Staff splitting - Help! - page 2
Okay, I need HELP! I've been in nursing for many years, but I've only been working in psych for about two years. I recently cared for a patient who was depressed because of a recent romantic... Read More
Aug 14, '03Thank you all for your help. I have definitely learned a lot. I will have a lot to think about if this situation ever occurs again.
We do not have a clear complaints procedure in our facility, but I am going to suggest one.
Thank you, Frankcah for what you have said. You seem to have nailed this particular situation right on the head. I have not seen this particular situation happen, and I thought I did the right thing at the time. Most complaints from patients are just nit picky nothings, but I really felt this situation was different. The patient was smart and was not delusional or paranoid. She had no complaints about any other staff member, and other than this one nurse's behavior, she was very pleased with her stay. Like you said, I have beat myself up over this. And, yes this nurse has a history of bullying people.
Hey, I mentioned this once before, but I will again - not many of you have commented on the nurse's behavior toward me. She called me at home, and this was not a nice call, either, as she was screaming at me. I think calling me at home AND screaming at me were very inappropriate. I can understand that she was upset, but I rather thought this was a big overreaction to the situation. What do all of think about this?
Oh, and by the way, on our unit, when we work as charge, there are only one to five other people working (usually two others) and that includes one to two therapists. Our charge nurses are not responsible for any type of employee evaluations, suggestions for employee improvement, etc. Our charge nurses still do patient care and so they are not considered the type of charge nurse that that is in a supervisory position (our job descriptions support this). I would say most people would call this a team leader. I have worked in hospitals where the charge nurses were responsible for much, much more and definitely were supervisors.
All of your comments have been immensely appreciated, and I welcome and want more. Thanks!
Nov 14, '03Sounds like you are dealing with a patient with a Borderline Personality Disorder. There is a reasonably new Therapy called
DBT-Dialectical Behavior Therapy where all blame is removed and
the patient has limits set by each individual as to what behaviors will and won't be tolerated by you in your relationship. If you go
by the old mandated or mandatory rules system you are setting
yourself up for manipulation and staff-splitting by the patient. With DBT we don't blame patients for staff-splitting and there are
no rights or wrongs when staff members disagree. This prevents the two or more staff members from having to be absolutely correct in the situation. You handle the patient in a manner--when it doesn't break mandatory unit rules--the way you feel
comfortable with relating to them. For instance: I might not feel
comfortable with a patient touching me in any way--so for me when a patient does touch me i let them know that I do not feel
comfortable with the behavior. If they tell me that Mrs. So and So lets them do it. I tell them that that is the limit on touching that
she has set, for me I am uncomfortable with touching. That way
I do not fall into the practice of judging other nursing staff and they do not judge me. It also prevents the patient from using one
staff member against the other. Try to see if there is anything valid in the response from the patient. As much as we try to deny it there is always a kernel of truth somewhere in what the patient is saying--focus on that. And please remember you need to have a staff member treatment team where you support one another, discuss the things that are not working with patients and help people deal with these very difficult patients who will
drain you if you are not careful------------Lauren
Nov 14, '03RedWhiteBlue,
You posted that you wanted some thoughts on how the charge nurse treated you by calling you at home and screaming at you. I think it was innappropriate and unprofessional. Perhaps it would have been better for you if you had not allowed her to speak to you like that. You might have told her that she sounded very upset and that she could call you back when she was calmer. Or maybe you could have suggested that since this was so upsetting to her that you and she could sit down together with your unit manager to discuss the situation. This is what I would have done(If it was not PMS week. If it was PMS week I probally would have given her a really good reason to scream lol). Anyways, I give you psych nurses credit. I don't think I could do this type of nursing.
Nov 21, '03The first clue was, " I recently cared for a patient who was depressed over a recent romantic break-up," .... and your staff has just been split! Live and learn
Nov 21, '03i am primarily by hx an er nurse, i am now doing crisis intervention service, and am also a new SRNA ..... however -
i think a basic principle that I have always tried to follow is - address the person first - if that doesn't solve the issue then go further - of course if this pt was demanding it be reported than you have a responsibility to do that whether the claim is bull or not..
the pt may not have had a dx of BPD - that doesn't however mean that she isn't - and on top of that - the majority of the personality disorders have very manipulative origins.... staff splitting is a very common phenomena... i would readdress that nurse and explain that perhaps you could have spoke w/ her first, but that her behavior could have also been handled differently - and perhaps you both could start over...... you never want a charge rn as an enemy - or any other nurse that you work with - it makes for unhappy work experience.
May 12, '04Hey thanks for all the comments. The nurse in question and I did have a talk, but she is still a bully. She leaves me alone now, though. For the person saying I should have reported this if the patient requested and insisted on this being reported - that was the case. The patient was adamant that I report the situation to the director. Hey, Raphael... We all know that's what we should do, and that's easy to do with patients, but not so easy with some other folks (especially this particular nurse). She has pretty much caused everyone on the unit to dislike her and to not trust her. Fortunately we no longer have a charge nurse. We are now responsible for our own team of patients.
laurenkist -- I think this Dialectical Behavior Therapy sounds great and I am going to research it more.
May 12, '04I just now saw this thread pop up. I hope I did not make you feel offended? I thought the person was BPD and I sure was not tryind to diagnose him/her LOL. I would not like being called and screamed at either.
I just know some patients like to staff split and if you cannot see that which sometimes we may not, it can cause a heap of trouble.
May 12, '04No, renerian, you did not offend me. I wanted to learn. I think the whole thing upset me so much because of the nurse's subsequent actions. And, hey, I did learn a lot.
May 12, '04Yep we all learn every day. As long as you have that mindset you should be fine.
May 12, '04I think that the charge nurse reacted unprofessionally, and that your NM should have left your name out of it, as you'd asked.