Offended a coworker

[Possum_RN]

I've worked on a unit for over a year as a NA, and I'm in nursing school. I used to work weekend nights full-time, and I built a good rapport with my coworkers. I have recently gone PRN due to the time constraints of my nursing program, and work weekday night shifts. I have had a really hard time building a rapport with a few of them.

Recently, things seem to be coming to a head and I'd like input on how to proceed and deescalate the situation: I just want a good working environment.

I was working with a particular nurse recently. Twice before, bed alarms have gone off with her closer to the patient than I was. She stood there and looked at me as I ran by to respond. Last night was the third time this happened - I was almost twice the distance away. I spoke with the TL and expressed my concerns, and the TL addressed the group asking "whose in charge of patient safety? Who responds to bed alarms?" we all do.

But, obviously the nurse knew I had talked to the TL, because she saw me run by.

Shortly after, the other NA on the floor berated me for going on break and not telling her of one patient on my assignment with a bed alarm. She claimed that the nurses were in the dictation room and that I had put a patient at risk by not telling her he was on a bed alarm. Before I went on break, I had told all my coworkers that I was going...so why were they all in the dictation room?

For the rest of the night, that NA would disappear and that nurse would call me to respond to her assigned patients. I did so, because I didn't want to perpetuate drama. Maybe I should have stood up for myself more?

It just seems to me like this is getting to the point of bullying. How should I proceed? Talk to the supervisor? I don't want to call anyone out. I just want to work and not offend the clique. I think patient safety is a valid reason to have said something, but now I'm facing "group punishment" for lack of a better term. Any advice for how to respond professionally and effectively?

[TheMoonisMyLantern, ADN, LPN, RN]

I know this will sound blunt but I truly don't intend to offend you. Okay first of all not all interpersonal conflict is bullying. Second of all if you had an issue with the nurse you should have brought it up WITH the nurse in question and not tattle on her to the TL. Thirdly don't sweat the small stuff, should you have mentioned your to the other CNA who your bed alarms were? Probably but lesson learned, the other CNA will get over it. Go to work, do your job to the best of your ability, keep your head down, make your money and go home, let the rest roll off your back. It's a lot easier that way.

[Possum_RN]

Thank you for the response.

Sure, I understand, but I'm not a new CNA. I'll report off on bed alarms when I leave...but I really don't think this is standard procedure- at least no one in three years has ever reported this to me. I'll have to start giving complete report before I go on break?

I was curious about your point of going to her with it though: if she is my superior, going by the chain of command, wouldn't I go up the chain? I let it go twice...when it's obvious that this is not a fluke (she didn't hear it, or something), how would you bring up the issue, or expect a CNA to bring it to you? What if you have a preceptee (sp?) by your side?

Good point about interpersonal conflict. I've written an essay on my concerns but deleted it for brevity.....to put it bluntly, I really think patient safety is at risk, and I'm not willing to let it go. But, taking your advice, I will give the CNA FULL report in the future before going on break, and see how her patience for that goes. I will adress her directly next time she disappears. I will adress the nurse directly when she asks me to perform patient care on patients who are not assigned to me when the CNA is "still on the floor" to the best of my knowledge. Any input or personal examples of success in that regard are appreciated.

I did bring it here, because I have a concern, but do NOT wish to discuss it with my coworkers that I do get along with, contributing to the cliquy issue. I do try to keep my head down, but if theres no outlets at all....isn't that how burnout happens?

[Nurse SMS, MSN, RN]

Any time I left the floor I gave the person covering for me the courtesy of a run down on high risk or other notable issues. There is a lot of territory between full report and a quick review of who is bolting out of bed unpredictably, who is frequently soiling and who might need to be turned. Don't make this all or nothing. You can even write it down if you want. "I am going on break. Here is a list of my rooms on bed alarms. I just changed so and so and Mrs A appears to be asleep but has been on the call light frequently today. Mr Jones is due to be turned at 1:30. Thank you so much!" Then go on break.

[Emergent, RN]

I have a feeling, from your account, that they are all buddy buddy and trying to get back at you. It might just be a toxic environment or it might blow over.

Give it some time and see what happens. There is only so much your boss can do in these types of situations. Sometimes there is an healthy culture in some workplaces. There are times when it's good to vote with your feet.

[Apple-Core, ASN, BSN, RN]

I have a feeling, from your account, that they are all buddy buddy and trying to get back at you. It might just be a toxic environment or it might blow over.

Give it some time and see what happens. There is only so much your boss can do in these types of situations. Sometimes there is an healthy culture in some workplaces. There are times when it's good to vote with your feet.

I agree. I know often times people suggest ignoring it, but I have been in toxic work environments where it becomes hard to even concentrate on your work because you can sense the hostility.

[CapeCodMermaid, RN]

I worked in SNFs as the director of nursing. Everyone is responsible for answering call lights and especially responding to alarms. I have seen nurses walk three times around the unit looking for a CNA to answer a light. I never walk past a call light unless I'm on my way to an emergency. It sounds like all these people need to care more about the patients than they do.

PS. Alarms do NOT prevent falls.

[jdub6]

I can't get the quote feature to work but from your OP "She stood there and looked at me as I ran by to respond. Last night was the third time this happened - I was almost twice the distance away. I spoke with the TL and expressed my concerns, and the TL addressed the group"

Did you say anything to the nurse before going up the chain? It looks like you didn't. I would always speak directly to the person before going to the boss about something like this. I don't know how close/far from the patient you were. If I were a nurse about to give a med or in the middle of documenting, heard a bed alarm and saw a CNA available and responding I might not go to it if the aid could get there reasonably quickly. If the aid was also busy I would probably respond. But it's a judgement call and that's the kind of thing l would want someone to address with me before the boss.

If you now have a reputation as a snitch or a princess/snowflake and the night staff is a small close group it will be hard to shake that. Ask the CNA what info they want when you go on break "I'm not used to reporting who has bed alarms but if that's how you do this here I definitely can...what else do you need when I go on break?"

I sense that perhaps she is making the bed alarms an issue because she believes you overreacted about them with the nurse. Responding to bed alarms is everyone's job...It's also your job. If you are available and hear one, go to it even if you see other staff nearby. Try to demonstrate that you do your job.

As far as the nurse calling you for other people's patients...that's tricky. maybe "is X busy? It's her patient but if she's on break or giving a bath I'm happy to help as soon as I finish toileting my patient." Then if it happens again say the same thing except add "X is assigned to that side tonight..she has the river side and I have the street side. If she's busy though I can help you as soon as I finish up with xyz on my side." Then if it continues maybe mention it to the aid once "Nurse Y keeps calling me about your people...do you have a really busy room you've been stuck in or what is going on? I will always help if you're busy but I feel bad because it takes awhile to get there since I do have my own side too." Then if it continues and you still feel its intentional I would go to the boss at that point.

As Emergent said if this is just a toxic staff you may be stuck leaving or dealing. None of what I suggested will work if they are bullies. If that's the case and you can't leave and you've tried to resolve things the nice way THEN put your foot down...do your job well, when the bed alarm goes off "hey Y, can you get that? I'm in the middle of xyz..." when they call about another person's patient AGAIN "that's D's side. I'm sorry but I've got abx going on over here so I'm tied up with my patients. when I'm done ill check and see if you still need help but it will be awhile" and so on.

[Possum_RN]

Thanks for all the replies.

I know it's hard to get the "feel" of a situation down in writing, but I really feel the situation was...if not bullying, then at least toxic. The original call bell was already going off when I came out of the galley ...I ran down the length of the hall to respond - the nurse was about halfway between. No way she didn't hear it.

As for addressing the nurse, i'll do it next time, but I dread it. The nurse is very buddy-buddy with some staff, but I and at least one other CNA are apparently not "in" with her group. I don't know who else is or isn't....I haven't gone around taking a poll :) Just something another aide mentioned to me.

In all honesty, I'll probably bounce if I cant get some sort of congenial rapport going. I'm in nursing school, my last semester. At this point I have no debt, so If I need to go into a little, it'd be more worth it than adding this stress to my plate. But I will make an effort.

Thanks again.