Staff splitting - Help!

  1. 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 breakup. This patient pulled me aside and told me that the charge nurse had been very rude to her. She was very upset and asked to speak to the director of our unit Since the complaint was about the charge nurse, and I did not feel like the patient was just trying to get sympathy, I told the director that the patient wanted to speak to her. I aksed the director to please keep my name out of it because I didn't want any trouble with this nurse. Well, the director told the nurse, following which the nurse called me at home, telling me she didn't appreciate me telling the director about the complaint against her and that I should have come to her because she was the charge nurse and because she felt she should have been told so she could talk to the patient. She said that I was malicious and unproffessional for speaking to the director and that I was just feeding into the patient and causing staff splitting. She said that this was just BPD behavior (patient did not have a diagnosis of borderline personality) and that if hadn't been so inexperienced that I wouldn't have done this. I did not see the borderline type behavior of he said, she said, I don't like you, I don't like her.... I have asked two other nurses their opinion of this and I've gotten two different answers. One says I should have spoken with the nurse directly and the other says I did the right thing. I've tried to keep the facts to the basics, because I need answers. What do all you out there think! Thanks
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  2. 23 Comments

  3. by   renerian
    I would have talked to the charge nurse myself. Even if she was not in charge I still talk to the person being accused so they are not blindsighted when the information comes out. I was not there but I know people who have BPD are extremely manipulative so that could have been an issue but since I was not there I cannot say.

    JMHO

    renerian
  4. by   mag48293
    I've been in Psych Nursing a long time. BPD is the toughest type of pt for staff. I do think that as you gain experience and have more time dealing with BPD, the 'answer' will jump out at you as soon as it arises! Consistency is very important in the treatment of the BPD pt. Perhaps you could have had the patient come with you to 'talk it over with the charge nurse'.......bet the pt would've declined...and that would be your first clue!

    Good luck with your career in Psych. It can be very rewarding, but frustrating at times too! As I'm sure you're finding out.
  5. by   RedWhiteBlue
    Okay, I knew that might be the response, but this situration did not seem to match the typical BPD antics. She also did not have a diagnosis of BPD. Are there exceptions to this rule? Also, what do all of you think about what the charge nurse said to me? I'm upset about the way she acted. In all my years of nursing I have NEVER been accused of being unproffessional and I'm not a malicious person. As a matter of fact, I've been told repeatedly over my nursing career that I am kind and caring. Also I have had other complaints about this nurse and I have always gone to her in the past. That's been the case every other time a patient has complained about other staff. I truly thought I did the right thing at the time. This has surely been a learning experience.
  6. by   mag48293
    I didn't mean to offend you in any way, it's just a very real part of Psych Nursing. I'm sure your patients percieve you as kind and caring. The problem is that the patient must also percieve you as
    'matter of fact', 'not easily manipulated', and somewhat 'detached'. That can sound contrary, but a patient who has Borderline Personality traits, even if not on their 'official'
    diagnosis, almost has a sixth sense about who is a 'softy'......you can also see how 'kind and caring' can be percieved as a 'softy'.

    It's really great to care about your patients and genuinely want to help them. However, sometimes the 'best' help you can give them is matter of fact, not at all nasty, 'reality check' on the situation. Such as, "it sounds like your unhappy with treatment you recieved from Nurse X, why don't we go and speak with her about it and you can tell her how you feel." While maintaining a very NEUTRAL position, letting the patient know that you're not in the business of 'taking sides', just willing to assist her in 'solving her own problem.

    Please don't take this situation personally. I doubt if any Nurse who has worked Psych hasn't at some time, early in their career,
    been sucked into an uncomfortable situation by a BPD pt!

    I'm not siding with your Charge Nurse, but perhaps she's seen this situation play itself out umpteen times, or was just having a bad day herself. Psych, unlike some of the stereotypes suggest, can be a very stressful job.

    I do wish you well in your Psych career. Try to chalk this up to a learning experience.
  7. by   mag48293
    Let me also direct you to the thread lower on the Psych Nusring forum entitled "I'm in trouble B/C of borderline" Some very good insight and 'clues' there!
  8. by   maureeno
    I too would mark this down as 'learning'

    here are some things to ponder:
    could the patinet have directly contacted the director
    [units must have info posted]

    have you observed the charge nurse being rude?

    are you comfortable with enforcing the unit rules?

    are you comfortable with discussing conflicts with staff?

    do you have tx plans to which staff contribute and refine?



    one thing that has kept me interested for 30 years
    is I am always learning....
    no matter how good
    I am always improving
    many times through
    painful experience
  9. by   RedWhiteBlue
    No, Mag48293, you did not offend me. And, I have read everything on this board I could find about BPD and staff splitting. I think that if the nurse in question had said something like, "Perhaps you could have handled this situation differently...." Instead she was obnoxious and rude to me. I think this is what has upset me more about this situation than anything else. It doesn't help that the director did not keep my confidence as she had said she would. Also, I wonder why the director didn't tell me perhaps I could have handled this differently.

    Maureeno, the director was not on the unit at that particular time. I didn't observe the charge nurse being rude in this situation, but I (and everyone else on our unit) has observed her being rude at one time or the other. She's difficult to work with and all but one other staff member would like to not have to work with her at all..... About 1/2 the time I work, I'm in charge so I do feel comfortable enforcing unit rules. I just really thought this situation was different --- As you all have said though, I was sucked in. No one on the unit wants to discuss conflicts with this nurse. Anyone else, I have no problem with. We do get a chance to work on those lovely treatment plans.

    I didn't want to mention this nurse's previous behavior to begin with because it had no bearing on my decision to go to the director. By the way, our director is not a nurse but a _ um, well, she has a bachelor's in Psychology and is working on her Master's degree. FYI - I have asked three people on our unit how they would have handled this situation. One told me the same as all of you. The other two said I did the right thing in this particular case. I asked another very good friend of mine, and she said the same thing all of you have said. I hope this never happens again (Ha, Ha, Ha), but if it does, you all have helped me immensely (and no, I won't call the director).

    Thanks a BUNCH!
    Last edit by RedWhiteBlue on Aug 1, '03
  10. by   Granted Fal
    Hello RW&B, I got your email....
    In this situation it seems that if a client is complaining then you have paliatively served the client's needs.

    However, before we haul off and diagnose this client with BPD, as most people like to do with 'difficult' clients, lets think a minute about a few things....


    A) You gave credibility to the client for their complaint, sometimes this can be a trap as some clientele use this to gain favor or items other staff have denied them. I usually preface my response to their request with, "Has any other staff told you that you couldn't have this, or have you spoken with any other staff regarding this issue." This of course doesn't ensure truthfulness but if they have lied then now their credibility is completely "shot" so to speak.
    and...
    B) You haven't heard the 'other side of the story,' in a sense this is jumping to some kind of a conclusion, however, you may know this staff to be less then pleasant with clientele. Either way your staff should get the benefit of the doubt.

    So to keep yourself 'out of the loop,' I would suggest that you acknowledge the clients complaint and validate their concerns..
    " oh it sounds frustrating... you are saying this is stressful for you... " etc... ( diffuse a potential explosion on your unit )
    and then suggest to the client to write down their complaint ( a positive coping skill ) and inform them that no action can be taken against them for complaining ( their rights as a client ) and refer them to their day case worrker or counselor or what have you to follow up ( continuity of care ). All facilities have a client advocate and a grievance form. Then document the objective occurrence of the situation and pass it on in shift report so oncoming nurses know what to expect if this arises again, that is the objective details not the hearsay details.

    This way you have addressed the client's concerns and given them a constructive way to handle their situation without getting in some bickering match on he-said she-said stuff etc.

    And for the sewing circle stuff.. can be stressful. but welcome to the field of nursing... hahaha


    Good luck with this.
  11. by   Milehighnurse
    Just curious, does your facility have pt. complaint forms? I probably would have directed the pt to fill one out. This removes you from the loop and lets the pt describe the complaint. I can see where the nurse had issues with being circumvented in regards to the complaint, but the way she handled it was not ok. Good luck.
  12. by   Orca
    Given the situation you presented, I would have spoken with the charge nurse first. I have been in the position of being a charge nurse and having a subordinate go to the nurse manager with a patient complaint, and feeling very stupid (and somewhat betrayed) when asked about a situation I had no knowledge of. It makes the charge nurse look like he/she has no idea what is going on on his/her own unit. Also, the patient manipulated you into circumventing the chain of command, perhaps expecting a quicker or more favorable response. It could also be that this patient enjoys getting people "in trouble", getting a feeling of power over making it happen. Remember that this is mental health, and you cannot take everything a patient tells you to the proverbial bank, no matter how well you believe that you know that patient. This is especially true if this was a single incident rather than a chain of similar reports from different patients (which is more indicative of an ongoing problem).

    Chalk it up to experience. If that is the worst mistake you make in your career, you're ahead of the game.
    Last edit by Orca on Aug 9, '03
  13. by   icu_rn_bsn2000
    I have 10 years experience in psych and BPD is a tough one. They make the best manipulaters. Nurses should always have the patients best interest at heart but not wear that heart on their sleeve in full view of the patient because they'll rip it out every chance they get. It is always best to refer a patient to the person they have an issue with and if they refuse, it is best to give the staff the heads up on the complaint. Chain of command is the best way to go to keep a pleasant working relationship and to nip the "trouble makers" in the bud.
    Louise
    Last edit by icu_rn_bsn2000 on Aug 9, '03
  14. by   Frankcah
    I must agree with psykoRN, there should be a clear and adequate complaints procedure in place which should provide the patient with a forum to make complaints. Of course people will say, "but everyone will be making complaints about the most trivial of things", maybe, but, the parties carrying out any substantiation/investigation should be able to assign the complaint to the most appropriate person to deal with the complaint and therfore take the most appropriate action.

    Just because someone is a charge nurse does not mean they are untouchable. Your director has a lot to answer for for divulging your name despite the fact that you made the complaint on behalf of a patient in confidence.

    Also the charge nurse seems to have also adopted what might be interpreted as bullying tactics to yourself. What is to say that if you did inform your charge nurse, that she would not employ the same tactics with your patient.

    Stop beating yourself up about it, you did the most appropriate thing given the circumstances. You had to make a decision based on what was presented to you. I feel you did the right thing!!

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