How to handle a coworker who is giving poor care

[TigerGalLE]

So I have been at a new job for a year and a half. I am at the same hospital I have always been at. I love my new job. However, I work with a nurse that has been in this current unit for 20 years. She is having some issues at home. Has been for a few years. she had always been a bully from what I have heard.

Well in my opinion her nursing care is atrocious. I have never experienced someone who gives bad care intently. She knows how to do better and doesn't.

We work with babies and they can't ask for help. Parents trust us to care for their children. I would never let her touch my child.

She is completely unapproachable. A bully. Mean. I have already been to the nurse manager who said she spoke to her about her attitude. There has been no improvement. My coworkers agree that she is slack and gives poor care but everyone is pretty much afraid of her.

What is my next step? Should I go directly to the director of nursing? Should I try to approach her? We only run with 2 nurses staffed at night so avoiding her is impossible. Should I make a list of things she does that is unsafe, slack, poor care?? I don't know what to do.

[Conqueror+, BSN, RN]

Just make sure that you are 100% sure,your motives are pure, and that it is all about the babies. Since your facility has kept her employed for 20 years they may be prepared to defend her and throw YOU under the bus including giving you the chop for being a troublemaker/liar. Be prepared to lose your job if it comes to that

[hppygr8ful, ASN, RN, EMT-I]

Thank you CBlover for your advice. I don't need anymore rude comments from any other members. I will take the advice I have received and go from there. This nurses behavior is not my fault and I am not responsible. I am trying to help. I have been to my manager. I was trying to see what other options I have. I will not be made to feel like crap by a bunch of people on the Internet. I now remember why I quit coming to allnurses.

I did not seeing anything in these posts that was rude. What I did see is people asking you to look and your perceptions and if valid act on them. When my son was in the NICU I observed two nurses "Flipping" him from front to back. It sacred me and I asked "What are you doing?" They explained that they were testing for a neurological response and had the pediatric neurology resident come and explain it to me. Things are not always as they appear. I worked LDRP and a bruised heel after a heel stick is not an indication of abuse or even poor technique. They can often be avoided with the use of heel warmers.

Now words like Slamming bring to my mind a baby being thrown onto the bed -in which case I would have stepped into the room commanded the other nurse to leave, assessed the baby for injuries and immediately called the house supervisor. But I have strong boundaries and would have told the nurse to leave even if I had to take on the whole assignment myself and bring all the babies cribs into or near the nurses station.

Failure to act is also a form of abuse - if you think I'm being rude by saying so - more power to you.

Hppy

[TheCommuter, BSN, RN]

I don't need anymore rude comments from any other members.

I do not think anyone's responses were particularly rude. Tone and connotation are difficult to measure in online communications because we cannot see the senders and recipients of our messages.

I will not be made to feel like crap by a bunch of people on the Internet. I now remember why I quit coming to allnurses.

No one on the internet can make you feel a certain way or take a particular course of action. No one can alter your feelings unless you explicitly consent to allow your precious head space to be rented. Good luck to you.

[imintrouble, BSN, RN]

I didn't read all the responses. It boils down to a peculiar human behavior.

When we don't like somebody, for any reason, they have to be awful people.

There has to be a reason, even if there isn't one.

If there isn't one, then we manufacture them.

If the OP had not said she didn't like the other nurse, I would be more likely to believe her post as gospel.

But disliking the other nurse colors everything else that follows.

I also got a bad vibe in the OP when describing how this one nurse is isolated.

Everybody talks about her. Nobody likes her. She gives bad care.....

It makes me wonder. Who's the real victim here.

[jadelpn, LPN, EMT-B]

With all this being said, OP, I would immediately (and especially if you have been keeping a log of incidents) go directly to your house supervisor as these incidents occur. If there's a policy of 2 sticks, that's it, then report it when she is on her 4th or 5th stick. If she is heel sticking in the arch of a foot, report it. If she is slamming babies down into beds, report it to CPS today. Like right now.

It doesn't matter who likes her, who doesn't, what her home life is, or that she plays solitare for hours on end. If this stuff is happening, it needs to be brought to the attention of CPS, your DON, corporate compliance, risk management. Today, like now.

I am curious as well if any of the parents of these infants have questioned any bruising, if they have been witness to multiple sticks, and the like. Or coming in to a screaming infant (and I have to say that infants that scream for hours on end have a hard time settling) have the parent's noticed? The moment a parent says "something is not right with my baby" THEN would also be the time to get the house supervisor immediately to discuss the concerns with the parents.

This is so much more than a "the 20 year veteran nurse with the personal problems is a bully" this is more like "a nurse is mistreating and mishandling infants"--which is criminal.

[Been there,done that, ASN, RN]

There are only two of us scheduled per shift. So yes I do go soothe her baby.. What is completely unacceptable is that I have to walk past her playing solitaire in order to get to her screaming baby. It isn't like she is busy doing something else.

And since there is only 2 of us it isn't always possible to stop what I am doing to make sure she is doing what needs to be done. I'm not neglecting to help in order to get "proof" for my log.

I think she is a bully because I have been bullied by her. I have been told that she has always been this way. I don't think being rough with a baby is subjective. I left details out. But leaving bruises from tying tourniquets so tight and slamming babies face down into the bed is rough.

I'm not trying to throw her under the bus because I don't like her personality. I'm concerned about the babies under her care and I would never let her care for my own child.

Honestly I am offended by the responses I have received.

And as far as what is going on in her home; she openly talks about it. We don't gossip about it.

Not so sure some responses are meant to "offend" .. rather to give you food for thought.

I was charge nurse for many years . I felt one nurse in particular "gave atrocious care"..etc. I took specific examples to the NM .. Atrocious nurse was approached, and both the NM an I were shot down.

The point is... you must have specific , witnessed strong examples.. in order to effect change. Keeping the log of behaviours is an excellent idea.

Do you have another witness to her behaviours that will stand with you? An anonymous report ( or several ) to compliance could go a long way.

Best of luck, I hope you win this fight. Let us know how it's going.

[BuckyBadgerRN, ASN, RN]

You witnessed this and did nothing? I'm BEYOND offended by your behavior then...

There are only two of us scheduled per shift. So yes I do go soothe her baby.. What is completely unacceptable is that I have to walk past her playing solitaire in order to get to her screaming baby. It isn't like she is busy doing something else.

And since there is only 2 of us it isn't always possible to stop what I am doing to make sure she is doing what needs to be done. I'm not neglecting to help in order to get "proof" for my log.

I think she is a bully because I have been bullied by her. I have been told that she has always been this way. I don't think being rough with a baby is subjective. I left details out. But leaving bruises from tying tourniquets so tight and slamming babies face down into the bed is rough.

I'm not trying to throw her under the bus because I don't like her personality. I'm concerned about the babies under her care and I would never let her care for my own child.

Honestly I am offended by the responses I have received.

And as far as what is going on in her home; she openly talks about it. We don't gossip about it.

[TigerGalLE, BSN, RN]

Well y'all have definitely opened my eyes. If she was beating a baby I would intervene immediately and protect the patient. It is more being rough. Which you say is subjective. Rougher than I would ever touch a child. Is she beating it? No. Slamming it into the wall? No.

I never said I didn't like her. I said she was mean and a bully. Which doesn't matter any way. I have worked alongside many nurses in my career that I didn't like. I never felt the need to find reasons to get them in trouble. I am not that person. I came here looking for support and advice. I was looking for some encouragement too probably. I don't want to get someone in trouble or fired. I want her to do a better job. I want to do the right thing.

I have a right to be offended if I want by the harshness of some on this thread.

I appreciate the helpful advice. From this point forward I will write an incidence report when she does something against policy or that is harmful to the child. And yes I will intervene if she is hurting the child. I haven't been sitting back watching her beat children. I am sorry it came across that way to some.

[Libby1987]

As much as some comments were offensive to you, mine apparently, you now have a better idea how your subjective terms could be received and how to best couch your report.

[champagnesupeRNova]

I think if you had posted this in the NICU forum, the responses would have been different because as a NICU nurse, I totally get what you're talking about. I have worked with a few "senior" nurses like this (not exactly, but mostly) that went about their patient care like they were just "over it." They didn't have patience, didn't seem to care about anything (except when they could take their break), and got by on the bare minimum. They have all either left for another job or retired by now. If we saw any of them being too "rough" with the babies, we would intervene by asking if they needed help or just standing in the room seemingly to make conversation. I never saw any of them slam a babies head into the bed though. Then there are the senior nurses that are excellent in patient care, but have become so used to handling the babies that they are swift and jarring in their movements of the baby which I would sometimes categorize as rough. I would definitely call this nurse out on her "rough" handling of the babies.

[TigerGalLE, BSN, RN]

Thank you for your response. I know what you mean about handling a baby with a firm confident hand. She does this but is cursing at the same time. So she may not be hurting the baby but when she cusses at the same time it sure comes across as shocking. And we all know she wouldn't act this way in front of the parent or management.

I am at work tonight (not with that nurse). I am Currently on break. The baby she stuck 4 times for an IV before asking for help still has bruised swollen hands where she didn't attempt to hold pressure after blowing the vein. I intervened at that point and held pressure on the hematomas. I told her the baby is bleeding and we need to hold pressure for a bit before we can continue. She said the baby bleeds like a pig and grabbed its foot and did a heel stick without applying a warmer first. So any way just an example.

[greenerpastures]

I understand you TigerGalLe. If you want to really see something done, you have to fill out incident reports. Start there. I learned this regarding an issue at my workplace. Oftentimes we see things that are unacceptable and wonder, "What do I do about this? I am tired of it!!" FILL OUT AN INCIDENT/SAFETY REPORT. This is a real paper trail. There is no other way to truly get down to the nitty gritty with behavioral issues (it seems) without the actual report. You watch, you fill out one of those with the details of what you personally saw and risk management has no choice but to address it. Report it this way from now on.

THIS! Fill out incident reports on everything that is an objective violation of care policy. If there is an issue with a baby and it's just the two of you - I'd find a way to casually call a supervisor. Even if it's just a speed dial you can call and hang up which alerts them you need them now.

As someone who was told by a supervisor that filing incident reports about other nurses was unprofessional, I continue to do them. As a result, I've seen a nurse who "couldn't keep up/wouldn't keep up with orders, pushing things off on other shifts, neglecting emergent orders", suddenly start "keeping up" after multiple valid incident reports. Where I work, incident reports are reviewed daily by a hospital committee that requires the floor manager to update them on what's been done to correct the situation. It forced the supervisor to do something about it. You might never know what the correction was, but if you watch close enough, you'll see it start to happen. If not, look for something else, or ask not to be placed with that nurse on the same shift due to your safety concerns.