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

Nurses General Nursing

Published

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 sounds like she has some kind of anxiety disorder, or OCD, with her need for this constant reassurance. I would stop answering her questions. You just feed into it every time you do. I would tell her that from now on, you will only answer questions that pertain to her job directly. Say the same phrase each time, such as “not your scope of practice” and nothing more. If she wants to start arguing about why she needs to know or whatever, just say nothing. Don’t engage. I might suspect you will see some other behavior manifest when you do this, as she might need to fulfill this reassurance need in another way. Just something to watch out for. Reporting her will only go so far... hard to fire someone for asking too many questions. At the same time, you won’t be fired for not answering questions that do not relate to her job.

Most of the time, the managers/directors know exactly what is going on but choose not to do anything about it. Sometimes they like the person you have a problem with so keep that in mind. Definitely push forward and try to do something about it. The person doesn't respect the director. The director isn't making her. That is your main problem.

Specializes in NICU.

What is a PSW???!!

Specializes in Tele, ICU, Staff Development.

Someone is not doing their job, and it's the Director.

There is an awful lot of time and energy being taken away from patient care because of this one disruptive, poor performer.

You are being harassed and spending time trying to work around this person's behavior. At this point she should be in progressive discipline with clear expectations.

Roll up a newspaper, smack her on the nose with it while saying a firm "NO"???

Specializes in Medical-Surgical - Care of adults.

I think I would explain to the PSW that she is coming very close to practicing nursing without a license which could land her in court with a possible fine and, if she harmed a patient, jail time if she performed any patient care not covered in her job description. I would also consistently refuse to answer her inappropriate questions during the work day. I agree with requiring her to submit her inappropriate questions in writing. I'd submit them to the director, keep copies in my own records with dates and times, and respond to most of them with some sort of standard comment about needing a license to practice nursing to deal with the issue raised. I wonder if she has some sort of personality disorder that leads her to rebel against authority by trying to undermine the supervisor's confidence.

Specializes in Psych, Corrections, Med-Surg, Ambulatory.
18 hours ago, hgarcia4 said:

Agree with (nearly) everyone else. I'm a CNA and taking pre-reqs for nursing school. I've sometimes asked the RNs or NPs I've worked with about a procedure or decision. BUT I always come at it with the attitude of "I'm just interested to learn" and I have no intention of trying to practice nursing or pick apart a practitioner's decisions in my current role. You're not being egotistical; you are protecting your patients from an arrogant and uneducated non-nurse.

To echo others, I would document *everything* and if HR/your director continue to be unresponsive, I'd ask for a sit-down meeting. In the meantime, put up a wall: tell her "it's not my job to explain that to you"/ "I need to deal with this other patient right now" / "you are not an RN so you cannot perform that task." Be a broken record. Good luck and I hope that management backs you up.

If you're a CNA who's in the process of applying to or attending nursing school, I imagine the nurses at your work are usually glad to answer questions and show you things, time permitting.

But someone who doesn't have time for schooling and thinks her job is some sort of apprenticeship - that's just out to lunch. This person would not likely do well in nursing school because she doesn't get what she doesn't get.

Specializes in Neuro ICU and Med Surg.
15 hours ago, Leader25 said:

What is a PSW???!!

A PSW is a personal support worker. It is equivilant to a CNA. I have mostly heard Canadian nurses use this term.

2 hours ago, TriciaJ said:

But someone who doesn't have time for schooling and thinks her job is some sort of apprenticeship - that's just out to lunch. This person would not likely do well in nursing school because she doesn't get what she doesn't get.

Couldn't agree more. And most schools have exactly zero tolerance for a student practicing outside their scope, or refusing to respect boundaries set by instructors or God forbid a facility nurse in a clinical. And the idea of this girl in nursing school watching to make sure nurses at her clinicals were "doing things right"? She wouldn't last 10 minutes. ?

But I disagree with having her submit questions in writing, or talking with her further about the consequences of her behavior. She's not listening, and way too much time that should be spent on patient care by the PSW and the OP is already being wasted on attempting to manage this chickie. Every time it happens, I'd just say. "We've been over this. That's the kind of question I won't be answering," and then redirect her to a PSW-appropriate task. I'd keep a quick tick list of times it happens to cover my six in case the excrement hits the air mover, but management already knows what's happening and elects to do nothing. Not OP's problem to fix, just to manage toward least disruption by and maximum productivity out of this subordinate.

Specializes in Psych, Corrections, Med-Surg, Ambulatory.

I'd "like" the above post but I'm maxed out on allowed "reactions for the day".

On 2/9/2019 at 10:59 AM, NurseAmyG said:

Roll up a newspaper, smack her on the nose with it while saying a firm "NO"???

Got my first laugh of the day! Thanks!

I've been browsing this site for a while and had to create an account for this thread because I am so disgusted by all you's posts. I'm a personal support worker and I want my voice to be heard. I can tell you that we do know what we're talking about, so you nurses get off your high horse with your my license is better than yours attitude. You may have gone to school for years but we learned on the job how to do things. I can do lots of things as good as or better than the nurses I work with. Nurses don't know their patients half as well as I know them but I don't get paid like they do to push pills and stuff but I'm the one doing the real care. I think you should teach her what she wants to know. She's good at her job, so what harm will it do if she learns how to do yours too. I'd be flattered that she's coming to you because she looks up to you. I think that if you show her how to do stuff, it counts as training. How many of you's watch youtube and learn that way? If it counts for training for the nurses, it counts as training for the PSWs. Period. Nurses like to hide behind scope of practice and other rules so that they can get out of teaching people stuff. Nurses like the ones on this comments are waht's wrong with healthcare today. Y'all are taking advantage of the workers and telling us we're not qualified to do stuff. You make us do tasks that are beneath us just because you can. It's sick. Teach the PSW what she wants to learn, or give her you tube videos to watch because that's the nice thing to do. You're overreacting and making this PSW out to be the evil one when you won't even give her the time of day. I bet being in charge you sit on your chair all day anyway. Our charge nurse is always charting stuff and hardly ever goes in to see patients unless something is wrong and she needs to get up off her butt. I would of reported you to for being rude. If she bothers you that much leave. I can't imagine what you'd do if god forbid you had to change someones brief or something beneath you. Oh wait, y'all probably just say you delegait that. Walk a mile in our shoes before you judge us next time. Our job is a lot harder than that.

+ Add a Comment