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.
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.
Who has time to deal with the same inappropriate questions over and over again? My nurse supports are very kind with an initial legitimate question. But, inappropriate and outside the realm of the PSW's practice? No...
A personal support worker. They help people complete their ADLs, or activities of daily living/life such as helping them dress, feeding them, bathing them, cleaning them up after a BM, turning or repositioning patients in bed, and helping them brush their teeth. PSWs do the important but time consuming tasks that do not require years of training.
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!
In this case, PSW is a Personal Support Worker. Either way, social worker or PSW, the questions are beyond her level of education. I'm just so sick of it all when it comes to this PSW. PSWs perform vital tasks, and they do time consuming and back breaking work. They are the muscle in our facility, and are a vital part of the team. This PSW is just a raspberry seed in my wisdom tooth. I will be going to the director again and expressing my concerns in a written report. This PSW takes up valuable time crying wolf and I am able to complete my job, but I always stay late when she is working. I think when I start mentioning harassment and insubordination, and hand my director a written report, the director and HR will change their tune.
Who has time to deal with the same inappropriate questions over and over again? My nurse supports are very kind with an initial legitimate question. But, inappropriate and outside the realm of the PSW's practice? No...
Usually, mine are too! They come to be with legitimate concerns and well thought out questions. They don't try and be something they're not. None of the other PSWs would ever question a nurse beyond, "Mr. A's looking off. He felt a little warm just now but he's saying he's freezing cold. Can you come check?" I've never had a PSW act like this one before, and I've even worked with PSWs who were working on nursing degree or diploma!
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 have to disagree with you, but I'm wondering how you came to this conclusion regarding me having a huge ego and needing to humble myself.
A personal support worker (PSW) is a very important job, but her job is to turn patients in bed, feed them, bathe them, help them with getting dressed and such. These are all important things to do, but do not require years of training to do. Even so, I do not pick apart her bed making skills, or how she applies a brief. This PSW does not handle medications, do wound care, or receive and transcribe doctors' orders, so she does not need to know how that's done or be taught how to do those things. Remember, training takes time. What is the point of training if she isn't even supposed to do a task? If it were part of her job, as laid out by our director, the PSW job description, and the facility policy and procedure manual, I would be more than happy to teach her how to perform safe medication administration and other such tasks. As it is, she is not allowed to do those tasks. It has nothing to do with her capabilities. She is simply not qualified to do them as she is not a nurse, and if she were to do them (which would be against our facility policy), it would result in harm to our patients and would result in her termination.
I don't think it's acting high and mighty when I tell her that she does not need to know how to do things because she is not going to be doing them. If I teach her how to do the things she asks, this implies that she can do these tasks, does it not? I don't think that's being egotistical when I refuse to teach her, I think that's reminding her that she cannot do a task and keeping my patients safe.
She has asked to be trained to do things, like flush a chest port or draw up and administer a narcotic, which involves a lot more than just a 5 minute lesson even when you hold a nursing diploma or degree. Of course, when she asked to be trained to do that, I refused: I am protecting my patient as this is a task reserved for nurses in our facility. Beyond the fact that such tasks are only to be performed by a nurse as per our facility policy and procedure manual, it would be putting my patients at risk AND my licence at risk if this PSW were to do those tasks. She is not even supposed to have access to the codes and keys to access supplies and medications, which to me says "If you can't have the keys, you can't use whatever is in that cart/room". How would I explain to my director that I let this PSW do such tasks when it is not in the PSW job description and the P&P manual specifically states that all medications, including oral medications, controlled substances, medicated ointments, medicated oral rinses, ear drops, inhalations, and eye drops are only to be accessed and administered by registered nurses and registered practical nurses.
Again, I am protecting my patients. Their safety is of utmost concern to me. I don't mind being questioned, but as this happens only with this PSW, and it happens multiple times a shift, it's getting old.
Lastly, every minute she spends pulling apart assessments, giving unwarranted (and unsafe) recommendations, and sending me on wild goose chases is a minute that I could have spent doing something else. Those add up over the day to a heck of a lot of minutes! Of course, I have to prioritize, but I always take her claims as true until proven otherwise, so I'm often leaving a less dire task to deal with her claim.
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.
I wondered that, but she isn't just interested in doing medications because she is interested in all things nursing related! On the other hand, she could be really good at hiding it like you said. I've asked before why she didn't go to nursing school and she said that she didn't want to be in school that long. All I could think was, "Ok! Then stop trying to get your nursing diploma or degree from me by asking to be trained to do nursing reserved tasks!"
... As it is, she is not allowed to do those tasks. It has nothing to do with her capabilities. She is simply not qualified to do them as she is not a nurse, and if she were to do them (which would be against our facility policy), it would result in harm to our patients and would result in her termination.
This would be my concern with one additional thought, What if she does a procedure that is harmful and out of her scope while you are her direct supervisor? That puts you on the firing line as well as being potentially liable should the incident become a lawsuit.
How does she have time to question you all shift? I would be giving her a new job every time she asked me something. "Sure we can talk about that after you...."
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.
Wow, I'm going to completely disagree with you here. I don't see the RN as having the ege, I see the PSW having an ego. It appears that she feels that with her minimal amount of training that she feels that she knows as much as the nurses. This can be very dangerous. I don't feel the nurse is being rude at all, I feel the PSW is being rude by questioning the ability of a person with qualifications that she is nowhere close to having. It would be one thing if another nurse was questioning another nurse, but, a subordinate questioning a superior, no way.... You are way off base.
How does she have time to question you all shift? I would be giving her a new job every time she asked me something. "Sure we can talk about that after you...."
I really have no idea where she finds the time. She is a great worker, but this means she is also too efficient and then finds pockets of time to question us nurses. She's still doing her job safely, she's just trying to get involved with the nursing side of things which is highly inappropriate.
Persephone Paige, ADN
1 Article; 696 Posts
Who has time to deal with the same inappropriate questions over and over again? My nurse supports are very kind with an initial legitimate question. But, inappropriate and outside the realm of the PSW's practice? No...