At wits end with a PnP

[PediNrs05]

I'm here seeking help and advice from my peers, it'll also feel good to vent a little. I write novels and this takes some explaining, so please forgive the paragraphs.

I've been a pediatric nurse since 2005. I worked mostly normal pedi, doing as much PICU as I could, hated NICU. I've also done school nursing and some home health. I came back to hospital nursing about two years ago. I only have experience in the pedi population.

About a year and a half ago, a PnP was hired for our hospitalist group. She was a new grad, friendly helpful, very approachable, etc. Everyone liked her. After about 4 or so months things started to change. She developed an aversion to O2. I quickly learned that anytime a patient hadn't gotten better overnight, it was someones fault. Either the previous shifts or the people the day before. She'd rant about how the PM shift didn't know what they were doing, etc. But she was still pleasant.

Fast forward a few months. Now anytime a patient is admitted and is placed on O2 at some point in time in their stay, we get chewed out for it...saying we're not doing enough, don't know what we're doing, or that we are over-reacting. The hospitalists have standing orders that if sats drop below 92%, O2 is to be placed by NC. So that's what we adhere by. But over time, her sarcasm, demeaning attitude, and overall unprofessionalism has had a large impact on all of the nurses at our small facility. Now it's common to see patients with sats in the high 80s and still be left on room air. This has been a constant issue between me and her, among other things.

My most recent issue was with her this past week. A child was desatting into the mid 80s, he was 4y.o., breathing in the low 50s, grunting, with nasal flaring and retractions. I placed him on O2. When she got there she chewed me out in front of the other staff and a float. Shes very unprofessional and verbally abusive.

Then I get calls on my days off from friends saying that she is rounding and telling other nurses that I am dangerous, a bad nurse, can't handle things, etc. And what's better is she pulls my charts from the day before and reviews my notes on those patients particularly, commenting all the way.

I've reported her to my manager several times but nothing has been done. I dread going to work every weekday. I've spoken to the hospitalists about it, but she's overly friendly with them there, even to me so without them seeing it they say they can't do much about it. Even in patient rooms she acts overly friendly to me, but as soon as we're out she treats me like dirt.

It's become a hostile work environment. She seems to focus in on me and find a way to make everything my fault. Even issues with other patients that I'm supervising over(I'm charge a lot). I'm a good nurse and I have a lot of people that will vouch for me in a heartbeat. But this woman is acting like a child and she's making me want to quit!

There is more to this story. I have helped her out more than I can count catching stuff she's forgotten or things shes written wrong. She has a lot of picu experience, but this normal pedi stuff she had to learn a lot of. Initially when she started she'd call me before the hospitalsists would round and ask me to check stuff over for her. Even fill out discharge instructions for her since she'd forget a lot of stuff. She still is writing things wrong and omitting things. I have half a mind to let her hang herself, but aside from her suffering a child could as well so that's not an option.

There are two issues where I know I have "wronged" her. The 1st being about three weeks ago. We were getting swamped with admissions. She left right in the middle of it to go eat lunch, three order sheets were not completed. We were hitting the rooms in order and I had spoken to a pts guardian. She said the pt hadn't peed since 10 AM, it was now 4 pm, and that she wasn't taking much PO. I checked the orders and they weren't filled out yet. So I gave the pt a bolus. I know this is wrong, but I was doing what I felt was best for the patient and I know it was stepping outside of my bounds. She didn't come back for 2 hours and she was eating lunch with the MD. Next time I'm just going to call them. The other issue was recently. A patient was seen in the ER and given Prelone at 3AM. They arrived on our floor at 8, with an order for a loading dose of solumedrol. Another more experienced nurse than myself asked me in passing if she should give the loading dose despite the prelone that morning and I agreed, not really thinking it through. When she found it in the chart she had a huge smile on her face, as she called the MD to tell her what we did. The physician wasn't impressed and dismissed it..It wasn't my patient, I was just consulted for advice. But still, that entire situation, in her mind, was my fault.

So the next days for both of those days she spent the day talking bad about me to my coworkers.

I'm seriously at an end here. I apologized for the things I did wrong, spoke to her and the physicians about it, etc. She is only ugly to me. She gives everyone a hassle about the oxygen thing. If kids are satting 85% ORA, she says to let them sit there unless they are in distress. It's unsafe. Work sucks now.

I've tried to lay it out as best I can. There's more to it than this, but I've already typed out enough here. If I need to clarify or elaborate anymore I will, it just sucks.

What can I do?

-A seriously upset nurse in Texas....

[TriciaJ, RN]

1. Document. Keep a diary of each of these incidents. Do this at home or keep it locked in a secure locker.

2. Document every conversation you have with MD, NM, etc about her behaviour towards you. Document the outcome of the conversation.

3. The hostile environment she is creating and management is doing nothing about is an issue for your union. But you probably don't have one, so never mind.

4. Since she makes many serious patient-care errors and you are documenting them, you might want to have a nice little chat with your BON. By the way, they are HIPAA-exempt so you can give them whatever pertinent info they require.

5. Good luck. One day you probably will have the pleasure of watching her screw up royally and leaving in disgrace. But the Universe works in its own time.

[carolmaccas66, BSN, RN]

I don't know what a PnP is - can people on here PLEASE put the meaning of the abbreviation the first time, then use the abbreviation later in the post? If we're from other countries, we cannnot understand what you're on about, and you may also miss out on valuable answers or info.

No amount of complaining to ANYONE - let alone nurse managers - will do any good unless you seriously take this person into a separate room/environment and CONFRONT her. She is bullying you and trying to demean you in front of everyone cos she can get away with it. Tell her everything that has been said to you from other sources, tell her also that you have complained to management and if it doesn't stop, you WILL go higher, ie: report to DON or nurses board.

The O2 thing is weird. How on EARTH does she get away with it. I'd be confronting the managers and asking them why nothing has been done. This is a very serious issue which is going to end disastrously one day in court and probly with a pt death.

She won't back down until you seriously talk to her face to face. Most bullies back down and will stop harrassing u after a while.

If all else fails, go straight to the NUM & call the risk management team - they have lawyers that can deal with this type of situation.

Don't put up with her crap, if you do, you're only encouraging her.

[canoehead, BSN, RN]

For one thing- have her write her O2 preferences as an order. Then if someone is satting 88% without O2 you have her order as documentation (and also an example of her judgement).

You don't mention talking with your nurse manager

[Ruby Vee, BSN]

i'm not sure what a "pnp" is. abbreviations make it difficult to understand the nature of the post . . .

i'm assuming that you're dealing with a mid level provider of some sort. i agree with triciaj . . . document, document, document. above that, i'd probably have a private conversation -- not necessarily confrontation -- with this person. if you can accomplish what you need to -- getting her to stop running you down to others -- without an actual confrontation, i'd go that route first. if that doesn't work, then a confrontation with the offender -- and some conversation with superiors -- will be in order.

good luck!

[hiddencatRN, BSN, RN]

I'm assuming PnP is pediatric nurse practitioner.

[netglow, ASN, RN]

You may, once you have exhausted all, need to "lay it out for her" the way I eventually do. You will have to be a bit rough and to the point.

"Look, you and I need to have a talk, NOW" -- she knows exactly what it's gonna be about, and I'd have no problem if other's heard you make the demand. You could do it with support if you want. But I would be shockingly to the point.

I will "out" people publicly by using their own words and actions and asking them what the hell is going on with them lately. I also would tell her that it's best that "you and I, take a walk...to discuss" yes, it is meant to be a threat. Be prepared for her to ask you, "Are you threatening me?" She'll do it in front of everyone and probably try to faint (LOL). This is a counter throw-down by her, to which you respond, "What part of 'you and I need to take a walk...' don't you understand?!"

I won't mess around for too long whether it be MD or nurse, it doesn't matter.

[NicuGal, MSN, RN]

When she starts in, you need to say, "I think that we need to go somewhere in private and discuss this" and if she continues, you turn, walk away and call your manager or supervisor. You need to stand up to her. Your human resources can help also if you feel she is bullying...there is a stauch stand on this and she will be reprimanded, esp if you have witnesses to this. But,you have to go thru the chain of command...where is your manager in this, or at least the charge nurse. If on an off shift, call the charge nurse and if you have to the supervisor.