Hi! I currently work in critical care, on this unit since last fall. There is a lot to learn.
I worked last night. There is an aide who has worked there for 30 or so years. He is very set in his ways, and for example, starts his day at 0630 (no one does that anymore) and punches out at 1500. Takes his lunch at 1100, NO MATTER WHAT. Will get frustrated if you bring fresh towels in the room for a clean up "Why are you doing that, there are towels in the drawer" (in the room)). I know several of the longer term staff roll their eyes when speaking of him. They say he used to really be crabby until an accident about a year ago. But I always respected his longevity, and got along, and was always really nice to him.
I worked overnight last night. I had tried raising the head of a patients bed and noticed a crunching sound, it was an O2 tank wedged in the foot pillows of a Kinair bed. I took it out and propped by the wall. I was changing lines. My patient decided very suddenly at 0630 to drop his sats, while on a vent, to 73, and raise his BP to 200. My charge RN was notifying RT/MDs while I was giving O2, suctioning, ect. and wondering if he was having a PE.
Just then, the aide was in the room stocking washcloths, and saw the O2 tank and said to me, "This is very dangerous, this shouldnt be like this, ect" I said "I can't talk to you right now I am dealing with this situation" "This is equally as dangerous, AND YOU WILL TALK TO ME" "I WILL NOT TALK TO YOU NOW" ""YOU WILL TALK TOME NOW" "No, I WILL TALK TO LATER" "YOU WILL TALK TO ME NOW" this excange went back and forth while I am trying to get the pt's sats up and see if RT was called. The MDs were in the room at this point. He SLAMMED the washcloth drawer, and STOMPED out of the room, waving his arms in disgust at me. I was so shaken I could hardly focus on pt and MDs and their questions.
The sats slowly came back up after several long minutes, and BP down, still dont know what happened, but was still shaken a little while later when MDs rounded and were asking me questions.
I went to asst nurse mgr, and told her the above, and she said that O2 tanks were this guys "pet peeve". She said she would talk to him, and it was right my focus should be on pt. I did see him and her casually and calmly chatting a few mintutes later (as I was charting).
I am worried this guy will go off on me in the future, or get 'mad' at something, like a request for a turn, and really honestly would prefer never to see him ever again, but since I know that won't happen, what should I do? How should I handle this, and what do you think of this situation? Very upsetting for me!! Thanks
Jun 13, '12
how about being the bigger person here and approach him, ask him if you can speak to him privately, and then apologize for the situation. you don't have to apologize for what you did or say that you were wrong, but if you're going to have to work with this guy (and it sounds like you are) then it would probably make it more pleasant for everyone...especially you...if you confront the tension head on.
from my experience, when a heated exchange takes place BOTH parties feel awkward regardless of who was right or wrong, but nobody wants to bring it up. instead, they try to forget about it and the tension builds...and builds with each little, tiny incident from there on out. and you're probably right that he will be annoyed with you when you ask him to do things since you went to the manager about something that could've been handled between the two of you after things settled. if he was dead wrong or did something dangerous then maybe it should've gone straight to management. he wasn't though...and it was taken to a manager before an attempt to deal with it personally. nobody appreciates that.
you're right that the patient's condition was the priority when he started going downhill after the O2 tank was propped against the wall. however, the tank was propped against the wall before the patient started going downhill so technically it should've never been put there. i'm not trying to place blame...i'm just saying that technically he's not "wrong" in saying the tank shouldn't have been put there. if someone had been doing an inspection, they wouldn't have cared what happened after you propped the tank up against the wall either. they would say, "the tank should've never been placed there."
instead of saying, "i can't talk to you right now. I am dealing with this situation," why didn't you just say, "i know, joe, you're right. i meant to take it out with me, but he started going downhill and i got distracted. i'm sorry....could you put it away for me?" that would've taken just as long as the, "i can't talk to you, etc..." exchange that took place and none of this would be happening. i mess up ALL THE TIME and I find it's a lot easier to just admit my mistakes which validates the person who pointed out the mistake and holds me accountable.....even if i feel like i did the lesser of two evils in the situation. the lesser of two evils is still "evil."
Jun 13, '12
Appreciate your response. Cant deal with exchange like that when patient is actively crumping. I was the only one there for my patient and had to figure out what I should do and do it, not deal with this aide, seconds count. Exchange was for me to get him out of my focus so I could stay focused on pt., which didnt work, obviously. Slamming things is NEVER acceptable. I did say to him I would address this later, which he did not accept. I was concerned about my patient at that time, not his idiosynchasies.
Jun 13, '12
you're still concerned about being right. being right doesn't matter at this point.
you misplaced the tank. it would've taken just as much time to say, "i know....could you put it away? thanks" as it would have to do the, "i can't deal with this now," ..."yes you can,"..."no i can't" etc, etc. exchange that took place.
slamming things isn't acceptable. neither is propping up an object that can double as a deadly missle. there was really nothing to "address" later. the tank needed to be put away...you didn't do it....he could do it for you, but instead of getting him out of the room with the tank in tow AND no hard feelings.....look what happened instead.
i once got a verbal beating for leaving a vitals machine in the hallway because we would get "dinged" for that IF an inspector were to see it. i had grabbed the machine when a patient was going downhill and half of the hospital staff was in his room. the patient ended up being transferred to ICU and with everything that was going on, even after the dust settled, the last thing on my mind was a machine sitting in the hallway. there had to be at least 15 other people walk by the machine too. not to mention...SOMEONE pushed the machine that WAS inside the patient's room into the hallway...probably to get it out of the way when moving out the bed.
so, when my manager came by and everything seemed "calm" and said to me in her "mean" voice, "this machine can't be in the hallway. we'll get "dinged" for that. you know this," i could've explained how we had just stabalized a patient and how i had to call the doctor and RT and give report...and besides, i wasn't the one who put it there.
instead, i said, "i know...i'm sorry. i'll get it." end of story....no hard feelings...no right or wrong. the machine shouldn't have been in the hallway....regardless of the "good reason" and it needed to be put away. that's all that matters in the end. sometimes it's just not worth it. this sounds like one of those times to me. just my opinion......
Jun 13, '12
You were right to take care of your patient first.
I wonder if the aide has seen what happens when one of those tanks takes flight? I have. I was in a hallway when the guage broke off of one that someone was carrying (by the guage) and it dropped to the floor and FLEW down the hallway, embedding in a wall. Maybe that accounts for his rigidity about the situation?
I think the two of you should talk this through or it will haunt both of you for awhile.
Jun 13, '12
Why didn't the tech just move the O2 tank?
Jun 13, '12
I think that if the aide got a stand for the O2 it may have been a smoother exchange. And perhaps saying "I understand that the O2 tank should not have been standing up propped up against the wall. My bad. If it happens again, please just take care of the tank, as my priority needs to be my patient who is just this close to coding" (and then you, Mr. CNA, would have been doing chest compressions instead of banging drawers<---no, I wouldn't say that, but honestly...) " I will try not to let that happen again, however, it was a rapid situation, and I need to set my own priorities for the patient I am responsible for" (<---and I will try not to blow us all up to smithereens in the process......again, this is probably EXACTLY what his "beef" is) Also a reminder for the future, perhaps jammed at the foot of the bed is not an ideal place for an O2 tank.... You could also use his experience and wisdom as well....."what have you seen done with the tanks in rapid response situations?" Make him part of a solution to this. Doesn't matter who is right, wrong, or indifferent in this case. If he would like to be the O2 police, then he needs to have available a stand for the O2 in each room that one is put at the end of the bed <---which is not ideal practice either......
Jun 13, '12
I don't understand why you just can't approach him about it after everything has calmed down. Even now a day or two later. Things can get heated between people all of the time, especially in high pressure situations, but I don't think it is any reason to be afraid to deal with this person in the future. Perhaps COMMUNICATING with this person will help smooth things out instead of just letting it linger.
Jun 14, '12
Quote from beeble
appreciate your response. cant deal with exchange like that when patient is actively crumping. i was the only one there for my patient and had to figure out what i should do and do it, not deal with this aide, seconds count. exchange was for me to get him out of my focus so i could stay focused on pt., which didnt work, obviously. slamming things is never acceptable. i did say to him i would address this later, which he did not accept. i was concerned about my patient at that time, not his idiosynchasies.
[font='comic sans ms']you posted a vent, and then asked a question about how to deal with this guy in the future, and you got an excellent, articulate and well-considered answer. and now it seems that what you really wanted were responses assuring you that you did the right thing and the other guy was totally out of line. i'm sorry. it sucks to be on the receiving end of constructive criticism when you're convinced you were completely in the right. nevertheless . . . .
the advice you were given was excellent. if you now attempt to make this a part of your future practice, the next time a similar situation pops up, whether it's with this particular guy or with someone else, you'll automatically respond this way. yay for you.
of course, you can just go on telling yourself that you were completely in the right and the other guy was completely in the wrong. it's your choice.
Jun 14, '12
I can hardly believe you are being criticized on this forum.
The assistant is a bully and he has gotten away with it for years.
Find his job description, it most likely says that he works "under the direction of a registered nurse".
Pushing the issue of the O2 tank while your were involved in a rapid response constitutes insubordination AND interfering with the functioning of the unit.
A good assistant (as opposed to one with a self-inflated ego) would have simply moved the tank and mentioned it to you later.
Now... you must go over the assistant mangers head if the behavior does not change, she is not effective in managing hiis behavior.
It will up to the next- in- line to interpret the "interfering with the functioning of the unit" standard.
Stand firm on this , his behavior was outrageous.
Jun 14, '12
Of course the patient was your first priority right at that moment, OP. But the exchange went both ways, and took your time/attention away from the very patient that you were trying to concentrate on.
If you don't want to have conversations like this ... do not engage the person.
Jun 14, '12
I do agree that you should break the ice,,,if you find yourself in a similar situation next time try delegating "yes I realize that, my hands are tied right now, I need you to get the tank,, thanks for your help"
My CNA would have walked in the room and taken care of the tank with out saying a word then come back to see what else she can do..
Jun 14, '12
I would have called a Code Green and had security haul him out of there.