What to do about disruptive behavior?

[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

[meandragonbrett]

I would write an incident report for disruptive behavior. The other nurse is creating a hostile work environment.

[rcon]

I would write up an incident report against that nurse for sure! We have all had those days where you are so busy, you cannot do everything you are supposed to...so you must prioritize! That nurse should have pulled you aside and spoken to you with some maturity if she had something to say to you. Your colleague behaved live a child and there is no excuse for publicly attacking someone. She needs to be educated on the proper way to interact with colleagues. I have had some similar occurences (none quite this awful though), and it creates a negative work environment! ICU nursing is a team effort. Although turning a patient is important, I think we can all agree that it comes after hanging blood or administering an important medication like levophed. Some patients who are really sick can take up all of your time....they are unpredictable, that is why they are in ICU!

I want to apologize to you on behalf of that nurse! The truth is that she is the bad nurse. Transitioning to ICU is hard and even the most experienced nurses need help when given a difficult assignment. We are all humans and we need to work together and kindly help eachother...we owe it to our patients! If the day or night shift did not do something (as long as it is within reason), we should not yell or scream, we man up and pick things up where they were left off! I think you are doing a great job and your assignment sounded very challenging. We have all had those! I can guarentee you that at my facility, that particular nurse would have been fired for sure...if she was screaming at you and calling you names in public. I mean are we in the first grade? There should be a zero tolerance policy. Ignore this nurse and keep working hard!

And learn from the experience. Now you know to delegate to others and make sure to follow up on what care was given to your patients.

[Sugarcoma, RN]

Yes, you need to inform someone of this nurses behavior. This is unacceptable in a professional environment (or should be). How embarrassing for you. I really hope family/visitors were not around to hear this nurses tirade. You did the best you could. That is absolutely all anyone can do. You had a challenging assignment and you had to PRIORITIZE your care. A good nurse knows how to do that. You asked for help when you needed it and you made sure the most important interventions for your patient's were completed. I say good job!

Admitting that "you're right" probably made this person feel justified in their anger and fueled the fire. This nurse was not "right." You are not an "undesirable" or a nurse who provides "substandard" care. You are a nurse who is new in an area where rushing around to check off tasks can kill people. It is o.k. to not be perfect and you need time and experience to grow into your role.

You need to set boundaries for yourself on how you allow others to treat you. Should you ever experience an angry coworker screeching at you again it is perfectly acceptable to say something along the lines of "We can have a professional and private discussion regarding this matter when you regain control of your emotions" Then WALK away! Or you can just walk away. Much easier said then done I know! It took me a long time to learn to be more assertive but the payoff in the end is soo worth it!

[boogalina, ADN, ASN, BSN, MSN, LPN]

I'm a CNA in an ICU. I agree with the above commenters. The nurse's behavior was not only incredibly uncool, but could have posed a danger to patients in the unit, as lots of yelling and screaming is not good for fragile patients (like your younger patient). You should certainly do an incident report, as well as take notes of what occurred (you have a pretty good synopsis in your post) so you can refer to them if anything like this happens with this nurse in the future (although, heavens, I hope not, once should be waaaayyy more than enough).

I've never, never, never seen anything like this from any of the nurses I've worked with/for, but maybe a little over a year's experience hasn't provided me with the opportunity (?) to see something like this. Maybe the other nurse is having some sort of serious stress problem or something outside of work that has her thong tied in a knot, but I suppose that is for management to sort out.

"Be kind, for everyone you meet is fighting a hard battle" - Plato

[Mudwoman]

Thank you all!!!! I did fill out a Disruptive Behavior Incident Report today. The charge nurse that heard all of this was there this morning and I wanted to make sure the patient was okay and he informed me that he was. Then I was shocked. He laughed and said that after I left, he remarked to this nurse that she sure was "grouchy". This is the same charge nurse that stood up in a unit meeting 3 months ago and remarked that he was tired of some people on the unit being ugly to other nurses and nothing being done about it. WOW. I nearly fell over. Several nurses said I should just learn to live with this nurse's outbursts. She is related to one of our House Supervisors and our person just under our Unit Manager is her sister.

So, after I did this today, I also sent an email to my unit manager explaining that it was the hatefulness and cruelty that ultimately made me realize that this needed to be reported and addressed. It was not the fact that she found the patient not being turned a problem, but rather that she intentionally was hurtful and hateful and cruel. In a work environment that is not acceptable behavior. It is one thing to give constructive criticism and it is an entirely different matter when you know you are being really ugly to the point of evil, and don't feel bad about it.

I got the cold shoulder from my fellow workers after I sent the report. Several won't even speak to me. As the day progressed a few warmed back up, but not all. We will see how it plays out.

Thanks to all of you, I had the guts to do this. I had talked myself out of it several times. I appreciate all your input. After the support for doing the right thing, I also embraced that I would withstand whatever comes of this. It is not always easy to do the right thing. I realized that I would never, ever talk to ANYONE the way she talked to me.

I'll keep you updated.

Charlee

[blondesareeasy]

This has been up for only one day and has over 600 views and only 5 comments. This is apathy at its best.

What's worst about this job is that after all you've been through in a day from hell, you need another hour to document all that went wrong.

Nurses collectively are guilty of not following through due to fatigue and exhaustion. But after you've been doing this long enough, you'll have the power to go back down the throat of the insecure loud mouths. And, you've also experienced the coalition of co-workers that are for, or against, the perpetrator. And you can be sure that you were the subject of their conversation for the rest of night.

The comment was correct about creation of a hostile workplace. Exhausted as you are, I've found it extremely satisfying to take a piece of paper and start writing down the idiots complaints, one by one, as they are spewing them off. After that, you tear it up in front of them and say, "All better now?" But I'm old and experienced. And I'm a delightful a-hole.

[RNforLongTime]

With people like that, I find it's best to give it back to them. Treat them like they treat you. IF she was yelling at you, yell back(in the breakroom--not in the middle of the nurses station) Once someone learns that they cannot walk all over you, they back down.

[Creamsoda, ASN, RN]

It sucks that you let that one slip, I think we all agree that was a big mess up, But it did not need to be handled in that fashion by that nurse. I agree a report was needed for that, good for you for owning up, great that you have a supportive charge. That being said, you should definately make a report for her behaviour. All she needed to do was point out your error, you owned up to it, speak with the charge for "counseling", done and done. Her behaviour is rediculous. I had a doc ream me out for no good reason, totally disruptive. It was the first time anyone in my career had done that to me, it was down right rude and condescending, not constructive at all. I was going to report it, i never did, but now i really really wish I did. That behaviour cant be tolerated.

[Nursetastic]

If her behavior continues a formal complaint to HR will be in order. My unit has 2 nurses that behave this way on a regular basis for little things. We've filled out numerous incident reports about their unprofessional behavior including in front of patients and families in an overt attempt to lay blame and make the previous nurses look bad. Last month, one nurse who is a particular target for both of them, finally went to HR and filed a formal complaint regarding hostile work environment. Their behavior has continued, incident reports have continued, and another nurse has filed a complaint. The next step is the Ombudsman. As a group, my shift is DONE with this type of abuse. Do not tolerate this behavior from her or anyone else. You accepted responsibility, wrote yourself up, and have learned from the mistake. She should respect you for that. Not belittle you.

[Rmshad]

The Head Nurse (Nurse Manager of the unit)should be addressing the patient assignment issue. If there were more ICU experienced nurses present during the shift then one of your patients should have been assigned to them and a less acute patient be given to you with the other critical assignment. It sounds like a few issues have to be addresses here including the bullying issue.

[PrayeRNurse, ASN, RN]

i am so sorry you had such a difficult time. as a new nurse i will take one thing from your post; follow up on tasks that are delegated. i have a question for you, you seemed to listen to her yell at you for some time, should you have walked away inviting her to talk to you when she could do so in a professional way? as i said i am a new grad and i am trying to learn from the post as well as reply. i would put any complaints about this nurse in writing in a professional tone, maybe in a third party voice. that way you and the person you give it to have it in writing. hope you have better days ahead.