[weesyanne]

Hi guys,
I work for a relatively small specialty hospital. We have a lot of interaction with ancillary departments, particularly with respiratory therapy. I think the majority of their staff is phenomenal and all of them are quite knowledgable. However, one of the R.T.'s is doing something that is quite disturbing to me at times.

I called this R.T. for assistance with suctioning a vent dependent patient because the person on my team was unable to assist me at the time and it is a two person job. When this person came to the room, she assisted me in suctioning the patient and getting her squared away, which is what she is supposed to do. But she starts to question me in front of the patient and the family member present about why I hadn't told her that the patient's vent had briefly made an alarm during the previous 2 hours or so. I had assessed the patient when the alarm went off, the patient had denied needing suctioning, all the pressure settings were within normal limits, etc. so I didn't call her about that. Vented patients sometimes set off alarms for all different types of reasons that don't require the immediate intervention of a respiratory therapist----for instance, if the vent pops off while turning the patient, etc. The RN (me in this case) is there to assess the need for the RT to intervene, such as when the patient needs a breathing treatment or suctioning and is responsible for calling the R.T.to assist him or her with the patient.

Anyway, I felt like she treated me like I didn't know what I was doing in front of the patient. I feel like she is undermining the patient's trust in me to care for her and do the right thing by planting doubt in her mind or in the mind of the family member as to my ability to care for her. I also feel like it could potentially lead the family/patient to mistrust the entire hospital staff. The alarm was because the patient took too long to take a breath on her own. This happens fairly often with some of our vent patients. I don't mess with the settings if they need resetting, I let the R.T. handle that.

This isn't the first time that this particular R.T. has acted as if an RN has done something wrong in front of a patient or family member when they haven't. I don't question her expertise about the vent, but I felt undermined.

How would you all handle this? Ignore it? (It's not likely to stop.) Or talk to her in private about it? Or would you approach your supervisor to let her know that you feel your position as the coordinator of the patient's care is being undermined? I feel like the hospital could also be affected negatively by this person's comments to nurses in front of patients and family members. Whenever a colleague is criticized, the hospital expects us to say something supportive of our colleague while listening to the patient's comments without judgement.

Thanks for any comments or suggestions about how to handle this situation.

[caliotter3]

You have correctly identified the problem in your third paragraph. In general terms, this person is professionally jealous. Also, she might have been lollygagging, when your request for assistance interrupted her more important activities. See her behavior for what it is and avoid bothering her as much as possible. You also should bring up the subject with your nurse manager and the supervisor in the RT dept. This person might be successful in making you look bad, but she is also presenting the RT dept in a bad light. Also, what she is doing is potentially placing the pt in emotional jeopardy. By deliberately denigrating the pt's care in their presence, she is providing the seeds for adverse outcomes, including being included in a lawsuit. Even if everything negative being said is 150% true, you do not criticise care in front of the pt, for emotional and lawsuit reasons. If the pt is capable of communication, this info can be passed on to those who may find a need to take action against the hospital. People sometimes get fired for what the RT is doing. That is why you should bring this up to supervisor personnel.

You might want to retort the next time she does this: "You are the RT, the expert in this. That is why I called the expert for assistance. If you made your visits to our resp pts more often, you could keep up with their condition and give them the expert care they deserve." One or two times, saying this should have an effect on her behavior.

[PNS]

First and foremost, you need to address the problem with the RT in private. Why drag more people into this if it could possibly just be a misunderstanding? Have you asked her why she is questioning you in front of the patient? Is she just concerned about the alarm and not thinking when she asks in front of the patient, or do you feel this is intentional?

Tell her that you have assessed the patient and know when to call her. If she has questions, tell her it is best to ask you in private. Have her put herself in the patient's shoes. The next time she asks you in front of the patient, give the answer you typed above. Do not retort and stoop to her level. It's not professional and it will make things worse, not better. You certainly won't gain any confidence in the patient if you try to make the RT look bad in return.

If this doesn't work, then goto your nurse manager and come up with a plan.

[burn out]

I would page her every single time the alarm peeped the next time I worked with her then ask her why she took so long to show up. If she wants to know every time it goes off I would let her and expect her to fix it, even if it means just coming down to reset it. Then at the end of the day I would tell her if she had a problem with my patient care to please not address it in front of the patient or family.

[RedCell]

I would treat this person just like I would an arrogant physician. If they want to be notified everytime the blower alarms, that is exactly what I would do. Put their pager number in your speed dial and let 'er rip! Usually after 1-2 hours of friendly professional notification causing them to miss enough smoke breaks....they surrender.

[RedCell]

Originally Posted by burn out

I would page her every single time the alarm peeped the next time I worked with her then ask her why she took so long to show up. If she wants to know every time it goes off I would let her and expect her to fix it, even if it means just coming down to reset it. Then at the end of the day I would tell her if she had a problem with my patient care to please not address it in front of the patient or family.

I like your style!

[Emma333]

Personally, I don't think revenge is a good way to handle anything, do you really want your work life to be about constant backstabbing and one-up-manship? Talk to the RT in person, privately or with a non-biased third person if you prefer and explain to them that you respect their knowledge and appreciate their help, but that you would appreciate being questioned and 'constructively criticised' AWAY from the patients bedside because you are concerned you are being undermined in front of the patient. If this doesn't work then go to the petty revenge thing, but at least you gave the healthy work relationship thing your best shot first!!!

[weesyanne]

Thank you everyone for your suggestions and comments. It's a repeated problem with this particular R.T. and not just with me, but with many nurses. No other R.T. has ever done anything of the sort. If they have a problem or suggestion, they ask you outside the presence of patients or family members.

I don't really know her intentions. I will try to remember to stay calm and talk to her one-on-one outside the presence of the patient the next time she does anything like this. Although the suggestion about beeping her each time the machine tweaks or twitches at all is very tempting.....

Our patients are so anxious and already think that their needs won't be understood or someone won't respond appropriately and they will die, particularly those who have not been on the vent for long since being injured. It adds to their anxiety level to have someone questioning the care of their nurse in front of them, in my opinion. Not to mention the anxiety level of the family members who may be present. I have 22 years of nursing judgement and generally know when something with a patient needs to be addressed (or at least I hope I do by now!) I always err on the side of caution. Vent patients can be scary at times, I know.

Thanks again!

[Roy Fokker]

I once did something thoughtless to a PT.

She was ambulating one of my patients and I asked her, in front of the patient, when was the next time she would be able to make rounds.

She made a non-commital reply, and went on to finish her work.

Then she came back - and told me right off that she didn't appreciate me questioning her like that in front of the patient. She has her own priority lists and to question that gives the patient the impression that PT doesn't have time for them.

I recognised my error and apologised for putting her in a sticky spot.
Lesson learned.


So, my advice?

Pull this RT across to a room and hash it out. Tell RT that you appreciate her concern for her job, but by questioning in front of the patient and family, RT was undermining your authority and trust.

cheers,

[jennifer_25_nurse]

In my experiences I have noticed that some people have a malfunction that I have termed "loss of filter" If a co-worker starts talking about things that shouldn't be discussed openly then I just say "hmmm....they lost their filter today" Now sometimes you may encounter the person that has a permanent loss of their filter or in other words has no tact. This person really in fact has no clue that anything they have said in the past, present or future will affect anyone the way that it does. Now to deal with the situation you need to be stern and pull them aside and tell them they although they may not have intended to demean you in front of a patient/family they did and that next time you would hope as a colleauge they may treat you with a little bit more dignity in pulling you aside before letting you know what you did wrong. Also make it clear what boundaries that person wants. If this RT wants to be called for every beep and whistle then make that wish her command and she will get the point. Don't take anything personally or get emotionally involved with the whole incident. I'm sure it was nothing personal. Some people are just not fortunate to have a filter. Be glad you can use your filter for good and not evil...LOL. Good luck either way.