I work PRN at a local psychiatric hospital. Every shift I work I drop in to an unfamiliar patient population and rarely have a stable crew of coworkers. The vast majority of the time I have to take stock of who I'm working with and what the patient situation is. I'm a little unpopular at this hospital because I frown on patient abuse and engage in deescalation early rather than trying to goad a patient into violence so we can call a code and have a little fun.
I do not like to go hands-on with patients. If it is necessary, if someone's health and safety are in imminent danger, then I am quick to react and will go all the way to ensure the safety of all present. However, the threshold is very high and the circumstances must be extreme before I will force compliance. I have a great deal of compassion for the suffering of patients who are afflicted with mental illness.
Tonight, I was told by a regular staff LPN that, "I'm the med nurse, I don't know where XYZ paperwork is." She normally assumes a shadow organization charge nurse position when float staff are on duty, so this was probably a passive-aggressive attempt to put me in my place. That doesn't bother me much, but the problem is that the taxi arrived for the patient and I needed to know where the discharge paperwork is located. I saw the carbons in the patient's chart, but I didn't know where the originals were. This patient is free to go and I'm held up. I don't think that is professional workplace behavior. I found the paperwork 20 minutes later in the patients' packed belongings, but it would have been nice to be told where the regular charge nurse would have put the paperwork.
The other incident involved a charge nurse on another unit who wanted me to ambulate a patient. I have no problem ambulating a patient. That's part of what nurses do. However, I'm being called from another unit to perform this task when there are two nurses and two techs on their unit. Why me? I was told that it's because I'm a big guy and this patient has fallen at least twice a day for several days.
If this patient has a history of falls this recently, then why are we ambulating him? Patient reported a broken patella 2nd to a sports injury. Cold extremities, possibly overmedicated and nodding out on oxycontin and oxycodone, reporting lower extremity weakness, and barefoot. I don't think this is good judgment. All my questions were rebuffed that this patient needs to be ambulated.
I gave it a shot. I got him some grippy-bottomed socks, and had him do some upper body exercise in the wheelchair for a bit to get his blood pumping. He did OK with return demonstrations and seemed to be possibly able to ambulate a short distance. I socked him up, locked the chair, and had him stand. Wobbly and painful, but able to rise on his own. That's a good sign. I had him follow the wall on a short piece of the hallway, which he was able to navigate with prompting and assistance before "my knees are buckling" so I swooped in with the wheelchair and scooped him up. Pt immediately nodded off.
For some reason, this charge nurse seems to have authority on the unit above/beyond the norm. She had no gait belt, no 2:1 staff to help if he fell, and it kind of seemed like she was bullying me into performing this task.
I don't have a problem with work, but I do have a problem with being set up to swallow an incident report.
I do not like to write up my coworkers, but I also don't like being taken advantage of.
Give me some feedback. I need to take stock of this set of circumstances and figure out a course of action. I'm going to be back for the next couple of days and will be floating between these two units with these staff, so I want to put a game plan together. Part of me wants to set boundaries and drive appropriate behavior, and part of me wants to go along and get along. Both are important. It's a balancing act, so I don't want to go too far in either direction.