charge nurse dilemma

  1. Hi, I need some views on my capacity as a charge nurse in my LTC facility. I was oriented as charge two months ago. I really feel I have limited experience as a p/t nurse, worked the floor in the hospital skilled unit and assisted living charge.
    Here is my dilemma. Have LPN, been there 19 years. Likes to moan she is treated like "an lpeon, but also hides behind her title to avoid anything out of the med pass ordinary. Saturday I was charge, looking forward to a peaceful weekend without all the staff chaos-you know what I mean. Well, there was four CNA call offs that led us to a staffing crisis, which got thrown in my lap. Walked down for a cup of coffee before I got on the phone to call agencies. The list was missing so I had to look up numbers in the phone book, which was outdated, etc. Coming back through the hall, a family member told me her dad was in pain. Same thing happend the day before. Epigastric and back. History kidney stones. Vicodan and demoral IM (for severe pain) ordered. I did a quck look at him, alert and non-diaphoretic. He always has a hard time spitting out words and when he is in pain, this slows him down more. Asked the LPN on his side to give him a pain pill, and started to inform her that he was like this yesterday, I thought it was a kidney stone, has seen him before like this---she interrupted me and said "I'm not giving him a pain pill, he is lethargic." I asked her to get vitals on him and she stomped down the hall. Came back with vitals on a scrap piece of paper and they were way stable. I asked her again to give him a pain pill and she started to inform me that I was the nursing supervisor and it is my job to go down the hall and take care of him. I asked her if he was diaphoretic and she stammered 'no", and I asked her if she could assess him? She got very mad at me. I always check up on residents who are experiencing changes. I did look at him again, and talked to the family and asked them IF I assessed him and felt it was cardiac involvement, which I did not, would they want him sent out, and they said no, make him comfortable. Of course, I charted in depth on all of this. Two and half hours later, I checked on him again, probably the fourth time, he was still in pain, I instructed the LPN to give him IM demoral. He was good for the next 24 hours, when in the am I checked up on him and he stated he had pain just about every day, the same kind, etc. I then instructed the LPN to give him a vicodan during the med pass, which she grudgingly did. The wife called and I explained all my rationale and she stated how glad she was that I was there.
    This LPN seems to resent my RN status, I spend a great deal of time passing meds and being charge at the same time when we have a call off or agency is unavailable or just doesn't show. When I am charge and have 2 LPNs I try to get some paperwork done, vitals, help the CNA's and spend alot of time with the agitated to help calm them down or see to their needs. This LPN seems to resent that I have time to do this, and thinks I should do her work instead of asking her to do it. Why can't she assess the resident, as she needs to have knowledge of what's going on on her side. If she disagrees with my instructions, I can see that she has the right to NOT give a pain med, but assess him first then tell me she is uncomfortable with my instructions.
    Am I barking up the wrong tree here?
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  2. 25 Comments

  3. by   txsugar
    Absolutely not! Carrie, I totally agree with you. I've been an LVN for 7 1/2 years and worked charge in a couple of nursing homes for the majority of that time. I was always so thankful when an RN was willing to pass meds or help out on the floor as well as the charge desk. I have been in your shoes and I completely understand your frustration! There are LPN's out there who do resent the fact that you have more education. What they see is that you are an RN so you must be able to get away with more, have more time, more money, and just don't want to work. What they don't see is the huge amount of responsibility you carry, the increased work load, and the stress that uncooperative staff causes you. I had CNA's who were the same way. I finally got to the point where I would tell them, hey if you don't like what you do find another job or get yourself back to school so you can get some more education. I know, I know. Mean, right? But i got sick and tired of hearing how I "had it made" and they had to work so hard. Not true. I've been there. I may not be an RN (yet) but I totally feel your pain. Wish you the best. Stay strong. you are on the right track and honey that tree is certainly the right one.
  4. by   jevans
    I can certainly empathise with you

    Have you tried to determine what makes this person act like this?

    Does this person have sufficient knowledge?

    Is this person stressed?

    Are there any problems that you may not be aware of?


    I don't mean to lecture but have recently been in a situation a little like this and I have completely misread under current communication

    BUT GOOD LUCK
    j
  5. by   cargal
    Thanks for the input. She has been there 19 years in a facility that is very short staffed, they need the warm body, but they don't value their employees. (Or should I say some!)
    Let's face it, with the nursing shortage, she can do just about anything as long as it isn't dangerous.
    This nurse has never worked in a facility with assessment flow sheets, so probably never thinks in terms of assessment. LPNs here do not do IVs either. Most times the medication pass and the paperwork are the extent of the shift, unless a resident has other needs or change in status. She likes to behave in a "I don't know nuthin about birthin no babies" manner to avoid any extra work. She is not stupid either.
  6. by   jevans
    Carrie

    Is there something that she does really well? that you can utilise. Once she accepts this, you can then covertly get her to start working with you and not against you.

    Time is a huge factor in this type of situation. Please don't think that it will happen quickly
    j
  7. by   cargal
    Jevans,
    Thanks again for the input. I think the problem is we all have on foot out the door at all times. I will think of ways to work with her , not against her. I don't view this as a problem most of the time. I just sometimes wonder where the LPN duties and the Charge duties blend and don't. I should probably just keep my mouth shut next time and she can remain a med nurse like she wants. I am not going to change her.
    Hey, I have been reading a little about where you are located and work, from your other posts. MMMM , sounds nice. Can you tell us more?
  8. by   caliotter3
    I was going to give advice about taking the bull by the horns, but after reading your subsequent posts, I think you would be wasting your time. However, the situation with the pain med not being given should be addressed, I believe, in writing. There is an obligation to attempt to alleviate pain. When this nurse failed to follow your instructions, more than once (and apparently long term), to give the med, she actually violated the practice act. Not only that, she was just plain insubordinate to you. If she disagreed with your instructions, then it was her responsibility to address the problem. If necessary, she should have called the MD if she so strongly disagreed with you. Therefore, she has no leg to stand on. Even, if she is there another 19 years with no changes, you need to counsel her and put it in writing. This will put her on notice that you draw the line on being a "pushover". Also, you will be covered, if something like this happens again, and the family takes the matter to authorities.
  9. by   duckie
    I have been an LPN for over 20 years and I hate this LPN/ RN debate, but this is one time I would have thought it very proper to say do it or I'll write you up not only for neglect of a resident in pain but for not following the directions of a supervisor. Sounds to me like this gal either don't give a crap or she's in drastic need of a heart but no matter what the reason, you DO NOT let a patient suffer!!!!!! I would write her up daily if I were you or any other nurse that witnessed this behavior. I treat every resident like they were related to me and that means, if they are in pain, I call the doctor and take care of it stat. What does she mean, "I'm not gonna kill him?" Yea, let's keep in alive in total agony because that is the humane thing to do. Give me a break. As you can tell, this is a sore spot with me and I would not hesitate to bring her down a few notches, she's there to relieve pain and suffering, not to just get a paycheck. The MD gave those orders for a reason, so USE THEM! Okay, off my soapbox, gotta get my B/P down!
  10. by   cargal
    To clarify, she did give the vicodan as ordered. I asked her to chart and she did and added that she gave the vicodan as per RN instruction. I have no qualms about this. If she really felt that it was unsafe to give, I just would have wanted her to say, "I am uncomfortable giving a pain pill until you have checked on him." Assuming she had done vitals and informed me of his status. She just wants to put the whole thing on me. One time she stated that a CNA told her a hospice resident was in pain, but she looked at the MAR and no one had given it prn (roxinol q 6 hrs and prn) for two weeks and she didn't want to be known as "the nurse who medicates". I stated she had the MD order, she had a license as an lpn, what is the problem?
    Nice to hear from all of you, Thanks!
  11. by   night owl
    I am always thankful to have an Rn available to answer questions or help me out when I need her/him, and I feel very secure in knowing that. Why b/c they do have more knowledge than I. If it was me in her situation, I would have said, "Do me a favor...please check so n so's status. He's requesting a pain pill, but I feel he's too lethargic. Here's his vitals, but I'd feel more comfortable if you took a look at him and tell me what you think." If you thought it was OK to give the Vicodan, then so be it, I'd give it. No big deal and a great big "Thanks alot, I appreciate your input!" Thank God for the Rn's...love em all!
  12. by   tinkertoys
    I agree with much of the above posts... there may be a problem with perceptions that need to be dealt with, but the bottom line is that her patients are her responsibility. If the patient is c/o pain, it is her responsibility to assess and act on that assessment. If she is uncomfortable with what she finds, or has questions, then she need to consult with you. But consulting with another nurse DOES NOT RELIEVE HER OF HER RESPONSIBILITY TO HER PATIENT!!! It appears to me that her actions are both negligent in regard to this patient (and who knows how many others), and blatent insubordination, neither of which can be overlooked, regardless of the staffing situation. Her actions and attitude need to be brought to the attention of your DON. She may have some insight into the situation that you do not have, and together you can come up with the best way to address the situation. But it does need to be addressed. Otherwise your relationship with this nurse will continue to deteriorate, and you will be doing her (your)patients a great disservice... because, ultimately, they are YOUR patients, too.
    I hope that you are able to resolve this issue with this nurse. You sound like a good and caring nurse, and you're working very hard to do what is right for your patients and staff partners.... I know I would be proud to have you on my team!

    GOOD LUCK!!!
    Last edit by tinkertoys on Sep 5, '02
  13. by   jevans
    Cargal

    Hi!

    I am a deputy ward manager of a stroke unit with 24 beds. Our admission criteria is that we will take any adult who has experienced a stroke. This means that our patients vary from 20's to 90+

    We have an extremely strong team who are sooo dedicated. The qualified nurses are mature and most have had senior positions in the past. However due to lfe experiences all choose to work in this field. It is so benificial as each of us has some unique experiences that make us the team we are.

    Whilst the manager and myself do the actual man management we adopt a team approach to actual development.

    We are very lucky as we have our own multidisciplinary team which means that there is continuity which is vital for stroke pts.

    We all believe in holistic care to promote well being. It involves family members and pt alike. Stroke affects all aspects of life

    If you would like to know more PM me
    j
  14. by   adrienurse
    Cargal,

    Can I EVER relate to your story. Sounds like my situation 3 years ago when I was the lone RN on nights in a 300 bed PCH. I worked with some LPNs who were very skilled and whose intuitons were as sharp as they come, but I also worked with some who were weak, and very ignorant to the needs of our geriatric patient load.

    It's a very tough and draining position to be in. All I can say is document document document. Make sure your managers know exactly what it is you have to put up with and do without.

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