Bullying + hospice

[cubelle]

I've been a nurse for 9 years. I truly love being a nurse! I am having trouble sleeping tonight though. A lot on my mind. I am the facility nurse for my home care hospice. I meet some awesome cg's in the facilities I go into. In one facility, though, I experience bullying by several of their staff members, especially nurses. And it's not cause of me. It's cause they have there own hospice, but we transferred our pts into their facility. They would like for their hospice to take care of the pts we have. I like to think I have a caring heart. I care about my patients & also the cg's I meet. I want to make the facility staff's job easier too. This one facility's bullying has really got to me today though. Something out of my control happened, and the DON has fired me from the facility! I was so upset. Our management is supposed to meet with their management to try to work things out. The DON said, "If we can work things out, she (which is me) can come back." I think the bullying there is affecting my health. I really don't want to subject myself to that anymore. What would you do?

[heron, ASN, RN]

We can't possibly give a sensible answer without knowing the specific behaviors you refer to as bullying. Do you want to stay with this facility? Will you lose your job over this?

[cubelle]

No my supervisors back me up. This is the 3rd one of our nurses this facility has fired. My supervisors would understand that I wouldn't want to subject myself to this bullying again. It's just sad cause truly we should all be on the same team. No matter what hospice we work for. I know hospices compete, but that's no excuse for bullying. We all just want to keep our patients comfortable. I look at the work of my dad. He is an awesome family physician in the area, and though he "competes" against other family physicians in the area, he supports them & helps them any ways he can. He helps them with their call & vise-versa. All companies should work together like that. Bullying should not be tolerated. I like to stay pretty vague on this online forum. Thank you so much for your response!

[heron, ASN, RN]

While I can appreciate wanting to keep things vague online, I'm afraid that "bullying" has come to be the trash designation du jour. It's a meaningless term that makes it impossible to offer any meaningful feedback. I wish I could be more helpful.

[TammyG]

This kind of thing happens ALL THE TIME in facilities – both those run by competing hospices and often in your run-of-the-mill ALF or SNF that are more closely affiliated with another hospice. I cannot count the number of times a small-minded, immature and vengeful employee attempted to either have my hospice or me thrown out of the facility by blaming us for their own mistakes. It is very, very upsetting.

Obviously, this facility's employees are having trouble getting along with others. This has nothing to do with you. Your administrator does this kind of thing all the time, and that is why they pay her the big bucks.

I'll tell you what you do. Take the high road. Report the truth and only the truth to your supervisor. Go about your life and other business and do not let this bother you. It has nothing whatsoever to do with you or your hospice. Let everything settle, and either you are back in there or you are not. Hopefully your patient is getting good careand be happy about that and get on with your life, because if you let these type of people and situations bring you down, your life will be unhappy.

[cubelle]

Thank you, Tammy! That was spot on. Since that happened last Friday, I've had a great week. Taken care of some really sweet Patients & families in home care who Have really appreciated me. It makes it all worthwhile! I'm actually pursuing my masters now in hopes to teach nursing. This bullying situation has inspired me to teach on workplace bullying one day in hopes to prevent it for future nurses. May God bless & every one of you hospice nurses as well as all nurses for the work that you do in comforting others!

[nutella, MSN, RN]

Thank you, Tammy! That was spot on. Since that happened last Friday, I've had a great week. Taken care of some really sweet Patients & families in home care who Have really appreciated me. It makes it all worthwhile! I'm actually pursuing my masters now in hopes to teach nursing. This bullying situation has inspired me to teach on workplace bullying one day in hopes to prevent it for future nurses. May God bless & every one of you hospice nurses as well as all nurses for the work that you do in comforting others!

I have worked for home hospice and been in facilities. It is not so much bullying in my opinion - but I know what you are talking about.

See - they all like to cook their own little soup and most facilities like to collaborate with just one or max 2 hospices and they actually do not want hospice because they need help with symptom management - most nurses in longterm care facilities have good basic knowledge about end-of-life care. They want hospice because of the "perks". Meaning the additional equipment and HHA. Especially Assisted living. I can not tell you how often a relative has said that they would like their dementia ridden family member to stay in assisted living but they will only agree if hospice takes that patient on as they need a broda chair,, hoyer lifter, air mattress, somebody to medicate .....

In nursing homes it is all about the broda chair, air mattress, and HHA to help with primary care.

So - naturally they will gravitate to one of those commercial hospices that accommodate their "needs" and otherwise do not bother them too much. A lot of facilities perceive hospice nurses as snooping in their business and they are very sensitive to one's attitude as they often feel under appreciated and that the hospice tries to tell them what to do...

It is all around a very touchy area and my advice is not to take stuff personal but to be mindful of the facility's dynamic. Be clear that you are the guest in their house and behave like a guest. Most staff in facilities is protective of their residents and knows them well - always get their input into how the resident is doing. The nurses AND the aids usually give good input into what symptom control the patient needs/support. If you run into the problem of patients not being medicated with as needed medication and find somebody uncomfortable know that scheduling medication is the way to go - it takes the "guessing" out and decreases nursing bias when it comes to "as needed". If you notice something is not ok or the patient has a new pressure ulcer or similar - do not jump on them or be judgemental. Instead say " I have noticed the resident has/appears xyz - what it your opinion" and go from there. Collaboration is the main word. They do not like nurses and HHA who come in for a short period of time and "try to tell them how to do their work". Always ask how you can support the family as well or the team. Even if there are no immediate needs - it is good to ask. Be responsive to their calls and get back to them in a timely manner...

The only time I put my foot really down was after a resident fell with a broda chair and the facility blamed the hospice chair for it and tried to pin the fall onto us. But I was professional and did a root cause analysis and told them in no uncertain terms (after talking to my manager), that the patient fell because the patient was unsupervised, confused and tried to get out of the chair....

Don't think that your manager will back you up. If a facility asks for you not to come back they will simply not send you there anymore because they need to collaborate plus they need the business. Managers know that if the facility does not like you , they won't get referrals and lose revenue. Guess who wins???? On the other hand - of you do your job well and they like you they will get your company more referrals...

[heron, ASN, RN]

One thing I'd like to add to nutella's excellent post: bear in mind that for many residents, we paid caregivers are the only family they have. I work in a building with majority APS placements of people neglected by their families or who have no families involved at all. As nutella pointed out, we get very protective, and can get our shorts in a twist if we think that a company is signing on residents then providing little to no support outside of dme and comfort meds. (For some companies, LTC residents are a real profit center, even at routine home care rates, since facility staff provide all bedside care. Comfort meds, dme and a nurses' weekly run through the company's clients are pretty much all a company has to provide to get paid)

Mutual respect and communication are, as nutella pointed out, the key.

[cubelle]

Thanks for the posts & insight, guys!

[jeannepaul, BSN]

I always make sure up I have lots of pens, note pads and anything else I can get my hands on. I also thank them for their help before I go. I know it's sucking up, but it works! There are still some facilities that will totally ignore me, but I just assume they have a miserable life. AND, if you haven't been kicked out of a facility or home, you haven't been doing hospice long enough. I think everyone is kicked out of somewhere. I got "fired" twice, the first one I was fired one night , then she was calling me to visit the next day. The 2nd, I was very happy about it because she was a piece of work, it was stress off my back and one less on call visit I had to make!!