How to write a verbal warning on poor work relationships

Nurses Relations

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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

Thanks everyone! You all have been very understanding of what I am experiencing. So far, by reading your helpful comments, I do believe my Nurse manager is also challenging me, or giving me a duty she doesn't have the nerve to confront;I sense the latter. I believe a verbal warning should be just that...a verbal. Since I have already had the discussion with the pct and documented it in my personal notes, warned my boss, this should be sufficient until further action is warranted. Hence, I do not have any factual evidence of her breaking policy rules. Reporting vital signs to me is not practicing outside her scope, scheduling an patient appointment is not either. Again, she cover herself by being overly analytical, hyper critical and nags the RN about it to make hassle on the RN while relieving herself of accountability...covering her butt! Yet, this is not a crime...she being difficult and I can't write her up for that, right?

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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

you said your new there? so maybe you can try and teach her and take a more gentile approach. when she comes to you with a ''omg!!! p is 115!!!!'' you can explain to her why that although elevated, is not significant in that this pt......blah blah.

it might be nicer instead of string up something in a new place. if she cant take a hint, let her read your post! just kidding, but let her gently know that you appreciated her concern however often she comes to you with trivial information that make it difficult to get your work done.

i dont have a clue about her education but maybe she really does not understand?

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Specializes in APRN / Critical Care Neuro.

You are right to be concerned and you need to tread carefully. Document specific dates, times and people involved any instance that is not team player or outside the scope of her practice / job. Make sure your write up includes a plan of action for improvement, when you expect to see improvement and how muct time she has to make the improvement. Then document concequences if she does not improve. Make 3 copies. One for you. One for the file that she will sign saying she recieved it and one for her to keep. Whatever you do, do not sit down with her alone. Make sure a 3rd person is there. Make sure the 3rd person understands they are not to get involved, simply listen. When she gets upset, and she will, keep your tone even. Decide what you are going to say before hand and stick to it. Do not argue with her, simply end the conversation with "We need to see improvement and a desire to become a part of the team."

You may not have this opportunity, but often it is best to deliver this type of message in the middle of the work week, not on her "Friday" as tempting as that may be. It is also best to deliver half way through her shift and allow her to go home early, paid to think about it. Have her come back the very next day and make sure everyone understands they are to support her and not judge her. You could turn her around, but if you don't...there will be no lawsuit and no unemployment...management will be happy with you.

Good Luck!

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Specializes in Adult/Ped Emergency and Trauma.

My only hope for this "Currently" inneffective NM is that she wants someone else to make an official disciplinary move, before she does alone. I still disagree, because if I was the NM of your unit, she/he would be in front of my desk explaining her/his side of the story for documentation on an "out-of-the-scope" of practice move. If a Nurse started Medically Diagnosing and Medically treating patients, and ordering labs, and discharging patients that should have gone 3 days ago, THAT nurse would be in my office explaining her side of the story. They are both SEVERE. They are both against the LAW.

What is Soooooooo important to remember is, . . . your the one that has the license, that BOTH of you are working under. Not trying to induce panic(as in OH! Your going to lose your license!), but to enforce that she has absolutely NO RIGHT to assume your job when there is probably PLENTY should could be doing with-in her own scope.

Also, this sounds like a pretty intimidating, or weight carrying CNA, but you are in the right, and that puts MORE weight on you and YOUR AUTHORITY. Never forget they practice UNDER our Supervision, and LICENSE, and we are TOTALLY responsible and ACCOUNTABLE for the care they give- whether it is with-in or with-out their scope of practice if we don't report it. So, I WOULD document your actions on the "Written-Verbal Warning" as well. Here is what I would DEFINATELY write.

EXAMPLE:

On the Date/Time of 4/30/2012 @ 15:30 PM it came to my attention that Jane Doe, CNA had violated the policy and procedure of John Doe Memorial Hospital by:

1. Discussing the Private details of a patients care, disease process, treatment, current status, lab, symptoms, and other protected health information with the patient's family members- which is also outside the scope of a CNA according to STATE Nursing Practice Act, and/or the Policy and Procedure of John Doe Memorial Hospital.

2. Conducting Teaching, Giving Medical Advice, and Advising Patient/Patient's Family Member on issues that are out of the Scope of Practice for a CNA according to the Nurse Practice Act, and The Policies and Procedures of John Doe Medical Center.

3. Instructing/Advising Nurses on Care/Assessments/Goals/Evaluations/Implementations that are ALL beyond the scope of practice of a CNA, and against the Policy and Procedure of John Doe Memorial Hospital which also violates the Nurse Practice Act of STATE.

CNA has been directly observed displaying these behaviors, and I have discovered throught Patients, and Family Members that he/she has conducted Teaching on Diagnosis, Medications, Current Health Status, as well as discussion of what to report to Patient's Physician.

As following the Chain of Command, I have reported these occurences to my Supervisor, Minnie Mouse, RN, on 4/30/2012 @ 15:40 directly after occurences came to my attention. I was instructed to write up a "Verbal Warning," and meet in person with Jane Doe, CNA to discuss occurences, and provide with written explanation of Warning.

Further Disciplinary Action will be taken (1) at the descretion of the Nurse Manager, Minnie Mouse, RN, (2) Further Occurences by Jane Doe, CNA that are out of the scope of practice for a CNA. (3) Not PROPERLY reporting Vital Signs, I&Os, Meal Percentages, and abnormal findings in a timely, Scope of Practice Manner.

I would sign and date the bottom, as well as have the CNA sign/time/date.

(I would let the CNA write a brief explanation of her understanding of the incident at the bottom, or on the back of the page, as well as an action plan to prevent further occurences. I would turn a copy in to your NM, keep a copy for your records, and present the CNA with a copy).

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Specializes in LTC, assisted living, med-surg, psych.

May I make a small correction?

CNAs do not "work under our license". They have their own scope of practice and are accountable to the state BON for maintaining the professional standards for their position. They also can be disciplined for violations of the nurse practice act just like we can.

We, on the other hand, are to direct and oversee the work of the CNAs under our supervision. A CNA who fails to take and record vital signs could face discipline by the BON; it's our responsibility to be familiar with CNA's level of competence in performing this essential task, and to ensure that it's done.......period.

Carry on! :D

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If you have already given her a verbal warning, documenting your conversation (which is not a verbal and written warning together), then the next step in most places would be a "written warning" and a written plan of action to change behavior to better suit the CNA's scope and the needs of the unit. Make sure that your HR person is present for all, and that if this is Union facility, the person has a Union Rep with them. Think about what you WANT the CNA to do. Focus on the positive ie: familiarize herself with the patient's range of vitals, and report to you if it doesn't fall into the person's "norm" or patient is symptomatic or whatever it is she SHOULD be doing, as opposed to what she does that interferes with the workings of the Unit. Also keep notes in personnel file on if the verbal warning worked, and if it did not, you have written proof of the need for written warning. With that has to usually come a plan of improvement, documented proof if the plan is not followed, before a termination.

And just as an aside, in Mass. CNA's DO work "under the license" of the RN/LPN. When, as licensed persons, we delegate to an unlicensed person, we are ultimately responsible for the outcome. Nurse's aides are certified, not licensed, therefore, as the licensed person on, we do hold the responsibility. It is a "rumor" that LPN's work "under the license" of the RN. THIS is incorrect, as we have our own licenses that we work under.

With ALL that being said, it does bear watching to be sure that one of your patients doesn't have a blood sugar of 30, or a BP of 200/100 or some such thing, the CNA then decides NOT to tell you, and there is a poor outcome, and the CNA writes "RN aware" or some other statement to cover her butt. Another idea is to have this CNA write her vitals on a clipboard, give it to you, and you do a quick scan of it, see who is NOT in the "norm" and assess those patients first. Bottom line is that when this CNA is on, and if you don't trust her judgement, you need to assess all of your patients yourself--maybe going room to room with her--if she starts to "freak" then it would be a teachable moment to say "Mr so and so can have a BP as high as xyz, his pulse rate is pdq, he otherwise assesses WNL. In this instance, let's use the other arm, and use a manual cuff...." Not sure what your other responsibilites are on your unit, however, given this situation, I would definetely make it priority to eyeball all of the patients you are responsible for yourself, and most especially before giving meds......

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Thanks everyone! You all have been very understanding of what I am experiencing. So far, by reading your helpful comments, I do believe my Nurse manager is also challenging me, or giving me a duty she doesn't have the nerve to confront;I sense the latter. I believe a verbal warning should be just that...a verbal. Since I have already had the discussion with the pct and documented it in my personal notes, warned my boss, this should be sufficient until further action is warranted. Hence, I do not have any factual evidence of her breaking policy rules. Reporting vital signs to me is not practicing outside her scope, scheduling an patient appointment is not either. Again, she cover herself by being overly analytical, hyper critical and nags the RN about it to make hassle on the RN while relieving herself of accountability...covering her butt! Yet, this is not a crime...she being difficult and I can't write her up for that, right?

This sounds so much like someone I used to work with it's almost giving me nightmares. You're absolutely right - it's not that they're acting above their scope, it's actually the opposite, they won't take any responsibility or accountability for anything, and if challenged on it will say they are trying to do the right thing by reporting problems.

'Mrs Smith doesn't look well', 'I think there's something wrong with Mr Jones', 'I just took Mrs Brown's pulse and it's 105!! That's abnormal isn't it?', 'Can you please check Joe, he said he doesn't feel the best', 'I don't think that catheter is draining properly', 'June said she wants to see you', 'There's a mark on George's arm, you need to look at it', 'Bill feels hot, I checked his temperature and it's up a bit' and so it goes on all day long, and each one is made out to be an emergency that must be addressed right now (and she would act very righteous about being the observant one who was able to notice and report these kinds of things). So I would be going to check on something or someone every 5 minutes.

If I asked what sort of mark, or what do they mean when they say they don't feel well, or why do you think something's wrong, the answer was always 'well, I don't really know but I thought it was important, that's why I'm telling you'. Arrrggghhhh! As I write this down, I realise it sounds like the kinds of things you would want an aide to tell you, from anyone else it would be, but from this person it was that every time she found something that needed to be investigated a little bit further, instead of doing so she constantly passed it on to the RN because 'it's something you need to look at, I'm only a CNA' type of attitude.

The other thing she would do was that once she’d told me something, she then took no further action on the problem – she’d told me so now it was my problem. This is fine when it IS something the RN needs to address but even then, on a busy day, a gentle reminder from a CNA is much appreciated. It’s not so fine when it’s something she could easily take care of herself with a little thought and perhaps some effort and she would gleefully go around telling others (including family) ‘Well I told the RN about that’. Very very hard to manage that sort of thing as there are no lies and it only makes you look an idiot if you complain that people are telling the truth.

What I did in the end, after nearly having a nervous breakdown on the days I worked with her, was learn to pass most of it back to her. 'Please go back and check the pulse again then do it again in 10 minutes, then come and tell me what it is', 'Please go and ask Mrs Smith what she is feeling, if there's nothing specific, please check her temperature and her pulse and check the bowel chart, etc, etc, etc then come back and tell me', 'Please check Bill's temperature again, give him a drink of water, then check it every 20 minutes. Let me know if it's above x, and I'll be down to see him soon', 'Thank you for letting me know about that, there's no need to call the doctor at this stage but make sure you check him again before lunch'.

When I got time to go and look at the mark or the catheter or to check the one who wasn't feeling the best, I would find the CNA and and say 'come and show me what's going on'.

Seems obvious but for the longest time it didn't occur to me that I needed to do this. It actually got worse before it got better because I was checking and re-checking constantly to make sure she was indeed going back and doing what I’d asked but eventually we came to a sort of understanding that I expected her to take some basic steps before she came to me with her list of concerns and that I expected her to monitor these issues throughout the day and not think she could forget about them once she’d told someone.

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Specializes in Adult/Ped Emergency and Trauma.
May I make a small correction?

CNAs do not "work under our license". They have their own scope of practice and are accountable to the state BON for maintaining the professional standards for their position. They also can be disciplined for violations of the nurse practice act just like we can.

We, on the other hand, are to direct and oversee the work of the CNAs under our supervision. A CNA who fails to take and record vital signs could face discipline by the BON; it's our responsibility to be familiar with CNA's level of competence in performing this essential task, and to ensure that it's done.......period.

Carry on! :D

Yes, Always, and Thanks on the Correction!

No more sleep deprived posting for Boston, just wanted to emphasize that we're responsible for the CNA's work to a degree- I overkilled it. Just wanted to express how we can build a wall between their mistakes and our license. Your clarification nailed that, so all thats left to say is, Thanks Viva!

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Wowww, CompleteUnknown, you have captured the full idea of what I have been dealing with. Exactly! I thought I was going crazy and no one would ever begin to understand the concept of complaining about a CNA who is telling the truth, but reliving herself of any accountability by reporting everything to me. Even minute issues. Your idea is great. I will start to pass it on right back to her! Thank you so much for taking the time to share your experience.

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Wowww, CompleteUnknown, you have captured the full idea of what I have been dealing with. Exactly! I thought I was going crazy and no one would ever begin to understand the concept of complaining about a CNA who is telling the truth, but reliving herself of any accountability by reporting everything to me. Even minute issues. Your idea is great. I will start to pass it on right back to her! Thank you so much for taking the time to share your experience.

You're very welcome SoulSpirit, I hope it helps. :)

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