Just ignore it or have a discussion?

[dudette10, MSN, RN]

I have a coworker that is a tad less experienced than I (but not by much) and is a good nurse. I also have a fairly good reputation, and all the nurses I work with across many units (I float) will bounce situations and questions off each other and help each other out when needed. It's a good collaborative nursing environment for which I'm thankful.

The problem is that I feel she oversteps her boundaries. It's happened three times, but the most recent involved a situation in which I knew my patient well, having taken care of the patient a few times during his stay. The patient has been very difficult--refusing things, insisting on discharge, etc.--all of which was documented thoroughly by pretty much the entire healthcare team (docs, nurses, other professional staff). My coworker hasn't taken care of him.

While I was addressing some instability in one of my patients, I got a call from my coworker that the difficult patient wanted to speak with me. I knew what the problem was, I really couldn't do anything about it (we were waiting on a consult to round), and I had already spoken with the patient about 20 minutes before and got the same response that I got from him every single time he was upset about waiting. I told my coworker this, and I mentioned that I was currently preoccupied with a patient that was unstable.

Later on, my coworker came up to me and said, "Oh, yeah. I read through the notes. I see he's put everyone through the wringer." Knowing my coworker, I also know she went into the chart to see if she could "fix things" without asking me first. That's where she oversteps her boundaries, and this isn't the first time.

We all ask for help when we need it, but she just blew through without asking if I wanted the help AND after I explained the un-fixable situation. There's a difference between hanging a new bag of saline for a coworker or flushing a line after an antibiotic is done or toileting someone else's patient vs. addressing a more complicated issue of a difficult patient insisting on discharge before the doctors, nurses, and everyone else feel it is time.

What would you do? Ignore it? Have a latent discussion about it? Wait until it happens again then have a discussion about it?

[bugya90, ASN, BSN, LVN, RN]

In my facility that would be against policy. We are not allowed to look up patients charts without being directly involved in their care or asked to be in their care by a coworker (need assistance with procedure, med, etc). Since she was not the assigned nurse nor did you as the assigned nurse ask for help it would be a violation. If she is approachable try talking to her about it in a non confrontational manner. She may not realize she is crossing any lines and if no one tells her she will never know.

[icuRNmaggie, BSN, RN]

I think her intentions were good; she just wanted to help out while you were tied up with an unstable patient. I can also see how you might have felt that she was interfering or had no boundaries. So just say that, I know you wanted to help, but next time please check with me first because ultimately it is my responsibility to handle these things. I really don't want you to get in any trouble for accessing his chart either. Thanks.

[MunoRN, RN]

I have no problem with, and freely welcome any input someone has about what might benefit a patient (or me). There are different nursing environments out there; some are very individualistic and self-reliant, others have a more team oriented approach where essentially every patient on the floor is everybody's patient, patient's have a primary nurse but every nurse is expected to help other nurses as they are able, which means helping to deal with a problem even if another nurse didn't specifically ask.

[jadelpn, LPN, EMT-B]

"Please let Mr. _____ know that I am currently with another patient, and that per our plan of care we discussed, consult MD will be rounding, and will be seeing him. This patient has difficult dynamics, so we just need to be consistent in following his plan of care. Either that or he will still be here when we are ready to retire, or we shall be readmitting him from now til Christmas. Please advise him that I will be meeting with him after consult has rounded. Thanks, and I appreciate your helping!"

We are all on the same team, and all contribute to discussions regarding patient care. Sometimes fresh eyes are good ones, but regardless, this patient needs consistent consistency in following the plan. And to address the patient's manipulation of nurses, however, story for another thread.

[Libby1987]

With just what you've described, I would ignore. there are so many issues that can come up between coworkers, one nurse reading a chart on a patient who complained to her and then validating your statement would not be one I'd take up.