Co worker issue

brandy1017, ASN, RN · Jun 15, 2018

The charge nurse came to me after the PCA complained and initially I was surprised because I did recognize that perhaps I may have been "mean." She told me it was better I apologize and I did. I also explained to the PCA why I was stressed. When I spoke with my charge nurse I explained the symptoms and that I did not know I hurt her feelings or was maybe to harsh. I will post an update after speaking with my manager.

Personally from my own experience I feel the PCA is being manipulative and was insubordinate to you and then tried to turn it around and blame you for her own behavior by complaining about you. I don't have any advice to you, but wish you luck and watch your back!

TriciaJ, RN · Jun 15, 2018

Personally from my own experience I feel the PCA is being manipulative and was insubordinate to you and then tried to turn it around and blame you for her own behavior by complaining about you. I don't have any advice to you, but wish you luck and watch your back!

This type of manipulative behaviour is more common than you think. No more apologizing when it's not your fault. Mean? It's the ED for goodness sake. People are dying while you're supposed to tiptoe around each other's feelings.

For future reference, it might be prudent to involve the charge nurse much earlier in the game, for several reasons. 1. It's above your pay grade to be dealing with uncooperative personnel. That turd needs to go in the charge nurse's pocket. 2. Whoever gets to her first is the one telling the truth. People tend to believe the first story they hear. 3. When you can't get what you need for your patient for whatever reason, the charge nurse needs to be involved promptly. It's good CYA.

When responding to accusations, never say "I feel..." State the bare facts as undramatically as you can. "I asked her to get a stat EKG. She refused. What do you suggest my next step be in the future?"

Good luck.

allnurses Guide · Jun 15, 2018

This type of manipulative behaviour is more common than you think.
.....
When responding to accusations, never say "I feel..." State the bare facts as undramatically as you can. "I asked her to get a stat EKG. She refused. What do you suggest my next step be in the future?"
Good luck.

This. Couldn't have said it better myself.

You asked 3 times for an EKG on a kid you knew was high cardiac risk! and you were "mean"? Newbie needs an a**ectomy.

CanadianAbroad · Jun 15, 2018

I'm sorry, I don't ever recall in nursing school where a splint takes priority over a cardiovascular issue. Perhaps this PCA needs a little lesson on ABCs and prioritization. I would bring this up with the charge nurse.

cyc0sys · Jun 15, 2018

One problem is that a PCA, per her job description, doesn't have the expertise or authority to prioritize between different STAT measures. So, if the PCA is being told by another nurse/doctor/PA that some other measure must be prioritized instead, it's not really her duty to decide for herself which one to do first. She should do one then the other, and the conflict between different priorities should be resolved by your charge nurse or whoever is most directly for supervising her.
I've seen this time and time again. The tech must observe the chain of command while exercising a very limited scope of practice which does not include prioritization as Cowboyardee mentions above. Even if the PA didn't do the splint as ordered by Doc, regardless of protocol, it will ultimately fall on the tech because she received the initial order. It is not the tech's responsibility to inform the Charge of your need to re-prioritize tasks, that's your job.
Let's also not forget, floor transfers can be a quite a debacle for the tech in this situation because no one wants to own something left undone.
ABC's are limited to Basic Live Saving Measure. If your patient wasn't coding or choking, it did not warrant working out of task order because the tech was still performing under the direction of the Doc.
That being said, Techs can get out of control with insubordination and passive-aggressive behaviors. I've found it's usually because they feel underappreciated and disrespected. With a little one on one face time, off line, I've been able to resolve these types of issues.
The team building process requires mutual respect and emotional investment. Insincere apologies are cheap, its easier just to acknowledge someone else's feelings. All people respond better to the carrot than the stick. Though it may be effective short term.
Bottom line, the task was completed in a timely manner and did not result in an unfavorable outcome for your patient.

**LibraSunCNM, BSN, MSN, CNM** · Jun 15, 2018

Wow, this situation is crazy. My main thoughts are that if I was the parent of the unstable child having chest pain I would have been flipping the F out until they got an EKG, and that the nurses really, really should be able to perform EKGs in situations like this. And that I wouldn't have apologized to anybody for anything in that situation, because it is the freaking ED and you need to be able to deal with emergencies in a timely manner without worrying about feelings getting hurt. Solidarity!

JKL33 · Jun 15, 2018

I've seen this time and time again. The tech must observe the chain of command while exercising a very limited scope of practice which does not include prioritization as Cowboyardee mentions above. Even if the PA didn't do the splint as ordered by Doc, regardless of protocol, it will ultimately fall on the tech because she received the initial order. It is not the tech's responsibility to inform the Charge of your need to re-prioritize tasks, that's your job.
Let's also not forget, floor transfers can be a quite a debacle for the tech in this situation because no one wants to own something left undone.
ABC's are limited to Basic Live Saving Measure. If your patient wasn't coding or choking, it did not warrant working out of task order because the tech was still performing under the direction of the Doc.
That being said, Techs can get out of control with insubordination and passive-aggressive behaviors. I've found it's usually because they feel underappreciated and disrespected. With a little one on one face time, off line, I've been able to resolve these types of issues.
The team building process requires mutual respect and emotional investment. Insincere apologies are cheap, its easier just to acknowledge someone else's feelings. All people respond better to the carrot than the stick. Though it may be effective short term.
Bottom line, the task was completed in a timely manner and did not result in an unfavorable outcome for your patient.

Although I appreciate the idea of not exaggerating the situation, the retrospectoscope does not provide a legitimate assessment of a situation that someone else had to handle in real time. The tech was not doing anything for the doc, she was twitting out worrying about being accused of something dumb. Instead she needed to do her assigned role in the process of ruling out "ABC"-related things in a situation where there was at least some potential for badness. This incident did not cause her to have to choose between two similar priorities whatsoever - and when that does happen, her role is to tell the two staff/providers to choose the priority for her, not to tell those whose role it is to decide priority what she is or isn't going to do.

ABC-related concerns are given priority assessment in every ED patient. Every single one. And the principles of the PAT are assessed as a priority first look @ every unwell pediatric patient. The basics may be completed/cleared within seconds in most cases, but that doesn't mean no one took account of them. If they can't be cleared (such as in this case) - - they remain the priority. That means they bump every other thing that is not of equal or higher priority.

A 30-minute EKG is not considered a timely manner for a STAT EKG in any ED in this country.

:clown:

gemmi999 · Jun 16, 2018

I'm still stuck on the fact that RNs can't do EKG's at your ER. I can't count the number of EKGs I do, if a tech is splinting someone/transporting someone/not available/called out sick. When I'm in triage and need a stat EKG, I try to get a tech to do it WHILE I triage to save time but if one isn't available I do my own EKGs.

allnurses Guide · Jun 16, 2018

I'm still stuck on the fact that RNs can't do EKG's at your ER. I can't count the number of EKGs I do, if a tech is splinting someone/transporting someone/not available/called out sick. When I'm in triage and need a stat EKG, I try to get a tech to do it WHILE I triage to save time but if one isn't available I do my own EKGs.

This!!! Anyone should be able to do a stat EKG! PCA's can and do all get

caught up in other things!

inthecosmos, BSN, MSN, RN, APRN · Jun 16, 2018

I am interested to hear the resolution here. We can always find better ways of communicating. You took some responsibility in the issue, now the PCA needs to!

kbrn2002, ADN, RN · Jun 16, 2018

Regardless of how this situation resolves the fact is it shouldn't even be an issue. There is a huge system problem that needs to be addressed, why is a tech the only person with equipment access when the licensed staff is clearly qualified to perform the task when a tech isn't available?

K9lover, ASN, RN · Jun 17, 2018

The charge nurse came to me after the PCA complained and initially I was surprised because I did recognize that perhaps I may have been "mean." She told me it was better I apologize and I did. I also explained to the PCA why I was stressed. When I spoke with my charge nurse I explained the symptoms and that I did not know I hurt her feelings or was maybe to harsh. I will post an update after speaking with my manager.

I thought you were referring to 'patient-controlled anesthesia' PCA and was visualizing explaining to the PCA! I need more coffee...