Charge Nurse Feels like a Rat, Tech Refuses Patient Assignment

[Nurse Beth, MSN]

Dear Nurse Beth,

I am a new charge nurse and at the end of the shift had a nurse tell me the tech working with her ignored an assigned patient, the tech was unhappy at getting.

I listened to this nurse as she explained the tech was unhappy regarding the assignment because she had to walk from one end of the hall to the other and expressed hoping this patient would fall so myself and the nurse would get in trouble for the fall. The nurse did say that she took total care of said patient and did not let me know until end of shift because she did not want to be labeled as a trouble maker.

I was not able to speak with the tech because she left. I spoke with the manager regarding this because I feel this tech abandoned the patient. What would others have done. I feel like a rat. Thank you.

Dear Feels Like a Rat,

The secondhand complaint about the tech needs to be investigated and the tech needs to be disciplined accordingly. Discipline of this nature is the manager's responsibility. What's just as concerning here is the nurse's behavior.The nurse who reported the complaint to you should have notified you early on in the shift and not at the end of the shift. I would question her reason for taking matters into her own hands, preventing you from interceding, but then coming to you at the end of the shift to complain.

Outwardly she condoned the tech's insubordination but then as soon as the tech left she reported her.

As a charge nurse you have to recognize when you are being manipulated and call it out. Here's an example of a response "I can see why you're concerned about the tech's behavior. Refusal to care for a patient is extremely serious. In fact, it's so serious that I'm surprised and concerned you chose not to report this issue until now. Is there some reason you did not report this right away?"

and follow with "What would you like for me to do with this information now?" which calls for her to take responsibility.

I would conclude with "Thank you for letting me know. I am notifying our manager right away. I'm sure she'll contact you for more information." The next conversation that takes place needs to be between this nurse and the nurse manager.

In this way you let the nurse know it is not acceptable to not report behavior that affects patient safety, and that you do not condone what appears to be triangulated passive-aggressive behavior. She had a responsibility to report this matter immediately, and did not.

As far as splitting patient assignments the length of the hall, this is something you could look at. It causes staff dissatisfaction, and often the "orphan" patient does not have access to their nurse and tech. There are many different ways to make an assignment, such as acuity, breaking up isolation rooms, continuity of care, block assignments... making assignments is something you will become more skilled at. Remember the rationale for making an assignment is always to match the patient's needs to the nurse's skills.

Lastly, you could help this nurse with her communication skills through coaching. She most likely did not want to confront the tech and did what she could to get the job done. Alternatively, she could have asked you to change the assignment if the complaint was valid. If she sensed out and out insubordination, she could have asked the tech "Are you refusing to take this patient?" to put the responsibility back on the tech.

The remark about wishing the patient would fall is very inappropriate and needs to be addressed. It sounds like an expression of anger from someone who does not know how to express frustration in a constructive manner. The anger was directed at you and the clinical bedside nurse from the tech, who likely feels powerless and frustrated.

Being a charge nurse is a wonderful opportunity for your own personal self-development. Good luck in your new role.

Best wishes,

Nurse Beth

Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

[Daisy Joyce]

I wonder if the nurse had reason to believe that nobody had her back.

I've been in LTC facilities where if there was friction between the nurse and the aids , the nurse was told "you handle it", but has no authority or leverage to make compliance happen.

And there simply isn't always time to "build rapport" with every single co-worker.

i especially wonder this because OP feels really bad about it all (as if she was wrong).

[RNrhythm, BSN, RN]

I don't understand the "feel like a rat" part at all. With that attitude, you are going to get walked all over, again and again. In addition to wise advice from Nurse Beth, focus on the facts: The tech had an assignment they did not like. Did the tech bring it to you? Did the tech neglect their assigned patient all shift? Did the RN know about this problem and neither informed you nor corrected the problem, all shift? These are facts.

There is a lot of passive-aggression on your unit and I encourage you NOT to play those games. You, the RN, and the tech need to do your jobs.

Being a new Charge is hard. You would rather use the bedside skills you know you are good at. Now you need to develop management and leadership skills.

[Have Nurse, ADN, RN]

I wonder if the nurse had reason to believe that nobody had her back.

I've been in LTC facilities where if there was friction between the nurse and the aids , the nurse was told "you handle it", but has no authority or leverage to make compliance happen.

And there simply isn't always time to "build rapport" with every single co-worker.

i especially wonder this because OP feels really bad about it all (as if she was wrong).

I too wonder about the cause that triggered this, but the bottom line here is Risk Management, and Patient Safety. It seems she did care for the Patient because she knew she must, but I agree with Nurse Beth that this must addressed immediately.

[Have Nurse, ADN, RN]

I don't understand the "feel like a rat" part at all. With that attitude, you are going to get walked all over, again and again. In addition to wise advice from Nurse Beth, focus on the facts: The tech had an assignment they did not like. Did the tech bring it to you? Did the tech neglect their assigned patient all shift? Did the RN know about this problem and neither informed you nor corrected the problem, all shift? These are facts.

There is a lot of passive-aggression on your unit and I encourage you NOT to play those games. You, the RN, and the tech need to do your jobs.

Being a new Charge is hard. You would rather use the bedside skills you know you are good at. Now you need to develop management and leadership skills.

Amen!!