respect might just come across as a little “precious”. (No offence)
    You also say the hospital has a high new hire turn over rate – well these two have stuck at it for 30 years and they’ve probably had their share of new nurses coming in and being ‘in charge’. Perhaps you’re their 4th this year. Who knows?

    These two don’t sound like they’re slackers or bad PCTs – but they’re probably more bothered by having to ‘induct’ another new nurse and prove themselves every time.

    At the end – you remain accountable but you’re responsible for running this as a team. I’d try to get them on side a little and take the time to have a 5 minute chat with them and tell them –
    “I’m new and I’m here to stay.
    I know your experience is far greater than mine but I remain accountable for the work being done.
    I’m still getting the hang of that part and especially on how to work with others like yourselves who are more experienced.
    But I do have to be accountable and I’d appreciate your tolerance while I get used to the role. In the meantime, if you’ve got any advice for me on how I might be going or if you can help me to ease into the role better then the sooner I can get used to this and keep things running smoothly”.

    Being a good team leader is not about keeping on top of everyone – it’s more keeping everyone up on the same level as a team.

  6. brickwall Says:

    it sounds like she was doing her job, and following up on delegated tasks appropiately. Being a good team leader and keeping members of the team informed is important, but team members work ethics and attitudes can make or break outcomes of patient care. if the pct has not yet documented the vs, I&O, etc.., then you have every right to follow up, and also to check on the patients yourself, they should not feel insulted. In the end you are held accountable.

  7. Mr Ian Says:

    I’m deeply intrigued how some places still haven’t moved on from the Florence Nightingale premis of nursing as requiring military order.

    These are people all working together to perform a single job and with all this pervasive ‘dictatum’ of nurses over all their juniors – is it any wonder nurses have such a hard time getting on par with doctors? Nurses seem to propagate the same behaviour amongst their teams that they complain about when doctors do it to them.


  8. Male Nurse Jamie Says:

    Number one, once you take the patient you are responsible and liable for every part of their care during the course of your shift, even that of the PCT’s, and whether one nurse asks them to do something different than another is of no consequence as you may provide care differently but within the realm of competence…the PCT’s are there to provide the care as you see fit…let them know tactfully you dont work on their time and they are your assistants…and to Mr Ian yes dictatum is appropriate without it things are left undone, or worse overlooked…Your license to practice is based on the fact that you have the knowledge and know how, and that you use it…

  9. Mr Ian Says:

    But we’re not talking about clinical skill or professional liability – and with all the respect in the world to Rachel who is only 2 weeks grad – we’re talking about an ability to run a (small) team effectively.

    There is presumption that these two PCTs with 60 years experience between them don’t do their job properly because they don’t report or behave as Rachel might like. This is indeed an issue but I argue the resolution is not for the RN to assert authority over someone as a first line approach.

    That’s like giving morphine for a headache.
    When it becomes seriously challenging or compromises safety in a real way – then it has to be done. But there are many other approaches before taking the authority assertion route and I’ll tell you why this should be done.

    This is something that nurse training repeatedly fails to address – we’re all happy as students working under a Q nurse and doing our clinical thing. But when we get fresh out onto the floor – what training or guidance has been given in team leadership? Or on being a ‘senior’ to ‘juniors’? IME very little.

    I accept the lawful predicament of the nurse – but the answers are, and so much like nursing and other health care solutions, all about the here and now and taking a hammer to crack a walnut and don’t consider the bigger picture.

    “Nurses eat their young” is a phrase I read and hear repeatedly on here and other sites.

    Now, everyone telling Rachel it is her responsibility to assert her authority over her junior staff is telling her to behave as if to ‘eat her young’ – or juniors.

    Yet we despise and decry this when it comes to senior nurses doing it to junior nurses.
    We also complain when doctors do it to us.

    There is no logical flow to the argument to resolve all the issues by being confrontational where it suits and compassionate where it disaffects us.

    I’m happy whatever gets decided – as long as something is decided and it remains consistent.

    But you can’t have it all ways and the logical consistency needs to be considered.

  10. brickwall Says:

    honey, being afraid of inadvertentaly insulting an older more experienced technician, doctor, or nurse with 30 plus years experience won’t save you in a medical malpractic suit. Do you think a jury or judge cares about how long someone has worked somewhere when someone suffered a negative out come.. .NO! Assuming someone did there job based on their years of experience is crazy, after all we are all human and make mistakes, things get missed, and people forget. Nurses must be vigilent in every aspect of care, sorry but I still think she should stand her ground. These are people lives we are talking about, and it should be taken very seriously. Stepping on toes is unpleasant but necessary at times.

  11. anikac321 Says:

    I feel offended. What does being African American or White have to do with this scenario?

    I am 19 yrs old and I currently work as a PCT while pursuing my BSN. I work in a nursing home and pier diem in a hospital and notice that the same situation happens in both places amongst co-workers of different ages and races.

    I understand that you are a new nurse who is cautious when practicing. However, when you are faced with people who have been working as a nurse’s aide for such a long time, they start to feel annoyed when you start to question their line of work. The same thing goes for nurses when they work with resident doctors. It has nothing to do with race, gender, or age. Just reassure your co-workers that you don’t mean to be an annoyance (which are thought of from new nurses)but you are just following up on the status of your patients.

  12. riiiight Says:

    “mr. Ian” likes to argue anything and everything possible, using vague language and big words but not really saying much.

    BE more vocal about what you have done for them.
    Say, “Hey I just cleaned up mr whoever. Would you mind getting him back into bed so I can go give this pain medication?”
    Say thank you .
    It will get better. It is always like that at the beginning, till they realize your a team player too.
    It probably just gets annoying to have a slew of young inexperienced nurses telling them what to do. They probably know a lot about the unit and even about the patients. They are treated poorly and have a sometimes thankless job. They are just taking it out on you because you are new.

    I don’t think asking for from your Aids necessarily parallels to how Doctors treat nurses. Aids are working directly under your license. They have NO independent functions or assessment skills- like nurses and MD’s. They are doing directly delegated tasks. And you have to follow up on that. And if an aid is insubordinate- since in THEIR JOB Description it says we supervise them, at least at every hospital I have ever been at- Main authority resides with the nurse in these cases and managers should support you .

  13. Mr Ian Says:

    hmm… I did leave a reply but it seems to have escaped into the ether. So here’s another one.

    brickwall – sweetheart – why is it that every time something does not go strictly to plan that a patients dies and/or a nurse loses their license?
    Lets keep it real here. There is no suggestion from Rachel’s post that these nurses are actually failing in their job. Their attitude – perhaps yes, but a patient does not die from a grumpy nurse.

    Further – this scaremongering tactic does nothing to support Rachel in her role.
    The reality is – she is a 2 week new grad nurse given responsibility for managing a team of 2 PCTs that are giving her difficulty.
    Rachel is here asking advice presumably because the support she needs is not readily available at work. If either of these two PCTs should fail to advise her and heaven forbid something happens as a result of this concern Rachel raises – if I were in that position I would be asking:
    1. Where was my role preceptor?
    2. What management plans were agreed or put in place in order to ease into the role?
    3. Who was responsible for supervising and supporting the transition from novice to beginner?
    4. What monitoring and feedback processes were being used to review the transition?
    5. What process was being used by the clinical leader when delegating tasks and teams to this junior?

    See, nurses may be accountable, but this remains at all levels and also applies to managers who employ a new grad nurse, to ensure they have the skills and abilities, or the opportunity to acquire them along the way.
    As I said – team management is not a student nurse activity and as such managers are responsible for ensuring this skill is acquired in as comfortable a time as possible.
    If they’ve just stuck a new grad nurse out there on the floor and expect them to be expert in all areas – then they are asking for trouble.

    anikac – I share your sentiments.

    You make an ad hominem attack on me suggesting I don’t say much – then you paraphrase my whole argument in the next paragraph. Ending with a thought on how nursing aides have no independent function or assessment skills – which makes me wonder how you manage your aides if you are having to constantly tell them what to do, supervise them and they aren’t able to tell when a patient needs a nurse.
    Your suggestion that aides do not work independently or even make assessments is ludicrous. They may not work at the same level of clinical complexity as nurses – but they are not idiots and their whole raison d’etre is to provide the nurse with an extra set of eyes, ears and hands.
    A doctor may be held liable for any detriment in patient treatment. A doctor places trust in a nurse to do their job competently.
    Nurses cannot do this for aides?
    Again, this is not a clinical matter – this is a team work matter (with potentially clinical implications) and it does not require an authoritarian approach to deal with it.
    It requires use of good inter-personal skills to get the team on side.

  14. brickwall Says:

    dude, the point of the story is this, the new nurse is being hassled by overly experienced CNAs because she is a new nurse and new to this floor. This so called hazing (breaking in treatment) is stupid, non-productive, and pathetic. This happens to new CNA, New nurses, and new doctors, by their peers. Obviously this girl is intellegent enough to be polite in asking for their assistance, but was still met with insulted remark by the tech who felt this was a blow to her ego on how she performs her job, clearly she is carrying the huge chip on her shoulder.

  15. brickwall Says:

    p.s. I am not trying to an insult anyones intellegence here, or the ability to perform functions of their practice, whether it be cna, nurses, or doctors. All members of the health care team are important and vital to good patient outcomes. Unfortunately, we work in health care, and our jobs are of the utmost importance, and everyone needs to be on the same page, with out all the hidden agendas. Technicians are very important, but just like certain nurses, MD, and techs, all do not perform on the same level, so you can not generalize people and how they perform specifically, and assume that everyone will perform their job to the standard required to perform safe patient care. Following up on delegating tasks is appropriate, doctors check up on their patients too. Please the attitudes must be dropped to avoid negative pt outcomes.

  16. katie Says:

    As a PCT (student nurse) who will soon be a new grad in april, I understand where YOU are coming from. If i was working as a PCT, and maybe it’s because I have this nursing background, but when a nurse ask me about certain things or needs help, whatever, I do understand it falls back on them, so I don’t mind what so ever. So when it comes time for me to be a new nurse and in this situation, I will gladly explain to whatever PCT is giving me a hard time about the legal issue at hand, and if they don’t like it, they shouldn’t be a PCT. As a PCT/student nurse, we are there to HELP the nurse. Not go on our own path.

  17. Mr Ian Says:

    brickwall – dude – matey –
    Your making a lot of assumptions from a little information. But we do agree with the waste of effort these things cause.
    This story relates a time honoured yet hated tradition of nursing – poor inter-staff communication. I’m not saying it’s the RN’s fault – but I’m equally not saying it is the PCTs alone either. Other things need to be considered – but we do agree it is her problem and responsibility.

    If your skills in team work are limited to the direct and heavy approach then I guess it supports my theory that nurses are not trained in team management or interpersonal skills enough.

    I’m not saying the matter doesn’t need to be dealt with – and I agree with the very reasons everyone else gives (tho I am not about to panic over patients dying and losing my license quite so easily).
    What I’m saying tho is it doesn’t need to be dealt with in the recommended aggressive assertive as a first choice.
    And I’m not just being argumentative –
    These two highly experienced PCTs have probably seen it all. They may not tolerate any reproaches well – they’ve already indicated they don’t like being questioned.
    If they feel offended with her assertions – they can easily make her life hell and bang goes another good new nurse.

    Nurses only have one way of dealing with problems and that it to panic and react.
    They don’t consider and respond.

  18. Mr Ian Says:

    The hospital is always having me meet with people who ask what they can do to keep new graduates.

    You can tell them what your issues are – be frank and honest and let them know what annoys you.

    If you want to give them a practical answer to the problem I suggest telling them – new nurses need guidance and support in small team management and how to respond to challenging behaviour from other staff.

  19. jane Says:

    I guess it depends on where you work, in certain units, these minor things like I&OS, VS, and closely monitoring the critically ill/injured or post op patients, yes, lives can be on the line daily, even hourly, minutes even. depending on where you work of course, if you wait for a so called negative outcome God forbid before addressing this issue, your already sol. Handling this issue I guess depends on the nurse, and how they would go about it. Good luck to you.

  20. KAP Says:

    I’ve had adversity among PCT’s and nurses alike. People that have been there a long time feel almost threatened, and I’ve learned that’s normal. I’ve also found that just being respectful and being the one to jump in and help usually does enough to win them over. You have to give respect to earn respect, and that’s especially true as a new grad and a new person on the floor. I’m sure that with experience and time it’ll get better, because you’re all there for the same reason: the patients. Also-you need to explain to them that it’s your job to double check things: you’re the one with the professional liscense that could possibly be revoked/litigated if things dont happen the way they should. Try to be strong: you’re doing the right things 🙂

  21. skagsl Says:

    I’m sure that many of us have been PCT’s before becoming nurses. Both jobs are very stressful and sometimes it’s hard to work together, especially when several patient’s need something at one time. I always find my tech before the shift starts and say, “If you need anything, please don’t hesitate to call. If I can’t help you, I will assist you in finding someone that can”. This let’s them know that you are willing to assist them (which is not always the case. we all know of some nurses who will not lift a finger to help the tech with a bed bath). The PCT’s have been burned by these kind of nurses and may have some preconvieved notions about what you will or will not help them with. Usually, when they realize you are a team player, they will back off, give you the benefit of the doubt, and even request to work for you.

  22. lesleigh32 Says:

    I’ve been both the PCT and the RN. I’ve tried doing all the work myself b/c I remember being the PCT and didn’t like those RN’s that never did anything but order me around. I wanted to be liked by everyone. (Not saying that you’re ordering them around). But I realized that it put me really behind in my work. I then moved onto the asking nicely, assisting when I could and I still met resistance with some of them. After that, in some cases, I had to throw my weight around. I told them that when they were licensed to pass meds and do complicated procedures then I’d be glad to do the vitals and clean up. Sadly, some people will always be threatened by someone above them that is younger. Realize that age doesn’t mean anything. It is your job to delegate and take care of those people.

  23. chaedden Says:

    Well your situations really stinks, as a PCT I was always less busy for nurses who I know would help me or respected me. As a nurse I have a tendency to only ask PCT that I like to help me and those who are just there to get a check I ask to complete tasks, although it does not matter who you are I check to make sure that things are done and are done right because it is my license that they will go after and I am untimely responsible for pt care.
    As a young nurse it does not matter how old your PCT are they still need to respect you and complete tasks asked of them without attitude. I also feel that as a white woman that I am accused of being racist allot, that any time I ask some PCT to complete a task that is not easy or enjoyable that I am racist. When I follow a policy I am also racist which really drives me nuts because I am not my husband is black so come on people.
    Continue to do your job, ask your PCT to do the tasks that you need done, and let the other stuff roll off your back. When it comes to larger problems like tasks not being complete report them to their supervisor.

  24. Amanda, RN Says:

    Hmm, the hospitial wonders why it has such a high turnover of new grad nurses? A two week orientation is hardly enough, IMO.

    With regard to the PCTs, it will get easier. It sounds like your approach is good w/ them. If their response it ‘Just asking is offensive’ then that is their problem…

    If I have a post op patient or a patient on frequent vitals, etc., I’m going to ask them whether they like it or not.
    They shouldn’t be offended; they may think they know it all, but it’s my job to double check that they do know what they are doing.
    If I asked, and they responded, ‘Of course, don’t you think I know my job?”
    My reply would be to the effect of, “I’m sure you know your job, but I’m new and just getting into the swing of mine and will need to checkup on things a little bit more than some of the other more experienced nurses you work with. Can I get those vitals?”
    But that’s just me! Good Luck, you’ll do Great!

  25. Amy Says:

    Sounds like a bad situation. If it was me I would level with them I’d say something like, Look I understand that we both have jobs to do here, I understand that you’re job involves alot of work and you do a great job at what you do, however, its very easy to forget a set of vitals here or there and if it happens I understand but I need you to understand that I am ultimately responsible for the patient and making sure that everything gets charted and I don’t want to lose my job. I try to help out with your tasks and clean patients/take vitals as much as I can, but you’re job is to work with me to take care of patients and when I ask if something was done its not because I think you’re slacking, I’m just making sure it was done so that I can move on.

    I’ve heard nurses on my floor yelling at our techs and that goes badly, but try to let them know you aren’t going to back down and you have the patients best interest at heart and you just want to make sure that your license is safe and the patient is safe.

  26. Ira Says:

    A prenursing degere allows for you to earn the required course work before entering a BSN program at a university.Most jobs health-care related will require you to get some sort of certification, at best you could test to become a CNA. Some doctor’s office’s might hire you as receptionist but they usually prefer Medical Assistants.If you looking to have a job while going to nursing school, I suggest you get certified as CNA, not only will you earn money but you will learn about nursing especially if you work at a hospital and some of that experience will become invaluable during your education.

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