Is this insubordination? How do I deal with this PSW?

[guest1048932]

I need advice on how to deal with a certain PSWs behavior. I've been following the advice of my director and the behavior is improving but it's not stopping. I'm also not sure if the following situations count as insubordination or just disrespectful behavior that I'm not handling properly. Some background:

I am an RN and I am in charge of my shift at an extended care facility. One PSW (has never attended nursing school, only a 1 year college program for PSW certificate) has been very difficult since I started. She will question and verbally pick apart nursing assessments, interventions, and processes. She will also question doctor's orders (example, asking why a resident is suddenly on oxygen via NC and we'll say that the doctor ordered it as the resident has a low O2 sat related to a current pneumonia. She'll say that the doctor is wrong, and the person "is obviously asthmatic and needs a "blue or orange puffer", not oxygen". We'll tell her that no, the x-ray and radiologist report confirmed pneumonia, and nurse's/respiratory therapist/doctor's assessments are correct and the resident needs oxygen).

She'll also question every little thing you do. Many times a shift, I find myself saying to her, "You don't need to know how I calculated and drew up the morphine dose/inserted a SUBQ butterfly/debrided a wound/flushed a chest port because you will not be doing any of those tasks." She usually follows my response with, "I was only asking because I was curious and I wanted to be sure you were doing it right" or, "I do so need to know how you did that so I can train on it, do it, and tell you if you did it right." I tell her that the task was completed correctly, that it is never her job to be doing such tasks, and that training or not, she is not qualified to carry out the task or evaluate nurses on the task. I tell she has been told this many times, by myself, other nurses, and the director, and that she has been asked to stop questioning things unnecessarily. She then claims I am bullying or harassing her and puts in a complaint to HR (which is not found to be harassment or bullying).

The director has talked with her about her comments and behavior and asked her to stop. The PSW is improving slightly by not questioning quite as much, but it's still happening multiple times each shift and I'm getting tired of reminding her to stay within her scope and remember her role.

Questions remains:

Would the previous scenarios (questioning doctor's orders, questioning my competency or saying "I do so need to know how you did that so I can train on it and tell you if you did it right") count as insubordination? What would you call those scenarios if they aren't insubordination?

How do I identify insubordination and how do I handle it? I always thought it was refusing to do a task, not questioning your superiors.

How should I handle her questions/comments?

Should I be reporting every incidence of her comments/disrespectful behavior? I feel like this is overkill and tattling. My director has said to just ask her to stop questioning things and to keep reiterating that the task is correctly completed, it is beyond the PSWs scope to do such a task, and that the PSW is not qualified to do or evaluate such a task.

What else should I be doing?

[JKL33]

19 minutes ago, Jb92 said:

Should I be reporting every incidence of her comments/disrespectful behavior? I feel like this is overkill and tattling. My director has said to just ask her to stop questioning things and to keep reiterating that the task is correctly completed, it is beyond the PSWs scope to do such a task, and that the PSW is not qualified to do or evaluate such a task.

What else should I be doing?

Yes. Since there are so many, send a daily report with a brief sentence for each incidence. You can't not report this anymore and then next month have to start all over again telling them, yep, she's still doing it 20 times a day.

But, who truly has time for that reporting, in the end? So, in addition to the daily reports (for now), I would stop answering her. She is owed no more explanations at this point, even the brief ones your director suggests.

If she asked me one more inappropriate question, I would say "I'm sorry but we have been over this multiple times and I can't entertain these questions any more; I need to focus on patients."

If she did it again, "I'm not answering that."

And I would move from there to actually not replying.

Enough is enough.

[crazin01]

"I do so need to know how you did that so I can train on it, do it, and tell you if you did it right." (Sorry, that made me laugh a bit) Are we back in high school? wow.

General consensus seems to be that:

Insubordination in the workplace refers to an employee's intentional refusal to obey an employer's lawful and reasonable orders. Such a refusal would undermine a supervisor's level of respect and ability to manage and, therefore, is often a reason for disciplinary action, up to and including termination.

Sounds about right to me.

I would keep documenting, discuss specific incidents with your director subjectively. If other nurses have reported the same issue and director has discussed this with her, with minimal to no improvement, I would like to think they're simply building a 'big enough file' HR-wise for termination. Although a pain, you and others need to continue documenting all incidents.

Of course, my smart-a$% answer would be: to ask her for documentation to substantiate her claims, print P&P from company website. Hand to her in person, politely stating: Even though this action/medication/procedure/order is well outside your scope and qualifications, perhaps reading company P/P will increase your understanding, eliminating confusion in the future.

good luck, she sounds like a peach!!!

[Persephone Paige, ADN]

I don't know, man. I never heard of such a thing. If I had addressed something once, I would start asking her if she was feeling okay? Is she on drugs, drinking, what? Because no one who is caring for patients should have to be again told the same thing over and over. I think SHE is a risk to the patient. If I was feeling particularly prickly that day, I might ask her how she feels about being charged with harassment? I don't play at work.

[Jory, MSN, APRN, CNM]

I would take her aside the next time she does it and tell her nicely and firmly, "This is the last time I am going to remind you to stop trying to practice nursing without a license. The director has already spoken with you, I am doing you a favor by addressing this with you one-on-one. If this doesn't stop now I am going to start reporting it every time."

I think a bigger problem is what is she telling patients and families when an RN isn't around????? If she's that bold in front of you, imagine what she says when she's with residents/families alone.

[Sour Lemon]

I'd think I'd ask her to her write her "important" questions down so they could be reviewed and answered on an *as needed* basis. Every time she started talking, I'd just cut her off with, "Write it down, please!" Maybe I'd even hand her a pen. I'm so annoyed just reading about this.

[Persephone Paige, ADN]

2 minutes ago, Sour Lemon said:

I'd think I'd ask her to her write her "important" questions down so they could be reviewed and answered on an *as needed* basis. Every time she started talking, I'd just cut her off with, "Write it down, please!" Maybe I'd even hand her a pen. I'm so annoyed just reading about this.

Meee too!

Great idea about the writing it down. Once everything has been answered, ask for a copy and whip it out. "I refer you you bullet point #4." Or tape it to your back!

[brownbook]

I love the write it down response. I also love to read Miss Manners and often think what she might say. One of her oft repeated replies to inappropriate questions is, “I will forgive you asking me that question if you will forgive me not answering”, then just go about your job.

I can’t believe there are so few PSW’s looking for work that the director thinks she cannot simply let this PSW go.

[TriciaJ, RN]

First of all, stop telling her you did the task correctly. You don't answer to her. You need to report to the manager that this is still a problem and the employee needs to be given a specific work plan, with a section for daily evaluation by you.

From now on, each time she questions you inappropriately, it goes on her work plan. If she ever goes to nursing school she will then learn the correct way of doing things. Meanwhile, it is not her place to evaluate the work of her superiors. Stop engaging in this nonsense; just put it on the work plan.

[guest1048932]

5 hours ago, JKL33 said:

Yes. Since there are so many, send a daily report with a brief sentence for each incidence. You can't not report this anymore and then next month have to start all over again telling them, yep, she's still doing it 20 times a day.

But, who truly has time for that reporting, in the end? So, in addition to the daily reports (for now), I would stop answering her. She is owed no more explanations at this point, even the brief ones your director suggests.

If she asked me one more inappropriate question, I would say "I'm sorry but we have been over this multiple times and I can't entertain these questions any more; I need to focus on patients."

If she did it again, "I'm not answering that."

And I would move from there to actually not replying.

Enough is enough.

Thanks! I've been sending the director messages daily, but unfortunately, I've been clumping things together. Rather than detailing the ten things she saw "wrong" with a medication administration, I'll write "PSW questions nurses' abilities to administer medications and count narcotics. I found nurses administering medications safely and narcotic count showed no missing meds. I explained to PSW that she cannot keep questioning nurses and their completion of tasks. I explained again her scope of practice." I do this so that the director doesn't have to read through three pages of scenarios and so I have some hope of getting out of work at a decent time.

I send a daily updates to the director to keep her in the loop, but I don't write every little thing down. I'll take your advice though and write a sentence for each situation now. I'll still write in detail the more important incidences, like when she volunteers to do a narcotic waste or asks to be taught how to administer vaccinations. Those one I will write out in almos essay form! However, since most of my actions and responses are the same (confirming patient safety, confirming correct task execution and procedure, reiterating PSW scope of practice, reassured PSW that things are done correctly etc) I think I can lump those at the end.

That said, I will try to be more direct now. I like your ideas for handling this PSW. I will definitely be using those ideas next shift. Maybe then she will get the point!

[guest1048932]

5 hours ago, crazin01 said:

"I do so need to know how you did that so I can train on it, do it, and tell you if you did it right." (Sorry, that made me laugh a bit) Are we back in high school? wow.

General consensus seems to be that:

Insubordination in the workplace refers to an employee's intentional refusal to obey an employer's lawful and reasonable orders. Such a refusal would undermine a supervisor's level of respect and ability to manage and, therefore, is often a reason for disciplinary action, up to and including termination.

Sounds about right to me.

I would keep documenting, discuss specific incidents with your director subjectively. If other nurses have reported the same issue and director has discussed this with her, with minimal to no improvement, I would like to think they're simply building a 'big enough file' HR-wise for termination. Although a pain, you and others need to continue documenting all incidents.

Of course, my smart-a$% answer would be: to ask her for documentation to substantiate her claims, print P&P from company website. Hand to her in person, politely stating: Even though this action/medication/procedure/order is well outside your scope and qualifications, perhaps reading company P/P will increase your understanding, eliminating confusion in the future.

good luck, she sounds like a peach!!!

I know. I would train her to do something, and then she would watch me do it later and tell me if I'm doing it right. Yep. That makes perfect sense.

I agree with you on the point of building a file though. That makes a lot of sense and I didn't think about that. Fortunately, she hasn't done anything to harm a patient (that we know of, and we're pretty darn observant and careful), but that's not to say that she won't decide in the future that she's qualified to do something and cause unintentional harm to a patient.

I like the idea of getting her to document her claims and then printing off policy and procedures and handing them to her with that polite statement. How delightful! It's so wonderfully passive aggressive!

[guest1048932]

5 hours ago, Persephone Paige said:

I don't know, man. I never heard of such a thing. If I had addressed something once, I would start asking her if she was feeling okay? Is she on drugs, drinking, what? Because no one who is caring for patients should have to be again told the same thing over and over. I think SHE is a risk to the patient. If I was feeling particularly prickly that day, I might ask her how she feels about being charged with harassment? I don't play at work.

The thing is, she never makes exactly the same claim twice. She might claim daily that medications aren't being given correctly, but one day it will be "Nurse A gave Mr.S with the puree diet a whole pill and it should have been crushed" . The pill was pradaxa. Every nurse knows that it can't be crushed, and Mr.S takes the pill just fine in pudding. The next time, it will be, "I saw Nurse giving Mrs. B a syrup, and I've never seen Mrs. B get syrup before." It's cough syrup, and Mrs. B has a cough.

I worried too that she was a danger to patients, but we watch her like a hawk, and she does her job safely and adequately. It seems to be that she just needs a lot of reassurance that things she can't do are done correctly by qualified nurses.

I'm not going to entertain the harassment idea yet, but I will keep it in the back of my mind. I might have to mention it to the director in my report (PSW harassed author multiple times this shift with claims of patient risk which were found to be false).