Accusation Against Male Nurse (Me)

[Lapzs]

So here's the story. I am a male RN. Recently, I had a conflict while at work with a female CNA. For the sake of anonymity and simplicity, I will call her Jen. A relative of a patient of ours asked for his IV to be wrapped so that they can give him a shower (bless this family for being so involved in his care). I went off to find Jen in the break room and asked her if she was on break or on lunch. She said she was on lunch, so I replied "Ok it can wait then." I explained to the family that I couldn't wrap the IV at this particular time due to my having medications to pass to my other patients, but that Jen could do it when she came back from lunch. I even held the meds that I had in my hand up in the air for them to see. The family understood and said they can wait. I go off to pass my meds.

After I finished my last or second-to-last med pass, I was walking down the hall towards the nurses' station when I hear Jen's voice, screaming "Lapzs! Why didn't you wrap the IV?! The family's so pissed! God! You're so unprofessional!" I stood there dumbfounded. The only words I could get out were "I had meds to give." Before I could explain any more, she scoughed, turned around, and made way for the supply room. I called out her name, but she ignored me and went inside. I followed her in, and on my way I noticed a patient's family member looking stunned (possible witnessed what she was yelling about). The following conversation ensues (as I recall to the best of my memory):

Me: Jen. We need to talk.

Jen: God Lapzs! You could have wrapped the IV!

Me: First of all, if you have a problem with me, you take me somewhere private and talk. You don't yell at me in the hallway like that.

Jen: I wasn't yelling!

Me: Fine. But I told you. I had meds to pass.

Jen: That doesn't matter. You could have wrapped it before! God you are just so lazy!

She tries to walk around me to leave, but I stand in front of her to prevent her from doing so.

Jen: Don't you EVER do that to me!!!

Me: Fine. But we need to talk. We can't let this issue get out of this room. I already talked to the family. They were ok with it. Plus those meds were important.

Jen: You still could have wrapped it before.

Me: Do you want to pass my meds for me then? That is my job. That was my priority. If I could have wrapped it, I would have. And I already talked to them. This is your job. You're the CNA...

Jen: I'm NOT just a CNA! I'm more than that!

Me: Fine. So like I said, I had meds to give.

Jen: No! You could have wrapped it!

The back-and-forth goes on for a little while like that until she walks around me again and leaves. After that, the only time we talked again during the rest of the shift was when I asked her if she took a patient's blood pressure (she didn't document it) and she asked me about a patient's diet. I even talked to the patient's family afterwards and asked if there was a problem. They insisted there wasn't and asked me why I thought there was. I mentioned that I know Jen came to them a little while ago, and they said "Oh yeah she seemed pretty pissed."

We both talked to our charge RN individually. The next day (Jen wasn't working but I was), the same charge RN tells me that I need to apologize to Jen or do whatever I can to mend things because Jen told our director about this event and that she was going to file an incident report because she felt her safety was at risk. Charge RN tells me that our director told her to tell me to file a MIDAS (our internal reporting service) so that I can defend myself. Charge RN says that she already vouched for me. I filled out my MIDAS report at the end of my shift.

That's that. I am a 24 year old male RN and Jen is a 40-something year old CNA. I have been an RN on our med-surg/telemetry unit for two years. For pretty much all of that time, I was the only male worker, RN or CNA, on the floor on day shift. Jen and I have known each other that entire time. We were good friends and even took pictures together at work. Also, I'm confident most of my other female coworkers would vouch for me as well.

What do you all think? Was I in the wrong here? Was she in the wrong? Is my career and license in jeopardy? I know we both could have definitely handled things better, but I felt that her non-stop yelling, insulting, and unwillingness to slow down and listen and talk prevented us from squashing this issue.

[Lapzs]

My apologies, I know I'm behind in this thread.

I have to say that I agree, the OP should have just gone ahead and wrapped

the IV. And, I'm not sure that he has fully acknowledged this. Maybe he has.

But, I don't think he knew that the CNA was going to completely blow a

gasket over, golly!!, being asked to wrap an IV. If he would have known

that the CNA was THAT DANG BUSY, and that she would have a fit over

it, I'm sure he would have never asked her. Yes he did ask her during her

lunch break, but he did acknowledge that she was on her lunch break

and could do this task when she finished.

He really was not in the wrong for asking the CNA if she would do this

task. He was only in the wrong for blocking her way from the room.

I think your post sums up pretty well my forethoughts on this entire ordeal.

[Lapzs]

I work on a high acuity BMT unit. All the patients are required daily showers and CHG baths. They all have central lines. We, the nurses, do all the IV wraps. I have to wait a few minutes to give meds often...but that is what it comes down to in non-emergency, but still urgent meds, a few minutes delay and saving me from situations like yours! As it always happens, patient is ready to shower at the most inconvenient times....but I always pause a quick minute, wrap that IV, and be done with it. I have been a nurse 20 years...I learned long ago that is faster and more efficient to bang out the little things... Me? I would have wrapped the IV in the time it took you to hunt the CNA down on her break. I often empty urinals, commodes, emesis basins, etc...teamwork, it is all about teamwork!

Agreed. However, I can't perform my job if she doesn't perform hers. We both have roles to play and unfortunately, she cannot perform all of mine. So I prioritized, like I'm supposed to do as the RN, and made a decision and delegated a task. And as I explained in my earlier posts, I didn't "hunt her down." That phrase makes it seem like it took much longer than it actually did to reach her when in reality it took a minimal amount of time.

I stand by my decision.

[OrganizedChaos, LVN]

I disagree. Though, I can see how I may have come off as such.

1. I already clarified this. I think 5 times now. I won't explain any more.

2. Stopping her from leaving was definitely a mistake. I already acknowledged that.

3. It is within my scope of practice but it is NOT ultimately my responsibility. What is my ultimate responsibility is to ensure the well being of my patients. Making sure less important tasks get done is secondary to that. In this case, as I've said many times, my meds were my priority. I delegated this task appropriately. I've also explained this part of the story numerous times, including my interactions with the family before and after the conflict. I stand by that judgment call.

If she was hurt, I didn't mean it. However, we were at work. And at work, I am the nurse and she is the nursing assistant. I did not treat her like a servant, even if she felt like it. That certainly wasn't my intention. I delegated a task well within her scope of practice. I didn't force her off of her lunch. I told her the task could wait. There is no way I can force her to end lunch early. If she gets hurt and feels like a servant every time one of her work friends (the RNs) delegates a task to her, then she must get hurt quite often.

1. There was no reason to even discuss anything about wrapping the patient's Aiv awhile she was on a break, it wasn't an emergency so it could've waited until she was done.

3. Yes it was ultimately your responsibility. If the CNA doesn't do it, it is within your scope of practice to do it. You knew it needed to be done so you are responsible. If a CNA doesn't get tasks done you can get in trouble too because you can do what they do but a CNA won't get in trouble if all of your work doesn't get done because they can't do your job.

[OrganizedChaos, LVN]

I already addressed your concerns in this thread. Many times.

I think you have an incorrect perception of what happened. I didn't tell her to stop her lunch. I told her the task can wait until afterwards. And I did talk to the family. What you would have done is similar to what I told them. If you want any further clarification, I suggest you re-read my original post and any subsequent ones.

It has been brought up several times that it was rude to interrupt her break to begin with for a non emergent request.

[OrganizedChaos, LVN]

Agreed. However, I can't perform my job if she doesn't perform hers. We both have roles to play and unfortunately, she cannot perform all of mine. So I prioritized, like I'm supposed to do as the RN, and made a decision and delegated a task. And as I explained in my earlier posts, I didn't "hunt her down." That phrase makes it seem like it took much longer than it actually did to reach her when in reality it took a minimal amount of time.

I stand by my decision.

But you can do hers.

You did state before that you had to "hunt her down". Which is why some of us are dubious of your story & believe you should've just passed the meds you had in your possession then wrapped the IV.

[DTWriter]

People are assuming that he would have just needed to wrap the IV...again, there are families who drag things out once they get the RN in the room. So what if the family has been cooperative prior to the incident? There are families who turn on the dime. One moment, they are cooperative, the next, they are expecting the sun and moon.

Plus, there are families who are pros at staff splitting. This family could have vented on Jen, leading to Jen to vent on the OP and so forth.

If the OP was in the middle of med pass, then he made the right call to try to delegate the task; he happened to pick the wrong person and then make the grave error of blocking the door...though, she is not so innocent herself (not saying that the OP is excused but the CNA herself should also be in trouble if an incident report is filed).

Extra: Even asking a family to wait until after med pass is a risk. This was a lose-lose situation.

[nursel56]

I mentioned our genders because of the incident report I was told she'd file.

How would the incident report make gender a factor?

[OrganizedChaos, LVN]

People are assuming that he would have just needed to wrap the IV...again, there are families who drag things out once they get the RN in the room. So what if the family has been cooperative prior to the incident? There are families who turn on the dime. One moment, they are cooperative, the next, they are expecting the sun and moon.

Plus, there are families who are pros at staff splitting. This family could have vented on Jen, leading to Jen to vent on the OP and so forth.

If the OP was in the middle of med pass, then he made the right call to try to delegate the task; he happened to pick the wrong person and then make the grave error of blocking the door...though, she is not so innocent herself (not saying that the OP is excused but the CNA herself should also be in trouble if an incident report is filed).

Extra: Even asking a family to wait until after med pass is a risk. This was a lose-lose situation.

Have you read his posts at all? He said the family was *never* an issue. He stated they were always nice to him & involved in the patient's care. They never flipped out on Jen & thought her reaction was over the top & ridiculous. Remember what happens when you make assumptions.

[NightNerd, MSN, RN]

I feel like this would be the best ever class discussion in Delegation 101...Nursing students, watch and learn.

Personally, I'm in the wrap-it-yourself camp. I don't think anyone is arguing that it's not an appropriate task to delegate, because it certainly is. But it is ultimately the RN's responsibility to ensure that the patient is safe, receives all prescribed treatments, and is hygienic. How this gets done is variable. I think of it like this: if I had a patient who needed incontinence care, and my tech was on his or her lunch break, I may finish passing the meds in my hand. But I am not going to leave that patient soiled waiting for a specific other person to clean them simply because it's an appropriate task to delegate to them. Urgent situations and emergencies are one thing, but most meds can wait five minutes so a person can be clean and comfortable. We're here to take care of human beings, not satisfy the MAR. As for the "If You Give a Mouse a Cookie" families, it's a matter of determining priorities and having confidence in the boundaries you set, even if they don't always get it.

For what it's worth, I try not to delegate anything to my techs during their breaks, even if it's something that can wait 30 minutes; how many times have we forgotten something like that during our own downtime (or felt like we had to get up and do it right then)?

As OP had already acknowledged many times, blocking in the tech was clearly the wrong move. However, I find the whole attitude of "we need to settle this NOW, MY way" to be just as troubling. OP's statement that accompanied the action rubbed me the wrong way, not only because it can be perceived as threatening, but because it creates a power struggle where one is simply not needed. Why didn't he just say, "I think we had a misunderstanding earlier about the IV. Can we talk about it in a while?" Then follow up later with, "I thought we left it so that you would place the IV after your lunch. What did you get from our conversation?" Figure out what happened, clarify how you'll communicate in the future, and move on! As it stands, this is so much unnecessary drama (NOT all created by OP, to be sure)!

[bgxyrnf, MSN, RN]

I didn't tell her to stop her lunch. I told her the task can wait until afterwards.

But you *did* interrupt her break. You should have (a) asked her if she was on break, and (b) left her alone the moment that you realized that she was on break.

If I'm on break, I completely ignore any work-related dialogue... that's why it's called a BREAK.

[BostonFNP, APRN]

So you can't multitask now? In all of the "10 seconds" (which I'm sure took longer) you couldn't wrap it yourself? I'm not arguing which one is more important. You were already there, why track down the tech? Seems counterintuitive to me. It's not like you weren't even close to the room. I just don't understand why you couldn't take the 1-2 minutes to cover the IV site instead of getting in this hot mess.

I see you've only been a nurse going on two years, I've been a nurse for 7. Let me give you some advice, learn when to pick your battles & how to multitask. Unless it was a code those pills weren't emergent & you could've covered the IV site while passing meds.

I agree that sometimes it is just easier to do things yourself.

I don't think anyone disagrees that this was:

1. Assessed and triaged correctly as a non-urgent issue by the RN.

2. Was within the scope and job description of the CNA assigned to that patient.

3. Was correctly delegated to the CNA by the RN.

The CNA might resent that, but it was handled appropriately and it was her "job" to do it.

I disagree that wrapping an IV takes precedent over med pass; these types have things have been demonstrated in the literature to increase the risk of med errors. It is not an issue that the RN "could have done it": RN can technically do everything the CNA does, so arguing that is akin to staying that an RN should never delegate anything to a CNA simply because that can do it themselves.

You defiantly should not have blocked her in and your career make take a big hit for that action. I do think gender in this case matters and I have seen men fired for less.

[DTWriter]

Have you read his posts at all? He said the family was *never* an issue. He stated they were always nice to him & involved in the patient's care. They never flipped out on Jen & thought her reaction was over the top & ridiculous. Remember what happens when you make assumptions.

So what if the family has been cooperative prior to the incident? There are families who turn on the dime.

How many times do I have to reiterate that point? Plus, we do not know how the family acted with Jen. Yes, we do not know. As you pointed out, as others pointed, we only have the OP's story. The family could have "unintentionally" left out a few details in regards to their interactions with Jen.

Though, it did not have to be a family issue -

Extra: On a personal note - back when I did bedside nursing, I have had patients who were pleasant one day then turn into, well, dare I say,...no, let's say "uncooperative individuals" the next. I remember incidences where something that should have taken a few minutes to do end up being an hour ordeal because the patient had another request or wanted to talk about something.

Could we not agree that there are patients/families who milk it once the RN is in the room?

Could we not agree that this family could have been one of those families despite how they acted before the incident?