Frustrations with coworkers taking over without communicating with me

[Newbie4567]

Hey ya’ll,

Over the past week or two, I have been the unlucky recipient of multiple heavy assignments. A lot of random emergencies have been happening on my shift, and naturally I have needed to rely on my team to support me during those situations.

I’m a newer nurse, and I have always felt that my coworkers look down upon me because of it. I started in the ICU and no one has been shy about sharing their concerns about my lack of experience. Even though I feel I have been improving, it feels like no one else sees that except a few coworkers.

With these emergencies, I’ve noticed that some of my coworkers will come into the patient’s room and do things to “help” without communicating with me directly. For example, I had a vented patient who was dysynchronous with the vent and decompensating. I was literally unable to leave the room for two hours. I was in the process of bolusing Fentanyl, per the provider (who was outside of the room)’s order. Another coworker walks in, logs me off of the COW and starts signing out and pushing meds. I asked him what he was giving my patient and he looked at me like I had two heads and said “we’re pushing roc!” like it was obvious. While I appreciate the help of my coworkers, I also feel like I should at least be informed as to what my colleague was doing to my patient.

More recently, I had a patient on continuous dialysis that started to alarm for an unusual alert. As I was trying to troubleshoot using the machine’s directions, I called for help as I had never seem the alarm before. Neither had most of my coworkers, so my admin charge came into the room. She’s a domineering person and has a tendency to come off in a condescending way. She also hasn’t been at the bedside in YEARS.

While the dialysis alarmed, the patient’s pulse ox (which had been reading 98% ALL DAY) suddenly had a horrible pleth and was reading 68%. The patient’s voice had been hoorifice and unclear all day, in relation to her mental status. I knew my patient was probably fine, but my charge started to freak out and completely took control of the situation. She applied a NRB, suctioned her and had us boost the patient and said “we need to focus on the patient’s oxygenation right now” and “She’s so hoorifice!!” in an incredibly condescending way. The way she said it was like I was a first year nursing student who didn’t know a thing.

As soon as we applied another pulse ox probe, the pleth improved and her oxygenation was 100%. While I appreciated her help, I felt like I was more than capable of addressing a pulse ox with a bad pleth and ultimately my concern was more with my dialysis circuit, which was failing. After the situation was under control, I saw her standing outside of the room talking to my manager, which made me feel like she was complaining about the way I had handled the situation. Afterwards, she came up to me and was saying “this is ridiculous, the patient looks horrible, where are the doctors” and reiterating concerns that I already was planning on addressing during rounds (the doctors were rounding on another patient down the hall). I even emphasized that once the patient was settled I was going to ask the doctors to round on her next, by my charge didn't seem satisfied.

I’m just frustrated overall because I think I would have been able to take the lead in that situation and my charge didn’t give me the opportunity. While I appreciate her help and concern for my patient, I knew my patient was okay and purely the victim of a bad reading. My dialysis was at the risk of clotting, which would have been a bigger safety risk overall. I feel like she (unintentionally) made me look bad by not allowing me to guide her care.

[JKL33]

I have been on both sides of this and have witnessed it countless other times. Bear with me, this is lengthy and also straightforward, language-wise.

You have to change the portion of this that you can change, right away. At the same time, be strategic about addressing others' part in messes like these.

You are a thinker. That's great. But you have to realize that your thoughts are not communications. The two other staff members you reference used horrible communication. And you, quite possibly, are not communicating enough.

18 minutes ago, Newbie4567 said:

Even though I feel I have been improving, it feels like no one else sees that except a few coworkers.

Some of our estimations of improvement come from our feelings. Example is saying to yourself that you handled something better as evidenced by feeling more calm this time around and having clearer thinking due to feeling less anxious. That's great and it is a bona fide improvement. But it doesn't translate to anyone else.

23 minutes ago, Newbie4567 said:

Afterwards, she came up to me and was saying “this is ridiculous, the patient looks horrible, where are the doctors” and reiterating concerns that I already was planning on addressing during rounds (the doctors were rounding on another patient down the hall).

Your plans are not communications. Sometimes, especially when still learning, your plans are also not appropriate. Those things together (the un-communicated plans of a less-experienced nurse who must rely on others for help) are the basis of the nurse's freakout. And I am *not* saying that her communication style or her behavior regarding the pulse ox was appropriate, I am just telling you the whys. If this problem is troubling you, you will have to accept the whys in order to change things. People are going to come along and tell you she is just a mean, lazy, judgy crusty old bat and this is NETY and she has no right to treat you that way. You can go that route with this if you want to, but you will fare far, *far* better if you focus on improving yourself.

The bottom line with this scenario is that your patient looked like crap and you had some plans about what you were going to do about it at some future time. Others became aware of the situation because one of your machines happened to malfunction.

We can argue about whether life is fair, but....right now you simply don't have the privilege of mulling things over for extended lengths of time without open communication about what is going on and what you are thinking and doing about it. You yourself have said that you must rely on your coworkers in emergencies - - that is perfectly acceptable!! And it's wonderful that you recognize your resources. BUT - - in the interest of patient safety and fairness to everyone, you can't keep to yourself until an emergency arises and you need others' help.

44 minutes ago, Newbie4567 said:

[...] and reiterating concerns that I already was planning on addressing during rounds (the doctors were rounding on another patient down the hall). I even emphasized that once the patient was settled I was going to ask the doctors to round on her next, by my charge didn't seem satisfied.

You must communicate these things, run them by people. This is for patient safety. Patient safety!! Not anything else. If you are relatively new you owe it to patients to make darn sure that your plans are appropriate. Establishing yourself with your coworkers is going to involve a lot of communication, too.

42 minutes ago, Newbie4567 said:

I’m just frustrated overall because I think I would have been able to take the lead in that situation and my charge didn’t give me the opportunity.

See previous paragraphs.

1 hour ago, Newbie4567 said:

For example, I had a vented patient who was dysynchronous with the vent and decompensating. I was literally unable to leave the room for two hours. I was in the process of bolusing Fentanyl, per the provider (who was outside of the room)’s order. Another coworker walks in, logs me off of the COW and starts signing out and pushing meds. I asked him what he was giving my patient and he looked at me like I had two heads and said “we’re pushing roc!” like it was obvious. While I appreciate the help of my coworkers, I also feel like I should at least be informed as to what my colleague was doing to my patient.

Yes, definitely. I suspect that additional communication issues underlie this situation as well, but yes, the handling of this was not appropriate.

****

You must start talking a little more. Interact with your peers, run things by them.

It might not be fair (or it might be perfectly fair) but they need to know something about your thought processes if you want to give them a chance to trust your developing nursing judgment.

The summary/bird's-eye-view of this situation is: 1) Coworkers assume that, like many nurses still learning, there will be things you overlook and misjudge. [Yes I know this can happen with more experienced nurses but that isn't the topic of this thread]. 2) You are doing good in your own mind with your thinking and your plans, but no one else knows about these things, and sometimes the plans may not be appropriate. 3) They come into a situation and find a patient that looks very poor and you want it to be recognized that you had plans and were right on top of it.

The good news is that with some improved communication (pronto), you can probably forge rapports with all but the most unreasonable of your peers. ??

[Been there,done that, ASN, RN]

You haven't proven yourself in the unit yet. Everybody is on high alert right now. Appreciate any intervention you get. Discuss it after the fact with your coworkers.

[Sarah2018, BSN, RN]

one of the most important qualities in a nurse is to be fast in doing the most important things.
from my experience, I love it when my colleagues help me in taking care of my patients even without consulting me. They are every one’s patients. I have NEVER thought that my colleagues looked down on me because of anything. Maybe no body actually observes us. I don’t observe any one.