Surviving a passive aggressive co-worker?

[TheOracle]

Just scanning through the forums I can see that all of us have at one time or another had to deal with a difficult personality at work. I wanted to put my situation out there and see if I could get some feedback on how I'm currently managing a situation that is really starting to put me at the end of my rope.

I am the only male working in a clinic/urgent care; I am studying to be a FNP and am the only RN (aside from NPs) in a clinic with LPNs and medical assistants. I work in a managerial capacity ensuring that patient care is delivered effectively and safely in a streamlined manner in addition to occasional odds and ends in actual practice. I started as a medical assistant at this clinic while in nursing school and worked my way up to where I am today and am continuing to work towards becoming a provider.

I'm noticing a split with the girls at work - one half is very open and willing to work with me to build our success and the other half wants to bicker and complain and fight me on policies that are set outside of my control. One of the girls in particular is giving me the most grief right now and she frequently stirs the others up.

She's roughly the same age as me (mid-late 20s) and says she started working as a medical assistant when she was around 16, eventually going no further in education than becoming a certified medical assistant. She moved from another state where she had more liberties (such as administering medications) and a more hands-on role in lab work. In our state medical assistants can't administer injections and that's just the way it is. For the most part, her job falls into reception type duties and phlebotomy.

She initially expressed dissatisfaction with this, so I took measures to involve her more in the lab as well as clarifying that she could draw up meds provided there was documentation she had been trained to do so, it was not a controlled substance, and that another nurse checked behind her. After that she still persisted in complaining about how she was not challenged in her job and how stupid it was that she couldn't do what she knew she could do; further she complained the LPNs were keeping her out of the loop on doing lab type stuff. I had a talk with my LPNs to reiterate that if they needed a hand to let the medical assistant know.

I was only half surprised to find that they tried to involve her, but she always made them feel like they were imposing on her and that she would make a fuss about how she couldn't leave reception and that it was on them if she got in trouble. So they just stopped going to her. As I looked further into it some of the others were lodging complaints that this girl had confronted them on numerous occasions accusing them of talking about her because they were either ending conversations when she walked past or were attempting to keep from grand standing with patient details that didn't directly concern her.

This girl comes in to work and is distantly cordial and she is sharp at what she can do lab wise, but there's something missing in her attitude. Ask her to help with something, she sighs heavily, will roll her eyes (and think I can't see her out of the corner of my eye) and just gives off the overall energy of a bad apple.

She complains about everything. This past week I listened to her complain about having to work the day before and the day after Thanksgiving and when I offered to see if someone would switch with her she refused and continued to complain. She complained to me, her other co-workers and one of the providers about how sorry it is that our boss insists on being up, but isn't working herself. She complains because her pay is low and that if the boss didn't go buy a new dress or eat out maybe the pay would be better. etc etc etc

She complains that no one helps her, but she never indicates she requires assistance. I finally had her convinced if she was unhappy with how her professional life was going she would have to do something to change it and so she enrolled in college (part time) again with the hope of becoming a RN because as she said "if they let you in, they would be crazy to not take me." Now she complains about how hard it is to work and go to school and it's stupid that she has to do it because she knows what she's doing, etc. etc. Never mind that I did her job while going to school full time and am still going to school full time as well as working full time.

What started out as passive aggressive behavior and backhanded compliments when dealing with me is now progressing to more and more hostile behavior and speech. She ignores me if I ask her something or she'll just turn around and walk off if I'm in the middle of talking to her. She goes around me completely on tasks and problems that I specifically handle in the clinic, so I'm always out of the loop.

I've tried focusing on her positives and made it a priority to catch her doing things right and letting her know what a good job she's doing and she smarts back about how I'm just trying to brown nose. So I can't win with this girl and it's about to make me physically ill.

The rock and the hard place I'm stuck between is that the boss likes her and thinks she's smart and sharp; from a professional clinical stand point I agree that she has valuable skills, but I'm worried that her personality is gonna be a problem not just for me, but the patients as well. She wants to be taking vital signs and brief HPIs and I'm not okay with that because she's too abrasive and non-therapeutic in the dealings she already has with our patients.

With this girl on the clock, our no shows are at an all time low because she gets in there and gets the patients in by calling and following up with appointments.

If the decision were completely in my hands, I'd have fired her weeks ago. But at this point my hands are tied and I have to find a way to manage the situation better - any advice? I'm south of fed up with walking on egg shells around her by a few thousand miles.

[mazy]

Ladies and gentlemen, people, humans -whatever is not an offensive term: what I said would be no different from my "woman" boss saying I'm her "boy" or "guy" or calling me "her" medical assistant or "her" RN except that in this case I happen to be a guy who sought some advice among peers. I feel like I wouldn't have been called out on this had I been a woman.

That would be horribly wrong for her to do that. Unfortunately, I get the impression, from reading some posts from male nurses, that you all have to put up with this kind of treatment a lot. It's not OK for anyone to treat you like that. It's embarrassing to me as a woman to know that my colleagues have to deal with that kind of nonsense, especially after everything we women have gone through historically to be treated as equals.

Anyway, as I said earlier, it sounds like you are trying to do all the right things as a manager to handle this problem, it's just that the gender language seems to be clouding this -- from both sides of the abyss.

[plasmatix]

......At the end of the day I am the boss and if doing the job according to standards set by federal regulations, nursing practice, and our own clinical practice board is too much then they will each need to find another place of employment. I'd really like to enjoy a meeting of the minds with the team and try my best to facilitate that, but the long and short of it is that if they insist on an organizational pyramid, they'll find me at the top.

Oracle, your passive-aggressive employee is exploiting your staff's (and your) emotions to hold her workplace hostage to her personal frustrations. Whatever action you take on her behalf will only serve as "justification fuel" for her irrational complaints/behavior. So instead of changing the clinic's operations to suit her "needs", refocus your energy on the needs of the clinic and its patients. Your (management's) obligations to her are limited to decent working conditions, and the contracted paycheck.

I'm not saying that your early efforts were wrong. In fact, I think you've exhibited essential - but, unfortunately, rare - managerial qualities. But, given her DSM-IV-worthy responses, a change is warranted. I do admire the insight and the resolve exhibited in your recent post. You make sure (as many others have mentioned) to "document, document, document". My recommendations, based on long experience and lots of scars.....

-- Stop trying to "help" this woman. She will not, now or ever, know what she wants. You'll risking your license, professional standing, and sanity trying to find it for her.

-- Prepare a list of duties for the position that fit the needs of the clinic, and have it approved by clinic management. Do not include ANYTHING for which this woman is not qualified (by licensing agency standards) or in which she has not (a) received a measureable level of on-the-job training by YOUR clinic staff, or (b) academic credit for the requisite learning, and © demonstrated both proficiency and willingness to perform regularly. Above all, remember that the clinic's obligation, legally and ethically, is to the well-being and safety of their PATIENTS. This woman's dissatisfaction and her belief that she is overqualified do not enter into the equation.

-- Deal with her on an as-needed-only professional basis. Don't enter into ANY discussions on nonwork-related subjects, or allow her to draw you into them. I'm not suggesting that you be rude or nasty, simply cordial and professional. This will significantly reduce her opportunity to create drama, i.e., occasions in which she can be "wronged".

-- If she is does anything that violates legal or workplace guidelines/ rules, you need to address it in a timely and direct manner. Start keeping a file of your own for documentation of performance issue investigations/ discussions (or any encounter seemingly at odds with acceptable professional behavior). They don't have to be lengthy, but they do have to be able to stand on their own in a legal setting.

-- For any significant or repeated violation, write a brief description of the incident, and your recommended remedial action, and present it to the employee at a formal meeting. Notify your boss of the violation, advising him/her of your proposed action.

-- Limit discussions of this employee's "shortcomings" with other employees to those required by your role as a manager. It is appropriate for you to offer support in difficult situations engendered by this woman, but nix the break-room b*tch*ng and email commiseration sessions. In the case of viable complaints, recommend that they document the alleged offense in writing. Follow-up is essential since overall staff morale suffers in situations like the one you describe.

-- Get the employee's written acknowledgement of the position duties/expectations. Avoid the pressure to "negotiate". She can choose to accept the job, or she can walk away.

The employee now has a clear-cut list of duties she is expected to perform. If she consistently fails to do so at a level necessary to the smooth operation of the clinic, you have grounds to fire her - and documentation to make it stick.

At the least, you'll reduce your frustration level and protect your professional butt. And limiting your communications will frustrate the hell out of the problem employee, who requires a steady diet of "issues" to which she can "react" with her faux outrage.

You sound like you're working toward being an effective manager who provides high quality patient care and a positive work environment for employees. Don't let this experience discourage you from that goal.

[DixieRedHead, ASN, RN]

I believe the OP was saying that this MA is HELPING the practice by calling patients and getting the to come for their appointments. Note the phrase: "With this girl on the clock, our no shows are at an all time low because she gets in there and gets the patients in by calling and following up with appointments." So bringing this to the attention of the boss would actually benefit the MA.

I totally misread this. I had it in my head that the no shows were higher when she was there, not withstanding it says the exact opposite in plain English. Sorry.

[ProgressiveActivist, BSN, RN]

Might be a good time to write an employee Code of Conduct which is something required by JCAH for hospitals to decrease lateral violence. Require everyone to sign a copy and if they violate it, (gossip, nasty comments, negativity, rudeness) then you have grounds for progressive disciplinary action.

Is the CMA licensed by your state? I think not. Does she work under the supervision of an MD, an RN or both. Maybe you need to check with your BON for clarification.

You have to be a role model of professional mature behavior and she will hate you for it. Eventually no one will feed her need to feel superior, believe a word that she says or talk to her and she will move on.

I would try to touch base with every patient and let them know that everybody is going to be polite to you and if they're not, the doctor and I want to know about it.

We just had a nasty character like her, a CNA, leave our unit and OMG she created horrible problems for every well qualified RN. I feel your pain, I really do.

[nursel56]

Oracle - The first thing that jumps out at me is that the two of you have a major personality clash - a separate issue from the other problems you detailed, but it's certain to aggravate them. Saying you were only "half surprised" to see your efforts fail is kind of a tip off. You mentioned that you work in a "managerial capacity"? Is there anyone, other than you and your boss who works in a managerial capacity? Sometimes a fresh approach can be effective, and you have nothing to lose by trying, as you've stated the boss likes her despite all the complaining by your co-workers.

Since it appears that you will be working together for the foreseeable future, I'm just going to throw some thoughts out there . . .

How long has she worked at this clinic? Were you two medical assistants working together at any time? It's almost a truism that when there is an in-house promotion the promoted person must deal with the "crab effect". Not crabby :) but the tendency for former peers to want to pull you back down.

She's been a medical assistant for ~ ten years.

You won't allow her to take vital signs or ask the patient why they are there (hx).

I think I would be irritated by being told I was too abrasive to take vital signs, especially if I posessed enough social skills to convince no-shows to come in on time, a rather daunting task in my experience. In fact, that could be reason enough for the boss to keep her despite the malcontent attitude she displays.

Do you hover over her more than the other MAs there? It sounds like she may resent your advice about nursing school, because it steps beyond your role at work. If she normally sighs, rolls her eyes, and intentionally avoids you it is not likely that she views you as a mentor, so I would not do that anymore. I'm sure she already knows how to alleviate what she feels is her over-qualification for the job (I agree with her btw - it surprised me that your state doesn't allow MAs to give injections).

It seems that your only real choice would be to back off a bit, while documenting the negative interactions with others she displays and keeping your boss apprised at all times. Sorry you're having such a rough time. I think the bad apple- the boss loves is one of the most disruptive issues you can encounter, and every place seems to have one!

Last, less than a week ago someone took a woman to task over the exact same thing, referring to CNAs as "the girls". So we're gender neutral on that anyway.

[DixieRedHead, ASN, RN]

Oracle, I am 64 years old and I can hide a can of cat food under each breast. Call me a girl, I will say "THANK YOU." Ahhhhhhhhhhhhhhhhhhh who cares? If your professional stature is so tenuous it rests on something this small, you probably are a girl.

[ProgressiveActivist, BSN, RN]

I didn't read anything negative into him referring to the employees as girls

[Shazdalady]

Hi, I cama accross your post by accident, I am going for a Band 6 (sister) post and was looking for some tips lol.

You sound like a very good manager and clearly this member of staff is in the minority. I think she is a narcissist from reading your post and if so she will be totally unaware of the trouble she is causing as it will allways be someone elses fault. I would suggest that you invite her for her performance appraisal and present some of the issues to her, set her an action plan addressing the problems, if she flies off the handle you have folllowed caapability procedure. Make a note of all conversations yoy have with this individual, form aggreed action plans together offer her study days etc.

I dont think there is much more you can do to be honest, she is an obvious problem. Maybe stop trying to help her and find suitable policies and procedures to move her !.

Sharon

[TheOracle]

Thanks guys! I appreciate the input. I don't hover over this MA any more than the others. My observation that she is abrasive with the patients is merely my own and hasn't been shared with her. I find it odd that she gets no shows into the clinic, but is very non-therapeutic once they're in.

I finally had a serious sit down with my boss and she told me (as it has been advised here) to stop going out of my way to make this employee happier in her work. She told me that I do the evaluations and it is my call if "the girls" (her terminology) get raises or if they even keep their jobs. It is part of their job descriptions to meet the standards I set forth and I don't owe anybody an explanation for expecting the standards are met.

I feel soooo much better and more prepared to handle this situation now. It helps knowing I'll be backed up. I've had bosses before who wouldn't back me up.

Thanks again for all the awesome advice! :)

[Guest717236]

In my over 25 years in nursing, wish I had worked for a manager like you!

Oracle,

Best wishes on your FNP studies...happy to hear you have

autonomy as a manager.

[SHGR, MSN, RN, CNS]

-- Prepare a list of duties for the position that fit the needs of the clinic, and have it approved by clinic management. Do not include ANYTHING for which this woman is not qualified (by licensing agency standards) or in which she has not (a) received a measureable level of on-the-job training by YOUR clinic staff, or (b) academic credit for the requisite learning, and © demonstrated both proficiency and willingness to perform regularly. Above all, remember that the clinic's obligation, legally and ethically, is to the well-being and safety of their PATIENTS. This woman's dissatisfaction and her belief that she is overqualified do not enter into the equation.

...

-- If she is does anything that violates legal or workplace guidelines/ rules, you need to address it in a timely and direct manner. Start keeping a file of your own for documentation of performance issue investigations/ discussions (or any encounter seemingly at odds with acceptable professional behavior). They don't have to be lengthy, but they do have to be able to stand on their own in a legal setting.

This was a fabulous and long post. I just wanted to point out in addition to the above that the OP stated that in his state, MA's cannot administer medications. This is different than in my state. MA's can administer medications including some injections- but we have a policy at my facility that people of any licensure do not administer medications that they haven't drawn up unless the syringes are properly labeled, and even then rarely. I'd be insulted, personally, if another staff member insisted on drawing up my meds!