Looooooong rant... Condescending nurse... advice please!

[alkaleidi]

I am finishing my orientation as a new employee in an ER, and over the past couple of weeks I have been working alongside another nurse who, unlike literally everyone else, has not even bothered to do the friendly introduction. I love this place... everyone else has been so nice, helpful, welcoming, and willing to assist/answer questions whenever necessary.

This individual, however, seems to go out of her way to be insulting and condescending. She is a lead occasionally on nights when the other 2 assistant managers are off, and is a nurse practitioner student doing her clinicals at our ER as well. I hate to take this personally, but there is a decent group of established staff that she seems fairly chummy with (though her personality in general is dry and kind of flat/blunted as well), and yet toward me individually she has developed an attitude I've honestly never encountered and can't quite read.

I'm still learning (I'm sure you'll have that as a new ER nurse who's 6 weeks of orientation is, as of today, complete), so obviously I'm a tad slower than the more experienced RNs. Over the past couple weeks, when I have someone who is discharged, she has jumped on the opportunity to grab the chart while I'm finishing something else up and goes in and discharges my patients. I would think she was doing this to help me out in a kind way, however, she's kind of rude and cold to the patients, and when I walk in to see if I can finish up, she abruptly says "No, I did it" and when I show appreciation, genuinely saying things like, "Thanks so much for your help -- I saw the discharge pop up on the screen and was finishing and then had planned to head right in here, but I appreciate you helping me out!" she doesn't have the decency to even say you're welcome -- nothing. She doesn't respond, and then walks away. What on earth?! A few days ago, I had 2 patients -- one of which came in with abd pain and vitals were stable, the other also abd pain but bp was around 100/50. I had been in the stable pt's room around 1945 to give her a pain med, and saw that the bp was going to be taken (by the machine) at 2000 (q2h vitals required in our ER)... I had charted my last set of vitals at like 1810 so I figured I'd just let the machine take the next set at 2000 and I'd come in shortly after and check her pain after the med, and chart the vitals. In the meanwhile, the stable pt went to the bathroom (so she took off the BP cuff), and I was in checking on the other pt and took her BP finding it had dropped to 74/40. While dealing with this pt, I didn't make it in to check on my stable one for about 20 minutes or so, popped my head in and checked to see how her pain was, noticed the BP cuff was off, and didn't check her vitals but went back to do some more stuff with the hypotensive pt. When I finished, I went to the nurse's station to print off some things for the more stable pt that was going to be admitted, and as I was getting ready to go in her room to get a set of vitals prior to calling report, this nurse addresses me in front of several nurses and ER docs, saying, "Well Amanda since you haven't gotten a set of vitals on your patient in room 10 in god only knows how long, why don't you just call report so we can get her out of here?" Where this came from, or why she had nothing better to do than to check my charting, I have no idea. She wasn't lead, and we were pretty busy so I'm sure she could have been helping someone or taken one of however many admits were rolling in.

I blew off the remark, despite the fact that she was obviously trying to make me look bad in front of the other staff standing or sitting around, and continued doing what I had planned. At that time it was about 2100, so my patient went 3 instead of 2 hours without a set of vitals. I realize I screwed up by not going in exactly every 2 hours or less and physically making sure the patient was hooked up to the vitals machine, and that's my bad, but I guess I prioritized making sure my other patient didn't bottom out completely ahead of a set of routine vitals on a stable patient.

So after I call report on my stable pt that was admitted, I very casually mention to her what happened (why I didn't have my 2-hr vitals in for the last set), and I get a very motherly, "Well, we can't always rely on machines, can we? Patients do some funny things, but this is why you need to check on your patients every two hours," and on and on talking to me like I was a 6 year old child.

Today, she jumped on one of my discharges literally within a few minutes of the discharge being put in the computer and rx/instructions being printed off by the doc. The patient was spanish-speaking and the translator was gone, so the only other people in the room were his mother and wife (both also only spanish-speaking). I had done fine with him his entire stay due to my being able to speak pretty decent spanish, and was looking forward to discharging him so I could make sure they understood everything. She went in and when I came in, the same cold detached attitude, and in english -- how can you stand there and have someone talking to you in spanish and not even stop and think maybe you should have someone there who can understand the patient to know if they have questions or even understand the instructions for when they go home???

Then while I was drawing blood/starting an IV/giving insulin to a new pt LATER, she calls on the overhead pager for me -- I hit the call light in the room because I'm trying to get the J-loop connected and fill the tubes with blood... she tells me I have a new patient in room 2. I say "Ok, thanks -- I still need to finish up in here" and *click*. I quickly finish what I'm doing (maybe 5-10 minutes including assessment, answering questions, sending stuff to lab), and go to room 2 to find my new patient has tears rolling down her face crying, unable to breathe, clearly stating she can't breathe, O2 sat is 87% with 2L of O2, and she's standing there over the pt trying to get the pt to hold a thermometer in her mouth for a temp (when the pt is clearly VERY SOB, gasping and bawling and then trying to keep her mouth shut for the temp to take)....

And she'd been in there since the patient arrived and had been standing there waiting for me, when she could have been triaging the patient and maybe putting a non-rebreather on her or calling respiratory for a neb?

I'm just floored. I really don't like working with this chick, and part of me would like to just ignore her and hope whatever this issue is will go away... but I'm afraid it won't. The other part of me would like to flat out confront her and ask her what her problem is -- whether she's always this condescending and degrading, or if she just has a personal issue with me individually (and if so, what on earth IS it?!). The other little hidden "I used to be a prison nurse" part of me wants to go all out gangsta and tell her to get off my freaking back! But, I am out on parole and now in a position where customer service and nicey-niceness are priority. So, the prison nurse has been tucked away. LOL.

I know this is a SUPER long rant, but I am so frustrated... I hate being treated like that, and in another situation I would definitely be uber-assertive (borderline aggressive) and not tolerate this at all, but being a new employee, not knowing who I can talk to in confidence and who belongs to what clique, I am just being the passive new RN.

This woman is just another staff RN, and on occasion she acts as lead when the 2 assistant managers (who both work 7p-7a) are off, so she works as lead 1 day a week... the other days she works, like tonight, she's just another RN like the rest of us, but oddly enough she doesn't take patients for what seems like forever. Tonight she spent the majority of the night (when she wasn't a thorn in my side) sitting next to the lead RN, took NO patients from 7pm all the way up until 1am when I left... I just don't get it -- 6 hours of playing lead when we already have a lead? What gives?!

How do I address this? I don't think she's going to be receptive of me taking her aside in private and asking if there's something I'm doing wrong or if I've done something to offend her (seeing as how we've never had a conversation outside of my team of patients I don't know how that's possible)..... should I mention this to my nurse manager or one of the mentors for us new employees? At least now I've vented to you guys -- I got 90% of my frustration out -- now I just have to take the other 10% and resolve the issue at work!

Thanks for listening! Even if no one listened, at least it's all typed out and I can rest without being irritated by this tonight!

-A

[loricatus]

My goodness! This is deplorable behavior, but oh so common.

Not much you can do except to confront her back when she make remarks in front of others. I can tell you that the good nurses already know what she is doing and choose to stay out of it. What you have to worry about is the patients and those that do not know what she does, here her put downs. If you confront her back with statements like "You should know when the last set of vitals were taken because I had to put back my patient's cuff after you took it off and never put back it back on" "Great lesson you are teaching a new nurse, do nothing while you stand at a patient's bedside just to watch them suffer in pain and gasping for every breath so you could obtain a chance to insult and belittle me in front of that patient"

If you assert yourself in front of others, she should pick and chose her battles a little more cautiously. Oh, another thing to remember is: smile while you make the statements back to her because you didn't mean anything more by what you were saying than what she was meaning to imply to you.

[jojotoo, RN]

I'm probably going to make some points that aren't going to be very popular here.

You say that you just got off six week orientation, then I'm sure you'll agree that you're probably still pretty slow. And that is understanable, but it also means that some one else is going to have to help you either pick up the pace or finish your assignment in a more timely fashion. ER nurses discharge each other's patients all the time. You say you weren't busy at the time. That may have been, but you never know what's going to come through that door in the next 30 seconds. That's why we have the mantra - treat 'em and street 'em. A discharge home should not be a surprise to either the patient or to the nurse taking care of that patient. You know when all of the testing is complete (labs, imaging, etc.) and should be anticipating a disposition on the patient - whether it be admission, transfer, or discharge home. It isn't neccessary to wait for the "official" discharge to give a patient handouts or written referral/ teaching material. Especially if you're not busy. What may seem like "a few minutes" to you, may seem like a much longer time to a more experienced nurse who may need you to empty that bed for another patient.

As to the nurse not having a patient assignment for the six hours that you observed her. You may not have been privy to what was going on between the charge and the intermittent lead nurse. Perhaps she was being groomed for a special progect in the ER or had been assigned clerical/ documentaion duties in preparation for JCAHO, or she was on light duty for medical reasons. There can be many reasons for this.

If this was a problem for you, you could have asked what was going on.

My last point is the closest to my own heart. If you have a problem with somebody, I think that you have a moral obligation to at least attempt addressing that problem directly with the person involved. You are both adults. You are both professionals. You don't have to hang out with each other, but you both need to be able to work effectively together as part of the team. By initially going behind her back to management to complain, you will doing yourself a disservice.

You're going to piss her off, you're going to make at least some of the management team think that you are a whiner, you may alienate some of your coworkers who will perceive you as a tattle-tale, and finally, you will deprive yourself of an opportunity to practice conflict resolution. Of course, if after a mutual discussion of what each of you think the problem is, and you two cannot come to some type of understanding, then you may have to take it up a step and involve a mediator.

Good luck.

[Dragonnurse1, ASN, RN]

I had two weeks on orientation on days - no preceptor. Went to nights. My first patient was an overdose, pyridium overdose. Ace, our #1 ER Doc was on that night and when the medics called report he and I grabbed the med/surg ref. The treatment for pyridium overdose is methalyne blue ivp. Puts your patient into a seizure for about a minute then they stop. Urine looks like melted chocolate and your patient turns orange. [EVIL]The ER nurses failed to run me off![/EVIL]no other nurse ever saw that type of patient. So you a not alone. 3 new grads started at the same time and one remained, me.

You have a nurse that is actually not secure in her skills so she throws off on you, your defence is your charting chart her attitude, statements she makes about your patients. Anyone knows that unless the patient is a child 70's/anything requires immediate attention. If this patient is on the "non-critical" side they should have moved them to a trauma bay.

Eyes open, ears open, mouth shut(unless you have a question and the only stupid question is the one you DON'T ask. Pace yourself. You will gain speed but only if you ignore Shotnose. Say thank you when she d/c's your patients do not explain why you were not right there waiting for the discharge. You were working.

Believe in yourself you can do any thing in the ER that anyone else can)

Right before latex retired me from nursing :angryfire we had a burn patient arrive no one could get an IV started and we needed one stat so she could be intubated I put a 22 across her in step and asked for fluids and meds everyone in that room was shocked. Someday you will be able to do the same thing.

9 years in ER Burn specialist TNCC Keep paddleing

[edprincess]

I am so sorry to hear this but you will run into "these" type of nurses (and people)everywhere. 1. I wouldn't confront her alone if you do choose to 2. Noone deserves to be treated that way and give you alot of credit for staying quiet so long. 3. Speak with you nurse manager and request another preceptor. Not only will you not have to deal with her day in and day out but you'll learn a lot more if you ahve someone that wants to teach you and help you learn. I love having students and newbies. I think it's great (except when it's a bad day). Tell your nurse manager there is a personality conflict and you feel you would learn better from someone else. Explain (politely) that you don't feel you're taking full advantage of your orientation because of this conflict and would like someone who would be able to explain different procedures to you. Orientation is YOUR time to learn and noone should deprive you of that. You'll always have someone there (even when you're off and on your own) but it's nice to have seen and done things first with an experienced nurse. You need to speak up either way otherwise she's going to drive you to hate you job and leave. Good luck

[alkaleidi]

Update:

Ironically, I have had the 2 other RNs who went through orientation with me (they worked other units and transferred to the ED, I came in from another facility) BOTH come up to me individually and ask in similar wording, "What do you think of So-and-so?" When I ask, "Why do you ask?" they basically go into a big long explanation of how mean she is to them, how she's cold one day and frigid the next -- some days they say hi to her and she doesn't even acknowledge them despite the fact there's no one around and she CLEARLY heard them speak. She was actually one of their preceptors for a week their usual preceptor was off, and the orienting nurse said it was a "week from hell." Same condescending remarks, etc.

As far as "street and treat" goes, I understand what you are saying about wanting to get people in and out because you never know what is going to roll in the doors next... HOWEVER. Being a former prison nurse, one thing I pride myself on is my word. The only way you gain trust (and thus gain the "we got your back") from inmates is when your word is good. When I said I would do something, I did it -- PERIOD. When I wasn't sure whether I could follow through, I said so -- I would say "I don't know if I'll be able to -- if I can, I will. If not, check with so and so" or "Remind me next time I pass your meds in case I don't get a chance to check on that today" -- but either way, the inmates learned that what I said I'd do, I did. I value that now, and it really made me angry that I told someone I would do something for them, and then was not given the chance to follow through with that. It's one thing to discharge a patient for someone, but it only takes 15 seconds to pop your head in the door and say "Hey, I'm going to discharge your patient in room 10 -- do you need to tie up any loose ends, or do you need to do anything else with them?" Something like that would have been fine... I just felt bad knowing I had intended to make some referrals that would have greatly benefitted the patient, and because of her hostility and "helpfulness" *note: sarcasm*, the patient was booted out the door.

Thanks again for the responses! I actually have just played the whole "Kill them with kindness" routine... and it's worked (for me, at least!) LOL. I don't waste energy on the negative... life is way too short. I am also not a doormat though. :) Thanks again everyone... off to bed!

[canoehead, BSN, RN]

I agree she is being a witch. Her issues seem to be the same as any long term nurse could have with new staff, though she is dealing with the situation poorly.

You don't realize how much longer it takes you to do everything- at least four times as long. So what might take five minutes, is actually twenty. New nurses have a terrible time juggling. If you have time to poke your head in putting on the BP cuff will take about ten seconds more, unless you are new, then it takes five minutes.

That's not a negative, just the way it is, and things will change with time. She seems to be partially reacting to that, and partially has a permanent stick up her butt. I DON'T think charting her behavior serves any purpose other than to make you look vindictive and inappropriate. Talk to one of the other experienced nurses, they will probably tell you she is like this to everyone. If you confront her I predict things will be worse (though she's begging for it). Just ride it out. Your patience and self confidence will fix the problem over time.

If she's hurting a patient definitely take action. In the SOB case I would have mentioned your observations to the team leader. As far as discharging goes, I think they are up for grabs, unless you leave a note on the chart to include papers you've copied, or "needs DC teaching" to tip someone off that one patient is different from the norm. You need, and will get a lot of help over the next few months and should expect people to jump in, sometimes when you might wish they'd waited a minute.

[alkaleidi]

Thanks for your response. I actually think I'm doing pretty good time-wise. I know I'm nowhere near as fast as the very experienced nurses, but I'm getting there fairly quickly with the exception of very difficult pts / critical pts and trying to cut off family members who want to talk and talk and talk and talk and talk and talk and talk!! One think I think slows us down in our ED specifically (can't speak for anyone else) is this whole Magnet hospital and Press Ganey crap. I believe nurses should be kind and compassionate, sure. However, I am not a waitress nor am I a servant, and I don't think we should be expected to kiss our patients' you-know-whats just because we need to be at the 90-whateverth percentile in patient satisfaction to what... make more money? Nurses where I work aren't getting tips or raises for each "excellent" patient satisfaction survey they receive, so why are we expected to bend over backwards and do cartwheels on stilts to try and make each and every person ecstatic and happy to have spent 1, 3, or 7 hours in our ER? I think that trying to be a people-pleaser in the ED is a little time consuming in itself. I have no problem treating everyone nicely, but people seem to get irritated when you cut them off and politely direct them back to the problem that brought them in, not all the other little things that have been going on for the past... oh, 10-20 years. LOL. *sorry for the venting snuck in here*

Anyway, like I said, I appreciate the feedback.

Any suggestions on keeping things brief, or a good line I can use to get out of pt's rooms when I need to be doing other things?

[edprincess]

I usually politely excuse myself saying I have to take care of other pt but assure them I will return as soon as I can. Also, I ask, "While I'm in here and you have me for a few minutes, anything I can do for you and/or get you?". That usually holds people over for a little bit, enough to check on a few more pts w/o feeling like you just left 'em hanging.

As for the Press Ganeys, I agree, their BS. SOme people aren't going to be happy no matter what. If they're in/out, we weren't thorough enough. If the tests take a while, we delaying care (How long can just a few blood tests take?). Yeah, I know, no matter what, you're not going to win. Then you have the others that have been in the ER for 27 hours, poked, prodded, and pinched who knows how many times and they're still smiling and saying, "No problem, I understand". Welcome to nursing and life.

[33-weeker]

First I would read over your facility's policies about staff relations in the workplace to familiarize yourself with them.

Next, I would pull her aside and calmly explain to her that you want to have a good working relationship with everyone and that you hope that you can have that with her, but you sense tension between you. Breifly describe the things she does that bother you (taking over your discharges, etc...) Don't let her take over the conversation - stick to your guns, but use nonthreatening language. "When you do/say this it makes me feel..."

If things don't change, then expain that you don't appreciate being spoken to inappropriately in the workplace, especially verbally abused in front of others - which is unprofessional, and that if she doesn't stop her ill treatment of you that you will be forced to make a formal complaint and work your way up the chain of command until the problem is solved.

People will walk all over you if you let them - especially bitchy old nurses. I used to be Miss nice & got crucified at every turn. I've gotten a little tougher in my old age. But you know what? People don't mess with me much anymore either. Don't be afraid to be assertive.

[vampireslayer]

OMG, I think we work with the same woman! I have one that is just exactly as you describe. I'm not much of a "confronter", and I don't think it works most of the time anyway. The whole "clear the air" idea generally results in more animosity, from what I've ever seen. I agree with everyone who said that if you do speak to her about it, don't do it alone, I guarantee it won't go well! She's already proven she won't be receptive to reasoned conversation about your working relationship.

In my case, the only time I ever sort of confronted her (after many instances just like the ones you mentioned) the nurse rolled her eyes at me when I did something, can't even recall what it was, and I lost it, just outright said "WHAT IS YOUR PROBLEM???" Any normal person would have replied "nothing, nothing at all", but of course, witch from hell couldn't just deny, she said soemthign about "well I just don't see why everyone has to try to make everything so complicated"...had to do with me & a tech, and possibly a 2nd nurse, if I remember right, doing a bunch of things with a patient at triage, all at once...you know how it appears chaotic when there's a lot of activity going on, when in fact it's just a lot of necessary tasks being done all at once. Anyway, I ignored her. And now, when I see her I just look directly into her eyes, with absolutely no expression whatsoever, I just want her to know that I see her, I know she's there, I don't greet her, I don't do anything, I just look, then walk away. Sorry, that makes me as big a witch as her I guess...but the "kill 'em with kindness" didn't work on her, not at all, made her more condescending, the small confrontation (the "what is your problem") had no effect, so now I just make every attempt to ignore her existence. She does the same to me. She has a core of friends, she's been there a long time, I just don't get it, she instantly took a dislike to me. But I've also heard other people say the same thing so it's not just me..

We do currently have a program going on right now that's specifically about "horizontal violence" in this very way, people being condescending, trying to sabotage others, the whole "nurses eating their young" thing, and our educator is leading this initiative. It's more trying to reward the opposite behavior, rewarding people who have shown that they're helpful to their coworkers, rather than punitive to the people who are mean...but our educator is also a friend of mine so I did give this person's name to her, just on the off-chance that she might hear that name again from some others, and it might go somewhere. I don't plan to escalate it myself, but if that name is brought up about that subject enough, maybe someone will look more closely at her. Who knows.

So anyway, no advice, I know I don't handle it maturely, but I dont' want a confrontation with her, I dont' want to escalate anything, and I don't work with her often, so....I feel your pain!

VS

[SDS_RN, RN]

When I was up on the surgical and peds floor I had a nurse that was the same way. She was just waiting for you to do something or forget something so she could jump you about it. She especially liked to pick on new grads but she also did it to the vets so I knew that I was not the only target of hers. Our new nurse manager that came on board must have gotten wind of how she was and since then she has been more tactful when approaching me about things I missed or should have done. I now have switched to the ED and have been warned about one in particular that likes to go on power trips and have dealt with her previously because she is a noc house supervisor so I'm already aware of how she is. She is a very good nurse and I have learned a lot from her but she can definatly be intimidating and condescending but I use the kill them with kindness approach as well. Hope it gets better for you. Good luck.

[runawaytrain]

Ugh!

As both a new ED nurse and a new grad, I feel your pain. There is a nurse I work with who is like that with me, too. I have kept this in for so long and now I actually have a place to let it out! Here goes...

This nurse, we'll call her "Sue", actually trained me a little when I first started. She said I was doing a great job and was so nice to me during orientation; even helping me cope with my first death in the department. I thought she was a really nice lady until after I got off orientation...

When I was out on my own, she turned into the biggest beotch in the world. She never had a good thing to say about me, even when I stayed over three hours to help her! When another nurse and I tag-teamed one of her rooms for her while she tended to the others and the other nurse was about to leave and give report to Sue, not knowing I was staying to get her upstairs (I never leave a nurse a pt. she doesn't know to give report). When Sue asked if the assessment was done, the other nurse said she was pretty sure I had done it (I had, I was just too busy to chart it at the moment), Sue said in a shitty tone "Well, she needs to learn how to do her assessments" and blahblahblah. I was listening to the conversation the whole time without them knowing and I heard the other nurse tell her that she should be thankful that I did anything at all for her. I chimed in and let her know the assessment was done and I was about to sit and chart it, but that it didn't matter because I keeping the pt. She just rolled her eyes and went about her business.

Every time I try to help her now, she gets mad at me. Any time I need help, I have learned not to even bother asking her. She never has anything nice to say to me, and will even chime in on conversations to say something crappy to me. We were stocking the rooms on a slow night and we met up in the same room and I told her I had the stuff for that room (she was writing what was needed and I was just bringing a bunch of stuff and putting them where they were needed), she stopped what she was doing and stood at the nurses' station and talked. She will also take over my pts after I have assessed them. I cannot stand working with her and every time I see that we work together, I cringe.

The funny thing about this is that she's only like that when we are on the clock. In the breakroom, she is the same nice lady from orientation. I was told that she's like that with new nurses. She feels like we step on toes.

Maybe that nurse feels the same way. I don't have any advice for you because I'm just as confused as to what to do as you are, but thanks for this post to let me see that I'm not alone!