DCDs and the one who should not be. What do you do?

ktwlpn, LPN · Feb 12, 2015

Maybe you should focus on the message here first and the deliverysecond.You can't just decide to not follow a written order.....If you did not agree with the order you should have consulted the wound care team.

Gooselady, BSN, RN · Feb 12, 2015

Even if everyone else is doing it wrong

I agree that how you deliver criticism is important. And if a peer RN I worked with got promoted over me and started wagging her finger in my face I'd want to break her finger

About the dressing change . . . my last position was my first position in acute care, I'd managed to avoid it for 17 years. The nurses who oriented me not just to policy, procedure and 'how we do things here', they also educated me in 'their own' way to do this or that. A few of them were very handy, time saving. And didn't follow orders quite exactly. I got busted doing something that just seemed like no big deal at all, 'everyone' was doing it. They really were. But *I* got busted. I almost said "Everyone else is . . ." then I bit my tongue and realized what I was about to say. I took the 'busting', promised to leave my iPad locked in my locker or just not bring it. I realized my excuse that 'everyone does it' would have A. made me sound like a five year old and B. throw coworkers under the bus to get myself out of trouble and C. (most important). We had a rule about electronic devices on the floor, including cell phones. They were no nos. The fellow RN who who cracked the Apple software and showed me how to use the silly thing back hiding in the doctor's area was just a massive temptation and I did know the rules. Doesn't matter how many people do it or why, the rule is the rule no matter how often it is broken. It's an adult's way of doing a job. If you do it wrong and get busted, suck it up. I started leaving my phone in my locker too, though hardly anyone else did. I'll be honest, I didn't want to be busted again. I'm too old to enjoy pushing limits I guess.

So I see two things happened. One, I can relate with -- my previous peer shaking her Nurse Boss finger in my face -- no thanks But on the other one, it's your butt that got burnt, no matter how everyone else is doing it. It's a lesson on looking out for Number One no matter what everyone else is doing.

blinky, ASN, RN · Feb 12, 2015

i didnt do the order differently because it was easier or faster, i did it because i did the research on the product and thought it was perfect for that wound. my way was longer and harder just an FYI. This wasnt done as a short cut or get around work.

and i did follow the order everything the order called for was there. But instead of simply tapping the super absorber on like everyone else was i put a proper fitting dressing on it.

part of her argument was that my dressing didnt allow for breathing, but per description of the product it allows for proper micro climate inside the wound area.

B- the way the other nurses were doing it, there was no way it was breathing anyway. as the sheer amount of tape they had to use to keep the non adherent super absorber pad on sealed it everywhere.then it just drained out over the tape as it didnt bond to the.

I also did verbally consult with one of the wound care team RN members and he said ya that would work as to the mepilex dressing i chose to use. SO why is one agreeing with me and one not?

How come no one is commenting on the behavior of a DCD supervisor in charge of nurse education? the dcd who chewed me out BTW is not in charge of wound team, she is in charge of nurse education.

Ill double check the order but it may or may not of even specified a type of covering, or " tape super absorber to skin"

So I see two things happened. One, I can relate with -- my previous peer shaking her Nurse Boss finger in my face -- no thanks But on the other one, it's your butt that got burnt, no matter how everyone else is doing it. It'as a lesson on looking out for Number One no matter what everyone else is doing.

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if all you got out of it was her shaking her finger, you missed many demeaning disrespectful things that occurred from her end. Of how one professional should not do/say/treat to another. If a nurse did what she did to me to her, she would get them fired.

klone, MSN, RN · Feb 13, 2015

What is a DCD?

You indicated that you have been disciplined before for not following procedure...what is that about?

As to her behavior, I agree with you that it was inappropriate. Unfortunately, a lot more is involved in being an effective leader than just experience and clinical skills. And sadly, many/most employers do not invest in teaching how to be leaders. THey just expect people to know or learn on the job.

Gooselady, BSN, RN · Feb 13, 2015

I got your drift, my way of communicating it just wasn't very clear.

What jumped out at me was her shaking her finger in your face like you were a naughty three year old. That, to me, said EVERYTHING that was inappropriate, childish and poor-leadership about this person. I'm with you. How she behaved was embarrassing to nursing leadership. I hear ya.

And couldn't agree more about your assessment of her. This is an unfortunate incident, and if she's willing to shake her finger in your face like that she'll do it again, probably. You sound righteously angry, I would be. My personal thoughts always turn to 'what can I legitimately DO, for myself and the patients?'

It's hard to know what to do when your immediate supervisor or superior or whatever she is is a crappy leader. One thing I always, ALWAYS keep in mind is to cover my butt first. And keep it covered. I would avoid doing or saying anything in anger that would give the impression I'm unprofessionally 'angry' or hot tempered. People stop listening to you then, and pretty soon, even if you have been 'right' all along, you'll be the one with your butt in a sling. I had a nurse manager that screamed, literally, at me and another nurse for allowing a psych patient to shave her pits without supervision. Finger wagging and all. She turned bright red to boot. It was astoundingly unprofessional, one, and two, it made her look like a fool. I just stood there and nodded and 'listened' to her tell me what I already knew until she got tired and realized she wasn't going to get the reaction she wanted.

When people act like that, they are hoping you'll get defensive so they can escalate themselves and maybe even write you up for insubordination. By just nodding and gritting my teeth (and planning to work elsewhere, it wasn't the first time I'd seen her lose her nut) I REFUSED to 'give' her the opportunity to get even more angry and inappropriate. I refused to defend myself, who had no idea someone had given my patient safety razors and foam to shave with. I didn't tell her 'had I known I'd have supervised her'. She was intent on having a temper tantrum, plain and simple, I'd seen it happen often enough with other staff.

There's not much YOU can do back to her without getting your butt in a sling, probably. You can try. I don't have any ideas for doing that for you.

As for your dressing change, I hear you that you didn't cut corners. I really didn't mean to imply you did, my example wasn't the best. What I meant to say was what I said before; it's always your own butt you have to cover. In my hospital, if I brought the more proper dressing technique to the attention of the wound RN, she would have asked me to call the doctor and get the order modified. That would cover your butt AND the patient would have a more effective dressing protocol, it sounds like.

Always cover your butt :) You really don't have the power to fight something like this, even if you are 'right'. That's one of those unspoken 'rules' you learn eventually, and usually the hard way. Sorry you had to go through this.

ktwlpn, LPN · Feb 13, 2015

I don't agree with her delivery of the message,as originally written it sounded like you just decided to dress a wound the way you wanted to instead of following the written order.....When someone speaks to you like that no matter who they are you should react professionally and appropriately in the moment.And then document it and follow up.I don't see a big problem with her coming to you out on your unit unless you had an audience.You say she "lectured" you?Well,yes....ok.....I was not there..if you have had problems and been counseled before as you state I can see where a" lecture" would come from.As for the wagging finger YOU should have stopped her in her tracks in a polite and professional manner....

blinky, ASN, RN · Feb 14, 2015

The previous issues were 1 i had left a house stock suppository in a room with a AOx 3 pt who said he didn't want me to insert it and was going to do it soon,my shift was ending and i chose to leave it with him. Told the oncoming nurse about the issue and left. I suppose he didnt use it and a DCD found it still on his counter un used, he wrote me up but was very professional about it and this was a DCD i very much dis liked, but i had no issues with how he handled the write up.

Another when i was a nwe RN and i didnt properly document wounds on a new admit and left it for the next shift, i was counseled and never did it again. again very professional, a different DCD. And i had no problem with it, i learned and moved on.

There was an audience as the unit station was right behind the cubby i was in with all the day/night nurses giving report. Why wasnt I? well my replacement was late.

Again i followed all the instructions and as mentioned i did consult a member of hte actual wound team on the dressing and he told me as long as it fit over the wound it would be appropriate. my dressing took more time and was harder not easier than the actual order.I don't want anyone thinking i did it my way because it was "easier"

I documented the situation as best i could for being up 22 hours and having a pt younger then me die and left it for my DON who is in the chain of command above the DCD's, following procedure.

Director of Care Delivery (DCD)

then each have sub titles, hers i believe is nurse education ironically.

. I just stood there and nodded and 'listened' to her tell me what I already knew until she got tired and realized she wasn't going to get the reaction she wanted.

from what i remember thats what i did, i did try to defend myself and explain, but once the finger wagging began i just nodded in agreement. All i think to do was to document how un professional she was for a supervisory and nurse education position and left it for the DON who hasn't spoken to me about it but our paths don't cross as i work midnights. Spose i should just let it go.

TY for the advice and replys you two.

I have seen her be this way with other RNS and CENAS, so it's a behavior that is going to continue so i chose to try to do something about it. Other nurses commented "thats just the way she is" who i spoke with, well to me thats not acceptable and if the roles were reversed i'd be fired or given final warning most likely.

Gooselady, BSN, RN · Feb 18, 2015

I would also want to find some way to communicate this to her superior. The trick to doing that is to word it, and time it, in a particular way (word and time your written report of her behavior).

Unfortunately, doing a write up of a supervisor who just wrote YOU up is gonna fall flat with most higher management. Unless you very carefully worded this incident, it would just look like vengeance and sour grapes. How a write up is worded means there are two levels to any communication. A person can say "You didn't do a dressing change correctly." with a concerned look on their face, and their voice tone could be also concerned. The same sentence with a finger wagging in your face automatically gets your dander up.

So if you were to write up this DCD you'd have to carefully explain she was 'right', you didn't do the dressing change exactly according to orders. That's the truth. We both know WHY you did it the way you did, not because it was 'easier' but because you were using critical thinking based on what a wound nurse taught you (for instance). But in the write up, you would NOT go into all the reasons WHY you did what you did. You'd acknowledge your 'error' (while biting your lip off) and FOCUS INSTEAD on this DCD's unprofessional behavior.

You don't SAY "unprofessional behavior". You don't judge. You give facts instead, like 'raising her voice loudly', 'standing very close to me and pointing her finger close to my face' and 'raising her voice in a public area of the unit which was heard by staff and loud enough to carry into patient's rooms". Describe the behavior without using 'judgment' words.

Even better is to express your concern to her supervisor after you've witnessed her being similarly unprofessional with ANOTHER staff, be it nurse or housekeeper. Unprofessional behavior is unprofessional no matter who you are yelling at.

So a write up that begins with an admission of your 'error' says you are a person who takes responsibility. This gives you points, many more than an explanation of why. Then, to advocate for another staff gives you points for being concerned not for just yourself but for the whole team, which I'm sure you are. Finally, include your incident with this DCD. Use objective 'charting' type language. We never say "the patient was a complete jerk" in the chart, we say "the patient refused to cooperate and called this nurse an expletive." Believe me, that gets the point across!

People go to their managers or their manager's manager all the time and complain 'they did nothing'. I've been a manager who had that same criticism. When people came to me, I had to learn how to get the facts from them, because all I would get is judgments, emotional descriptions heavy with personal judgments, and then I was expected to simply BELIEVE what the staff was saying, and if I didn't immediately agree and sympathize, I was 'doing nothing'. Most of the time the staff GAVE ME NOTHING to do anything about! But when I got "Nurse ___ was out to smoke at 1930, 2015, 2100, blah blah blah and off the unit for fifteen minutes each time" I had something to work with! Kind of like evidence in court. "She's constantly taking smoke breaks! Every time I look for her she's off the unit!" are judgments, so to speak. I could go to the smoker nurse in question and say "I've heard you take too many smoke breaks." Smoke Nurse will say "No I don't!" and "I am not constantly taking smoke breaks!" It's her word against the complainer nurse, and each has equal weight because there's no evidence either way.

It's easy to go vent at a manager but not so easy to spend time documenting behavior and really putting your butt on the line and standing up for your own word. It's easy to be very defensive but not so easy to be specific about what the DCD actually DID that was inappropriate. But I'd say it is worth the effort.

blinky, ASN, RN · Feb 22, 2015

I would also want to find some way to communicate this to her superior. The trick to doing that is to word it, and time it, in a particular way (word and time your written report of her behavior).
Unfortunately, doing a write up of a supervisor who just wrote YOU up is gonna fall flat with most higher management. Unless you very carefully worded this incident, it would just look like vengeance and sour grapes. How a write up is worded means there are two levels to any communication. A person can say "You didn't do a dressing change correctly." with a concerned look on their face, and their voice tone could be also concerned. The same sentence with a finger wagging in your face automatically gets your dander up.

ty for response, she didnt write me up just chewd me out.

i've not complained to my DCD or ADON/DON for 2 and 1/2 years i've been there. So coming from someone who doesnt complain for that long hopefully gives my complaint more validity.

I cant write a DCD up they are above me, it's up to the DON now, who hasn't spoken to me about the letter i did carefully write and word about the incident. I did spend 30 minutes after my shift to best phrase and word this complaint as best i could.mostly trying to draw attention to how is a DCD who is responsible for RN education, being effective with the behavior she demonstrated with me. And how i felt after she chewed me out, which should speak to how counterproductive her approach is.

What do i do now? However shes said many times [my DON] that if we have complaints or ever want to talk just to ask her for sometime to have a meeting. Shes very approachable and fair from what i've seen and heard.

Ironically after all of this thank god the pt has changed rooms and per policy i got to change all of his dressing changes from night shift to day shift.

Whats even more funny is i heard the same dcd that chewed me out had a fit when she found out, and was told by another more senior DCD that i was correct and following policy.That felt good.

caliotter3 · Feb 23, 2015

Once worked at a facility where the DSD acted like that, as if she owned the place. She threw her weight around no matter what the problem was, who it involved, or what the matter was or was not. The ADON was afraid of her. Guess what happened when the administrator and Director of Nurses both left within a couple of weeks of each other? After the new regime took over, it was a matter of a couple of months and the DSD was gone. Her full time job hours were cut, and then cut again, until she figured out that her 45 mile commute to work was not worth it, and she quit. Exactly what the new regime and everyone else wanted.

As for your method of approaching the dressing change: you stated you conferred with the wound care specialist, who agreed. All I would need to continue doing what I have been doing for weeks now.

jadelpn, LPN, EMT-B · Feb 23, 2015

Just be sure, OP, your documentation backs up your actions. In other words, if the MD order is "wound care per wound care team" then be sure that you document "consultation with wound care RN ________, r/t skin integrity of ____wound, orders changed, MD aware." (of course add whatever detail).

It is difficult to deal with a supervisor who will not listen to your explanation, but instead chooses to go off on a tangent. Even more so when the dressing down occurs in front of co-workers. However, what is to your advantage is that you have witness to the fact that this inappropriate exchange occurred. Further, do not ever go into a "private meeting" behind closed doors without your union rep, ask if you could have a meeting with her and the manager, the ADON, HR....not ideal, however, it is just not you and her which then becomes a he said/she said, no I did not moment.

If you can get a word in edgewise, and I will say that may be difficult, as this type of management style allows for little input by you, if you can redirect the conversation "I have orders/had a consultation/documented appropriately." Further, if you can keep her in the loop (and again, I KNOW it is really hard to be professional, however....) "Patient in room 334 was showing some signs of redness around the wound site. So I consulted with the wound team, and they were on board with the dressing being altered for the patient." Plus, be sure that is part of your shift report.

Make sure you are covering your butt with documentation. Otherwise, try to stay under her radar. If you are writing a well worded complaint, and nothing is being done, then unfortunately, in my opinion, they are not concerned with this style of management. I will say to further cover yourself, get malpractice insurance. When you have a manger who is watching you like a hawk to screw up, bad mouthing your work, you need to be sure you are proactive in protecting your livelihood.

Wishing you nothing but the best.