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.
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.
Definitely agree! It reminds me of something one of my instructors was always saying in nursing school: the task-oriented nurse is a very dangerous person! When all you are focused on is the task, you aren’t giving complete and competent nursing care because there is more to it than simply checking it off the to-do list.
Walk a mile in our shoes before you judge us next time. Our job is a lot harder than that.
I would bet that a fair number of us have been in your shoes before we earned our licenses. Which is why we understand how you feel (I am sure we all felt abused or unappreciated by nurses at some point while working as unlicensed assistive personnel), and also why we know that acting beyond scope and training is potentially harmful.
By the way, when it comes to patient care, nothing is beneath me. It's my patient and I am responsible for the care given. If I have assistance, that's a good day for me.
A PSW is a Personal Support Worker. We take an 8 month (2 semester) college course to become one. Usually found in LTC's but hospitals have them now too. Also know as PCA - Patient Care Attendants.
A lot of PSW's take further courses to become nurses at some point or another.
I work with some strong amazing PSWs who make all the difference during a shift and know the residents better than me, in some ways, since they've been working with them for over a decade.
I also work with a couple who seem to have a chip on their shoulders (or just plain lazy) and think nurses "Don't do anything." They seem to question all that you do and expect you to attend to every little call they need (and they seem to need a lot). Maybe some people just get frustrated with their work and think the different roles in the healthcare setting are unfair.
I also know nurses who expect managers and doctors to "Do more" and even bring up their salaries. People don't understand that unless you get the qualifications to have certain titles then you should know your role and just do a good job without expecting those in different roles to do your work for you.
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.
THIS. SO MUCH THIS.
On 2/5/2019 at 11:12 PM, 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.
and then you'd have all the proof you needed for HR.....
0.9%NormalSarah, BSN, RN
266 Posts
Definitely agree! It reminds me of something one of my instructors was always saying in nursing school: the task-oriented nurse is a very dangerous person! When all you are focused on is the task, you aren’t giving complete and competent nursing care because there is more to it than simply checking it off the to-do list.