Afraid my manger is going to retaliate against me

[Nurse Beth, MSN]

Dear Nurse Beth,

I am an ICU RN. I have ER and flight experience. I’m 44 years old and trauma is my passion. I work in a level ll and have expressed my desires to be a core trauma ICU RN, had the chief trauma surgeon express interest in me and had one trauma surgeon write a letter to my director requesting me to be a core trauma. Nonetheless, my managers always assign me someplace else, usually Neuro.

Well, with that said, one of my managers was a Neuro nurse in our ICU before her new role as clinical manager and, oh boy, I have a situation I need some feedback on regarding my manager and her behavior.

I had a pretty good assignment. Until.... one patient had just returned from an arteriogram and simultaneously my other went into afib RVR 160-180. As my manager walked around getting updates from us I requested that she call our secretary to the unit to help me page MD, answer his call, print my strips, grab me ekg tabs... I didn’t think this was unreasonable as I was also doing Neurovascular checks Q 15 minutes with VS.

I did have help from a colleague who helped calm the patient in RVR, cleaned her sudden code brown. My manager looked annoyed and didn’t react to my request so I had my colleague continue care on the s/p arteriogram while I paged the doctor, etc.. (my helpful colleague was precepting a new nurse, which was her priority).

In any case, the Neuro arteriogram patient had timed nimotop due at 1800 .And now it’s 1830 and my colleague is about to administer the nimotop as I was giving digoxin, hanging amiodarone, bolus, etc.. the manager who also manages the nimtop admin times walked into the room and asked my colleague “is that nimotop? It’s late, make (insert name here) give it.”

My colleague called me out to tell me and made me sign in to the computer and scan it and give it. My other patient still required orders to be carried out and family was upset. The nimotop admonition was interfered by my manager. How should I handle this . My colleague suggested I do something because she was horrified to be put in that situation and I feel sabotaged and more importantly, patient care was interrupted. Team work is essential and she blocked any form of it. I’m sick to my stomach because she is going to retaliate. This isn’t her first complaint.

Dear Sick to my Stomach,

When you say "she is going to retaliate" I'm not clear if "she" means your manager or your colleague. I'm taking it to mean your manager, even though there is nothing to retaliate against.

In this scenario, it sounds like you needed help to manage an unstable patient and a fresh angiogram patient. Your manager did not help but instead made an issue of you administering the medication 30" "late". Technically, 30" is within the accepted window.

I would have a conversation with your manager. You asked for help, and you correctly prioritized the pt in afib with RVR. Ask her what you should have done differently. Approach her calmly and frame it as wanting to improve your performance.

It doesn't really make sense and I feel something is missing here. Perhaps there's been a previous situation or conflict? You say it's not the first complaint. You also say the manager is new in her role, and it could be she is inexperienced and rigid.

I hope you are able to have a productive conversation with her.

Best wishes,

Nurse Beth

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[LovingLife123]

The problem with the nimodipine being late is how was it scheduled? Every 2 or every 4 hours? It’s such a tricky med. I’m guessing this was an aneurysm pt in spasm? It can be a problem even being 30 minutes late depending on your BP parameters and how much the med is dropping it.

You work in a neuro/trauma icu and you only want trauma patients? That’s your problem. You can’t just request trauma only. Neuro can be draining at times, so I like to be able to switch between trauma and Neuro. If I had a colleague that thought she didn’t need to take any Neuro all the rest of us should, it would rub me the wrong way. You are in a Neuro/trauma icu. Neuro is part of the deal. Those patients are just as sick as your traumas. Trauma pt drive me nuts sometimes too. Especially when it’s a man 20-35 years old with a couple broken bones and he’s screaming louder than my 85 year old grandma with 7 broken ribs.

Your problem OP is you think you are above Neuro and that’s rubbed people the wrong way.

[JKL33]

On 2/16/2020 at 9:01 PM, LovingLife123 said:

Your problem OP is you think you are above Neuro and that’s rubbed people the wrong way.

?

The OP's interest in trauma may have rubbed the former neuro nurse the wrong way, but that's her personal problem.

It sounds like at that place there is some precedent for the idea the OP is interested in, since people don't normally go around getting recommendations from co-worker physicians to be allowed to have different employee expectations than those of all their other peer RNs. I'd think if that were the situation someone would've promptly told the OP that things don't work that way and that would be the end of it. I also can't see a trauma surgeon getting in the middle of that sort of an individual effort, either.

[Traumamama02]

I’ll clarify a few things now that I’m not as emotional. Clearly I did elaborate as to how my ICU’s are delineated. There are 4 trauma, neuro, cardiac and med surg. There are core staff in each specially and the surgeons have a say in who they would like to see become core staff. They don’t get involved passed a request ... if it doesn’t happen, it doesn’t happen except for the cardiothorasic surgeon, he gets who he wants. That’s just the way it is.
Next, I will say that when I mentioned retaliation, I had a scenario in my mind of being singled out by my manager if I went to my director for guidance. Yes, there have been several (hearsay) complaints in regards to her disruptive behavior by other nursing staff and this was not our first interaction. I’m just at my wits end with the disrespect, the constant ridicule and nit picking ... I mean, last month she sternly told me to take down my comfort care sign on patient with a new diagnosis of brain death. Her exact words were “I’m going to need you to take down that comfort care sign, it’s not comfort care anymore, he’s brain dead”. My mind was blown as she said this to me in the door way of the room and I’m certain that comfort care continues on with such a sensitive dynamic as brain death, it’s multi faceted with grief. My response to her was that it’s a gentle reminder to our colleagues that there is a sensitive situation in this room and she just demanded I take it down.
I just don’t see the benefits of being so mean, no compassionate and interfering with teamwork. Shouldn’t a manager have walked into any of my mentioned situations and acknowledged each situation even slightly as to carry out my simple request to call secretary to delegate tasks to in my first scenario and maybe introduce herself to the patient’s family, offer her her card and her support in my second scenario instead of displaying disruptive behavior? Maybe I am rubbing the wrong way, but I can’t see how. I appreciate any and all responses, advice and opinions.

[Traumamama02]

On 2/16/2020 at 6:01 PM, LovingLife123 said:

The problem with the nimodipine being late is how was it scheduled? Every 2 or every 4 hours? It’s such a tricky med. I’m guessing this was an aneurysm pt in spasm? It can be a problem even being 30 minutes late depending on your BP parameters and how much the med is dropping it.

You work in a neuro/trauma icu and you only want trauma patients? That’s your problem. You can’t just request trauma only. Neuro can be draining at times, so I like to be able to switch between trauma and Neuro. If I had a colleague that thought she didn’t need to take any Neuro all the rest of us should, it would rub me the wrong way. You are in a Neuro/trauma icu. Neuro is part of the deal. Those patients are just as sick as your traumas. Trauma pt drive me nuts sometimes too. Especially when it’s a man 20-35 years old with a couple broken bones and he’s screaming louder than my 85 year old grandma with 7 broken ribs.

Your problem OP is you think you are above Neuro and that’s rubbed people the wrong way.

suppose I do rub people the wrong way, would that excuse the manager behavior to deny my request for help and risk putting a patient’s safety at risk ? Patient care is the bottom line with every assignment I get. Compassion is my number one compliment by colleagues and family members. I’m not a jerk to work with ... I love my job and I know what I do best, trauma. I know I can be an asset in that specific unit. Inside I’m annoyed and was venting with my post but I will absolutely work wherever I’m needed and give 110% to any and all assignments. I’m a happy nurse, friendly and smile everyday I walk in to work. I can’t stress enough that I’m not one to ruffle feathers and openly complain all day, I’m don’t walk around talking negatively about things .. I’m quite the opposite. I’m a team player and would never talk down to anyone.

[Nurselexii]

Honey, god bless you, you found a field of nursing that interest you, loving what you do especially in the nursing field is rare, I will say half the procedures, medications, and patient situation you mentioned went right over my head, sounds like your hospital takes care of some sick people, I hope you get your dream trauma job, with all those hot shots recommending you, the most she can do is hope theres a management position in trauma so she can be by you once more!