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.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
By the way, as a non-professional, she doesn't have a "scope of practice". She performs tasks as assigned by professional staff. Actually, this person sounds really dangerous. She seems to think she is an apprentice nurse.
It needs to be spelled out again that her position should not be construed as any kind of schooling or apprenticeship. She has already been told what her job duties are and aren't. If she is being told to look up P&P to support her questions and claims, that will take time from what she is supposed to be doing. She should not be collecting overtime for this "assignment" nor be allowed to work off the clock.
Next time she questions anyone's practice she needs to hear a curt "That's not for you to ask. Has Mrs. Doe had her bath?" Yes, take the fun out of her game by not answering the question, and giving her something else to do. Ideally, she gets let go, because she really is a loose cannon. It's a bummer that facilities have so much trouble keeping staff they have to hang on to people like this.
Well first of all I would humble myself if I were you, your ego is huge and it seems like this has really annoyed you that someone without your training is acting like this. What about all the trained professionals you see screwing up all the time, do you act this high and mighty above them?
Just privately talk to this person and tell them what’s up, don’t be snobby and rude because someone isn’t as educated as you. If you think the person is a danger to patients then report them. If they are not a danger then just explain things in a nice manner.
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?
She is, I think, supremely frustrated that she could not continue her schooling.
That does not excuse her making everyone's life difficult.
I think I would say, "Susie, you sound supremely frustrated, etc.". Acknowledge her and let her know you understand and applaud that she is eager to learn, ask her when she plans to go back to school, and try to befriend her a little. But let her know that you still need her to follow the boss' request because she is driving you crazy - or something like that. Use more finesse than I have here.
BTW, there is the trouble - the boss ASKED her to stop. She needs to issue an order. Stop or disciplinary action will happen.
So I still don't get what a PSW is... I originally thought it was something to do with social work and the someone else mentioned "personal support worker"? Which is it?
If she has a 1-year certificate as a hand-holder then I would no way even give her the opportunity to ask stupid questions.
She would hear 1 things from me: "its beyond your scope of practice".
Then I would direct her to the DON and tell her she is breaching HIPAA (may be a white lie but she probably doesn't know any better).
I would never entertain her questions. I would even tell her she is taking time away from residents for foolish questions that don't concern her due to scope of practice issues. PERIOD.
She needs to hear again and again: it's out of her scope of practice; she is not a nurse in any capacity; she has not has training to understand what she talking about.
She probably also needs to know she's making a fool out of herself.
Another poster mentioned it and I agree, she will shoot herself in the a** by practice something outside her scope!
It sounds like she might be trying to get access to the medications. I wonder if she has a drug problem. Often times an addict is so good that no one notices there is a problem. I've seen tragic results of this several times. A PSW should have nothing to do with meds.
Sounds like the poor lady desperately needs a psych eval.
Well first of all I would humble myself if I were you, your ego is huge and it seems like this has really annoyed you that someone without your training is acting like this. What about all the trained professionals you see screwing up all the time, do you act this high and mighty above them?
Just privately talk to this person and tell them what’s up, don’t be snobby and rude because someone isn’t as educated as you. If you think the person is a danger to patients then report them. If they are not a danger then just explain things in a nice manner.
Woah woah woah newbie, coming in a little harsh there. I don't think her ego has anything to do with it. I, too, would be irritated if a non-nurse was trying to work and/or act like a nurse. I don't think she's high and mighty at all. If someone kept doing something that myself, other nurses, and management asked NOT TO DO and that person kept doing it, I'd be very frustrated and annoyed.
OP -
Being short staffed is never a good reason for retaining a problem staff member. It always leads to more messes in the future.
Woah woah woah newbie, coming in a little harsh there. I don't think her ego has anything to do with it. I, too, would be irritated if a non-nurse was trying to work and/or act like a nurse. I don't think she's high and mighty at all. If someone kept doing something that myself, other nurses, and management asked NOT TO DO and that person kept doing it, I'd be very frustrated and annoyed.
OP -
Being short staffed is never a good reason for retaining a problem staff member. It always leads to more messes in the future.
WOAH WOAH...
I’m not new I just deleted my old account a couple years ago...
Off topic though...There is a serious problem amongst hospital staff, I don’t get why the people with the least amount of credentials try to bully over the people who do not have any credentials. It’s pretty pathetic to see these people come right out of associates degree program and the next minute they are being rude to every receptionist in the hospital.
Specializes in LTC, assisted living, med-surg, psych.
2 hours ago, Ron Wallace said:
WOAH WOAH...
I’m not new I just deleted my old account a couple years ago...
Off topic though...There is a serious problem amongst hospital staff, I don’t get why the people with the least amount of credentials try to bully over the people who do not have any credentials. It’s pretty pathetic to see these people come right out of associates degree program and the next minute they are being rude to every receptionist in the hospital.
I’m not new I just deleted my old account a couple years ago...
Off topic though...There is a serious problem amongst hospital staff, I don’t get why the people with the least amount of credentials try to bully over the people who do not have any credentials. It’s pretty pathetic to see these people come right out of associates degree program and the next minute they are being rude to every receptionist in the hospital.
I'll be honest, the biggest bullies out of all of the APRNs are the CRNAs if you really want to know. The OP isn't being arrogant at all....she is simply clarifying her training/expertise.
I have worked in a place where I had a secretary try to act like a nurse and she started answering patient's medical questions without forwarding those questions to me.
You don't really have that problem in your line of work because it is very complex and the only person you really answer to is the surgeon. But for those nurses that have this happen, it is a huge deal.
TriciaJ, RN
4,328 Posts
By the way, as a non-professional, she doesn't have a "scope of practice". She performs tasks as assigned by professional staff. Actually, this person sounds really dangerous. She seems to think she is an apprentice nurse.
It needs to be spelled out again that her position should not be construed as any kind of schooling or apprenticeship. She has already been told what her job duties are and aren't. If she is being told to look up P&P to support her questions and claims, that will take time from what she is supposed to be doing. She should not be collecting overtime for this "assignment" nor be allowed to work off the clock.
Next time she questions anyone's practice she needs to hear a curt "That's not for you to ask. Has Mrs. Doe had her bath?" Yes, take the fun out of her game by not answering the question, and giving her something else to do. Ideally, she gets let go, because she really is a loose cannon. It's a bummer that facilities have so much trouble keeping staff they have to hang on to people like this.