Feeling Frustrated with LPN on my team!

[Brightonrn1]

:angryfire:bugeyes:As a Hospice nurse, I have been always educating myself on good case management, symptom relief and of course social, spritual, and psychosocial issues. I have found what I love to do. I am currently with a LPN and we share our pts. I see them once and she sees them once in a week. The issue is She is questioning all my orders. Even though I have discussed everything with the NP and The MD. I am not feeling that she is asking because she is curosity as to why but more or less because she does not agree. This arrangement is ruining my days at a job I love. I am feeling stepped on and disrespected.

Quick example, we have a pt who is declining. she saw the pt today. Its been hours since that visit and she is yet to call with an update for me. I even called the pt and she had been there for over 3 hours. That was five hours ago.

I cannot work like this. I really want out of this arrangement but I feel like I am dumping on the other nurses if I dont continue to try. It seems no one really wants to work with her. Even the nurse that did who moved spent the last year complainting about her and saying she was leaving so let it go. I cant. I cant work with her second guessing all me decisions.

I am a very experience RN with 20 years in micu. Although, not hospice I still can learn and always will. I know what I am doing.

Any words of wisdom out there!!!! Not many to talk to about this, I feel like a lost sole......

[SKM-NURSIEPOOH, BSN, RN]

first of all...be careful of your tone towards your colleague being a lpn (it comes off sounding condescending ~ sorry). you didn't say just how many years of experience she has in this specialty & just because she is a lpn doesn't mean that her professional/technical opinion doesn't matter...she just may be annoying to you personally because you just don't like her?

secondly, your experience as a micu nurse is great...but it doesn't "trump" the other hospice nurses' (including the lpn ~ who is a nurse) years of experience...it's just different.

thirdly, *you* need to communicate with your lpn colleague & don't take her "questioning" or not "agreeing" with your orders as attacking, demeaning, or disrespecting you. if you look & respect her as your colleague...& don't look at her as not having qualified opinions or under-qualified...then i think your level of communication would benefit greatly. in otherwords...you two should be discussing the cases not only between the two of you, but also with the other team members as well. there are two sides of every coin & i bet if your lpn colleague was asked, she might even feel that you, the new rn on the block (to hospice care) is a bit over bearing to her...just a thought. i'm at a lost as to why it is your lpn colleague can't consult, question, or discuss things/orders with you, but it's o.k. for you to do so with the md/np?

you may have legitimate reasons for being frustrated with your lpn colleague but i would refrain, however, from titling threads with a lpn vs rn flavor (as a word of advice). it tends to be a sore spot here ya know.

[SKM-NURSIEPOOH, BSN, RN]

btw, welcome to allnurses.com !

cheers :cheers:,

moe

[Em1995]

I didn't get the flavor that you were questioning her because she's an LPN. What I understand (and please correct me if I'm wrong) is that she's not being a team player. It sounds like the last nurse had the same problem. Have you sat down with her and asked her about this...one on one? Have you told her how this makes you feel? I would initially suggest that and ask her input and ideas. I know with our home health aides, whom I cherish, we often meet and discuss our patients. We exchange ideas and really work well as a team. I find that directly and honestly speaking with our colleagues is always the best policy

If, after talking with her, she continues to go over your head and not speak directly with you, I'd go to your nurse manager and discuss this.She may have personal issues that relate to an inablity to be a team player. The RN is the one who is the case manager and she really should be working WITH you.

Keep us posted....all the best!

[SKM-NURSIEPOOH, BSN, RN]

hiya em1995,

may be i miss read or took the op's post out of context & took it personally....for that i apologize. i, in no way meant to be defensive towards you brightonrn1 & only wanted to give you some advice. thing is...sometimes i get myself into a sling when doing so :zzzzz. don't mean to step on your venting session ~ sorry !

funny how the written word can be taken in many ways. again...sorry for my *rant* & carry on! good luck with your lpn colleague...once you've sat down & talk to her...you two will be able to be the best team at your facility.

cheers :cheers:,

moe

[doodlemom]

I would talk to your supervisor about her and see if there is another person that can be assigned to your patients. CHances are that your supervisor is aware that there have been problems with this nurse in the past and maybe he/she will be sympathetic.

[Hospice Nurse LPN, BSN, RN]

:angryfire:bugeyes:The issue is She is questioning all my orders. Even though I have discussed everything with the NP and The MD. I am not feeling that she is asking because she is curosity as to why but more or less because she does not agree. This arrangement is ruining my days at a job I love. I am feeling stepped on and disrespected. ......

I've always been told there are three sides to every story: your side, my side, and the right side. I've been a hospice nurse for almost 9 years now and I couldn't begin to count the number of RN's who came from ICU backgrounds thinking they wanted to work in hospice. Some would come in and think they knew better than any of the LPN's about pt. care. Most didn't stay long. I don't want to get into the whole "RN vs LPN" thing, just want to put my 2 cents in. I consult with my DON about each pt. I see....at the end of the day. If there is something serious going on, I'll call from the pts. home. I call my own doctors, I order my own refills, I contact MSW or Chaplain if need be.

I also question orders. Why? Maybe I thought I had a better idea or whatever. That's how we learn. WHY did you order this instead of that?

I hope you and your co-worker can sit down and discuss the real issues at hand. Hospice is a wonderful field and many of us have found our true calling here. Good luck!

[Em1995]

HospiceNurse LPN...I hear you. I came from psych and the ER into hospice...and the death of my daughter, my mom, dad and aunt(all within a very short time of one another...not to mention 5 close friends (all in their forties..all at once...a story for another day). My ER experience really helps with assessing(and resolving) physical problems....but my life experience was most fruitful in that it has given me valuable life experience in dealing with transition issues.! I look at all of us on the team as connected and united. No one is more important than the other. In fact, if my HHA's calls me because he or she sees a change and believes I need to make a visit...I do. Each one of us brings unique gifts and talents to our patients.

You are very right re: those nurses who come to hospice thinking they know it all.I've found that most of them thought hospice was "simply about symptom control". They are the ones who don't last (thankfully).

I can't get out to see my patients for another couple hours. We had another storm last night and the roads are nothing but sheets of ice! It

is supposed to melt by noon....I hope.

[Em1995]

Hi Moe...I know what you mean as many times an e-mail can sound much different than what you really mean in the spoken word. But, I also understand the point you are making as I know many RN's who look down on LPN's. Quite frankly, we're all a team and no one is superior to another! The same RN's who look down on LPN's are also the ones who complain the most about doctors looking down at THEM. I think it all boils down to people feeling badly about themselves and making themselves look better by putting another down. But, to me, that also shows a severe lack of insight and intelligence....emotional intelligence.

All the best...

[Brightonrn1]

Please everyone, it was just a question. I certainly did not want to offend anymore.

Really!

Yes, I am a former micu nurse who always took excellent care of the pts who had to be surrogated from vents. I spent countless hours with families helping them and just being a ear. I too have had family and friends use hospice and am no stranger to death.

Believe I was fine on my own. My co worker is the only one of its kind in our hospice. I will use the suggestions given to be by all.

Yes I will talk to her one and one. Maybe I was quite to judge. I should view this arrangement as more of a blessing then a burden.

I will update when all is worked out.

Thanks again

[ktwlpn, LPN]

IWhat I understand (and please correct me if I'm wrong) is that she's not being a team player. QUOTE] I think that sometimes it's assumed that being a 'team player" means not having any input into a patients care plan.That's not fair to an experienced nurse (LPN or RN)

[Em1995]

Ktw...What I meant to say was this: if another nurse, social worker, volunteer, whomever...doesn't discuss his or her ideas with their co-worker, then no, they are not being a team player. This is all about communicating WITH each other. It doesn't matter what role they play on the team. Problems arise when there is a communication breakdown.

For instance, when I change meds with one of our patients, I notify my social worker and the HHA's on the team. That way, we are all in the loop. I also ask for their input and we work together for the main mission of patient and family comfort.