Polite refusal, how do I do it?

[KatieBell]

We have a nurse working with us from Agency. This is the Emergency Department. All her experience is in some sort of special long term vent unit. She initially appeared to be alright, but quickly started to complain that no one was letting her do the "fun stuff..." and that she knew more than any of the other nurses, but no one would "Give her a chance"

Well, I've seen some strange things

For example she had to ask a MD about Nitro SL- asking if the SL stood for some long acting form of Nitro...she didn't know it went sub lingually.

Wrote on a chart that Solumedrol 125 mg had been given by Resp Therapy (even though the order was for IV...of course the RT had given an albuterol neb...)

Recently we had a code situation in which she busted her way into the room (5 nurses already in there) and insisted on pushing the drugs. Instead of the paralytic, she drew up Narcan...and was stopped from pushing it. She later admitted that she did not know what these drugs did. She was angry because she made a mistake and informed us all that she could "Nurse circles around you all in cardiac" despite the fact that she had just not, and done something actually quite dangerous: 1. drew up the wrong drug and 2. did not even KNOW what the drug she was giving was supposed to do...

Now, the Charge RN is on top of it and is communicating with management to get her out of here. I am sure she is a fine nurse, but her previos scope of practice did not prepare her for the Emergency Department with no orientation.

My question: We are a very helpful ED. Everyone helps everyone else to take care of the patients. It's nice to know someone has your back. But, I want this Agency person to stay out of my rooms- with no exceptions.

I've tried, "I prefer to deliver direct care for my patients any time I can" but she continues to barge in and try to give medications on my patients.

So, Any constructive suggestions on how I can keep her away from my patients. She should not be here much longer, but I'm feeling stressed with her around, because she has shown an inability to interpret these orders properly.

PS: I'm not unsympathetic. I understand her interest in working ED, but I maintain that a proper 4-6 week orientation rather than coming by agency, would have been the proper route for this person.

Help me!

[Dayray, RN]

I always try to be nice and diplomatic with people. In this case I don't see any way around ruffling her feathers. If I were in your shoes I wouldn’t want her in my rooms either.

I would be very direct and come strait out and say, "I don't want you helping me with my patient's". I would then say, "I am sure that you are an excellent nurse but you have proven that you are not an ER nurse, I fear for the safety of your patients and do not want my license jeopardized by your actions".

Harsh, yes but true and necessary. She needs to know that she is unsafe. If she continues to believe she knows it all, she is going to kill someone. I work with a nurse that came from another area of nursing and has a similar attitude. Whenever someone tries to explain something to her she says "I know" but she doesn’t. Luckily she isn’t as unsafe as the person you describe. Yet she still seems to be missing pieces of the puzzle. I wish that the nurse that had oriented her had called her on it because now patients have to deal with her lack of knowledge and she will never learn.

Years ago I worked ER and EMS it requires a huge base of knowledge and skill to be a good ER nurse. If I were ever to go back to emergency nursing I would need a full orientation and lots of training. For someone to think they can walk in and know it all in any area of nursing is arrogant and dangerous.

[llg, PhD, RN]

Is there any way you can something like ... "I'm not comfortable with you providing care to my patients without my knowledge. If you want to help me, please come to me first and find out what I need. I'll tell you what needs to be done. Please don't do things I don't know about." Then when she approaches you, either give her a couple of tasks that you feel she can help you with (away from the patient perhaps) or thank her for her offer and say that you have nothing for her at the moment.

llg

[suzanne4, RN]

The agency had no business placing her in that situation. And shame, shame on that nurse for even accepting that position.

It is 100% for her to be in that capacity without a full orientation and that means taking a staff position.

This is another reason why documented experience, as well as competency exams, should be required to work agency. And it is by reputable agencies.

Just make sure that you document everything, and send a copy to risk management of the facility.

[rn/writer, RN]

One thing I find absolutely abhorrent is the combination of ignorance and brass balls. It's likely that she is tooting her own horn to compensate for feeling insecure, but there is no excuse, whatsoever, for this kind of know-it-all-when-you-obviously-don't behavior. No matter how well she functioned in her previous nursing life, she is now endangering patients and staff alike.

Working in an ED is challenging enough without having to constantly worry that this loose cannon might go off. You have to be able to do your job without constantly looking over your shoulder. Unfortunately, someone who is more concerned with her own status than that of her patients and co-workers is not likely to hear anything that doesn't grab her by the lapels.

You don't have to recite the litany of errors--she'd probably only argue, justify, or blame anyway--but you do have to set clear limits. Take what you said (which would register with any reasonable person) and ramp it up so she can't ignore it.

"Do NOT medicate my patients. Period. If you do, I will write you up."

Say this with calm confidence and without rancor. And no matter what she comes back with (other than, "Okay"), just keep repeating the same sentence until she gets the drift. With most folks, this would be overkill. With the kind of person you are describing, you have to make statement this bold to even be heard.

If you get any kind of remorseful or humble response, by all means help her to understand why you are reacting this way and what she could do to improve the situation. I give that about a 5% chance.

The sad thing is that, had she come in with a teachable (and safe) attitude, you guys could have gotten her up to speed without exposing anyone to the kind of risk she has created.

The only thing worse than not knowing something is not knowing that you don't know it. Or knowing that you don't know it and trying to bluff and bluster your way past your own ignorance.

Be direct. Be clear. Be bold. Do what it takes to keep your patients ( and your license) safe.

I wish you well.

[nicholrwalker]

One thing I find absolutely abhorrent is the combination of ignorance and brass balls. It's likely that she is tooting her own horn to compensate for feeling insecure, but there is no excuse, whatsoever, for this kind of know-it-all-when-you-obviously-don't behavior. No matter how well she functioned in her previous nursing life, she is now endangering patients and staff alike.

Working in an ED is challenging enough without having to constantly worry that this loose cannon might go off. You have to be able to do your job without constantly looking over your shoulder. Unfortunately, someone who is more concerned with her own status than that of her patients and co-workers is not likely to hear anything that doesn't grab her by the lapels.

You don't have to recite the litany of errors--she'd probably only argue, justify, or blame anyway--but you do have to set clear limits. Take what you said (which would register with any reasonable person) and ramp it up so she can't ignore it.

"Do NOT medicate my patients. Period. If you do, I will write you up."

Say this with calm confidence and without rancor. And no matter what she comes back with (other than, "Okay"), just keep repeating the same sentence until she gets the drift. With most folks, this would be overkill. With the kind of person you are describing, you have to make statement this bold to even be heard.

If you get any kind of remorseful or humble response, by all means help her to understand why you are reacting this way and what she could do to improve the situation. I give that about a 5% chance.

The sad thing is that, had she come in with a teachable (and safe) attitude, you guys could have gotten her up to speed without exposing anyone to the kind of risk she has created.

The only thing worse than not knowing something is not knowing that you don't know it. Or knowing that you don't know it and trying to bluff and bluster your way past your own ignorance.

Be direct. Be clear. Be bold. Do what it takes to keep your patients ( and your license) safe.

I wish you well.

I agree with you, it is one thing to give my patient a bedpan, but do not adminster anything until you talk to me first,it is irritating and DANGEROUS.

I can keep up with my work but not mine and yours. There is no polite refusal here, you have to be firm with that person.

[redwinggirlie]

Just say no

[ZASHAGALKA, RN]

but there is no excuse, whatsoever, for this kind of know-it-all-when-you-obviously-don't behavior.

Yeah. People that think they know everything are particularly annoying to those of us that do.

I agree though. Assertive statement, often repeated, and diligence. Everytime she comes near your chart/room - question it. "What are you doing w/ my chart?", "Why are you in my room?"

Of course, that will end any pretense of teamwork - but it's pretty obvious that her definition of teamwork is such that it will only remove the facade for you - and that will be liberating, if very tense.

The other issue (I've worked ED before) - this kind of open warfare can lead to trouble. It's very easy to hide your charts, etc. so that your work doesn't get done and then accuse you of not taking care of your pts because you won't accept help. Seen it done. (Or the classic taking your chart off the 'orders written and waiting to be done' stack and moving it to the pt's cubby - to look like there are no pending orders.)

But it sounds like your administration is gearing the wheels to take care of this anyway. Is it worth the fight is she's about to be gone?

~faith,

Timothy.

[suzanne4, RN]

If she is agnecy, and not regular staff, why has this been permitted to go on for so long? With any other place that I know of, she would have been out of there right away.

[Dayray, RN]

I just thought of this...

You could push this whole issue off on your manager. It would depend if you could trust them to follow threw or not.

You could tell them that you are worried about this and hoepfuly they would go to the nurse and tell her that other nurses (anonomus) have asked that she stay out of other peoples rooms.

Either way if this nurse has any sense she would leave after learning how the other nurses feel about her. It is possible she is just pig headed enough to stay to show everyone how GREAT she is.

[misschelei]

Know it alls who know nothing.....can't stand it. I take great pleasure in torturing residents with this type of attitude. But a nurse is another story. What is taking so long to get rid of her? Most places I go to would have yanked her right away. I would try to find out what the hold up is in hopes that I could avoid a confrontation. But if it came down to it I would be bold and ask her to leave my patient's room. Just keep your cool.

[moonchild20002000]

All it takes to get rid of her is a phone call to her agency.

Why are they dragging their feet?