How do you decide what to do with a difficult charge nurse?

[BeatsPerMinute]

Kinda long - see the TL;Dr (too long, didn't read) sentence at the bottom of this post if it's long for you atm.. appreciate any helps! 

Hey,

So, I could appreciate some feedback here... I'm an experienced ICU nurse (8yrs total) trying to figure out how to deal with a very experienced long term charge nurse (20 years on this unit, over 30 years nurse experience total) who I am having problems with. 

It's a pattern of behavior issue... Compared to other charge nurses, she does very little bedside care and only assists other nurses on the unit until she absolutely has to. She's valuable because she knows how to manage people, heads committees, has A TON of knowledge and experience, + she knows people (like, upper management). She knows how to phrase things and get things done, too. 

What's upsetting is when I clock into work, I work HARD. I'm a busy body. I check on on my neighbor nurses. I say yes to even the most undesirable tasks (help fellow nurse with a clean up - it's an ISO patient, and there's poop everywhere).I'm very good at paying attention to details and whats going on in the unit. I complete requirements / education / audits / whatever extra is asked of me - on time. 

Meanwhile, this charge nurse is sitting on her fat butt most of the time just chit-chatting with other people, being 'entertaining', laughing, joking, sharing stories, plans, vacations, whatever... When I approach her, she initially ignores me, and then I stand there until Im noticed by her. Side note - its really uncomfortable, and especially when other people are giving her subtle cues to be like "hey, she needs to speak to you' and then even that goes ignored for a lil while. When this charge nurse does acknowledge me, first response 95% of the time, is to give me a glare followed by a sigh... and then she asks what I need. When I tell her, she tries to delegate to someone else. When that cant happen and I truly need her help, her glares last longer and her sighs get louder. I can't even count the number of times this charge nurse brags about how mean she could be towards other nurses or family members. She brags about how much harder she could have come down on them.

I've received patients from the ED and other units, and the nurse giving me bedside report are nearing tears, telling me how mean this charge nurse is. 

Charge nurse will say things that communicate her intent to belittle people, to shut up, and leave her alone. It's hard to explain... I don't get it. 

Other info:

I get along with the other charge nurses and don't have issues with them. It's just this particular charge nurse I have a problem with.

I've ignored the charge nurses's behavior and moved on before. I've balled up multiple times and approached this charge nurse - again, she just uses tactics that I don't know how to navigate around...

I've brought this to my nurse directors attention before and things seemed to go well for awhile... now we are back to this charge nurse treating me like crap. I respect my nurse director and she would be totally willing to address this again, but our unit is going through a rough patch and I am trying to get creative and hold off until absolutely necessary because my nurse director has a lot going on right now and many things to juggle (not words from her... just my own observations and its all very matter of fact).

At what point do you just decide to go back to nurse director? what are things you can say to tell a charge nurse that uses intimidation when all you wanna do is communicate "XYZ makes me feel disrespected and it's unhelpful to me in just doing my job" at what point do you go to HR? is any of that of any use? am I missing something?

I'm not at the point of quitting because of this one charge nurse. sometimes it's tempting... but I've dealt with worse. So, I can tolerate it.

TL;Dr: Difficult charge nurse situation who is blatantly belittling and disrespectful towards me and others + causes other nurses from different units to become very upset. Goal here is to learn something about navigating around difficult people especially those who have leverage and much more experience than me. What do? Help?

[BeatsPerMinute, BSN, RN]

On 9/27/2022 at 2:18 PM, CommunityRNBSN said:

I definitely agree with “don’t stand there and wait for her to acknowledge you.”  She’s already rude and/or doesn’t like you, so why are you trying to be polite?  Walk up and say “Excuse me, Susan, I need you for a moment.”  I’m sure it feels like interrupting, because people are talking. But if they’re talking socially and you need help with work, you have every right to loudly talk over them to get her attention. Yes, people might think you’re being rude— so what?  She’s already being rude to you, so I wouldn’t worry too much about how you appear. Beyond speaking professionally and keeping a neutral/pleasant look on your face. 

Very fair point. I think my hesitation comes from the fact that she knows how to run the place and get things done - again, has many valuable traits.. She WILL complain about others and she has the upper hand in many areas. 

 I have noticed that whether it be me or a few others (usually, its the younger nurses) asking for help when drowning

Even if all she is doing is telling a story totally unrelated to work... and has been chatting for nearly 45 mins - it is like dare I interrupt that story tellingtime for when I legit need help. Somehow, it's always my fault. didn't get a break yet and it's almost 5pm (but I'm still interrupting her story teling time) = I am a nuisence and she is quick to try to tell others and management that it's obvious that I (or others) just cannot "handle things"

Current boss has heard things here and there and has been taking those things with a grain of salt when this charge nurse complains... however, still concerning for me. Again.. this charge nurse knows what she's doing... She can be rude all day. It's that fear of me upsetting her too often and running to boss to tell her all about it with all of the right words is where the anxiety comes from. 

I'm guessing my biggest problem is knowing how to step up for myself that is firm however professional and in a way that this charge nurse can't really use against me? Finding those words is hard in situations like this.. or maybe it's just me? Honestly, I do not know. 

[JKL33]

10 hours ago, BeatsPerMinute said:

She WILL complain about others and she has the upper hand in many areas. 

 

 

10 hours ago, BeatsPerMinute said:

she is quick to try to tell others and management that it's obvious that I (or others) just cannot "handle things"

1. You need to find a way to stop caring about this. Pronto. You need to stop feeling uncomfortable over other people's inappropriate behavior. I'm not chastising you--I did it for a long time, too. But really, how silly is it to watch someone else be inappropriate in one way or another, yet you come out as the one feeling embarrassed, afraid, upset, etc? THEY certainly aren't worried about how they look, and if anyone should feel embarrassed, etc.--its them.

The less you care, the less power they have.

They are able to affect and to some extent control your behavior **only** because you care about something that you should not care about.

Let this person go whine and complain and accuse you of not being able to handle things all she wants. The more she does it, the more SHE displays that she is the one with the problem, especially when her complaints are about anyone/everyone, not just you. If your manager does ask about you it (kind of unlikely), convey that you are unaware what s/he might be talking about. IN FEW WORDS. As in, "huh--not sure."  Or, "Sorry, not sure what she is upset about." Then don't stand there and continue to be engaged in hearing about petty complaints.

10 hours ago, BeatsPerMinute said:

Current boss has heard things here and there and has been taking those things with a grain of salt when this charge nurse complains... however, still concerning for me.

Nope. Not concerning for you. Go concentrate on what's important, which is taking good care of patients.

10 hours ago, BeatsPerMinute said:

It's that fear of me upsetting her too often and running to boss to tell her all about it with all of the right words is where the anxiety comes from. 

I hope you will continue to work on this. Re-read this post, I think it is solid advice or I wouldn't have written it.

You just have to believe it.

[JKL33]

PS - I appreciate that you have tried to "give [her] credit where credit is due," I think that's big of you. But just from life experience I suspect she really isn't all that.

If she were, she wouldn't have to behave this way. ?

[mmc51264, BSN, MSN, RN]

Re: the example you used about waiting for her to acknowledge you while she is "entertaining" others-I would walk up and interrupt that you need help, right now-not in a "pt is crumping" urgency, but don't give her the option of ignoring her. You said that others could read the situation. 

I would keep presenting the issue that she is not helping, I often use the hospital's values/mission statement when she doesn't help. 

I am a charge RN and we have some that have been around for a long time, others that just aren't "into" it (which frustrates me because I am like you, I work work work). 

We have one right now, that does her freakin homework while being in charge and because I am more veteran than others, they often come to me with questions/issues because this woman is no help. This is when I have a full assignment. 

I have a great relationship with my manager so I am working with her to help me figure out how to deal with these issues. 

Sorry you have to go through this. 

[JKL33]

47 minutes ago, mmc51264 said:

I have a great relationship with my manager so I am working with her to help me figure out how to deal with these issues. 

...sounds about right.

Would there be a particular reason that the manager doesn't put a stop to the homework thing?

[Emergent, RN]

I'm glad I'm out of the hospital setting. This thread reminds me why being a school nurse for construction workers building data centers is such a blessing to my life. 

[mmc51264, BSN, MSN, RN]

On 10/4/2022 at 7:24 PM, JKL33 said:

Would there be a particular reason that the manager doesn't put a stop to the homework thing?

Working on it....

[BeatsPerMinute, BSN, RN]

I have read and re-read all comments posted. Some make perfect sense. Some leave me confused and conflicted. This is a thought check and follow up using yesterday's situation as another example of the challenge I am trying to figure out how to wisely work through: 

I received a patient that per policy is supposed to be a 1:1. I went to charge before report (after a quick review on their labs and VS and notes, recognized that this patient was VERY sick), and then again mid report (which was cut off, because patient coded while receiving report from the ED) and then two more times went up to charge nurse asking the same thing. My questions to charge were simple: What was the plan? Was I to give up my other patient or not? To which nurse? And at what point? Charge responses were "I don't know yet" "still figuring it out" ... or just an eye roll, silence, and walking way totally ignoring me asking the question with no follow ups or answers to my questions. 

The patient I received from ED coded all throughout the shift... for hours.. intubated, CVC & Aline emergently placed, and the patient was eventually maxed on Levo, Epi, Neo, Dopa, Vaso  gtts + bicarb gtt. Shocked twice. Received many EPI and Bicarb IVPs through the whole ordeal. Literally I could not leave this patient. 

What happened at the end of the day: no one was watching my second patient. A person here or there would give a blanket or a food tray - but there were no assignment changes. No documentation was done after I received the super sick patient from the ED. There was no official hand off. There was no communication or confirmation from charge what was to happen despite me asking very directly, multiple times.

Only by the end of the shift was it shared with me that no assignment changes were made. I was technically still responsible for my second patient. No documentation on VS/assessments etc. Per charge nurse "but they were checked on the whole time and they are fine" - THAT is the kind of stuff worries me. Dare something happened to that other patient - would it not be on me? 

Only thing I could think of was to write a nurse note stating that care was handed off to charge nurse ***  - given that this charge nurse was "overseeing" that patient and telling neighbor nurses to do any tasks for my second patient, just being objective, made the most sense. One sentence, plain and simple, time stamped. CYA.

What do? 

Not gonna risk my patients lives nor my license for a charge who chooses to be that irresponsible and dismissive. 

Thoughts? What would you do? 

[Emergent, RN]

4 hours ago, BeatsPerMinute said:

Thoughts? What would you do? 

I would find a another job.

[BeatsPerMinute, BSN, RN]

21 hours ago, Emergent said:

I would find a another job.

Seriously considering it... resume has been updated and I'm searching around to see what's out there. 

[JKL33]

On 11/12/2022 at 3:08 AM, BeatsPerMinute said:

Only thing I could think of was to write a nurse note stating that care was handed off to charge nurse ***  - given that this charge nurse was "overseeing" that patient and telling neighbor nurses to do any tasks for my second patient, just being objective, made the most sense. One sentence, plain and simple, time stamped. CYA.

What do? 

Yes, although the after-the-fact aspect of that can be problematic. Better to leave no doubt that you are handing off care at the time you recognize the need. "I need to give a quick report on [so-and-so]; I will be in [other patient's] room indefinitely." Not a question but a statement that conveys they have about one second to decide if it will be them or someone else who takes the report. If they try the "we'll all help" routine or the "I don't know/still figuring it out" routine, then say "I am charting that I gave report to you, then; here's the run-down..." and give a quick report. Then you chart in real time that report was given and patient handed off to so-and-so.

Caveat to this is that it should be a rare thing....well, it used to be anyway. I wouldn't know now since I left the misery behind.

Good luck.