What to do about disruptive behavior? - page 3

by Mudwoman 8,123 Views | 36 Comments

I have been a med-surg nurse since 1994. In January of this year, I left my beloved med-surg floor and moved over to ICU. Even with my experience, I knew that this would be like starting over. I don't know if the other nurses... Read More


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    As I am sure you already know, sometimes there are patients so unstable every nurse on the unit is in one room. How do you think they turn their patients then?
    Quote from Nccity2002
    I do agree that nobody should be treated that way, under no circunstances.However, as an ICU nurse, I can't get past the fact that you did not turn/touch an ICU patient under your care for 12 hrs!!I am curious, how did you completed your documetation/charting if you did not assess/touch your patient??
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    Quote from Mudwoman
    I have been a med-surg nurse since 1994. In January of this year, I left my beloved med-surg floor and moved over to ICU. Even with my experience, I knew that this would be like starting over. I don't know if the other nurses notice any growth on my part, but I feel the growing pains for sure. That is good! That is a large part of moving to ICU: to grow and be a better nurse.

    I will not go into a huge amount of detail, but will be glad to answer specific questions if anyone needs me to, but I need some advice on how to move forward on a particular unpleasant encounter from last night's shift change.

    I had 2 patients. One patient had been a 1:1 until my day shift on 7/19. Young (21) and still very critical, on vent. The other patient had been moved from LTAC during the early morning hours of 7/19, but had been cared for by another nurse on 7/19. Pt is older and with a long, long hx of chronic medical problems and on vent. He is also in BIG time isolation (the works). I had both of these patients on 7/20 and they had the highest acuity on the unit. 3 other nurses helped me as their time permitted. I was so, so grateful for their help. I thanked them all over and over, and one of the nurses that is also sometimes the charge nurse made the remark that she didn't know why, but when "L***" is charge nurse, I always get the hardest load.

    At one hr prior to shift change, my young, critical patient had a STAT CT of chest ordered, and 30 min prior to shift change, we had her ready to roll to CT. I got back just after report was started. I handed off to 2 different nurses.

    I gave report first to the nurse taking my older patient. She had him on the night of 7/19-7/20. I have never met or worked with this nurse prior to this. I then gave report to the nurse coming on for my younger patient, and part of that report was that I had placed a rectal tube for constant diarrhea during the day, but moving her around for the CT had caused some leakage and I planned to get help cleaning her up and getting everything else back in order (monitor, tube feed etc) before I left. I found a float tech that was willing to stay over and help me. This was all accomplished by 1930.

    Now comes where I need help. The nurse for my older patient comes out of his room and started screaming at me in my face in front of everyone "You didn't turn this patient all day....he is in the same position he was when I left this morning...." She was right. I had not turned him. I had assumed that he had been turned by the nurses that were so generous to help me. The nurse that offered to give his AM meds was in the room for nearly 2 hours. I was in the room for over an hour catching up on his care while giving him blood. It was on my list of things to do, however, I got called back to my other pt's room by the physician....and time moved forward, but care for this older patient did not. I admitted to her very kindly, that she was right, I had not turned him. A sport bed had been ordered for this patient, but no sport beds were available, so turning him was something that was very important! I also did not follow up and check behind the other nurses that were so kind to help me. It was one of those days where you don't take a break, you don't eat, you just keep moving as fast as possible and at the end of the day, mark it down as one of the worst of your career; even when you did the best you could do.

    The next 15 minutes, I spent with her yelling and calling me names and telling me what a pathetic nurse I was and how the care I gave this patient was totally unacceptable and would not be tolerated in ICU. "We give excellent care around here, not poor, substandard care around here, and you are NOT up to our standard for a nurse"...."They say nurses eat their young, well I guess we do to weed out the undesirables". There was so much more said and it was said with cruelty and hatefulness. By this time, I am crying (darn it) and I can't talk for the lump in my throat that hurts so bad I can hardly breathe. The only thing else I could manage to say was "You are right and I'm sorry." The night charge nurse finally had heard all the yelling and got between me and her, and said, "I've got this, you go home Kid-do". The charge nurse is one of those nurses that you find so easy to look up to, consider a mentor and when you grow up as a nurse, you want to be just like him. I clocked out at 1950.

    So, we have an "EVENT REPORTER" that we are supposed to fill out if there is a nursing error, or disruptive behavior etc. I have already reported that I did not turn the patient all shift and I did not follow up and make sure someone else did when I could not.

    Should I also write a complaint of disruptive behavior on this nurse?

    Write a short note to my unit manager about what happened?....,or

    Should I just let the extra large bowl of Ben and Jerry's ice cream take care of the collateral damage and move on?

    I don't consider leaving an option. It is a wonderful unit. I'm learning lots. I have been at this hospital many years. There are lots of other nurses that do not agree with this particular nurse's opion.

    Thanks for any input....good or bad.

    Charlee
    This nurse was partly right in pointing out something that you neglected to perform on a patient, you may say that it was just turning of a patient but it is critical to an ICU patient, we may say that this badgering from the nurse will be part of your nursing/learning experience while in ICU or any department in a hospital, so try to remember them.
    Now on the idea on reporting it to the unit manager, if she did it once, you may let it pass and not to report it but make sure you don't make a lot of mistakes while she is around for you will definitely get another round of that badgering. But is she repeats it more often than needed just to remind evrybody of your previous mistake and it begins to affect your functions as a nurse physically and emotionally then that would be thetime to report her. To tell you the truth this nurse must have experienced the same treatment as a nurse in her early years and this action is just a reflection of the traumatic experience she had during those times, so don't let it get into you andjust do your duties the best you can. Good Day!
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    To dress down anybody in this fashion is a travesty. To find others trying to laugh it off or downplay it as something somebody can get away with because of who they know and how many years they've been holding their own personal courtmarshalls is no less a travesty.

    Nobody heals in a hostile environment, including our patients. We all get sicker together.

    Walking on eggshellls is not good for our feet, much less our profession.

    Grow on, and spread your seed far and wide.
    Sugarcoma and MahzieLPN like this.
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    Quote from gypsyd8
    As I am sure you already know, sometimes there are patients so unstable every nurse on the unit is in one room. How do you think they turn their patients then?
    In the future, please read the OP original post, before commenting. There was no reference of that patient being"unstable". She simply did not turrned or "touched" the patient because she became busy with her other patient.
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    the other nurse was waaaaay out of line, i've had times when pts were left in a mess(incontinence, dry iv bags, empty tube feeds etc.) that i would be upset about and be angry at the nurse, but not being turned? big deal. that pt was alive when you gave report and you did your best, eat that ben and jerrys and enjoy. if her behaviour continues then i would file a report.
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    Quote from Nccity2002
    In the future, please read the OP original post, before commenting. There was no reference of that patient being"unstable". She simply did not turrned or "touched" the patient because she became busy with her other patient.
    But that's what she's saying - if she has one patient that's circling the drain, or becoming incredibly unstable, how is she supposed to justify leaving the one that needs her NOW? She did state that she had coworkers helping her out, she was in the room for at least an hour, etc. It never said that she never TOUCHED the patient, just that she had not found the time to turn him.

    When one patient's going to hell, it's hard to find time when you have two patients. It's why you depend on coworkers.
    Sugarcoma likes this.
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    Do you have a policy on disruptive behavior? In my facility we have a zero tolerance on disruptive behavior. Anybody that bully, disrespect, hostile, and so on is written up and reported to the supervisor. The supervisor will make some fact finding and also the Board of Investigation. If you have done this once you will be given verbal counselling but if this is a repeated behavior especially if it involves assault and battery you will be terminated. Disruptive behavior in the workplace is unacceptable especially for health care profession which is very common. We sometimes get frustrated and work cannot be done. But there is no point of treating each other in an abusive manner. We should handle our differences professionally.
    MahzieLPN likes this.
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    12 hours without turning is horrendous. I hope you learned that lesson. Write an incident report and request an arbitration with the disruptive nurse. She was out of line. You also need to write an incident report on yourself for providing substandard care. If this patient developed a dti. Likely that's on you.
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    Quote from nohika
    But that's what she's saying - if she has one patient that's circling the drain, or becoming incredibly unstable, how is she supposed to justify leaving the one that needs her NOW? She did state that she had coworkers helping her out, she was in the room for at least an hour, etc. It never said that she never TOUCHED the patient, just that she had not found the time to turn him.When one patient's going to hell, it's hard to find time when you have two patients. It's why you depend on coworkers.
    And in accepting and depending on help, one must make specific requests such as hey, will you please turn so and so for me. Then follow up.
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    Part of the problem was an Intensivist physician doing constant STAT orders on the 21 year old trying to save her life and there were NO new orders on the 77 year old. The 21 year old had been a 1:1 patient until my shift. Sometimes your chain gets rattled and there is nothing you can do to control it. I did my best that day. The 21 yr old did live and did make it out of ICU 2 weeks later. It does not mean the 77 yr old was not important. He was. But a person can only do so much and as the day progresses you have to prioritize. I had a Dr prioritizing a lot for the 21 yr old. The 77 year old did get care. He did get cleaned up from 2 incontinent BM's He was unstable with a heart rate that went to the 200's everytime you touched him. I feel terrible that I couldn't give each of my patients everything they needed that day. On the other hand, I couldn't tell a physician ordering everything in the world to keep a 21 yr old alive that 'hey, first I need to go and turn my other patient. This Doc was in a panic because I couldn't get her to CT for 30 min because CT was in the middle of an emergency themselves. He informed me that when he said he needed a CT of her chest STAT, that meant NOW.

    So, a person can point out something like this and be helpful and a mentor OR they can be hateful, cruel, and mean. This nurse took the latter choice. My unit mgr was not happy about her choice either. This job is hard enough. It is important that we are nice and helpful to each other.

    Thanks for the support here. I am glad that I wrote her up and reported her. She is a skilled nurse, but it takes more than skill to be a really good nurse. I appreciate all the feedback.

    THANKS!


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