getting unwanted advice from non-nursing staff

klone, MSN, RN · Jan 21, 2015

When we said we were getting the tylenol to give her, the PT took the bottle and said that SHE would give it to her!

I would report her. That's fireable. What the hell. Just because it's an OTC med does not mean that anyone in the facility can give it.

The PT then said, "I know, but I care about this patient so much"

Sounds like she has boundary issues.

onthemark · Jan 21, 2015

That's what I thought, klone. Kind of unbelievable!

JustBeachyNurse, LPN · Jan 21, 2015

Report her. Boundary issues. Scope of practice. Lack of professionalism. Her usefulness ended at alerting you that there was a nursing/medical concern. Kudos to your precepting nurse for speaking up.

Karou · Jan 21, 2015

Wow. Boundary issues and practice issues. The physical therapist is out of her scope of practice for attempting to administer a medication to this patient. As the nurse it is your responsibility to asses and determine if a PRN medication is needed and to then administer it. Not the responsibility of the physical therapist.

I would report her to her supervisor, your supervisor, and the administrator. Unacceptable.

It would be difficult for me not to get nasty in this scenario. Here is what I might have said, if I could keep my cool...

"I have thanked you for alerting me to the condition of the patient. I have now assessed the patient, administered medication as appropriate, and am continuing to monitor. This is my role as her nurse and member of her healthcare team. I understand that you are concerned for this particular patient, perhaps you are too emotionally involved. Her physical therapy is completed for today, it is time to let her rest now."

imintrouble, BSN, RN · Jan 21, 2015

It's hard for me to imagine that a colleague in an ancillary role would behave in such a way.

What kind of relationship did the PT have with the patient? Relatives? Close friends?

The behavior described is seriously creepy.

guest777 · Jan 21, 2015

I thought this was quite common? I have had nurses questioning my med orders, wanting me to do workup on uncomplicated hypertension on-call and tons of other stuff any gp/family doc knows 10x better than a surgery resident, refusing to give patients meds upon discharge, as advised by the internist, refusing to give rivaroxaban instead of warfarin, due to "our way of doing things," failing to understand undulations of INR and insufficient therapeutic stability of warfarin, questioning taking patient history in the bay, demanding I wait more than 30min for a vacant confined room, although the diagnosis in question was nstemi, refuse to order transport or push bed with malignant hypertension and neurologic symptoms down to a CT scan, and then rig a perfusor with labetalol etc. Is this uncommon in the U.S? In my experience, ancillary staff meddles with everything, if it suits them. Glad to see that you nurses get ****** as well.

onthemark · Jan 21, 2015

Thank you all for your comments. You bolstered my confidence in confronting her today. (I've never reported anyone and don't want to if I not necessary. My rule has been to confront the person directly the first time; if it happens again, I tell them that if it happens a third time, I'll realize my warnings aren't working and will report them. So far, no one has reached that 3rd time.)

Anyway, after asking for a moment to talk, the PT and I found a private spot and I told her that I had always liked working with her but that I was surprised -- and actually offended -- by the way she kept trying to oversee everything my orientee and I were doing yesterday with that particular patient. She acted quite surprised and said she hadn't meant to offend me. She said the reason she kept questioning us was because the day before she had tried to alert the nurse caring for the patient then, but had felt that that nurse had not taken her seriously and had not extended appropriate care to the patient. I told her that I did not know about the previous day or the nurse on duty then, but that I still didn't think it was appropriate for her keep questioning us and even wanting to give the patient the tylenol. She kept apologizing and saying she realized it hadn't been necessary to doubt my care. I told her that not only was her behavior demeaning to my orientee and me, but that I felt she was encouraging the patient to lose confidence in us particularly when she'd said, "but I care about this patient so much." She said she only said it because she DOES care about the patient and she thought it would make the patient feel better but she understood now how it made my orientee and me look in comparison, and she was very sorry. She said she'd try very hard not to behave this way in the future. I accepted her apology and will hope that she really will think in the future about her behavior affects others. As I said above, if it happens a 2nd time, I'll tell her the next time I'll be reporting her, but I have a feeling it's not going to happen again.

Again, thank you all for your input and support!

JustBeachyNurse, LPN · Jan 21, 2015

Thank you all for your comments. You bolstered my confidence in confronting her today. (I've never reported anyone and don't want to if I not necessary. My rule has been to confront the person directly the first time; if it happens again, I tell them that if it happens a third time, I'll realize my warnings aren't working and will report them. So far, no one has reached that 3rd time.)
Anyway, after asking for a moment to talk, the PT and I found a private spot and I told her that I had always liked working with her but that I was surprised -- and actually offended -- by the way she kept trying to oversee everything my orientee and I were doing yesterday with that particular patient. She acted quite surprised and said she hadn't meant to offend me. She said the reason she kept questioning us was because the day before she had tried to alert the nurse caring for the patient then, but had felt that that nurse had not taken her seriously and had not extended appropriate care to the patient. I told her that I did not know about the previous day or the nurse on duty then, but that I still didn't think it was appropriate for her keep questioning us and even wanting to give the patient the tylenol. She kept apologizing and saying she realized it hadn't been necessary to doubt my care. I told her that not only was her behavior demeaning to my orientee and me, but that I felt she was encouraging the patient to lose confidence in us particularly when she'd said, "but I care about this patient so much." She said she only said it because she DOES care about the patient and she thought it would make the patient feel better but she understood now how it made my orientee and me look in comparison, and she was very sorry. She said she'd try very hard not to behave this way in the future. I accepted her apology and will hope that she really will think in the future about her behavior affects others. As I said above, if it happens a 2nd time, I'll tell her the next time I'll be reporting her, but I have a feeling it's not going to happen again.
Again, thank you all for your input and support!

What a wonderful example of adult, professional, respectful communication. Fortunately your approach worked as you didn't come out guns blazing but focused on how it appeared, your feelings and interpretation rather than accusatory. Good for you!!!!

LadyFree28, BSN, LPN, RN · Jan 21, 2015

There have been occasions where non-ancillary staff, like the business office and social services try to make recommendations about patient care and acuity and have NO reference to make determination; I and other staff have been very vocal about how they are members of the team and have a role, but have NO ROLE in determining pt care; we do; because it has a "small company feel", sometimes there seems to be an overstepping of boundaries that needs to be checked.

Usually a firm, polite response gets the message, but I had a colleague explain to one non-medical staff member during a fire drill the role they had to play and what would constitute safety; they were upset, but there hasn't been any over stepping boundaries since.

onthemark · Jan 21, 2015

Thank you so much JustBeachyNurse! You just made my day :)

klone, MSN, RN · Jan 22, 2015

Is this uncommon in the U.S? In my experience, ancillary staff meddles with everything, if it suits them. Glad to see that you nurses get ****** as well.

Wow, what a lovely sentiment.