What to do about disruptive behavior? - page 4
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... Read More
Aug 15, '12Do 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.
Aug 18, '1212 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.
Aug 18, '12Quote from nohikaAnd 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.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.
Aug 19, '12Part 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.
Aug 19, '12I DID touch the patient......several times. I was in the room for over an hour at one point and another nurse was in his room for over 2 hours. He was cleaned up X 2 from incont BM. He was unstable in that everytime you touched him, his HR went over 200. If left alone, he was stable. HOWEVER, there was also a 21 yr old that was in total system/organ failure that should have been assigned 1:1 AGAIN and she was not. I had a physician rattling off STAT orders on this patient constantly. The 77 yr old was assessed and he was touched. He just didn't get perfect care that day......the perfect care went to a 21 yr old that was dying before our eyes and no one had a clue why......and a physician that wasn't going to let her die without a fight.
So, I have to ask a question. Pretend that your 77 yr old father is in ICU and your 21 yr old daugher is in ICU. Your father has numerous chronic health problems that are serious and there is no cure. Your 21 yr old daughter became suddenly ill and if there is not aggressive treatment, she will die. Which one of your loved ones do you want to get the most attention? Do you care more about a possible decub on your dad or the daughter's life? I was NOT making these decisions.....a very dedicated physican was making these decisions for me.
I am not making excuses....just pointing out that I was doing orders in the priority they were being given and I was doing the best I could and others were picking up what slack they could. These 2 patients should have never been assigned together, but they were. So, one patient did not get the care that would have been exceptional. That care went to a young girl.....that did live because of it. The 77 yr old died after 30 days in ICU and he did not get a decub.
Aug 19, '12No one is judging. You DID ask for opinions. Part of Icu nursing is knowing when and how to ask for help. You didn't and a patients care suffered for it. Bottom line. Heartfelt analogies do not excuse your lack of care.I would have told another nurse or the house supervisor that I was unable to safely care for my second patient since it seems your charge nurse is against you. I've done it before. No one likes to admit they are overwhelmed but if you don't. People can die.
Aug 19, '12As an earlier poster said, remember her behavior and never do it to another nurse because we all have days like that. While working on the progressive care unit at my hospital I've had plenty of nightmare shifts (largely because they want it to be ICU/PCU acuity with med/surg nurse to patient ratios and on top of that they allow 24/7 visiting hours). In life there will be no shortage of people who want to yell/lecture/demean/criticize you just because they can (or think they can) and there will be coworkers who get away with murder.
I was recently treated to one of these "because we can lectures". I was starting an IV on an old lady with dementia and was trying to keep her from falling out of her bed but while doing this one of my other 4 patient's IVs started beeping and the secretary who can be less than helpful in the best of times just overhead paged a dozen times rather than taking some initiative when I didn't respond (because I couldn't respond) and asking someone else to check on it for me. So I did not respond fast enough and was rude when I got to the room (I am sorry to admit that I was indeed a rude because after dealing with a difficult situation I walk up to a room and hear a b****y no it's STILL BEEPING! then find they've buried the IV pole behind so much clutter that I can't possibly reach it without rearranging all of the furniture). The patient wanted another nurse and so I swapped patients with someone. This has happened to other nurses before and typically that's where it ends. Not today, not with this charge nurse and so I was called into the office by her AND the nurse manager and got an earful (while I was on duty mind you).
But not about that incident, not really. No basically under the guise of concern and constructive criticism I was told that because of three recent "complaints" they wanted to talk to me. Right of the bat I admitted that I had been rude and shouldn't have but that wasn't where this conversation was heading. No, it seemed they were concerned that perhaps there was something deeper at the heart of this incident. They applauded my "technical" nursing abilities BUT thought that maybe I'm having difficulty with the more subtle skills that are encompassed by the art of nursing, the caring/nurturing aspect because after all I WAS a paramedic BEFORE I was a nurse (a rather insulting insinuation about paramedics). I was told I need to be more responsive to those needs because this is a customer service industry and people won't remember that you were a great technical nurse so I needed to concentrate on those things. This made me very upset (I think mostly because I was having a bad mental health day but also this was an attack on my character). I do try and do those touchy feel-y basic needs things myself, if I can, but often times I have to rely on the nurse tech because I can't do all of my nursing tasks and delegatable tasks myself.
So now that I'm all worked up, I was told I seemed overwhelmed and that if I need help I should just ask for it (unless of course it involves a task that I can delegate to the nurse tech I guess). I then pointed out that my fellow nurses as wonderful and helpful as they are (and they are) are as busy if not busier than me and I can't just ask them to do my work because I'm drowning when they are too. Then, going back to the original matter at hand, I also pointed out had the secretary shown an ounce of initiative this whole IV situation would not have happened and their answer was something to the effect of "pshaw! You know how ... is!" like it's cute when she's lazy or doesn't do her job (and IVs aside I mean her basic job, like entering orders).
Now some might read this and say well maybe you're not warm and fuzzy and I wouldn't blame you for taking it with a grain of salt. But I will add that I had worked on this unit for a year and nothing like this ever happened. I had never heard any complaints to this effect, I was never called in to the office for anything negative related to my job performance, and had a stellar yearly review. I should also add, coincidentally (or not...), this "problem" developed very soon after I put in a transfer to another unit (which I graciously agreed to put off for 4 months because the unit's staffing was horrible and I figured I'd be a team player. That'll teach me!). Although I like to think that people are inherently good, part of me can't help but think it was done out of spite for transferring because they went way overboard with this meeting and there was no obvious purpose to this talk other than to tell me I'm uncaring paramedic who doesn't "get" what nursing is about. There were no suggestions made on how I could have dealt with this problem or how to prevent it in the future, they had no intention of speaking with the secretary about doing something differently, so why did this happen? BECAUSE THEY COULD, plain and simple.
Sorry if my ranting went off topic a bit but abuse of power and intimidation really grinds my gears.
Unfortunately doing the right or "ethical" thing is never easy and almost always gives you more grief than not doing anything about it. You become a "narc" or the people you had a problem with may become more hostile because let's face it, we knew nothing was going to happen, at best maybe a verbal warning that doesn't go in their personnel file. Now as far as being yelled at, I would just turn around and walk away and if she wants to chase you down and continue making a spectacle of herself that's her business. You can't stop her from yelling at you but you sure as hell don't have to listen. When you don't listen, she doesn't have any power over you and will most likely quit trying to intimidate you. Other times you just have to grin and bear it. Try not to let her ruin this experience for you but if you're really miserable you can always look elsewhere because unfortunately problem people don't go away. They stay and scare off a lot of good people. It's really sad and sounds cynical but that's often the way things are.
Sep 10, '12Wow!!! That is unprofessional behavior and uncalled for blatant horizontal violence. I would report her immediately.
Sep 12, '12I suggest that you re-read my post. I did ask for help and got help. I guess based on your criteria all nurses that day in our ICU were incompetent. I would love to be like you and never have a bad day or not be perfect. Reading your reply, I had to wonder if you are the very nurse that felt entitled to scold me.
Sep 12, '12Quote from 8jimi8ICURNSee my post above for this.No one is judging. You DID ask for opinions. Part of Icu nursing is knowing when and how to ask for help. You didn't and a patients care suffered for it. Bottom line. Heartfelt analogies do not excuse your lack of care.I would have told another nurse or the house supervisor that I was unable to safely care for my second patient since it seems your charge nurse is against you. I've done it before. No one likes to admit they are overwhelmed but if you don't. People can die.
Sep 12, '12I wish I could report that all is well, but I was told by management that I seem to have a target on my back for a few night nurses that simply "have it in for me". No complaints from day shift. No complaints from my unit manager or my Clinical nurse specialist and no complaints from 90% of the other night nurses. Just a few.......that no matter what I do or don't do find fault and complain. My unit manager is working with HR about the problem, but I don't imagine in the end that anything will be done. There are just nurses that end up in specialty areas that think they are perfect and can do no wrong. The reality is that we are all human and we can only do our best. Sometimes our best won't measure up. That is why team work is important. It truly takes team effort and any nurse that thinks otherwise is in my opinion the dangerous one.