The last straw

[jojo489]

I'm an LPN working in a long term care facility, but I work on their sub-acute rehabilitation unit, and I'll tell you...I just need to vent.

So I have 20 residents and they range from high acuity to low to dementia and fall risks. I'm crazy all shift, but I love what I do and I love my patients.

What I don't love is the facility. It's aesthetically pleasing but it sucks your soul a shift at a time. Just to throw it out there, this is my first nursing job and I have truly excelled. I've been there for about 15 months and inside the first 8 they had me orienting new staff. The downside... Extremely high turn over and the fact that we have had 4 different directors of nursing and 5 different unit managers in the time I've been there.

The last and final straw was just the other day. I have one particular resident who tends to be awake all night and battles confusion and hallucinations. His family is really involved and tough on the nurses but I've worked and built a good relationship with them. One morning, I walked in and this resident was reclined in his chair, asleep. From what I heard it was a bad night. So I get my report and my aids are handing out breakfast trays and I'm planning on them getting this resident in bed as soon as they're done. Then it happens.

A therapy assistant walks on the unit and begins to loudly (it's 7:15am) throw a fit about the resident not being in bed, never approaching me about it. The PTA then sees the residents family member walking down the hall and says, "we'll just let him see this for himself," and walks off. Ok, whatever. So the family member approaches me and I'm telling them about the night before and this PTA comes back, completely cuts me off, looks at the family, gestures at the resident and loudly says,"isn't this RIDICULOUS!" Now I'm angry. I again begin describing the night before and state that I am going to have him put to bed and the PTA continues to act like an *** and argues every point I make with things that do not apply to this resident in particular. I was able to politely get the PTA to shut up and leave and able to smooth things over with the family member, who seemed more shocked about her outburst than anything.

Now...my unit preaches customer service. It's a very big deal. But not only did the PTA throw customer service out the window....the PTA also chucked professionalism and mutual respect right along with it.

With all if the work that I have done to get the relationship with this particular family to where it was, I do not at all appreciate the fact that the PTA attempted to make me look bad, but in the process made herself and the facility look bad.

Then the real kick was that when I spoke to the PTAs supervisor...I was told that I needed to have a professional conversation with this person and explain how I feel and what they did wrong because we work as a team. Really? I don't think so, because at that moment I was not capable of being professional with that person and didn't really want to get a disciplinary action for what I said.

The final kick came about an hour later, when my aid (who is absolutely excellent at her job) tells me that the head of therapy attempted to reprimand her for putting the resident in the hall like that when the resident should've obviously been in bed. My aid didn't touch the resident...the resident was there when we came in, so the wrong person was reprimanded all together. Which, again, considering I am the aids direct supervisor, if she had approached me first like she should have before trying to yell at my aid....issues could have been avoided and blame placed in the right area.

My job is stressful enough, that nonsense is just completely unnecessary. I'd love to hear some similar stories if anyone's got some.

[Lucky724]

Is there not a Unit Manager, DON or ADON that could be brought into this? I'm confused as to why someone in therapy - regardless of their title - have the authority to reprimand someone on the nursing staff.

[jojo489]

Well first, the head of therapy gets a little too big for her britches sometimes and thinks she's everyone's boss. My unit manager was off that day and the covering manager wasn't in the floor at the time. And we do have a DON but she's too busy losing her mind to honestly care about that business.

My regular unit manager was made aware and the issue was handled. Therapy was made aware that they are not to reprimand nursing staff, they may report things but not do the reprimanding. And that PTA in particular was told about what she did and why it was completely wrong and not at all her place.

So it's been handled. But I still don't understand what possessed her to do that.

[TriciaJ, RN]

Some people try very hard to make themselves look important. If the PTA knew that the family had been difficult to deal with, she may have been trying to score brownie points with them at your expense. She may resent your authority as a nurse (such as it is) and try to undermine it to puff herself up.

I'm glad the administration in your facility handled it properly. The only other thing you could have done was write her up, with nice professional language about how her behaviour was a detriment to customer service and reflected very poorly on the facility. This nitwit was testing you. The better you get a staying calm, professional and standing your ground the less this kind of person will mess with you. You handled it well.

[applewhitern, BSN, RN]

I am confused. Why didn't the PTA simply get the patient back in bed? That sounds like something a physical therapy assistant would do. At some facilities, that's their job! Getting patients in-and-out of bed.

[toomuchbaloney]

Watch that PTA closely. There is an issue with appropriate professional conduct under the service of that employment and this person may well cause more problems for your patients, nursing support staff, and patient families.

Don't hound him/her. Don't stalk him/her, but pay attention and do not let bad behavior slide as it will only get worse if you do.

Good luck.

[jojo489]

I am confused. Why didn't the PTA simply get the patient back in bed? That sounds like something a physical therapy assistant would do. At some facilities, that's their job! Getting patients in-and-out of bed.

See, thank you for pointing that out. Out therapy staff doesn't do that...nor do our OCCUPATIONAL therapists toilet resident as they walk down the hall. Head of therapy says we're a team...I'll believe it when therapy does something to show it.

[pixie6089, BSN]

I understand where you are coming from. As nurses, we have assaults thrown at us sometimes just for showing up to work. This wasn't the first time something like this has happened and it won't be the last. Next time you receive another "assault" by anyone: a doctor, family member, patient, fellow nurse or aid, envision yourself responding in a calm and patient-as-possible manor. You don't have to be a saint, just patient as possible. When you show the assaulter how professional you can be you will beat him at the game. If they are just being overly unprofessional you are allowed to turn your back and walk away while saying, "I don't have to put up with this, I'm getting the manager." Then vent with anyone willing to listen on your break.

[jojo489]

Thank you for the advice. 99% of the time I use the kill them with kindness approach. For five years before I became a nurse I worked with adults with developmental disabilities and we took them to doctors appointments and all that, I so I'm used to dealing with family members and doctors and other staff alike who want to jump down my throat or try to make me look like an idiot for little to no reason. I've made it a habit to never vent in front of the residents or their family, only to the people I know I can vent to. It just took me off guard because most of the people that I work with are great, and I've never before had a problem with that particular person.

The part that still gets to me the most is that had she just come to me that morning and expressed her concern, the whole thing could have been dealt with riight then and there. But it makes sense when you say she had a motive behind it (which was to attempt to make me look like an ***). I just still don't understand why.

But in 9 short days it will no longer matter as I start in my new facility in April. And I'm super excited. :)