How to write a verbal warning on poor work relationships

[SoulSpirit_Rn]

Hi,

I am a RN and there is a PCT who seems to want to sabotage everyone. The matter is she does it in a CYA(cover your a$$) kind of way. For instance, she is overly particular and hypercritical about everything. Therefore, she does not know how to assess a situation within her scope of practice, thus she ecsalate everything as a serious issue. Then, I am forced to constantly address or fix the matter numerous minor concerns. For instance, blood pressures that are low/high although the patient is stable and well. A pulse of 115..."OMG call the doctor". Overly critizing co-workers mistakes. Simply, put she is impractical to what it really takes to be a teamplayer. She is self-centered, cannot think outside the box, has no critical thinking skills, and does not have her teammates back. I can go on and on. She causes a heap of petty, irrelevant issues in comparison to my full list of daily tasks as a nurse. And if I was to address EVERY matter, immediately, undividely, I would be burnt-out in a nut house or cursed out each time I call the physician. I would expect this demeanor from a intern/student, but not from an experienced co-worker. FYI- I just got hired in this unit. Everyone else is on board with the change, but she is a pest. She even encourage the patients to contact family with issues she impose on them. In return, patient's relatives call the unit or doctor, overly concerned about much of nothing. This interrupts my task; causing me to focus too much time on one patient versus using my time wisely among all patients...and keeping my sanity. She is exciting the patient and being over critical. My boss told me to give her a verbal warning in writing. But how can I be factual, when she is purposely covering herself with this perfectionist behavior. No one wants to work with her and she is not creating a optimistic, comfortable work enviornment, because everyone feels the need be too particular in response to her hyper-particularity. Help please because I have to get this action corrected, formally, and immediately.

Thanks

[BostonTerrierLover, BSN, RN]

Wow, I can't believe your supervisor isn't handling this, she gets paid to do this, and is delegating a "Management" job to you. I am skeptical of how well this going to work- or provoke her worse. Sounds like a nurse wannabee, and the only thing that will help is for a Charge Nurse or Nurse Manager to sit down with her, and express what is needed from her. She "is" going out of her scope of practice as a CNA, no beans. She should simply report her findings to you in a timely manner, and let YOU do the decision making and critical thinking.

Discussion with the family about calling/discussion with the Physician is Teaching in my book, and the CNA is NOT prepared for this in anyway. However this task HAS been given to you, so working with that, I would simply use the warning to explain that she has practiced beyond her expected scope w/potential consequences (some you listed such as affecting your prioritization of care, management of care, communication problems between Physician/Nurse (not CNA/Physician). I would emphasize she is working UNDER YOUR SUPERVISION, and also your LICENSE and AUTHORITY. She is a NURSING ASSISTANT, and not a medical assistant, fellow nurse, or Patient Advocate. She is there to assist with the ADLs of the patient, take Vital Signs, I&Os, and Meal/Activity Documentation- and she is to report her findings to you, and abnormal findings Immediately. It's not her position or scope of practice to in anyway to "Assess Patient Status, Diagnose a Symptom, Plan a Care Regimen, or Implement a plan of care, Evaluate a Patient Outcome.

Also, since your manager has passed this task down to you (Which I firmly disagree with), I would investigate if other colleagues have had the same or relevent issues with this CNA, and get them to Co-Sign the Verbal Warning with you- I would also keep a copy of ANY write-up my handwritting is on.

Everything you write should be totally factual with examples of times she has caused issues to arrise. Nothing should be an opinion, or generalization (e.g. CNA is always practicing out of scope, or CNA always takes it upon herself to aproach family with care advice and prompts discussion with physician). Use examples of times she has done these things.

Most important, document after this over. Write the time and date of each additional occurence- the what, who, why, how, and what happened secondary to the action- and you will be "bullet proof" when you need to follow-up on unchanged, negative behaviors. Never forget they practice under our supervision, license, and it is OUR DUTY to follow-up on the care they give.

Sorry For the Soapbox Lecture and Good Luck!

:redbeatheBoston

[caliotter3]

What a headache. Too bad you can't just tell your boss that you want this headache gone before you stroke out over her.

[CompleteUnknown]

Do you work in long term care? If I didn't know any better I'd think you were describing a person I used to work with!

If it's long term care I might be able to offer a couple of suggestions....

[Nurse SMS, MSN, RN]

Seems to me all you would have to do is set forth written information about what the legal scope of practice is for a CNA and cite the most serious specifics where she has operated outside of it. Intentions do not play into the law, even though she is banking on her apparent intentions being her saving grace. The outcomes and time spent dealing with the chaos she causes is not part of the write up. Sue Smith, CNA, was observed interpreting results to patient So and So....assessing patient outcomes on Mr. Such and Such.....attempting to educate daughter of So and So re: diagnosis/condition/symptoms.....etc...which are outside the legal scope of practice for a CNA. Sue Smith, CNA, provided hard copy of the scope of practice for CNAs in the state of XXXX along with a copy of the legal penalties for violations including potential loss of certification.

Just factually cite the behavior that is outside her scope. If she brings up her intentions, tell her she is welcome to write her side of the story to be filed on the write-up, but that it is going to be placed in her file and that further problems will be documented and escalated as necessary per facility protocol. The more matter-of-fact you are, the less leg she will have to stand on.

[roser13, ASN, RN]

I'm a little confused about your phrase "a verbal warning in writing." However, I do think that you should go back to your supervisor and address this again. Giving a fellow employee (even one under your supervision during a shift) an official "warning" of any kind seems very strange to me. Official actions must come from an official supervisor.Sitting down with the co-worker and giving specific examples of issues is one thing. Attempting to take an official action is another and should be done by your supervisor.

[NoviceRN10]

I'm a little confused about your phrase "a verbal warning in writing." However, I do think that you should go back to your supervisor and address this again. Giving a fellow employee (even one under your supervision during a shift) an official "warning" of any kind seems very strange to me. Official actions must come from an official supervisor.Sitting down with the co-worker and giving specific examples of issues is one thing. Attempting to take an official action is another and should be done by your supervisor.

I agree. What on earth is a written verbal warning? Why don't you just tell this person that her communications with the patients and family are inappropriate. If your supervisor won't do it, you need to at least try to address the problem.

[KelRN215, BSN, RN]

An official "warning" needs to come from the supervisor. If it were me (and I've worked with CNAs like this before), I would have a conversation with the CNA and say, "please report abnormal VS to me and I will assess further and determine what, if anything, needs to be done." I would also ask her to defer family questions back to me. I had situations like this when I worked in the hospital... I'd go into the room and Mom would say something like, "the other nurse said that he has a fever and that he could have a post-op infection. She said you would call the doctor and get an order for antibiotics." Naturally mom would then be worked up and it would be up to me to explain that A. 37.8 is not a fever that's indicative of a post-op infection, B. low grade fevers are common in the immediate post-operative period, C. Your child is already on antibiotics as everyone gets 3 doses post-operatively and D. I'm your nurse.

[GitanoRN, BSN, MSN, RN]

first of all, a written warning will be your best friend in the long run this will give you ammunition for the near future and trust me it's very near. having said that, i'm totally surprised that your nm is not managing this fiasco since she has known about it prior of you coming into view. pursuing this further, i sense that your superior doesn't care to be the one to confront this situation and it has passed the bucket to you sorta speak, which leads me to believe that she's testing you as well. needless to say, you need to keep a written log or a mental one of events, when this pct has not complied under the scope of conduct of a pct, including times, and those involved that this pct has disrupted their daily pt. care with her behavior. in this manner since she's is so good of covering her back you can uncovered her mask with the facts of her practicing outside of the legal scope of practice for a pct in your state, since she's working under your supervision and under your rn license. however, you need to do this a.s.a.p. for the simple reason that her type of behavior is the kind that can spread like a cancer to other staff members. moreover, her inappropriate conduct is portraying the facility in a negative way to those who visit the facility, and it's making you look like you don't have a handle on supervising your own staff. with that said, the warning must be precised and straight forward with a copy of the scope practice of a pct in order for her to realize that her conduct won't be tolerated any longer. in addition, in the warning you need to address the issue with dates and facts of her undesirable conduct, and specifically that she will be place on probation if she doesn't comply with ethics of conduct of the facility. on this level, she will ultimately face further actions if this continues to escalate which may include leave without pay or immediate dismissal. unquestionably, i'm sorry that you have to go through this kind of nuisance however, in other to regain your authority you must convey to her that the issue on hand is a serious manner. in conclusion, very often this type of behavior from staff is often seeing when a new authority comes into play, and those involved can either welcome or disapprove with their actions towards the new member which in this case is you, stand firmly on your ground and you will see those not in favor fall by their own actions. wishing you the very best in all of your future endeavors... aloha~

p.s. keep us up to date

[mamaxmaria]

Is she going for nursing or this is just how she likes do to her job? When I first started as a PCT 5 years ago I was nervous about everything! I quickly learned that all pt's have different norms and what not but what really helped me to relax was the nurse explaining to me WHY the pt's blood pressure was so high/low or WHY they were a bit tachy. If I think something is abnormal, It's my job to let the nurse know, and I love it when the nurse explains things to me ( as long is wasn't in "omg you stupid tech" kinda way )

In the long run it really helped me be better at my job and really helps that I am now going to school for nursing myself.

Maybe you can try explaining things to her in a non condensing kind of way. I know with some people it can be like beating a dead horse but It could be worth a try :-)

[JerseyBSN]

My very first warning ever was a "verbal" warning, written down that I had to sign. Supposedly so many "verbals" equal a "written" warning". So many "written" warnings can equal termination.

Can you sit this person down and talk to them? I have found it effective. They sometimes don't realize how they're coming across and appreciate you talking to them rather than reporting them. If it doesn't work, go for the write up.

[SoulSpirit_Rn]

A verbal warning in writing consist of verbally discussing an issue while warning for corrective action. And documenting the conversation. I was shocked of such thing too, but it is in policy