Dealing with entrenched coworkers

[LogCabinMom]

Hi everybody -

I've been at a SNF for almost 6 mths now, and just accepted a ft position there as a Primary Nurse on 3-11s. I really love the residents, and even tho the med passes are insane, I like the job; my unit mgr is awesome and I enjoy working with her (she's new to this facility also)... and would like to stay and try to make a difference.

The problem is, there is a handful of LPNs who have been there a long time (5+yrs). They are fairly young, 20's, all smokers, partyers, started out there as aides, and they think they have seen it all. (In contrast, I'm 41, a new RN, don't drink, and don't go out with anyone except husband and close friends).

Any question I ask of them is taken as a direct affront on them. Frankly, I'm just trying to find out information so I can do the best job I can. I am doing my best to be polite, respectful of their knowledge of the pts and nsg in general, but honestly, they are really ****** me off. :angryfire For example, last night a resident had to have a dsg applied on her coccyx d/t a stage II ulcer.. the tx book said "apply exuderm" --I did, but I sent an email to the "wound care nurse" (one of the LPNs) because I thought this ulcer looked far worse than it had a few nights ago and I didn't think an exuderm was appropriate. What I got back was a stream of vileness, telling me I should have gone to the inservice 2 mths ago to learn about wounds, why did I change the dsg anyhow (I had to, it fell off during pt's bath), etc etc. I was told I had "attitude" about this.

How do you deal with these people who don't like new nurses? Should I send this email to my unit mgr or would that be "running to mommy"?

[HouTx, BSN, MSN, EdD]

You have my sympathy.

I would suggest that you work with your unit manager & DON to conduct an inservice on scope of practice, including clarification of responsibility. If the patient (with the decubiti) becomes septic or suffers a worsening decubiti, the clinical liability falls on the RN staff because you are not only accountable for nursing assessment of your patients, but also responsible for supervising the practice of LPNs and CNAs who are working with you.

I know it seems sort of negative, but when faced with a situation like this, you should see if your actions pass the "red face" test. In other words, could you justify your actions to a plaintiff's attorney without getting red in the face? I don't think that "I didn't want the LPN to yell at me" would be a satisfactory defense for you or your facility.

[caliotter3]

You have my sympathy.

I would suggest that you work with your unit manager & DON to conduct an inservice on scope of practice, including clarification of responsibility. If the patient (with the decubiti) becomes septic or suffers a worsening decubiti, the clinical liability falls on the RN staff because you are not only accountable for nursing assessment of your patients, but also responsible for supervising the practice of LPNs and CNAs who are working with you.

I know it seems sort of negative, but when faced with a situation like this, you should see if your actions pass the "red face" test. In other words, could you justify your actions to a plaintiff's attorney without getting red in the face? I don't think that "I didn't want the LPN to yell at me" would be a satisfactory defense for you or your facility.

Ditto this post. When it comes down to the line, you are the RN and the one held responsible in the end. Are you going to let this group of people that you hold the professional responsibility over, dictate to you? You need to work with your DON and unit manager on this, before walking all over you becomes another one of the entrenched behaviors.

[LogCabinMom]

thank you - I wasn't even looking at it from the accountability p.o.v, but you're absolutely right.