Accusation Against Male Nurse (Me)

[Lapzs]

So here's the story. I am a male RN. Recently, I had a conflict while at work with a female CNA. For the sake of anonymity and simplicity, I will call her Jen. A relative of a patient of ours asked for his IV to be wrapped so that they can give him a shower (bless this family for being so involved in his care). I went off to find Jen in the break room and asked her if she was on break or on lunch. She said she was on lunch, so I replied "Ok it can wait then." I explained to the family that I couldn't wrap the IV at this particular time due to my having medications to pass to my other patients, but that Jen could do it when she came back from lunch. I even held the meds that I had in my hand up in the air for them to see. The family understood and said they can wait. I go off to pass my meds.

After I finished my last or second-to-last med pass, I was walking down the hall towards the nurses' station when I hear Jen's voice, screaming "Lapzs! Why didn't you wrap the IV?! The family's so pissed! God! You're so unprofessional!" I stood there dumbfounded. The only words I could get out were "I had meds to give." Before I could explain any more, she scoughed, turned around, and made way for the supply room. I called out her name, but she ignored me and went inside. I followed her in, and on my way I noticed a patient's family member looking stunned (possible witnessed what she was yelling about). The following conversation ensues (as I recall to the best of my memory):

Me: Jen. We need to talk.

Jen: God Lapzs! You could have wrapped the IV!

Me: First of all, if you have a problem with me, you take me somewhere private and talk. You don't yell at me in the hallway like that.

Jen: I wasn't yelling!

Me: Fine. But I told you. I had meds to pass.

Jen: That doesn't matter. You could have wrapped it before! God you are just so lazy!

She tries to walk around me to leave, but I stand in front of her to prevent her from doing so.

Jen: Don't you EVER do that to me!!!

Me: Fine. But we need to talk. We can't let this issue get out of this room. I already talked to the family. They were ok with it. Plus those meds were important.

Jen: You still could have wrapped it before.

Me: Do you want to pass my meds for me then? That is my job. That was my priority. If I could have wrapped it, I would have. And I already talked to them. This is your job. You're the CNA...

Jen: I'm NOT just a CNA! I'm more than that!

Me: Fine. So like I said, I had meds to give.

Jen: No! You could have wrapped it!

The back-and-forth goes on for a little while like that until she walks around me again and leaves. After that, the only time we talked again during the rest of the shift was when I asked her if she took a patient's blood pressure (she didn't document it) and she asked me about a patient's diet. I even talked to the patient's family afterwards and asked if there was a problem. They insisted there wasn't and asked me why I thought there was. I mentioned that I know Jen came to them a little while ago, and they said "Oh yeah she seemed pretty pissed."

We both talked to our charge RN individually. The next day (Jen wasn't working but I was), the same charge RN tells me that I need to apologize to Jen or do whatever I can to mend things because Jen told our director about this event and that she was going to file an incident report because she felt her safety was at risk. Charge RN tells me that our director told her to tell me to file a MIDAS (our internal reporting service) so that I can defend myself. Charge RN says that she already vouched for me. I filled out my MIDAS report at the end of my shift.

That's that. I am a 24 year old male RN and Jen is a 40-something year old CNA. I have been an RN on our med-surg/telemetry unit for two years. For pretty much all of that time, I was the only male worker, RN or CNA, on the floor on day shift. Jen and I have known each other that entire time. We were good friends and even took pictures together at work. Also, I'm confident most of my other female coworkers would vouch for me as well.

What do you all think? Was I in the wrong here? Was she in the wrong? Is my career and license in jeopardy? I know we both could have definitely handled things better, but I felt that her non-stop yelling, insulting, and unwillingness to slow down and listen and talk prevented us from squashing this issue.

[NotAllWhoWandeRN, ASN, RN]

My apologies, I know I'm behind in this thread.

I have to say that I agree, the OP should have just gone ahead and wrapped

the IV. And, I'm not sure that he has fully acknowledged this. Maybe he has.

But, I don't think he knew that the CNA was going to completely blow a

gasket over, golly!!, being asked to wrap an IV. If he would have known

that the CNA was THAT DANG BUSY, and that she would have a fit over

it, I'm sure he would have never asked her. Yes he did ask her during her

lunch break, but he did acknowledge that she was on her lunch break

and could do this task when she finished.

He really was not in the wrong for asking the CNA if she would do this

task. He was only in the wrong for blocking her way from the room.

But he said he had meds in hand. So did he take patient meds into the break room to find Jen before taking care of those urgent med passes?

Once I started on a unit with Vocera, nothing was sacred. I'd get paged by 3 different departments to take care of issues while I was supposed to be off the clock. I got no mental rest. If someone is on break it is reasonable to wait til they're back on the floor to address a non-urgent issue, and my impression is that all of this took place in a very short span of time. Unless they are an unreliable worker, it seems odd to me to approach someone in the break room to ask if they're on a legitimate break, then assign them work that they have to write down or remember until they come back on the floor.

I can't help but wonder if Jen has had blistering resentment building up because (accurate or not) she feels that the nurses, or OP in particular, are delegating to her because they CAN and not because it is really needed.

*edit to add* OP also mentioned it is a point of contention that the CNAs are taking their allotted breaks whether the nurses get them or not. I can't help but wonder if that contributed to his willingness to interrupt Jen's break with a work issue.

[NotAllWhoWandeRN, ASN, RN]

I feel like this would be the best ever class discussion in Delegation 101...Nursing students, watch and learn.

Personally, I'm in the wrap-it-yourself camp. I don't think anyone is arguing that it's not an appropriate task to delegate, because it certainly is. But it is ultimately the RN's responsibility to ensure that the patient is safe, receives all prescribed treatments, and is hygienic. How this gets done is variable. I think of it like this: if I had a patient who needed incontinence care, and my tech was on his or her lunch break, I may finish passing the meds in my hand. But I am not going to leave that patient soiled waiting for a specific other person to clean them simply because it's an appropriate task to delegate to them. Urgent situations and emergencies are one thing, but most meds can wait five minutes so a person can be clean and comfortable. We're here to take care of human beings, not satisfy the MAR. As for the "If You Give a Mouse a Cookie" families, it's a matter of determining priorities and having confidence in the boundaries you set, even if they don't always get it.

For what it's worth, I try not to delegate anything to my techs during their breaks, even if it's something that can wait 30 minutes; how many times have we forgotten something like that during our own downtime (or felt like we had to get up and do it right then)?

As OP had already acknowledged many times, blocking in the tech was clearly the wrong move. However, I find the whole attitude of "we need to settle this NOW, MY way" to be just as troubling. OP's statement that accompanied the action rubbed me the wrong way, not only because it can be perceived as threatening, but because it creates a power struggle where one is simply not needed. Why didn't he just say, "I think we had a misunderstanding earlier about the IV. Can we talk about it in a while?" Then follow up later with, "I thought we left it so that you would place the IV after your lunch. What did you get from our conversation?" Figure out what happened, clarify how you'll communicate in the future, and move on! As it stands, this is so much unnecessary drama (NOT all created by OP, to be sure)!

YES, ALL OF THIS. Also good work relationships don't break down over one misunderstanding. If a patient's family told me a coworker did something shady/lazy/inappropriate and I trusted that coworker, the family would not succeed in creating a yelling/physical intimidation encounter. Which is why even if the family was rude to the tech, it's entirely irrelevant to the tech's behavior or OP's. There were clearly already problems.

[OrganizedChaos, LVN]

So what if the family has been cooperative prior to the incident? There are families who turn on the dime.

How many times do I have to reiterate that point? Plus, we do not know how the family acted with Jen. Yes, we do not know. As you pointed out, as others pointed, we only have the OP's story. The family could have "unintentionally" left out a few details in regards to their interactions with Jen.

Though, it did not have to be a family issue -

Extra: On a personal note - back when I did bedside nursing, I have had patients who were pleasant one day then turn into, well, dare I say,...no, let's say "uncooperative individuals" the next. I remember incidences where something that should have taken a few minutes to do end up being an hour ordeal because the patient had another request or wanted to talk about something.

Could we not agree that there are patients/families who milk it once the RN is in the room?

Could we not agree that this family could have been one of those families despite how they acted before the incident?

No, I won't agree that the patient/family is like that because *nowhere* in any of the OP's posts has he ever alluded to that. You are assuming waaaaaay to much.

I worked in nursing homes & I know how frustrating & irritating (etc, etc & etc) residents & family members can be. But never in any of the OP's posts has he ever said anything negative about the family. This is only between the OP & Jen.

Could the family have flipped on Jen? Could the family have be any of the things you described? Yes. But we only have 1 side & there are 2 other sides missing, Jen's & the truth. Don't forget what happens when you assume things, you make an ass of you & me.

[AnnieOaklyRN, BSN, RN, EMT-P]

1) if you had the time to go chase down "Jen" you had the time to wrap the IV!

2) I agree with some others you made a big mistake stopping her from leaving, don't do that to people as some may take that as you being an aggressor, even if you don't see it that way.

Annie

[Daryl_G]

Blocking doors and cornering people in separate areas as a male nurse is a guaranteed way to have a complaint formed against you. Even if you have no ill intention, the mere act of blocking the only access to a room is considered "aggressive" and will be taken as a threat by any HR department. I am sure you understand this but rules for male nurses are a little different when it comes to these types of issues. You have to keep it professional to avoid actions that exacerbate a situation. Stand up for yourself but be aware of how other may view your actions because you will have to defend them.

What does worry me is how quickly the CNA took your passing off a task as "laziness". CNA's and other nurses know which people constantly

pass off task, rescheduling things so they land on another's shift, require twice as much time as others for simple med. passes, ect... I am not saying you are in fact lazy but that CNA may have the perception that you are. So you might need to review your current practices and ensure your not passing off everything outside of medications to others.

Look, you had two choices, take 2 min to wrap that IV or have the family wait for a CNA to finish lunch. I understand you had medications to pass but those medications were on your person so I assume it was for 1 patient. So complete the medication pass and come back to wrap the IV.

[swimmingfever00]

As a male nurse around the same age as you, I empathize your situation. I am a non-confrontational person so I try to avoid these types of things. I would have wrapped the IV myself, even though the task could have been delegated to the CNA. Telling a patient's family that you have other patients to take care of is also unprofessional, unless you had to attend to a code. Most med passes have an hour leeway and you probably could have stopped your med pass to wrap the IV. In addition, you could have asked the CNA to do it when she was OFF her break. I'm not trying to be mean, but it is kind of rude to bother a person when they are on break in the break room. It is their time to not be working. She could have been dealing with a stressful situation like a sick kid at home, and you seeking her out could have angered her more. Of course the CNA was wrong for yelling in front of the patient and it was unprofessional. Also, blocking her exit was intimidating on your part. Men are supposed to balance the unit and not add to the drama. I hope you make wiser decisions in the future. Wishing you all the best!

[Lapzs]

My final set of clarifications:

1. I couldn't wrap the IV after my med passes. I didn't have the opportunity. I was in the process of finishing up my med passes when I was suddenly bombarded with insults in the hall.

2. I didn't mean to interrupt her break. I already mentioned I didn't know whether she was on her break, lunch, (both of which are entitled), or just walked in to relax for a minute. If she was on the last of the 3 and not on either of her entitled breaks or lunch, I would have asked her to wrap the IV.

3. I didn't chase her down. My poor choice of wording gave some people here the wrong perception. At the same time, those same people refuse to accept the subsequent clarifications I provided.

[Lapzs]

I appreciate everyone's input, but it seems like some people formed a different perception, both of the event itself and of Jen and I. Others seemed to have read the story but did not absorb all of the details and are making suggestions of "I would have done this," etc. when in reality, I already did those suggestions or explained why they couldn't happen. Some details of the story seem to have been passed over by some posters. Others are fighting among themselves.

I've summarized all of my forethoughts of this event in subsequent posts. What happens from now on, only time will tell what happens with Jen and I.