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DIRECTOR OF NURSING

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Nishstar1 Nishstar1 (New) New

I would like advice on how to handle sabotage from staff nurses and technicians.

As Director of Nursing within an ambulatory surgery center with an upcoming Joint Commission inspection, there is an increased focus on getting the surgery center up to regulation.

Our staff so far is made up of two new nurses and three scrub technicians, and four of out of these five are reluctant to follow much needed direction.

The question here is what can I do to protect my license?

so far, I have documented what has happened and my steps to counteract and improve the environment so that patient safety comes first.

I have placed PRN nurses who are specialized in pediatric recovery from general anesthesia to offset the minimal experience the current staff has.

What other approaches can I take to counteract intentional sabotage and burnout and to fix the problem that theses nurses are causing that they have confessed are intentionally keeping me out of the loop?

Rose_Queen, BSN, MSN, RN

Specializes in OR, education. Has 16 years experience.

Have you gone to the staff to see what they need? It sounds like you've got a lot of new staff- that may be part of the issue in that they are still trying to learn their jobs. Are you coming out with guns blazing and just dictating changes? Because I can assure you that will not go over with staff. What needs to happen with changes is staff involvement- let them know what will be changing, when the change will occur, and why the change needs to occur. Because my personal experience is that that never happens, change is simply handed down with no explanation and sometimes no notice, and it's not well received from the staff.

llg, PhD, RN

Specializes in Nursing Professional Development. Has 44 years experience.

Why is the staff so unhappy with their working conditions that they are committee sabatage? People rarely go that far unless they have some sort of reason. What are their reasons? What do they tell you when you ask them why they are so unhappy?

I'm not sure, and I didn't identify a problem because I regularly interact and communicate with staff (almost daily).

It so happened one day that one nurses started venting to me after she couldn't come in to do her own work and expected me to drop what I was doing and do it for her.

Shortly afterwards all four staff members were venting from an emotional outburst and I couldn't determine what the reason was.

After 30 mins of trying to read between the lines and wasting enough company time, I decided that the only real problem is the hours and I told them I'm working on covering each of them so they can take lunch,etc.

They said they didn't see me as a leader but it's because I've been trying to learn this company's policies and procedures (in transition since January)

Rose Queen : I read your message and have been trying to absorb/back track on things I have missed. Another factor is that they are so young and haven't developed the ability or realize the importance of professionalism and there is tempers flaring, profanity, blatant disrespect, etc and it has created an aversion for me to try to go to them to figure out what's going on because there's also slander during their explanations.

Edited by Nishstar1
Need to mention whom it was addressed to

Wow.

I'm guessing you are not forceful enough. You have to somehow figure out what it will take for these nurses to see you as the boss and as a real leader.

First, try seeing to it that they get lunch. If you don't care enough to do that, why should they really respect you? You can leave your papers and policies for a while and see to it that you treat your staff with respect for their hungry stomachs and their bursting bladders. From January to now is 4 months. Isn't that long enough for you to have learned the new owner's ways?

Are you sure you want to be a supervisor?

Then let them know that they can express their views but not with cursing, disrespect, yelling, or any other method that is slanderous or rude.

End the meeting if they don't follow this rule. Tell them the meeting can resume when they are in control of their tempers. This meeting should be with each person individually. You could hold a group meeting after you meet with each individual.

You have to find out what the problems are, you can't have an aversion to meeting with your staff. You can always fire them if they are not willing to change, show more restraint, and be mature and professional. It might be easier to start over with new staff.

Is the company paying them enough? Benefits decent? Get some experienced nurses in there if these nurses aren't fixable. Maybe your boss can help you.

I agree with a lot of your points.

A littleore background to this is that I came in as DON and there were two RN's who were really great but they had gotten burnt out and had quit one week before I joined...so I picked up the pieces and worked in the OR/PRE-POST OP and really hadn't had time to get to know each section of the P&P's, California law (I moved from texas) and other information that I needed. So once we hired two new nurses, I had trained them to work bedside so I can regain my focus onto DON issues.

Honestly, I feel like I've been stretched too thin and it's costing me a lot.

I've contemplated throwing in the towel and letting somebody else lead them. I haven't even had time to write up everybody (yes, all four of them have been hostile and verbally abusive)

and the things they have done should actually have them on probation.

As for lunches, short of pushing them out of the door, I've tried. I've told them that they can stagger their lunches once they finish their patient and let me know and I can cover.

I haven't had a nurse tell me she wants to take a break. One of them prefers to work through because she can't focus on relaxing and the other one just likes to tell me days later.

Do I need to create a lunch schedule? It doesn't work when one patient takes longer to recover or we have a dull moment earlier in the day.

I have so far protected them when they are seen by the doctor as sitting on their chairs playing on the phones while in recovery, when the surgeon thinks they are goofing off.

It might be getting to me that I'm working almost 80 hours a week and my work is being compromised and my decisions are being undermined.

How have things progressed since your last post?

RobtheORNurse

Specializes in Surgery. Has 30+ years experience.

It sounds like one of the main issues is short staffing. Many surgery centers try to save money by running on a skeleton crew but in the long run it ends up costing much more because staff burnout becomes a critical issue. You are then forced to always have new people coming on board and the remaining staff then get them thinking the same way. It is a self perpetuating problem. Unless staffing improves to the appropriate level, I fear the problems will not improve. People must like their job or they will leave. Specialty nurses can walk into a job almost immediately and have no reason to stay where they are not listened to, problems appropriately addressed and they feel like they truly make a difference. My suggestion would be to speak to the owner of the facility whether it be a hospital, surgeon group or a private investment group and explain the situation. If they are not willing to finance the appropriate staffing levels, you are fighting a losing battle and may want to look elsewhere for a new job. There really is only so much you can do if you do not have support from both sides of the issue.