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'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.
You sound really angry. I think it might be because there is some information you don't have. Or maybe you've been unlucky enough to work with some bad, lazy nurses. There are bad apples in every field at every level, and I'm sorry if you've run into that.
I completely believe that there are things you know how to do better than nurses. I learn something from my aides every time I work with them, including changing briefs. I'm not better than they are and my license isn't better than anyone else's - it just qualifies me to legally perform certain tasks that theirs may not. And that's whats wrong with letting an unlicensed aide, even though she's certified, do some of the tasks I do - it's illegal. All the training my aide gets wouldn't qualify her to perform all of the same tasks that I can do - even if she knew how - because she isn't licensed. I don't hide behind scope of practice, hell I'd love it if there was someone else who could legally do everything I can, we'd make a better team together.
As to walking in your moccasins, I consider myself lucky when we're so short that they call nurses in to pick up aide shifts. I love having the chance to get out from under the impossible charting load and actually give hands-on patient care, and yes, that includes all the tasks the aide typically does. By doing so, I get to know the residents so much better and see so much more. I started out as an aide, and I was proud of the work I did, and still am.
You sound really angry. I think it might be because there is some information you don't have. Or maybe you've been unlucky enough to work with some bad, lazy nurses. There are bad apples in every field at every level, and I'm sorry if you've run into that.
I completely believe that there are things you know how to do better than nurses. I learn something from my aides every time I work with them, including changing briefs. I'm not better than they are and my license isn't better than anyone else's - it just qualifies me to legally perform certain tasks that theirs may not. And that's whats wrong with letting an unlicensed aide, even though she's certified, do some of the tasks I do - it's illegal. All the training my aide gets wouldn't qualify her to perform all of the same tasks that I can do - even if she knew how - because she isn't licensed. I don't hide behind scope of practice, hell I'd love it if there was someone else who could legally do everything I can, we'd make a better team together.
As to walking in your moccasins, I consider myself lucky when we're so short that they call nurses in to pick up aide shifts. I love having the chance to get out from under the impossible charting load and actually give hands-on patient care, and yes, that includes all the tasks the aide typically does. By doing so, I get to know the residents so much better and see so much more. I started out as an aide, and I was proud of the work I did, and still am.
Her post is just dumb imho. She's a new nurse with no experience and she's whining about having to show someone else the ropes. Boooo hooo! Just let the PSW learn and stop it with the scope of practise. I think she's just afraid that the PSW will do a better job than her. I've watched them do things and you don't need a license to figure it out but yeah it is illegal to do stuff without one. I can just go on the internet and watch youtube and find out how to do anything which is what they learn anyway. They just call me a PSW because I don't have a fancy degree, but I'm practically a nurse just no licence. To bad its illegal to call yourself a nurse when you're not but I can do everything a nurse can do and I have the experience. If you can't change a brief like me I'm sorry but that kind of validates my post.
Her post is just dumb imho. She's a new nurse with no experience and she's whining about having to show someone else the ropes. Boooo hooo! Just let the PSW learn and stop it with the scope of practise. I think she's just afraid that the PSW will do a better job than her. I've watched them do things and you don't need a license to figure it out but yeah it is illegal to do stuff without one. I can just go on the internet and watch youtube and find out how to do anything which is what they learn anyway. They just call me a PSW because I don't have a fancy degree, but I'm practically a nurse just no licence. To bad its illegal to call yourself a nurse when you're not but I can do everything a nurse can do and I have the experience. If you can't change a brief like me I'm sorry but that kind of validates my post.
Woah woah woah! I'm not showing someone the ropes here. This PSW is asking me to teach her tasks that cannot be taught to a PSW because they are protected actions. It doesn't matter if the PSW can do them competently or not, what matters is that the PSW doesn't have a licence to do the task. If she does the task, she can harm a patient and potentially lose her job. I'm not whining about having to show someone the ropes, I'm asking what I can do to keep my patients safe. Experience does not equal a licence anymore! I know a lot of nurses used to be trained "on the job" many years ago, but it's not that way anymore. Even to be a PSW where I am you need a minimum of two semesters to get your certificate.
I'm not afraid of this PSW doing a better job than me either.She is not allowed to do the job I'm doing because it is illegal for her to practice nursing without a licence. This is a very real crime! If I screw up at work, my licence is on the line in addition to any additional charges that may come with an error. I am held accountable to a higher power than just my employer. Yes, anyone can be taught how to do a task, or learn it from a video on YouTube, but if a PSW does something that is a nursing protected task and ends up in a court of law, saying, "I learned how to do it on YouTube" holds absolutely no value. While I may have watched YouTube videos in school about various things like wound care and assessment, I also went to lectures, had multiple opportunities to do the task in clinical settings, and many, many evaluations on whether I was doing things correctly. During my four years of university, I was receiving constant feedback about how to improve my skills to get me to where I am today. I'm glad YouTube and watching various nurses makes these tasks look easy, but I assure you, there's more to a dressing change than just slapping a Mepilex on a wound.
The fact is, you may think you are practically a nurse, but without a licence, you are not a nurse. Practically a nurse is not a nurse or even a designation, just like practically a pilot is not a pilot. I'm not saying that to be mean, or flaunt an ego, I'm saying that because you should be proud of your job as it is. You do a lot of work and are an important part of the healthcare team.
As for changing briefs, just because a nurse can't do one skill perfectly doesn't invalidate their ability to do other skills. Similarly, I don't rate a "good" or "bad" PSW based solely on one skill.
You sound frustrated and I get that, but you're way off base here. I'm sorry that you think my post is dumb, but I can't change the way you feel.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
1 hour ago, L82thegame said:
Her post is just dumb imho. She's a new nurse with no experience and she's whining about having to show someone else the ropes. Boooo hooo! Just let the PSW learn and stop it with the scope of practise. I think she's just afraid that the PSW will do a better job than her. I've watched them do things and you don't need a license to figure it out but yeah it is illegal to do stuff without one. I can just go on the internet and watch youtube and find out how to do anything which is what they learn anyway. They just call me a PSW because I don't have a fancy degree, but I'm practically a nurse just no licence. To bad its illegal to call yourself a nurse when you're not but I can do everything a nurse can do and I have the experience. If you can't change a brief like me I'm sorry but that kind of validates my post.
There is a reason licenses are required to do certain jobs. Lots of things look easy when you watch someone do them; there are a lot of procedures I wouldn't want unlicensed personnel performing on my loved ones. Most nurses are not going to do anything illegal just to appease you; they've worked too hard to achieve and maintain their livelihoods to risk them for silly reasons.
The whole "I do everything a nurse does; I just don't get paid as much" is a ubiquitous refrain. All it shows is that you don't know what you don't know. Many nurses (myself included) worked as aides prior to becoming nurses. It's damned hard work, no doubt about it. But having done both, I know the difference. You don't.
Specializes in Mental Health, Gerontology, Palliative.
19 hours ago, L82thegame said:
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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 of your high horse with your my license is better than yours attitude.
You dont have a licence period
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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
Correct in that PSWs/caregivers have the most hand on contact with the patients. I'd be screwed if it wasn't for my care givers, they are brilliant. That said, we both have very different jobs and responsbilities.
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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?
I've just had two days at university for my pathophysiology and long term condition management paper on the route to becoming a nurse prescriber. Funnily enough they arent big on using you tube videos to teach us how to prescribe.
Its not about being afraid caregivers will do my job better than me, there are parts of my job they arent able to do.
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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 tube videos dont count for training. And the fact remains you arent qualified to do alot of my job.
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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.
Alot of my care staff assume that I'm sitting on my *** I cant be doing anything. What they dont see is the 8 interrai assessments that are due in the next week. Or me chasing up prescribing because we dont have doctors on site. Or dealing with the patient who has fallen and fractured their pelvis and the well meaning but uninformed caregiver who wants to move them
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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.
I can do your job, you assume you can do mine, however there is much about my job you dont have a damm clue about. How do i know this? I had exactly the same belief when I worked your job prior to becoming a nurse
Can I suggest you get that exceptionally large chip off your shoulder
My patient well being will overrule every single time
If she writes down all of her questions, you can turn that in to the director of nursing instead of you having to write down a sentence each time.
Why is she looking at doctor's notes, at nursing assessments, etc. Only those with a 'need to know' should be reading the charts, and she does not have a need to know.
This is a HIPAA violation each time she does this.
Since your director has given you instructions as to what to say to her each time she asks an inappropriate question, I would type up a form that said "It is beyond the PSWs scope to do such a task, a PSW is not qualified to do or evaluate such a task". Each one would be on about a 1" high by 2" wide piece of paper. Each time she asks or says something inappropriate hand her one of these, but don't engage in conversation.
This person is sitting back watching you chase your tail by answering her questions, looking up information for her, etc. It is her amusement for the day. For people like this, any attention is better than no attention. They do not differentiate between positive attention and negative attention. She needs to be tending to her own work. Your director should have already taken care of this matter, I hope it gets better for you.
If she writes down all of her questions, you can turn that in to the director of nursing instead of you having to write down a sentence each time.
Why is she looking at doctor's notes, at nursing assessments, etc. Only those with a 'need to know' should be reading the charts, and she does not have a need to know.
This is a HIPAA violation each time she does this.
Since your director has given you instructions as to what to say to her each time she asks an inappropriate question, I would type up a form that said "It is beyond the PSWs scope to do such a task, a PSW is not qualified to do or evaluate such a task". Each one would be on about a 1" high by 2" wide piece of paper. Each time she asks or says something inappropriate hand her one of these, but don't engage in conversation.
This person is sitting back watching you chase your tail by answering her questions, looking up information for her, etc. It is her amusement for the day. For people like this, any attention is better than no attention. They do not differentiate between positive attention and negative attention. She needs to be tending to her own work. Your director should have already taken care of this matter, I hope it gets better for you.
She doesn't have access to the medical charts, thank God, beyond what is on a flow sheet in the kardex. All of the charts are electronic, and she doesn't have a passcode. She has access to the Kardex, and that is not a HIPPA violation as it gives her need to know information as it pertains to her duties.
When it comes to her picking apart nursing assessments, it's always because she has watched a nurse do something and is tattling. I shut this PSW down the other day by asking her, "Oh? Nurse ABC did it wrong? How do you know? Please, walk me through the correct way to do that assessment as laid out by the nursing regulatory body of our province and our policy and procedure manual." When she said she couldn't, I said, "You don't know how to do that assessment correctly, so you cannot tell me whether a nurse did it right or wrong, nor are you qualified, licenced, or even legally allowed to do that assessment. You need to focus on your work and leave nursing work to the nurses." I'm finding that by not giving in to her requests, and reminding her that she is not qualified or licenced, is putting a quick stop to her. Shutting her down at the source is very effective, and my director is on board with this new plan of reminding the PSW of her role, reminding her that nurses have to be licenced, and ignoring further comments from the PSW.
As for Doctor's orders, as a courtesy, we'll tell our PSWs that someone is on antibiotics (watch out for diarrhea!) or has had a medication change. These changes are in the kardex too. While the nurse is monitoring that patient, the PSW has been asked to report changes they notice, like changes in bowel habits, ease with ADLs related to decreased pain, and the like. It's not an assessment by the PSW and it is always guided by the nurse (ie, "let me know if Mr. B has loose BMs"), but it helps the nurse catch things in addition to the care the nurse gives. Unfortunately, the PSW I posted about takes very medication change as an opportunity to rip apart the doctors and talk about why doctors don't know what they're doing.
Now when she starts into a rant about doctor's orders, I just talk over her and cut her off with a firm, "I didn't ask you for your input on the medication, thank you." and then I just ignore her. This has so far been effective at shutting her down and we haven't had a medication rant in about 5 days!
She is getting a bit better, and I have had her write down her questions and hand them in to the director instead of me. I have yet to see any action from the director, but the PSW has improved and isn't tattling all the time. I think part of it too was that she spent a great deal of time writing down her questions and got sick of her own game.
Her post is just dumb imho. She's a new nurse with no experience and she's whining about having to show someone else the ropes. Boooo hooo! Just let the PSW learn and stop it with the scope of practise. I think she's just afraid that the PSW will do a better job than her. I've watched them do things and you don't need a license to figure it out but yeah it is illegal to do stuff without one. I can just go on the internet and watch youtube and find out how to do anything which is what they learn anyway. They just call me a PSW because I don't have a fancy degree, but I'm practically a nurse just no licence. To bad its illegal to call yourself a nurse when you're not but I can do everything a nurse can do and I have the experience. If you can't change a brief like me I'm sorry but that kind of validates my post.
I'm genuinely not trying to be rude, but to say you are pretty much a nurse is a slap in the face to nurses. Nurse licensure is there to protect patients because the "tasks" nurses complete all the time are based upon a depth of knowledge about what's going on in the body beyond the steps of that task. Just knowing how to draw up a medication and give it means nothing if you don't know the effects of it, how it works, how to assess for complications, and if you don't have the critical thinking we are taught in nursing school to act on any potential issue that comes up. It goes beyond the medication simply being pushed on the patient. Not to mention the fact that licensed nurses have a lot of prerequisite knowledge before even beginning a nurse training program, so to say that watching YouTube videos can give you the same amount of knowledge and preparedness as a licensed nurse is.....absurd. I smell a troll.
Oh and I'll add this edit. As someone who has worked as an unlicensed assistive personnel for a few years while schooling to be an RN, I am totally aware of the value of such personnel. I would never put down my prior fellow CNAs and techs for what they do. It's just a simple truth, before getting my license I would not have been qualified to complete nursing tasks and it would have been unsafe for me to do so, no matter how experienced or eager to learn I was.
Nurse licensure is there to protect patients because the "tasks" nurses complete all the time are based upon a depth of knowledge about what's going on in the body beyond the steps of that task. Just knowing how to draw up a medication and give it means nothing if you don't know the effects of it, how it works, how to assess for complications, and if you don't have the critical thinking we are taught in nursing school to act on any potential issue that comes up.
This is what I couldn't find the words for. Perfect. Ms. Practically A Nurse doesn't understand what she doesn't see and therefore thinks it's all about the tasks.
Katillac, RN
370 Posts
You sound really angry. I think it might be because there is some information you don't have. Or maybe you've been unlucky enough to work with some bad, lazy nurses. There are bad apples in every field at every level, and I'm sorry if you've run into that.
I completely believe that there are things you know how to do better than nurses. I learn something from my aides every time I work with them, including changing briefs. I'm not better than they are and my license isn't better than anyone else's - it just qualifies me to legally perform certain tasks that theirs may not. And that's whats wrong with letting an unlicensed aide, even though she's certified, do some of the tasks I do - it's illegal. All the training my aide gets wouldn't qualify her to perform all of the same tasks that I can do - even if she knew how - because she isn't licensed. I don't hide behind scope of practice, hell I'd love it if there was someone else who could legally do everything I can, we'd make a better team together.
As to walking in your moccasins, I consider myself lucky when we're so short that they call nurses in to pick up aide shifts. I love having the chance to get out from under the impossible charting load and actually give hands-on patient care, and yes, that includes all the tasks the aide typically does. By doing so, I get to know the residents so much better and see so much more. I started out as an aide, and I was proud of the work I did, and still am.