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.
Specializes in M/S, LTC, Corrections, PDN & drug rehab.
I don't understand your suspicions. Perhaps it was due to my wording? Or maybe a lack of clarification? I think I've re-explained and elaborated on this part of the story, like, 3 times now. I'll explain for a 4th time so you'll understand.
When I was asked to wrap the IV, I went off the find Jen. I knew she was in the break room because before all of this happened, I was having my lunch. Towards the end of my lunch, Jen walked in the break room. I didn't ask if she was on break (15 mins), lunch (30 mins), or if she simply went in to cool off for a minute. If she wasn't on either break or lunch, I would have asked her to wrap the IV. She told me she was at lunch, so I said "Ok it can wait," as I mentioned in my original post.
I hope that clears up any misunderstanding.
We'll agree to disagree.
By the way, you just said you went to "find" Jen. That suggests you didn't know where she was.
Did the CNA file the incident report? What are you leaning towards doing from here on out?
This happened quite recently, so I haven't heard anything from my director or anybody in upper management. As I said in my original post, I was just told by my charge RN literally the day after this happened that my director told her (my charge) to tell me that Jen told my manager (I hope I didn't lose anyone reading this) that she (Jen) was going to file an incident report. Whether she did or not, I have yet to confirm or hear from anybody yet. I guess only time will tell.
By the way, you just said you went to "find" Jen. That suggests you didn't know where she was.
It sounds like it was my wording that confused you. Semantics and diction were never strong suits of mine.
I've stated the truth from my perspective as best as I could. Whether you believe me based on my original post and my subsequent explanations/clarifications or not, is up to you. I appreciate the input you've given.
Specializes in M/S, LTC, Corrections, PDN & drug rehab.
This happened quite recently, so I haven't heard anything from my director or anybody in upper management. As I said in my original post, I was just told by my charge RN literally the day after this happened that my director told her (my charge) to tell me that Jen told my manager (I hope I didn't lose anyone reading this) that she (Jen) was going to file an incident report. Whether she did or not, I have yet to confirm or hear from anybody yet. I guess only time will tell.
If she hasn't filed an incident report I would suggest getting your charge or NM & Jen to clear the air so all of this doesn't turn into a toxic work environment between the two of you.
You don't have to like Jen, but you will have to work with her for however long you or her work there for. The last thing I would want is to have a formerly good tech going rogue on me.
This happened quite recently, so I haven't heard anything from my director or anybody in upper management. As I said in my original post, I was just told by my charge RN literally the day after this happened that my director told her (my charge) to tell me that Jen told my manager (I hope I didn't lose anyone reading this) that she (Jen) was going to file an incident report. Whether she did or not, I have yet to confirm or hear from anybody yet. I guess only time will tell.
Damn...
Well, bottomline, except for you, the rest of us are outsiders on this situation. Probably best to do what is advised by upper management, BUT, be careful about signing anything~.
I never made the latter statement. You twisted my words.
Verbatim copy and paste section of the conversation from my original post:"Me: Fine. But we need to talk. We can't let this issue get out of this room."
I agree with others that you should have just let her go and not get in her way. However, she is also at fault here. Regardless, if others think that you spent more time looking for the CNA than just wrapping the IV yourself, you delegated the task to the CNA. The CNA should have done the task. I am a CNA right now and if I a nurse told me to do something that is within my scope as a CNA I would do it because it was delegated to me. If I feel that the RN was taking advantage of me, then I would complete the task and speak to the RN afterwards and not make a scene.
First, apologize for blocking her exit from the supply room. That is certainly not professional in the least and if a simple apology can avoid further trouble from management it's not only the right thing to do because you were in the wrong, it's the right thing to do for your job. Second, I'd formally write up that CNA for insubordination. Yelling at your supervising nurse and calling that nurse lazy anywhere is not OK, doing so in a hallway where everybody can overhear it is beyond not OK. The difference in your ages and you sex has nothing to do with it.
OP: There are a couple of things to consider when you look at what happened. They dynamics of social interaction can be very "interesting" in the hospital setting.
1.Dynamics due to age difference - you are much younger but you are the RN and therefor delegate to her. Some CNA do not have a problem with it but some can have an underlying dissatisfaction over their own job situation and at times feel disrespected, not validated and so on - regardless of being treated "ok or not" by the younger RN.
2. Dynamics due to gender bias - similar to women working in men dominated professions, men working in nursing can run into the problem that they are being seen as "incompetent" because they underlying bias might be that "only women can truly care." It seems that men in nursing run into being accused of "laziness" more often than women (my observation).
3. Inexperience in how to manage those "breakouts" - as others already mentioned, standing in somebody's way and not allowing that person to leave is seen and perceived as an act of aggression. You meant well to get the situation straightened out I think it just added to escalate the situation.
4. Power dynamics - this is huge in hospitals. If the CNA perceives herself as somewhat "oppressed" or dislikes you or her work or if the workload is so big that it is "mission impossible" and overwhelming, coping can get "interesting". While the CNA was openly confrontational, which actually set everything else into motion, the more common reaction is "passive - aggressive."
I think it is good that you have a sense of role boundaries. It is impossible to pass out medications if you get interrupted to "quickly" do this and that. Yes, wrapping the iv might have been a quick task BUT you had medications already pulled it sounds and in your hand. Naturally, this is not the time to focus on something else. Medication administration requires attention to detail.
It is ok to ask the CNA to wrap the iv once she is done with her break - showering is obviously not an emergency.
When you look at your situation, you are looking at a conflict and conflict management is a skill that is acquired and does not come easily to most people. The reason is that all of us who work in healthcare seem constantly stressed but the multitude of tasks to complete - there never seems enough time to actually do everything- and the usually more or less punitive environment. Some hospital administrators seem to confuse a medical facility with "Disney World" and hope that their HCAPS survey will "magically" reflect "customer satisfaction" - that by the way seems a poor way of measuring quality of care. So - because all of us in acute care seem stressed all the time, we are not necessarily our best at all times. Patients and families can be difficult to deal with as their expectation may not mirror the realities of healthcare in a financially driven system.
Your choices for conflict management are:
1. Ignore the conflict
2. Address the conflict
What to do:
Despite the popular notion that "one should always address conflict right away" I caution against it.
It is a lot like in real life - you have to pick your battles. Conflict is normal but should not result in some crazy shouting match, physical stuff (including throwing stuff etc) or such. If somebody has some sort of "mental breakdown" and it is not their usual behavior it might be best to validate the underlying emotion in that moment. What that means is when Jen walks up to you and is confrontational and "accuses" you of being lazy for not wrapping the iv and also tossing out that the family is not satisfied you do this:
Scenario 1:
Pause with everything until she is done. Wait a few seconds. Say "Oh man Jen - you sound really stressed." with a friendly expression conveying that you "get it". Wait. It has been my experience that after outbreaks like that and me saying stuff like that things diffuse quickly in 95% or so. Important - if the other person calms down right away and speaks to it like "Oh yeah I am having the day from h *** and do not even know what to do first" just add something that conveys your empathy and also ensures he/she knows your relationship is still "ok" - like
" yeah - this is definitely a donut day - let's catch up in a bit when we have a minute to strategize how we get through the day"
That tells the other person that you get it - it was just an outbreak - we are all human beings and sometimes not our best. And we are still ok and there is not "bad air" between us. If that works - just forget about what happened. Wipe it out of your mind. Don't talk to others about it - no need to gossip.
Scenario 2 : You address the underlying emotion and the other person goes gung ho confrontational or starts crying or so.
In that case you just say "hey let's go to the breakroom and get a coffee and decompress for a second - it is a crazy day"
In most cases, people get the hint that their behavior is not suited for public display.
Now - there might be like some cases where the person walks up to you and is confrontational and you feel that it is absolutely not something that should be ignored for example also threatening in any form, being demeaning and disrespectful - we are talking more about the extremes here.
Scenario:
Jen walks up to you - she is upset. Accuses you of being lazy and gets very personal - in addition she says "I will make your shifts h*** from now on."
You can say "Jen, I see that you are upset. Is there anything I can do for you right now?"
If somebody is in escalation mode this simple question will pretty much throw off most people who are on the way to the moon. Don't take it personal in that situation and try to distance yourself right away. I always give people the benefit of the doubt.
If you feel that needs to be addressed, just go to the charge nurse and say
"You know what - Jen is really having a rough day it seems - she just shouted at me for 5 minutes and told me that she will make my shift really difficult. Do you think this is something we need to talk about?"
Most likely, the charge nurse knows what is going on and has dealt with stuff like that. If it is a pattern from Jen, she will most likely say something like "oh yeah she is not the best when it comes to dealing with new staff/dealing with stress / whatever. I will talk to her/ I will talk to the manager.
Or she might say "Oh she must have a real bad day - she is usually now like that -let me talk to her."
I would really recommend this kind of strategy.
It usually keeps all the drama out and instead of things just ballooning with people taking sides and enjoying the drama you will be seen as somebody who is not getting pulled into the drama easily.
The drama is real in healthcare. No joke. Don't give people that much control over your emotions and how you react.
Hope that helps... real life advice from working more than 20 years in acute care and community care ...in the end of the day, you still have to go back and work with all those folks. The above strategies should help you to deal with conflict in a way that does not suck life out of you.
I let go of a lot of stuff or most of it. It is almost always the expression of stress and often not about me - it is about something else.
Specializes in Psychiatry, Community, Nurse Manager, hospice.
I've read a few pages of comments. I'm going to list what you did wrong. Then give you some input about what to do going forward.
You were wrong when you:
1. Sought her out while she was on break for anything less than a total cluster-fart emergency. Respect scheduled breaks.
2. Blocked her exit. It is worse that you are male and she is female, because you are likely much bigger than her and the effect is more intimidating.
As others have said it would have been easier to do it yourself, but this is a different kind of error.
She was wrong too. Calling you lazy was inappropriate as was yelling at you in the hall.
Your biggest problem is going to be working with her in the future. I advise the following:
1. Do not demand apologies from her.
2. Express regret for having caused her to feel unsafe and promise her that you will never block her egress again.
3. Be polite, respectful and treat her the same as any other CNA.
3. If she responds poorly to you delegating a task to her, simply write it up and follow up with her supervisor to see how it was addressed. Do not talk to her about it.
Good luck. No more blocking people in when you want to talk and they don't.
Personally, I don't think this has anything to do with you being male or female. From what I read (and how the CNA acted), this probably isn't the first time she's felt that you're being lazy. Also, most hospitals give you a 1 hour window either way for passing meds on time. If your meds were due at 0900, you had between 0800-1000 to pass those on time. If there was a super important med that had to be given right away, you could have taken care of that and then come back to wrap the IV. You could have even wrapped the IV after you finished passing all of the meds. It really sounds like there was a communication problem--the CNA apparently wasn't aware that she was the one who would be responsible for wrapping the IV; the family had to wait a long time for assistance and it sounds like they may have taken it out on the CNA. At the end of the day, you can delegate all you want, but it is YOUR responsibility as the RN to ensure that things get done. Did you not notice while doing your hourly checks that the patient's arm was never wrapped for a shower?
I could be totally wrong here, but this doesn't sound like an instance where a CNA just has a problem being delegated to in general. And it doesn't sound like you're getting the short end of the stick because you're a male. It sounds like the two of you have some stuff to work out.
I can see why you tried to prevent her from leaving. She was angry, irrational, and probably about to make a scene in the hallway. Next time, don't do that. It can be taken the wrong way and it sounds like "Jen" took it as a threat. Apologize to her for frightening her and move on.
Wrapping an IV is a simple task. For the sake of simplicity and keeping your interactions with "Jen" and other CNAs like her, just do it yourself. It's easier and it'll save you the headache.
If I were you, I'd fill out my own incident report. Yelling in the hallway and acting angry in front of the patient's family is unprofessional on her part and needs to be addressed. You aren't the only one who needs to apologize.
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OrganizedChaos, LVN
1 Article; 6,883 Posts
We'll agree to disagree.
By the way, you just said you went to "find" Jen. That suggests you didn't know where she was.