Favoritism and the "Power clique"

[Hospice RNCM]

All,

I am a Hospice RN Case Manager with 11 years experience. I recently left a company I had worked for nearly 5 years. When I first began with them, it was a very good environment, almost familial. But in the last year or so, it deteriorated markedly.

Approximately a year ago, our longtime DON transferred to the Home Health Dept of the company, leaving an open spot in the hospice section's DON. This was soon filled by a new DON who was known to me as having been the DON at one of the NursingHomes I visited from time to time. With him came three LVN's. Two of these immediately went to the field as fill-ins, and the other one went to the office as ADON. Before long, one of the other LVN's came to the office and filled a newly created "ICM" spot, leaving the 3rd one in the field. About the same time as several complaints from family members asking for this LVN not to come back, this one was also moved to the office and made a 3rd ICM. There were already two RN's in the office, one was quality control, and the other was the 4th ICM. Several months later, the RN who was the 4th ICM was abruptly fired by the DON....I was told by her later that one of the LVN's, the same one the families did not like, asked the DON to get rid of her because "they don't like each other". With this firing, the three LVN's in the office established themselves as the "power clique". Things started getting dicey for the field staff from that day. Our workload was doubled, more requirements were laid on us, forms we had to fill out on each patient every 2 months for recertification were doubled, and our notes and care plans were closely scrutinized, and micromanaged. It was not long before many of the other RN's decided to pack it in and leave. I decided to stay as I hoped it would get better. Unfortunately it only got worse.

I finally got so worried about the eventual death of the hospice section that I went to the big boss himself, a very approachable man, and told him that I thought he was going to lose his hospice section. I told him that good nurses, social workers, and chaplains were leaving due to what they perceived as the increasing toxicity of the work environment. He arranged for me to speak to the DON, and give him my concerns. The next day I did meet with him, and he laid out all the reasons why there are enough nurses to handle the load, and that 30+ patients is not too many, because we have LVN's in the field who can take up the load. I asked him if that was the case then why 2 weeks before when I had to take time off for a respiratory ailment were none of my patients seen, and why did two of them go out of Medicare compliance which specifies that every patient has to be seen by an RN every 14 days. The reasson given at the time was "we don't have any nurses available to see your patients." The DON just shrugged it off and said these things just happen, and this is a business and it costs money to hire new RN's. I basically was told to suck it up, buttercup.

In the weeks following, I began to notice a pattern of things happening to me that did not seem significant at the time, but over time I had no choice but to conclude that I was being retaliated against for speaking out.

1) I was called in and ordered to re-write about 20 recertification packets I had submitted in the last couple of months because they were written wrong or they had wrong or incomplete information.

2) my patient load was almost doubled, and I often had to see patients for absent nurses that needed recertification, and because of the directives from the office that documentation needed to be completed within 24 hours, I often had to work at home (for which I was NEVER compensated)

3) I was called to account as to why I submitted a recertification on a patient the day after our weekly meeting when this patient was supposed to be conferenced with the doctor. THis patient was not mine and I saw the patient when I was told by them to see him, but still I was blamed because they said I should have known when that pt's IDG was, and seen him earlier.

4) I continued to be called in to answer as to why my recertification forms were still not done properly. I showed them the guide I was given, and was told that this guide was outdated and I should be using the newer one, which they claimed everyone was given. I told them I knew nothing about any new guide but they said I was lying.

5) I was written up by one of the LVN's (the same one that the patients' families asked never to return) because one of the nursing homes where I have a patient said I was seen in the patient's room watching TV. I told this LVN that if I was watching TV with my patient I was giving the patient some of my time by keeping her company while I worked on my visit note. Still the LVN told me that they have no choice but to side with the Nursing Home, wrote me up and reassigned that patient to someone else.

6) I was called in and shown all the incident reports I did for the last year when patients fell, and told that I had done them all wrong, because I had not filled in the Management section block. I told them I am not management and that's not for me to fill in, but they said no I AM management I am the Case manager, and that block has to be filled in.

7) I was instructed to make contact with the family members of patients who were being discharged, have them sign the discharge paperwork, then bring them back to the office. I did so, but the following day I was summoned and told that the papers had to be done again, because the wrong doctor's name was entered. I told them I was following the guide which told me where to find each patient's doctor's name, and they said "Oh you can't go by that, you should have asked first." I of course said well then what is the point of having the guide when nothing in the system can be trusted. I had the aggravating task of re-contacting the exasperated family members and asking them to pse meet me again to sign new papers.

I finally had enough and resigned. On what was to have been my final day, I got a call and was told that a particular patient was asking to be seen. This patient had been admitted the day before. I told them this was not my patient, and they said oh yes he is, we assigned him to you yesterday.....I of course questioned the wisdom (stupidity) of assigning a new patient to a nurse who already has one foot out the door. I had planned on finishing at an early hour so I could smoothly sign over all company property, have all outstanding notes done, and get home at a decent time, but instead barely made it back to turn in my gear right at 5pm.

Interestingly enough since leaving, the company very abruptly went under. It was absorbed into another company, and most of the field staff were laid off except for 3 RN's, a SW and a chaplain. However......the DON remains, and two of his "power clique" LVN's remain in the office, and the third LVN (yes the same one families don't like) went to the field ...and to make THAT happen, one of the field LVN's got laid off.

I am glad I made my escape from there, but can['t help but wonder......do I have any legal recourse as far as "Hostile and toxic work environment" and "favoritism" goes? What do you all think?

[Sour Lemon]

All,

I am glad I made my escape from there, but can['t help but wonder......do I have any legal recourse as far as "Hostile and toxic work environment" and "favoritism" goes? What do you all think?

Legal recourse? Doubt it.

The things you're describing sound like typical behaviors of an employer when they want an employee to resign. You did the right thing by getting out of there.

Good luck in the future.

[roser13, ASN, RN]

Exactly what type of legal recourse are you expecting? Of course only a labor attorney could advise you properly, but I cannot understand what you're questioning as illegal or discriminatory. Favoritism & toxic environments are everywhere and are not legislated against, as far as I know.

You worked in a toxic environment and you wisely resigned. Happens all the time.

[nutella, MSN, RN]

I worked in home hospice and loved working in the field. A new DON came when the old retired - and the ship began to sink.

It started to get really crazy, can't get into detail but main thing is that when it became clear that the new DON is basically unfit and tried to have other questionable competent people do work they were not qualified I decided to leave. After a while people including myself flocked out of the company. The DON left.

[Hospice RNCM]

The reason I am asking is one of the RN's who had been in the office and then forced out told me she got a settlement through the State Workforce Commission for "toxic work environment". Of course the difference was she was out-and-out fired. Reason she got her settlement, according to her, was that when they followed up on her complaint of wrongful termination, they could not ofer one good reason for firing her other than "we just didn't like her" .

[roser13, ASN, RN]

The reason I am asking is one of the RN's who had been in the office and then forced out told me she got a settlement through the State Workforce Commission for "toxic work environment". Of course the difference was she was out-and-out fired. Reason she got her settlement, according to her, was that when they followed up on her complaint of wrongful termination, they could not ofer one good reason for firing her other than "we just didn't like her" .

In "at-will" states without unions, no reason is required for termination. "Just because" is as valid a reason as any.