She Snapped...

Nurses Professionalism

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Specializes in Med-surg, telemetry, oncology, rehab, LTC, ALF.

I have a coworker, we'll call her Sarah. Sarah has been causing a lot of problems at work lately.

About two weeks ago, she came in and told me that she was exhausted, and that if I wanted her to work her next scheduled shift, she needed to go home early. I didn't care for the phrasing of her request - it seemed more like a demand, than a request, after all. I allowed it to happen anyway, since there was an extra nurse in the building to take her place.

Fast forward two weeks. I hear talk from another supervisor that Sarah has been especially negative this past week, especially when faced with an admission earlier in the week (something that is expected of all nurses in this particular facility, and Sarah has also demonstrated she is able to complete, just unwilling to do so). She appears OK when I come in for my shift, but approximately 5 hours into her shift, she begins complaining to another nurse that she doesn't feel well. Since I was in another part of the building, that nurse calls me. She tells me that her VS are abnormal and that she "just doesn't look right." I'm immediately concerned, so I check on her. She appeared to not be any acute distress, but she c/o feeling short of breath. I asked her if she wanted me to call an ambulance to take her to the ED. Sarah says no. She appears to be undecided about what to do, so I make the decision for her. I told her to count with another nurse, give them report and go to the ED.

She comes in the next day for her scheduled shift. She appears OK and tells me that she's feeling much better today.

Less than two hours into the shift, she confronts another supervisor when that supervisor notifies her that one of the people she is caring for is unhappy and making complaints about her. I happen to overhear the conversation, and the following all-out implosion on her part. She yells, threatens and uses profanities during her confrontation...that supervisor comes to find me (and to put space between the two of them). I then find myself in a front-row seat for another ten minute rage. Once she had finished, I waited until she left the room and contacted the director. I explained to her what had just occurred, and let her know that I wanted to send her home, since I did not feel that it was safe for her to be providing care to anyone, given her current attitude, behavior, and her inability to calm down and have a rational discussion. She agreed. I found a nurse to take her spot first, and then told her that I needed her to go home. She first persisted, making excuses as to why she could not leave yet, but I told her the director wanted her to go home. She then notified me about 15 minutes later that she was done, and that she was officially quitting (without a notice). (Although I wasn't certain at this time that she hadn't just been terminated.)

I later found out that Sarah has a history of similar behavior. She has apparently bounced around at this facility, and was given "one last chance" about six months before this incident. I have noticed that she is very good at acting remorseful and pleading her case, when necessary. It's honestly quite frightening that someone with such a short fuse was caring for so many people.

A lesson in professionalism...never implode on your boss!

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Sarah sounds like she has an undiagnosed medical/psych issue. This story kind of makes me sad. She's going to implode one day.

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Specializes in Psych, Addictions, SOL (Student of Life).
Sarah sounds like she has an undiagnosed medical/psych issue. This story kind of makes me sad. She's going to implode one day.

That's the first thing I thought of but I'm a psych nurse so I think that about a lot of people. The behavior described is strongly suggestive of an undiagnosed mental health issue such as bi-polar or possible a borderline personality disorder. The hospital did itself and her a disservice. What she needed was to be referred to employee health who could help her get an evaluation though an EAP program. She will eventually crash and burn. Hopefully she won't become violent and take somebody down with her.

Hppy

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It is sad when a person, with physical and/or mental problems that impinge upon their ability to work, can not be directed to a place where they can get help. Just to be let loose to wander into the ozone, allows the situation to continue until something really bad happens. I have wondered what an employer can do as far as forcing a person to go to a doctor or the ED from the workplace. I imagine, most of the time, the employer simply is satisfied with getting the person out of the building and off the premises.

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Specializes in Psych, Addictions, SOL (Student of Life).
It is sad when a person, with physical and/or mental problems that impinge upon their ability to work, can not be directed to a place where they can get help. Just to be let loose to wander into the ozone, allows the situation to continue until something really bad happens. I have wondered what an employer can do as far as forcing a person to go to a doctor or the ED from the workplace. I imagine, most of the time, the employer simply is satisfied with getting the person out of the building and off the premises.

They can't actually force it unless the person in question clearly presents as a clear and present danger to self or others at which point a call to psychiatric emergency services is warranted. Still the employer can council the person about their concern and give them information on how to confidential care through EAP. It will be up to the person referred to follow up but at least an employer can know they tried.

I remember a pretty famous case in which a Catholic Priest suspected of abusing children was simply moved from Parish to Parish with no mention in his personal file about why these reassignments took place. When he eventually was caught and prosecuted the church had to shoulder at lest some pf the blame.

Hppy

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.

At this point, Sarah should really be reported to the BON. She is too volatile to be able to provide safe patient care. Whether she gets help or not is her choice. At least the BON can evaluate whether she's fit to care for patients and take her out of the picture if she isn't. It's not fair to future employers and their patients to allow her to carry on.

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Specializes in M/S, LTC, Corrections, PDN & drug rehab.
That's the first thing I thought of but I'm a psych nurse so I think that about a lot of people. The behavior described is strongly suggestive of an undiagnosed mental health issue such as bi-polar or possible a borderline personality disorder. The hospital did itself and her a disservice. What she needed was to be referred to employee health who could help her get an evaluation though an EAP program. She will eventually crash and burn. Hopefully she won't become violent and take somebody down with her.

Hppy

They could give her all the referrals in the world but if she doesn't want help, she won't take it. You can lead a horse to water but you can't make it drink.

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Specializes in Pediatric Critical Care.
At this point, Sarah should really be reported to the BON. She is too volatile to be able to provide safe patient care. Whether she gets help or not is her choice. At least the BON can evaluate whether she's fit to care for patients and take her out of the picture if she isn't. It's not fair to future employers and their patients to allow her to carry on.

I don't know if you are right or not, but I would be very hesitant to do this, as it could irreversibly damage her career. I simply have no confidence in the BONs ability or willingness to objectively determine if the nurse is fit or not - I suspect that Sarah would just be placed in a monitoring program regardless. Maybe it is necessary, but I would only use this intervention if I truly thought it was the only option that I had to keep both Sarah and the patients safe.

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The entire time I was reading this, I was thinking Borderline Personality Disorder. I hope she is able to get the help she needs, but most likely will not and will end up hurting herself/someone else :sorry:

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Specializes in Med-surg, telemetry, oncology, rehab, LTC, ALF.
At this point, Sarah should really be reported to the BON. She is too volatile to be able to provide safe patient care. Whether she gets help or not is her choice. At least the BON can evaluate whether she's fit to care for patients and take her out of the picture if she isn't. It's not fair to future employers and their patients to allow her to carry on.

Agreed. Unfortunately, last I heard, Sarah had not been reported to the BON - and she was actually allowed to continue working there (apparently she came back at a later date and made her case after notifying me that she was quitting). I suspect that this was because they had no one to fill her spot. It's a shame, really...I'm sure the morale of the workplace has went to pot by now, due to her presence. I also suspect that the patients in her care are not being cared for properly because of this.

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Specializes in Med-surg, telemetry, oncology, rehab, LTC, ALF.
The entire time I was reading this, I was thinking Borderline Personality Disorder. I hope she is able to get the help she needs, but most likely will not and will end up hurting herself/someone else :sorry:

You're probably right, unfortunately. I really feel that she needs some psychiatric help, but I know that she won't ask for it or accept it.

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