Problems with LPN... just need to vent.

[NurseCard, ADN]

Okay, I'm working on a psych unit now. Our unit, on night shift, consists of two full time RN's and two full time LPN's. Every night, one of the RN's gets pulled to another unit, and one of the LPN's gets pulled. Anyway, I'm having issues with one of the LPN's that are really starting to border on severe. Some of them, perhaps, are more personal than anything but.... well, here goes.

First of all, this LPN is a male. He is a military nurse. I get very subtle, and sometimes not-so-subtle, hints that he has no respect for me, or for that matter a LOT of other people, whatsoever. His tone of speaking to other people just oozes with "you are BENEATH me". He has been nice to me exactly ONE time since I have worked there. The rest of the time, he pretty much speaks to me like I'm a dog. Much of the time, when he is on the unit and we are not busy, he has his head buried in something, a book or whatever, and doesn't talk to anyone much. However... there is this one pretty MHT that, when she is there, he makes it VERY CLEARLY OBVIOUS that he has the hots for her. I find it highly annoying and, again it makes it the more irritating that he talks to everyone else like they aren't human. He's just ... ARROGANT. He's one of those people that just.. KNOWS IT ALL, you know?

Okay, so how I convey that this isn't ALL personal stuff? Well, there's also the issue of him, and the other RN on the unit. On more than one occasion he has stated very loudly, very plainly, for EVERYONE to hear, that things would be going smoother if (insert other RN's name) were there. (On nights that I'm on the unit, and the other RN has been pulled). He knows that I am new and I am trying to find my way in this new world of psych nursing that I've found myself in, and yet saying things like that undermines both my confidence AND my authority on the unit. And (and yes this is very personal but hurts like you-know-what, nonetheless)... last night he said loud enough for me to hear, that everyone was collecting money to buy (other RN) a special gift for Christmas. I mean, she HAS been there longer than I have, she is older than me... but I still feel like I'm... having to fill her shoes when she's not on the unit, and..... I don't know, that just hurt.

So now the perhaps not-so-personal stuff that happened this morning that got me thinking about all of this in the first place. =( This morning was a world of confusion on the unit. We are supposed to be OUT of there at 7am; I mean, we are NOT supposed to stay much past that at all. Well, for some dang reason, sometimes patients that are supposed to be discharged, get scheduled to leave... at 7am!! When we are switching shifts!!!! So, we night shift people have to get the person up, make sure they shower, get their breakfast and possibly a lunch for them to take, depending on how far they are traveling... get their stuff out of their locker, have them sign for that stuff, make sure they are packed, and then we are supposed to get their medications that they are taking with them, and go over the instructions on taking them, with them. We are supposed to do ALL that, and also be collecting labs on some of our other patients. Well, *I* for one am busy as you-know-what that time of morning. I'm the one having to chart the hours that the patients all slept, I have to chart whether they got their labs drawn or refused, I have to chart their accu-checks, and I have to make sure all of their PRN medications that they received during the night, are charted.

My LPN did not do a DANG thing this morning to help me get the patient that was leaving, out. He did not do the medication teaching. He barely remembered to go get the patient's stuff out of the locker (which is in the medication room; the LPN's domain pretty much). He just left out of there at 7am, pretty as you please, and left me to drown. Oh, and there was a ton of confusion this morning regarding the labs, and who was actually supposed to have theirs drawn. He knew about all of that confusion and that I was trying to straighten it out. Didn't bother to help me. Nope.

Okay, so I know you are thinking that all of this is my fault. And yes, it pretty much is. I mean, you get respect when you command it. I'm having a VERY hard time in my new role in this job. I'm NOT used to being a supervisor. As a Med/Surge nurse, I was responsible for myself, my patients, and maybe one CNA, maybe two. That's it. And generally, there was a charge nurse on the floor that *WASN'T* typically me.

So it basically boils down to the fact that I have to sit down and have a long talk with this LPN, and I don't know quite what to say, or if I'm even justified in being angry with him at all. I'm just tired of his overall tone with people, AND with the patients. He BARKS at the patients. Some of our patients are so psychotic that sometimes you do actually have to be VERY VERY firm with them to get them redirected back to their rooms, or whatever. Those patients, he does well with. But some of our patients, he just makes them angrier than they are; that's all he succeeds in doing. And he calls them "MR Jones, or MR Smith, when everyone else on the unit calls them by their first names. I know that he thinks that this is some sort of respect thing, being military and all, but the way he says their names is still very condescending. "You need to get BACK to your room, MISTER Jones".

I'm tired of his blatant disrespect for me. I'm tired of the way he talks to me. I'm tired of feeling talked down to. I'm tired of being reminded that I'll never live up to what the other RN is... I think it is because she is much more of a "hard-*ss" than I am, and maybe that is what he respects... again, being military.

I'm tired of him not having my back when I need help. He's the other licensed staff on the unit; he needs to be helping me out. He needs to be backing me up. The only time he's good at backing me up is when there's a physical management; when a patient has to be restrained. And even then, I feel like he's pressuring me to be unreasonably hard on the patient. We had a patient recently that we had to restrain, and the LPN was putting pressure on me to keep the patient in restraints ALL NIGHT LONG. I felt that to be mighty unreasonable, and did let him out, slowly. He ended up doing just fine after that.

Anyway... I really need to sit down and have a talk with the guy, and I don't know how to do it. I'm so horrible at confrontation, but whether all of this should or not, it's really taking a toll on how I'm doing my job, and how I feel about my job, when this LPN is working with me.

Do you all think I'm just being stupid?

[meownsmile, BSN, RN]

I had a similar problem with a CNA when i first returned to work as a RN. It really is in the delegation. Make sure you are very clear about who he needs to get up and going in the morning. Dont wait till later in the night or morning to do it. Dont sit down with this guy at some random time to discuss his problem. At that point he wont have a clue what your talking about and it will end up being all about YOU. Have your conversation with him, in private (as much as possible) at the time the situation occurs. Call someone else up to be there since you have noone to back you up right there at the time on the unit. Maybe wouldnt hurt to inform whoever it is you are planning on calling that you are having some insubordination problems from him and you are planning on doing a conference but would like them there if that happens. Just dont leave yourself open to a one on one with him, he will have a totally different version. Give the other RN a heads up so he/she will know what is going on when you do call and can be ready for it.

Sometimes just putting the person on notice that you arent going to tolerate it will change things. If not then keep moving forward with the conferences,, and take it outside the time of work. Make an appointment with him and your nurse manager. If he has to come in on his time off to listen, maybe that will get his attention and let him know you mean business.

I know you were just venting, but just thought id throw in a suggestion. I know its difficult to work with people when they have problems with authority. Maybe why he isnt in the military anymore?

[Blackcat99]

I would try to write down exactly want you want him to do each shift. Hopefully, there is a copy machine nearby where you can make a copy of what you want him to do. When he doesn't do what you have assigned him, then you write him up for insubordination each and every time he doesn't do what you have told him to do. You are in charge. You need to let him know it. I've worked with people like that it is truly awful. I wish you the best of luck. It is a very difficult situation.

[P_RN, ADN, RN]

I like the assignment sheet suggestion. In addition if it is known a patient is to be discharged, then the med teaching could/should be done the night before, prior to bedtime. I worked on a unit for a short while where the "patient teaching" was done once a week. Every patient gathered for group and was given a copy of their current meds, certainly easy if you have computerized MARs. Each med also had a note as to why, what to report etc.

My state has a Universal Medication Form that is being integrated into most hospitals. It's a form for discharge teaching and for the patient to keep track of medication changes to show to his physician on checkups.

I'll try to locate the URL for you. South Carolina Hospital Association | Universal Medication Form

Their belongings are in a locker, so they could be bagged earlier than 7 am surely.

Finally, I don't believe you have a problem with "an LPN" so much as you have a disrespectful co-worker. If he is so arrogant/assertive to you- the RN -then how would it be beneficial to sit down with just him and you?

Since he is not attending to what you ask/tell him to do, I think talking w/ your supervisor first and then presenting a joint meeting with him would be best.

[rn/writer, RN]

Do NOT sit down and have a long heart-to-heart discussion with him. You only do that with someone who is reasonable and who cares about your opinion in the first place.

With a person who is rude and disrespectful, you do short, immediate bursts of reaction and correction. If he says something rude, inappropriate, or insubordinate, you instantly stop in your tracks, look him full in the eye, and say, "Excuse me?" in such a way that it conveys his remark is out of line.

Learn to say no. If he says, "I'm going to do such and such," and it's not what you asked or want, say, "No, you need to do this and that."

If he's coasting while you're drowning, delegate in clear concise terms. "You need to get so and so up and have him ready to go out the door by 0645. If you run into problems, plan on staying until they are taken care of."

Do NOT ask. Tell in an authoritative way that isn't rude but doesn't allow for ambiguity. If he refuses, ignores you, does something else, speak to him as soon as you see a problem. Say, "I'd like to have a good working relationship with you, but that can only happen with your cooperation. This ONE time, I will not write you up, but don't mess with me again." Then be sure to follow through.

Say what you mean and mean what you say. Don't let a bully run you out of a good job.

If you think there's any potential there, scope out the other RN. If she's in cahoots with this guy, that wouldn't be wise, but maybe she'll be open to giving you some pointers on delegation. However, approach her with your guard up. Don't turn to her like she's a refuge in a storm; that could backfire. Simply ask for any advice she might have about working the unit and delegating. Stay cool and professional.

Above all, like the old deodorant commercial used to say, "Never let 'em see you sweat."

If push comes to shove, ask the LPN outright, "Are you refusing to do such and such?" When put in those terms, lots of people fold. Even if he doesn't, you now have information to write up. Keep a running list of his behaviors. Confront him when you have enough. Read off the list and let him know that you aren't just going to look the other way.

Also let him know that you aren't looking for a constant battle. You'd prefer a good working relationship, but you aren't going to settle for insubordination and disrespect. You may be right about his military background being behind the behavior, but what matters now is that you are in charge and he needs to get with the program.

You might want to put a couple of feelers out with your superiors to see what kind of support you'll get if the two of you do go head to head. But even if they try to downplay the problem, you can still give off a completely different vibe than you have been.

Practice making bold statements. Reheorifice your responses to the kinds of remarks he's been making. REFUSE to be hurt by things like his talk of getting a gift for the other nurse. Jump right back by saying, "Oh, how nice. I'm sure she'll appreciate your thoughtfulness." That takes all of the sting out of what is meant to be a blow to you. Learn phrases that buy time, like, "I see," "Hmmmm," "Did I hear you correctly that you're planning on doing this when I asked you to do that?" Phrases like these do two things. They buy you a minute to think through what you want to do, and they signal the other person that it might be wise to reconsider. He or she won't always do that, but it puts them on notice that you mean business.

Make sure you follow through on the orders/requests you give. "I see you haven't yet done whatever. When will that be taken care of?" If he is in the habit of leaving you with undone tasks, let him know those days are over.

In short, get serious about being in charge. If you don't, why on earth would he change? Stick to your guns without holding a grudge, and communicate that you expect better of him than he's been giving.

There are no guarantees that any of this will change his behavior, but not changing your ways will pretty much guarantee that he won't. And revamping your style will leave you feeling better. It's one thing if he gives you a hard time. It's a whole 'nother thing (and a far worse one) if you do it to yourself.

Let us know what happens.

I wish you the best.

[SharonH, RN]

Do NOT sit down and have a long heart-to-heart discussion with him. You only do that with someone who is reasonable and who cares about your opinion in the first place.

With a person who is rude and disrespectful, you do short, immediate bursts of reaction and correction. If he says something rude, inappropriate, or insubordinate, you instantly stop in your tracks, look him full in the eye, and say, "Excuse me?" in such a way that it conveys his remark is out of line.

Learn to say no. If he says, "I'm going to do such and such," and it's not what you asked or want, say, "No, you need to do this and that."

If he's coasting while you're drowning, delegate in clear concise terms. "You need to get so and so up and have him ready to go out the door by 0645. If you run into problems, plan on staying until they are taken care of."

Do NOT ask. Tell in an authoritative way that isn't rude but doesn't allow for ambiguity. If he refuses, ignores you, does something else, speak to him as soon as you see a problem. Say, "I'd like to have a good working relationship with you, but that can only happen with your cooperation. This ONE time, I will not write you up, but don't mess with me again." Then be sure to follow through.

Exactly Miranda. You beat me to it.

I was just about to post almost the exact same thing. "Talking" to this guy and letting him know how you are "feeling" about his behavior will get you nowhere fast and will probably give him immeasurable satisfaction.

It might seem that you are dropping down to his level when you challenge him on the spot but honestly that is what people like him respond to. Don't ask, don't look for validation and do NOT look for approval. You aren't going to get it.

He will not do an about face after the first time you challenge him. But he will get the message. And try not to take it so personally, he would try to do the same thing to anyone else in your position if he thought he could get away with it.

[NurseCard, ADN]

Thanks all for the suggestions... I've taken some time today to think about the situation (and cool off) and I agree; I don't think a long talk with the guy is the answer. I think I'm just going to have to work on properly delegating the nurse-ly duties as well as all the other duties on the unit (duties that go to the MHT's), and not let him give me a lot of crap about it, if he tries to.

Talking to the other RN never is a good idea because she has this nice little tendency to go right to the other person and tell them just what I said. I have a feeling that in some way, she would still do this even if I asked her not to and even if I told her that I do plan on talking to the person, I just want her feedback. Unfortunately, talking to the other RN would actually help a lot, if I trusted her to keep anything between us.

[Katillac, RN]

I agree with several of the posters here in terms of the most effective approach to this person. Use his military background to your advantage, however be aware that he probably isn't going to like you, treat you kindly or respect you, but if it's laid out operationally and without emotion you may be able to accomplish working with him and having him respect your authority.

As women, we would mostly prefer to be collaborative and pleasant. He comes from a different background and most likely sees as weak the people who let him get away with what he knows is wrong. His military training has also taught him that he is SUPPOSED to protect and care for those who he sees as inferior, even if he doesn't want to. It's not going to be easy for you, especially as a nurse new to this unit. So pick your battles carefully. You can't do much about the tone of voice he uses, but you can say things that have been mentioned here that are behaviorally specific and quantifiable.

"I'd like us to get along and work together," is vague and makes you vulnerable. "What you think of my work is irrelevant. But saying things in front of patients about it being better when the other nurse is here affects their confidence in the staff and is therefore not appropriate. You need to refrain from such remarks," is specific and makes the point that you don't care what he thinks.

I'm sorry, but part of this is that you need to suck it up and deal. He's rude, arrogant, obnoxious and a bully. He isn't nice and doesn't want to be. He wants to win, with sexual conquest, triumphing over vulnerable patients and keeping you under his thumb. Think of him as a different species, one that you need to learn special techniques to defend yourself against and still get performance out of him.

Good luck with this. You can learn a lot here about how to manage difficult people, but it has to start with your moving outside your comfort zone, stop caring what he thinks, and toughening your skin. You will still be the warm, caring, nurturing person you want to be, just not to him.

[santhony44, MSN, RN, NP]

I wouldn't blame the guy's military background. I think this is his personality, and maybe nothing in the military helped any, but he wasn't a nice supportive person in the first place.

One of the best nursing assistants I ever worked with was a military retiree who was a student in the same program I was in. He was a "generic" BSN student, I was a "bridge" student. So, I saw him in class where we were on an equal basis, then at work when I was his supervisor. He was also older than me.

He was excellent with the patients, did a great job, and treated me and the other nurses with respect.

RealNurseWitch, I agree with the other posters that you're going to have to take charge and show him you mean business. He just might surprise you and shape up.

I wouldn't say anything to the other nurse that I wasn't willing to have printed on the front page of the local paper. Since you know the other nurse will pass on anything you say, you may at times be able to use that to your advantage, if you do it carefully!

Good luck to you. It sounds like a very unpleasant situation and I hope that it will get better quickly.

[banditrn]

It sounds to me like this guy does this kind of thing 'just because he can'. I had the same problems with a male Cna when I started at the LTC where I now work - and found out later that he's pulled a lot of the same garbage on every nurse that's started there.

Sounds like you've gotten some great advice here - work on an organizational plan for yourself - and if he doesn't shape up, by all means, talk to your supervisor.

[Mudwoman]

If he is ex military nurse, he is used to someone being stern and barking orders. When you walk on that floor remember you are a Major or General. Doesn't matter if you have the experience or not, you have the RN behind your name. Just get tough.

[Pompom]

I agree with making an assignment sheet for him and stipulating that he must check with you before leaving to catch up on anything that is last minute.