Interdisciplinary Bullying!

[jtydelskiRN]

I recently started a job at a new facility under the suggestion of a psychiatrist that I worked for at my previous facility that was closed down. He and his assistant stuck their necks out for me to get me the job which, for me, puts additional pressure on to do a PERFECT job because I don't want to embarrass them.

I work in inpatient adult psych. I have extensive experience in units in urban hospitals with very acute patients. I am currently working on my MSN and certification as PMHRN. I feel and have been told I do a great job on the floor and have a natural ability with the patients. I just happen to be a bit brash and say what I think in report, especially when feeling frustrated about something.

This new facility threw me on the floor in charge on nights without any sort of orientation. Anything that could happen from rapid responses to behavioral incidences have occurred. Since I have started I realize that the director of the unit is a social worker, not a nurse, and has little patience or understanding for nurses. Additionally the social work staff run the show up to the point that the social worker determines when people go home (not the psychiatrist).

This is a new culture for me and its been hard to adjust because where I came from the RNs ran the show.

Now every week since I have started several social work staff have complained to the director about me for the most ridiculous things. They were mad because I suggested a patient be discharged, then they were crossing out my treatment plans and writing over them because they didn't like what I wrote, the I was pushed off a project to improve treatment plans because the same staff didn't want me to work on them because it was 'their thing', then the last straw was the emailed the director saying I was inappropriate in report because I said we shouldn't keep admitting a frequent flyer who is very behavioral. They completely left out the fact that I said that we are doing nothing to help her behaviors and suggested a behavior plan or DBT therapy to help. They did not understand that when said patient cuts herself up or says she took a bunch of pills she brought in with her from home, all that goes under my license and I have to answer for it.

This staff is very two-faced and never approaches me about their concerns...its just a tattle tale situation and very childish. Today I was called into the office for the second or third time since I started a month ago. I became so frustrated I began to cry uncontrollably and had to leave early for the day because I couldn't get myself together. This is so out of character for me. I never react like this and feel even more embarrassed. Many staff tell me this has happened many many times to other nurses and I keep having staff (even my manager) beg me not to 'throw in the towel' or quit. Which isn't even a thought at this point. I just want to be left alone. I feel targeted and like my every move and every word is being watched and judged.

I'm used to a stressful work environment given I have chosen to work in psych. I feel we get enough abuse from the patients there is no reason for staff to be at each others throats.

Has anyone experienced this sort of thing?

[anon456, BSN, RN]

I am sorry I don't have a lot of advice for you-- this is totally out of my area. I know there will be people who can offer advice. I just wanted to alert you about your avatar. Please read this thread and protect yourself. I have co-workers who love Allnurses.com and I often try to remain anonymous so I can post stuff here and not have it conflict with work.

[Sam J.]

Social workers and nurses are historically arch enemies. Much of that is based on the pay disparity, but as nurses get paid less and less, the two groups may even end up as the best of friends, which is what they ought to be?

[jadelpn, LPN, EMT-B]

I am sorry this is happening to you. Just stinks.

The only thing I could add is that your manager needs to nip this in the bud. That is why your manager is there (well, in part, but you get where I am going with this). If your manager is asking you not to leave, then perhaps they are willing to hear you out. You are a seasoned psych nurse. Come armed with suggestions on how to make this work for the good of the patient.

Social work and nursing are 2 seperate things. The red flag to me is the "changing of the treatment plan" stuff. They have their treatment plan, nursing has theirs. And never the 2 shall be crossed out and changed. Your treatment plan involves the nursing process--a plan of care, and theirs would be more the "case management" end of things.

You should sit down with your manager, and discuss establishing firm boundries on treatment modalities. That a nursing care plan can be established on the goals of social work, but that it is up to the RN to establish these nursing interventions. When the interventions are met, then a plan for discharge can occur.

If you are re-admitting patients, that is not good for reimbursement. If you are not documenting nursing interventions per plan of care, then even worse. The behaviorally unstable patients need a specific treatment plan--and nursing interventions that protect the patient. So, as an RN, when this patient is admitted, can you design specific behavioral plans of care that are nursing intervention driven?

Further, if your manager is not a nurse, then perhaps a little bit of education on your nursing license. Oh, and a personal aside, get malpractice insurance if you don't already have it. Protect yourself every step of the way.

[SL2014]

This happened to me when I was in ICU and when I was in LTC. The staff were literally running to the manager for anything and everything, sometimes blatantly lying, other times making a big deal out of nothing by distorting the truth. I didn't even try to talk to management about being "picked on", here's why...

No matter what... If you are "in trouble" for something, anything that you say to "defend" yourself, despite being truthful and/or in the right... You look like you are trying to save your own butt and/or not taking responsibility for your actions- regardless if said actions even occurred at all.

So in both situations, I left.

I wish there was a better way, I have even thought about calling and telling them what happened "after the fact" when I no longer had a job to save but I figured that if the management was concerned with the morality of their staff they would have asked my opinion.

I'm sorry this is happening to you, it is extremely stressful and makes you feel terrible. To worry is hard enough, to worry about your job is harder and to worry about your job and feel like everyone is out to get you is even worse. *hugs*

Good Luck!

[Been there,done that, ASN, RN]

I have a suspicion that far from the psychiatrist and the assistant "sticking their necks out" to get you the position, you were simply one nurse in a long line of nurses that come and go at that facility.

Concerned that you feel you have to do a "perfect "job in order to please your so called benefactors.

The social work stafff has been in control for a long time, they are NOT going to give it up.

But you need to.

[llg, PhD, RN]

I totally agree with Beenthere, done that. You can't fix everything and everyone. The situation at that facility did not begin with you and it's not going to end with you. I hope you can find the strength to walk away soon.

If asked by the docs that helped you get the job, tell the truth in a professional way. Perhaps you could say something like, "You may not be aware of this, but ..." Tell them that the working conditions for nurses was horrendous and that the Social Workers there do not with nurses as peers. Give a few examples, but don't dwell on it. Simply say that you stood up for yourself and would not work in such a bad environment. End by thanking them for their efforts to help you.

[jtydelskiRN]

thank you...I changed it

[jtydelskiRN]

jadelpn

thank you so much...I am hoping to create behavioral plans as part of my clinical ladder project. There are so many times where social work is overstepping their bounds and scopes of practice. The same social worker literally looks at MD orders and makes comments that things aren't ordered correctly. It is like chaos in treatment team meetings. I have voiced several things: 1. my desire to meet with the director, manager, and the staff that keeps complaining about me which was shot down immediately with no good reason, 2. that treatment plans be separated into sections by discipline as they should be and were everywhere else I've worked, and 3. that if anyone has an issue to please talk with me first before reporting me to the director...I am approachable and would like the chance to explain myself if misunderstood.

Thank you again for your post.

[jtydelskiRN]

Been there, done that and llg

Thank you for your responses. You may be right. I have been told that aside from the few nurses that have been there forever, the turnover is horrendous and most of the nurses have been there a year or less. I'm disappointed more than anything and hate being caught up in petty drama. I just wanted a place to work until I am finished with school and get my NP license.

[nancyjoanlewis]

As a registered nurse, in a field you love, trust yourself. If you are working as an advocate for your patient and safely treating each patient, then let the other members of the interdisciplinary team talk. Because you are new to the unit, perhaps the others are intimidated by you. Perhaps they feel undermined by your confidence and enthusiasm as you find your way. Maybe they have valid concerns but, even so, seem to be handling the situation poorly. That is on them, not you. Talk to your nurse manager to discuss possible resolutions, and if you are comfortable, approach the offenders in a mediated environment. If you take the opportunity to confront the situation as opposed to allowing yourself to be controlled by it, you will be much happier and can, hopefully, move forward from it.