Nursing Supervisor

  1. Hello,

    I am a Nursing supervisor at a large acute care facility in California. I am interested in hearing from other nurses who have experienced or witnessed other RNs being insubordinate and refusing to provide care to patients. I experience this on a daily basis. Some of these nurses display "unprofessional" behavior in the presence of patients and their visitors. The reason for the refusal varies. Some state they are too busyor they don't like the other nurses, etc. In short, the reasons have nothing to do with what the patient needs or should have. The reasons are based on their needs & wants. The assignments are within their scope of practice and they are not assignments above the ratio. In addition, they are assignments for which they have been hired to carry out.

    I bring this up because I am very, very concerned about the quality and type of nurses we are attracting idue to te nursing shortage. It appears that a lot of people are simple going into nursing for the money. There appears to be a general decline in focusing on patients and meeting their needs. Please let me know what you think?
    Last edit by Lawdo2 on Feb 15, '04
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  2. 16 Comments

  3. by   canoehead
    Well, first I would not inform them of an assignment that I think they are going to object to in front of patients or visitors.

    You didn't mention why they say they must refuse, they don't like what you're asking them to do, but what don't they like about it. Sometimes compromising or helping in some way on a difficult task makes it easier to stomach. Also, I've found that if I go out of my way to help when they are really stressed the nurses will go out of their way if I need them to bend in a difficult situation. So...volunteer to go work out a conflict for them, or work with a difficult family, and make a point of backing them up in public, and then say "hmmmm, if we had approached the situation this way to begin with, we could have avoided all this" in private.

    Helping out clinically gives you credibility too. If you are able to work a shift on the floor, or help with a 2 person transfer, it helps. That way you and the floor staff are all in it together for the patient instead of adversaries.

    Have you talked with the nurse manager? She may have some great suggestions to improve your relationship with her staff.
  4. by   zenman
    People have to be held accountable...perhaps even more so in our profession. I tend to get along with most of the staff here, however, my life does not revolve around what others may think about me. Make sure that they are aware of their job description, other P & Ps and document every incident till they start to catch on. Hope you have a strong HR department. I also help out whenever I can. Last night I helped transport a patient from telly unit to ICU and helped CCU nurse wipe a patient's butt.
  5. by   Havin' A Party!
    Quote from canoehead
    Well, first I would not inform them of an assignment that I think they are going to object to in front of patients or visitors.
    Didn't read this in the original post.

    If I were a sup, I wouldn't refrain from asking a subordinate to do something I legitimately thought needed to be done.

    There are lots of examples of the kind of things mentioned. Many can even be gleaned from messages on this board. (But IMO, it's not mostly the newer folks coming into the profession... quite the opposite.) Just a short while ago, an experienced nurse here indicated she wouldn't cater to the preferences of the patient because that would put her in the role of a slave (?).

    We're taught to honor the uniqueness of patients yet when it gets down to it some nurses are strictly focusing on themselves.

    Agree with the previous poster regarding accountability. Perhaps due to existing economics, sups are more accepting of less than quality service / attitudes on the job. We need to be aware that unless something's done, those behaviors are being reinforced and indirectly rewarded. They'll also serve as models for those coming on board.

    Just some thoughts.
  6. by   mattsmom81
    Focusing on the 'uniqueness' of the patient?? No I focus on doing my job, getting him well...not catering to todays' 'customer service' whims. Customer service has gone to a ridiculous form these days. When catering to wants takes precedence over my having to ability to care for critical patients and being able to do my job, it is past ridiculous.

    Supervisors need to make sure what they are asking staff to do is doable. Would you do this yourself is a good question to ask. Also what are the reasons for refusing. We are accountable for a standard of care and if we cannot meet this we are mandated to refuse or risk losing our license......are the working conditions too poor? Are they staffed sufficiently? Do they have the support they need when a patient/family is abusive to them?

    Supervisors who don't listen to their nurses are one of the reasons behind nurses leaving the profession in droves, IMHO.
  7. by   live4today
    mattsmom said it all! I totally agree!
  8. by   plumrn
    We were asked during one of the 'customer service meetings' to not just TELL a visitor where something is, but actually WALK them to that dept.. We barely have time to slow down from a full run just trying to meet pt priorities, let alone leaving the dept. for something like that.
    Don't get me wrong. I think it is a wonderful gesture, but it was definitely suggested by someone who does not know how things really are in nursing these days. Ratios don't really mean anything. It's whats going on with each pt that matters.

    What I'm getting at is- the majority of nurses are so overburdened these days, that we are overwhelmed when asked to take on even one more task. It's not just new nurses, or older nurses, it is all nurses, because we are all working under the same near intolerable conditions. The general decline isn't because MANY nurses these days are bad. It's because the conditions nurses are forced to work in, are bad.
  9. by   1OldDinosaurRN
    hi, i think it's a wonderful idea---and ladies auxillary or volunteers should be the ones available to do it. we are usually just too bogged down with meds, txs, charting, calling doctors, etc. etc. to do this. it would be nice if we had the time to do it ourselves.
  10. by   fergus51
    I think the devil is in the details. What exactly are they refusing to do? Do they have the time to do it? Is it a nursing job? I find some of the customer service types have unrealistic expectations of what I have time to do for my patients. If a baby is coding, I don't have time to walk another parent to the bathroom to make sure she finds it and I don't have the time to empty a garbage can

    If you are reasonably staffed, and it is within their job description, I would wonder what your NM is allowing this for? I think leading by example works on some people (help them once and they'll pay you back), but for others you may need to get out a stick. Have unit evals, talk to people privately, point out that they are there to do their jobs.
  11. by   Rapheal
    Hmmmm..... I am curious. Of course as a nursing supervisor you have experience as a nurse so what are your observations on the clinical floor about the duites your nurses perform? Are they very busy? How high is the acuity level of the patients assigned to your nurses?

    Why do you make the statement that you think a lot of nurses are getting into nursing only for the money? Are you supervising a floor of new graduates? As an experienced nurse who has worked with many nurses you can not honestly believe that your experienced nurses are just in it for them money can you? I see so many caring nurses on the floor every day I work. Certainly we are not paid enough for everything we do.

    How is the management on your unit? Is the manager and supervisors "hands on"? Why are you asking the members of this board why your nurses are insubordinate? Why not ask them and discuss concerns? If you want a solution to the problems you are facing you must take accountability. If you are not communicating with your nurses, if your are not setting an example, if you do not know the causes of your nurses dissatisfaction then your are not helping solve the problems, you are contributing to them. Attitude reflects leadership. I suggest you get to the root causes of the prolems before suggesting that some nurses are only in it for the money or are not "quality" nurses. It to me is an offensive statement made more offensive when no evidence is presented to support it.
  12. by   efy2178
    In my view the 'uniqueness' of the patient represents individualized care. Every patient has the right to a care plan designed to their unique individual needs. The best way to find out why the nurses will not perform the requested tasks is to ask them. What specifically do you have a problem with? Is is a nursing need? (I'm sure you have done this but you didn't say what their reason was for not giving the care requested of them).
    I wholehearted agree that 'customer service' has become a bandage response to the problem of lack of staff. I have worked in hospitals who have had stupid courses on how to answer the phone properly, how to talk to visitors, how to direct a gift from a patient to the hospital (you're not allowed to accept gifts, they should give money to the hosptial instead). Fact is, most people would gladly help someone out if asked if they have the time. Telling a busy, overworked nurse to just 'make time' is just plan foolish. With nurses running as fast as they can to get basic care given it is unrealistic and totally ignorant of the problem. With administration so out of touch with the issues is it any wonder why good nurses leave the profession?
    Another problem I have is that 'the physician is the hospitals customer'. How ridiculous is that?!!! I thought we were supposed to take care of the patient not the doctor. They get paid far better than me. I think we do a real disservice to patients when we make nurses choose between catering to the physician versus caring for the patient. You can't serve two masters and too often I have seen doctors come first. But I do understand that many hospitals face the problem of physicians being staff for more than one hospital and they can direct patients to another hospital if they get pi**ed off at one hosptial. I just get so tired of the politics.
    Last edit by efy2178 on Feb 18, '04
  13. by   gypsyatheart
    Excellent post! You echo my thoughts exactly!



    Quote from Rapheal
    Hmmmm..... I am curious. Of course as a nursing supervisor you have experience as a nurse so what are your observations on the clinical floor about the duites your nurses perform? Are they very busy? How high is the acuity level of the patients assigned to your nurses?

    Why do you make the statement that you think a lot of nurses are getting into nursing only for the money? Are you supervising a floor of new graduates? As an experienced nurse who has worked with many nurses you can not honestly believe that your experienced nurses are just in it for them money can you? I see so many caring nurses on the floor every day I work. Certainly we are not paid enough for everything we do.

    How is the management on your unit? Is the manager and supervisors "hands on"? Why are you asking the members of this board why your nurses are insubordinate? Why not ask them and discuss concerns? If you want a solution to the problems you are facing you must take accountability. If you are not communicating with your nurses, if your are not setting an example, if you do not know the causes of your nurses dissatisfaction then your are not helping solve the problems, you are contributing to them. Attitude reflects leadership. I suggest you get to the root causes of the prolems before suggesting that some nurses are only in it for the money or are not "quality" nurses. It to me is an offensive statement made more offensive when no evidence is presented to support it.
  14. by   Stitchie
    As a new grad, I got paid the least, worked the hardest I have ever in my life, got bad assignments (vent pt on one side of the unit, three needy, compete-for-attention types on the other side of the floor) and was told that I wasn't a "team player" for suggesting balancing the assignment. Experienced nurses on the floor got preferential treatment and I was labeled as a troublemaker because I refused to take on another patient with the above assignment. IMO it's crazy to put new grads in this position when they, meaning me, need more time and help to deliver safe patient care. My nurse manager also told me to address the doc's by "sir" and, well, I just could not work on a floor where the attitude of the leadership, to quote, was to encourage the backstabbing and clique-iness of certain experienced nurses. Of course, the management set up new grads to fail every day, if you weren't a favorite, and it was an impossible situation. Did I mention that the assistant clinical manager: would ask if you were doing ok, need any help, and if you answered in the affirmative, simply walk away! :angryfire But he always had time for telephone arguments with his wife.

    So many things are wrong with nursing these days, and crying "nursing shortage" is one way for administration to get nurses to do more with less. This "focus on customer service" is ridiculous, too, and puts pressure on nurses who are already overburdened just trying to deliver health care. Of course, I can't depend on the techs assigned because they have not been properly educated on my unit to do what I need them to do, so, chances are, I have to do it myself. This isn't a rip on techs. Some are great. Some are great at disappearing. I blame the unit managers for not making everyone accountable to their job descriptions, including nurses.

    Leave the customer service to the restaurants and hotels, where it belongs, and let the nurses, ancillary personnel and physicians get back to making people better. Luckily, I moved on an ED where I can do the kind of nursing I want to do, instead of worrying about a unit manager who only cares about her next promotion.

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