New grad needs your opinion!

[ERRN13]

Hi everybody,

I am newly registered here, but have been reading the boards for awhile now. I enjoy the insight from all of you, and I'm hoping you can offer some on the matter I am about to discuss.

Let me begin by saying that I am a new grad, in the fourth month of my first RN position. Though I have hit "reality shock" to some degree, I am otherwise thrilled with my job including my co-workers. We have a great ER team and the nurses work together! My problem is with a Unit Secretary. This US is the most rude, obnoxious person I have ever had the misfortune of working with. She speaks to me and everyone else including senior RN's, in a way that is totally inappropriate. She questions nursing judgement in a way that makes it as though WE have to report to her. She created a major scene about a patient of mine. He had a room assignment, but was still in the ER. My crime? I didn't have a chance to get her "approval" because I was too busy hanging the Dopamine, trying to get his BP back. Since when does the US make decisions about patient care?

Another situation involved a severely mentally disabled patient. He had been in our ER the day before. He was acting out, which according to Mom was very unusual for him. The problem, was that he was mute, so we had to find the issue. His BM's were abnormal and we needed an abdominal CT. He couldn't stay still, so they sent him home with GI instructions. He came back worse the next day, and even after Ativan, remained unable to stay still. I agreed to shield and hold him for the procedure, but I needed the phlebotomist to draw another patients blood. I asked the US who the phlebotomist was, and she replied by yelling that it was so and so, who had "10 other patients to do." OK! I asked the CT tech to give me a minute so I could do the draw myself. Not even a minute after I stuck the pt., the phlebotomist walks in and says, "Oh, I guess you are taking this one."

These are two of MANY situations that have occurred. I spoke to the nurse manager, and she agreed that this US is "brash". But, "she speaks to everyone like that." She basically told me to just give it right back. That's fine, but I really don't have time to play verbal chess on the job. In the end, only the patients suffer. This is really bumming me out! Can anyone offer some advice?

[darn1219]

At our hospital the unit secretaries are under another supervisor. If we have an issue with our secretary we first go to our nurse manager. The unit secretary can really wreck havoc and make a difficult job even more so. It also appalls me (though doesn't surprise me as it's the same way with our unit) that your nurse manager just brushed this away. Perhaps going to HER superior is another choice -- anonymously if necessary. Good luck.

[Zee_RN, BSN, RN]

Hmmm... your facility doesn't have some kind of "Service Excellence" training going on? This individual is in clear violation of the "service excellence" concept (I know, *gag*) but you may be able to use that type of argument in your favor.

It's ironic how many unit secretaries I've come across who have this same attitude. A good or bad unit secretary can really make or break a unit. Also, ironically, the ones with horrible attitudes also sometimes seem to do the best work (in terms of accuracy and understanding the flow of the unit). Not ALWAYS, of course!!

Since your manager seems unconcerned, my approach would simply be to IGNORE her completely. Walk away from the tongue-lashings and use her as little as possible. See if you can work on that 'service excellence' thing with your manager :). An innocent comment, maybe....

[thisnurse]

zee...have you seen any fish lately? lol!

not only can the unit secretary make or break the unit, they can make or break YOU!

ive been punished because i did not put my chart

in the right place once. i had to do my own orders. the US was training me. sometimes i feel like i work for HER. ive seen them do some messed up things to nurses. if there is a nurse they dont like, her orders go in last, IF the US "finds" the time. these particular US are very good at what they do. they dont have an easy job either. if you are smart you will do just what zee says and ignore her. its in YOUR best interest to figure out a way to work with her. yes you can turn her in. she might even get in trouble, but she will find a way to get back at you. i just dont think its in YOUR best interest to fight with her. your job is hard enough already.

[ICUBecky]

i've had the same problem with one of my unit secretaries. she got to the point where she made me cry a couple of times. she's yelled at me in front of my patients, she didn't do anything i asked her (even if i did ask nicely), and she talked behind my back. so one night when i was fed up with her, i guess i was acting snotty (so she said). she took me to an empty room and asked "do you have a problem with me" and i said "as a matter of fact i do and it seems like you have a problem with me" anyways at the end of our verbal fight i said "look we don't have to be friends, we just have to work together" and i walked out of the room. since that time we basically ignore each other...but we do treat each other with respect, and she does do what i ask her to do and i do what she asks me to do. hmmm...this was my first and only confrontation EVER and it worked out for the best!!

[oramar]

I just wonder if inappropriate behavior is tolerated in other professions the way it is tolerated in healthcare. I have seen many, many really difficult people licensed or not get away with GOD awful abuse of co-workers, especially new people. When the new grads complain about them they are not imagining things. It is just that the extreme degree of their nuttiness is so obvious when you are new.

[betts]

I can't stand it! Just ignore the US? HUH...

With all the problems facing nursing today,why wouldn't you want too start at the beginning? The beginning being where you are practicing. You're advise is too Ignore Ethics? Morale is low enough as it is and the disregard for the professionalism in nursing by yelling at a nurse,refusing SOP while other clients/patients/residents and staff are around is okay?

You'll must be really overworked and tired because thats not logical or acceptable. I'd go again to the floor supervisor/manager then if need be the DON/DNS and if I had too Human Resources.

Althought the US is a professional in their own right that doesn't give them justification in demeaning any other professional in their duties. If we are too be seen as professionals then we must demand the same in the work place.

[thisnurse]

yeah go to the don and turn her in. good idea. they wll call her aside and let her know whats up. she will know who it was that did it. she wont yell at you anymore. she also wont put your orders in until she has to, youll prob miss some phone calls, any mistakes you make will be public knowledge, if there is an order she "cant" read she will put a little note on the chart saying it needs verification and that will be the end of that. so you will have to always be checking your charts and checking on her to make sure she is doing her work. you will have a hard time proving she is doing it on purpose.

betts you are right, that behavior is unacceptable, however its not ALWAYS in your best interest to run to management. most times they dont do anything about it anyway.

if a confrontation needs to take place, or if this behavior continues, then by all means take it up with management. until then i suggest you try to handle this without involving them. might try asking her what you can do to make your woking relationship better.

[betts]

Does this indivdual instill that much fear? If it's as bad as you say then the clients/patients/residents are also being put at risk.

Personally, I would show her the door as I'm sure their are many others needing employment. I'm a DON and have had my problems with 'Intimidation' by staff to other staff. I immediately have the accused in front of me with her accusers present and 'nip it in the bud', then and there! A good manager is aware of any conflicts on her unit and doesn't allow it too escalate.

I apologize if this upsets you as the last post must of but, there is NO EXCUSE for having too work under these conditions.

If I was so intimidated and afraid to report the actions or inactions of a caregiver that posed additional harm or threats of harm thereby jeopardizing the care of any client/patient/resident in my care; I couldn't call myself a nurse.

[shannonRN, BSN, RN]

ERRN13- i know how you feel. 6 months ago i started a new job on a med-surg floor. well, at first our secretary was super nice...but lately has been challenging my assignments when i am in charge. we also have a vent patient who has lung ca with brain, bone, and possible stomach mets. she has become super friendly with the patient's only daughter and has talked with her about lawsuits and other medical issues regarding this patient's care. i don't understand how someone who is not in the profession can challenge/disrespect the nurses and act as though they have all of the answers. no one has all of the answers. if she has encouraged the daugher to pursue a lawsuit...all of our nurses will be named in the case!!! the even scarier thing is that this secretary wants to go to school to become a nurse.

good luck with your secretary and let me know if you find anything helpful in dealing with them!

[wildtime88]

This behavior is not uncommon. In fact you can see it in others as well, respiratory, radiology, and others.

Nurses are in charge of the patients they are assigned to and many time especially in the ER that means setting priorities that others do not care about.

In some hospitals the nursing staff is so badly treated by the administration in general that the other departments and personnel adopt the same attitude toward us. The old you are just a nurse attitude. I have had words with some of these people and sometimes it is easy to say something like next time you can hang and titrate the dopamine and keep the patient from dying and I will do ........ instead. Sometimes it is not. Sometimes you have to be very assertive and remind them that you are in charge of the patient and that you will make the decisions as to the care and that is what you went to school for and make the money to do.

The great thing about the ER is that if it gets too out of hand all you need to do is go to the right doc and ask them to intervene.

If she starts using stall tactics after that about putting in orders and the docs start asking why has this or that not been done yet, then you can tell them loudly, clearly, and politely that the orders have not been entered yet then walk over to the secretary with the doc in tow and ask her when is she going to be able to put them in, then walk away and let her explain the situation to the doc.

Yes they have a hard job to do but so do we. I would not want to do their job, but that is not what I went to school to do. The ER is a team thing and for all practical purposes you are the head of the team when it comes to your patient. Unless told differently by the doc, you decide what the priorities are to ensure the best out come and also manage your own patient flow.

I have also used the concept of the last paragraph when dealing with some people who really need it. At the end I tend to ask if they would like to trade places, but always add that is impossible since they are not a licensed nurse.

One thing to remember though is that, especially as a new nurse and even later, sometimes these other personnel do offer good advice or a different way of looking at things which is actually beneficial to you. The old adage about not being able to see the face due to the crowd does hold true sometimes. Before you take a step that is severe in nature, please make sure this is not the case. Patients in the ER can be overwhelming especially when you know you need to be dealing with 2 or more patients at the same time as far as acuity is concerned.

[hoolahan, ASN, RN]

OK, forgive me all, but I am going to give you the down and dirty way to nip this in the bud.

You have to TAKE the b*tch DOWN!!!!

Next time she dares to question your activities or judgement, you need to stop what ever you are doing (within reason of course!) go up to her chair, stand in her personal space, looking down your nose at her and lay her out!

"Excuse me, but I believe that you would be questioning my professional judgement. Can you tell me when did you gradaute nursing school, because I must have missed it. Do not EVER question MY judgement again, or I will write you up so severely, you will wish you had never worked here!"

Now, those of you who know me, know I am usually very diplomatic, but this B*TCH is making people afraid to ask her to do her job?? That is BS!!! NO WAY should she get away with it. You can try to talk with a controlling person every which way, but it will be so draining to try to "reason" with them, I just advise you skip all the BS, publically humiliate her and get it over with. If you get called on the carpet for it, admit it, tell your boss why, and ask your colleagues to back you up. If your boss doesn't take your side, you will know who's the boss, and unless you want that nasty US to run your life every day you work, you will know what you have to do. Yelling at me in front of pt's, by a US???!!! THat would never float in my book. This chick needs to be put in her place now! Before the monster grows out of control.