Co-worker question

[SneakySnake]

There is a new nurse at our facility that encourages ALL the patients and their families to come to them with problems. This person has convinced many of the residents (and families) that they are the only one who will "get the job done". Some of the patients will not alert the nurse on their floor to a problem but will instead seek out this person to help them. Sometimes the patient may go a day or 2 waiting for this nurse to get back to work to have a problem addressed rather than tell the nurses on staff.

The other day a patient from another part of the building was coming down my hall and I asked if I could help them "is nurse "X" here?" they said. I replied "no they have gone home for the day and will not be back for 2 days. Can I help you with something?". The patient told me "No, I don't think you can help. I guess I will have to wait to see a RN". I politely explained that I was a RN and so was the nurse that was working their floor. The patient then proceeded to tell me how she could only go to this particular nurse for help. The thing is, I know the nurse that was caring for her that day is a great nurse and would help her in an instant. I called the patients nurse to report what had happened so she would have a chance to try and help the patient or else document that the patient refused care. I have had 2 different residents tell me that this nurse has told them to not bother with the other nurses but to come to them instead.

I know that some nurses and patients get along better than others. I have had patients and families say something like "oh, I know things get done when you are here" to me. The thing is....I never encourage this. I stick up (nicely) for the other nurses and usually respond "some days are more hectic than others I am glad I was able to help today". I would NEVER encourage them to only come to me or tell them to not report problems to the nurse on duty.

There are other things that concern me about this nurse too. I am not sure how to handle the situation. Any advice?

[Nascar nurse, ASN, RN]

What is this other nurses role? Is she a routine staff nurse or is she management? I know in the end it shouldn't matter. As a manager I prefer to empower the nurses to make decisions and judgements (as well as take on the accountability for those decisions) rather then micro manage every little detail. Unfortunately I have come across newer managers that believe they are the only one with the skills and knowledge to problem solve. This almost always comes back to bite them in the rear as no one can/should have that much power.

If she is just a staff nurse you may want to bring it up to your immediate supervisor. A resident could potentially have a bad outcome waiting on a person to come back to work two days later.

[SneakySnake]

This person is a staff nurse.

[SneakySnake]

I have tried to be direct and handle this in a straight forward manner. The last time this happened to me I went to this nurse and said "Hey I saw Mrs. Smiths husband was talking with you is there anything going on with Mrs. Smith that I need to know about?". This nurse assured me they were just chatting and nothing was going on.

Later in the shift I find out this nurse has reamed one of the aids for not doing oral care (she did btw, I was with her when it was done) and they also did a dressing change to a skin tear without telling me anything about it.

[TheCommuter, BSN, RN]

This person is a staff nurse.

If he is a staff nurse who is engaging in this type of behavior, I'm conjecturing that he secretly suffers from low self esteem, has an unstimulating personal life, and gets personal validation through the residents and family members. To make himself feel valued and worthwhile, he feels he must portray the super-nurse: the one who can get all his work done in addition to the work of other nurses.

In a nutshell, he is using the residents to fulfill his selfish needs. This is problematic because the residents are bypassing people who can actually help them until this particular nurse returns to work. In addition, if he's telling families to skip the other nurses and come straight to him, he's implying that the other staff nurses are not competent enough to get the job done.

Also, gender might play a major role. Many elderly people have been socialized to defer to male healthcare workers, so if he's told residents to come straight to him, they probably believe that they must obey his directive.

[SneakySnake]

TheCommuter, I think you are right.....what do I do?

[caliotter3]

If this behavior is degrading care for the residents, it should be brought to the attention of management. It is a set up for something serious to go unresolved, with possible negative consequences, because the residents are being psychologically coerced into cooperating with this practice that is ultimately against their own best interests. Doubt the nurse in question intends to take responsibility for any bad results brought about by his undermining of other nurses' ability to do their jobs.

[TheCommuter, BSN, RN]

TheCommuter, I think you are right.....what do I do?

This is a difficult situation. Your job might be targeted if you tell management. I would approach him quietly, with no witnesses around, and ask him about the situation point blank. Do not be surprised if he denies everything.

You could also be passive-aggressive. The next time a family member or resident refuses your assistance because they want to be helped by this nurse, you can offer to get him on the phone so they can speak to him or leave him a voice mail message regarding their concern. After all, he's told people to come straight to him, so what was he expecting to occur on his days off?

[MrChicagoRN, RN]

Each nurse has their own assigned patients that they are responsible for. While we should all be willing to do something for other patients when the need arises, it is unprofessional for any nurse to intrude upon the practice of another nurse and undermining his/her peers.

I'd suggest either approaching this nurse along with several of your peers or taking it directly to management.

[pixie120]

Each nurse has their own assigned patients that they are responsible for. While we should all be willing to do something for other patients when the need arises, it is unprofessional for any nurse to intrude upon the practice of another nurse and undermining his/her peers.

I'd suggest either approaching this nurse along with several of your peers or taking it directly to management.

Excellent advice. The biggest downfall in LTC, that I personally face each and every day, is staff who do this type of thing, and then...when it gets even more "fun", run to the Administrator and provide "secret" information on ALL the nurses, including the DON. Bad behavior all the way around. While we should all have a mentor and a protege, the rest of the the time needs to be spent in a supportive team nurse role, no matter WHAT our job title is. I agree, this leads families and residents to believe that unless THIS nurse is present, bad things will happen cuz clearly the rest of the staff is not capable, when in fact, they are VERY capable and that nurse is undermining the entire team, for whatever reason OR this is a person that could be mentored into a management role, but would have to be taught how to do it properly.

[Jules25]

Talk to your DON or ADON and be prepared. Have specific dates and examples of situations that have been brought to you by residents and families and what they said about only talking to the other nurse. Do you have a social worker on your team? She could be another source to refer questions or problems of residents and families to. If you have a good DON, this could be a topic for an inservice (team building, communication etc.)

[pixie120]

Talk to your DON or ADON and be prepared. Have specific dates and examples of situations that have been brought to you by residents and families and what they said about only talking to the other nurse. Do you have a social worker on your team? She could be another source to refer questions or problems of residents and families to. If you have a good DON, this could be a topic for an inservice (team building, communication etc.)

Great advice. It is always better to address and confront all issues openly, in a written logical manner and as unemotional as possible. And anytime one focuses on the resident, and is a true resident advocate, one will be successful, even when surrounded by unprofessionals.