Lead Clinical Nurse is Dealing with a Negative Nelly, HELP!

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Lead Clinical Nurse is Dealing with a Negative Nelly, HELP!

Hello Nurse Beth,

I need advice on how to engage a nurse who is frequently complaining about staffing. I am now entering my fourth month as a Lead Clinical Nurse on the chemical dependency unit of a freestanding, acute care psychiatric hospital. Our maximum census is 14, and, due to the brief nature of patient stays, we have constant activity. It is normal for 3 discharges and 3 admits to take place in a day.

Because of this, we have a split shift (1100-1930) admission nurse and mental health aid (MHA). While we cannot prevent admissions from occurring after the admit nurse leaves for the day, she does handle at least 50% of all admissions each calendar day. Also of note, we are one of two open units. We will not accept a patient who is actively suicidal, homicidal, self harming, assaultive, or psychotic. Patients with such severe conditions require the care of a locked unit, which is staffed with additional MHAs to manage the milieu and quickly respond to behavioral changes.

The RN who frequently complains about staffing has been with the hospital for 14 years, and I believe has worked on the detox unit the same duration. She is a weekend only nurse. I learned from my manager she receives a premium wage per her contract for working every weekend. When I accepted this leadership role, I was warned my staff are unhappy. I have successfully developed a mutually respectful rapport with each of my staff (7 in total), except this nurse. I have listened to her complaints about staffing. She uses key buzz phrases like "high acuity", "safe staffing", and "patient safety". "

However, when I ask her to explain how patients were unsafe and how having an additional person on the unit would prevent the non-existent safety event from happening, she is unable to provide an example. She uses the way a locked unit, with the same potential capacity, is staffed as her comparison. This is apples to oranges, and she does not see this. It has been brought to my attention that she is freely sharing her negativity in the nursing station when I am not scheduled. We did have a conversation to the effect of bringing awareness to the behavior, setting the expectation that the nursing station is a place of work and we need to support each other by creating a safe place to work.

I acknowledged venting is normal, though the nursing station is not the place. By choice, and to reduce costs of child care, I work 3 of 4 weekend shifts per pay period. I do not feel understaffed. We ARE busy, and there are shifts where I know I have definitely earned my paycheck, but I do not share her frustration. On the occasion when I feel we will need additional support, the house supervisor is able to send either an RN or MHA as requested 90% of the time. Our staffing grid is for 12-14 patients is 4.0 staff for an eight hour shift (either 4 licensed, or 3.5 licensed and 0.5 unlicensed when we have split shift staff). We are in California where the nurse to patient ratio for inpatient psychiatric care is 1:6. As charge, I take 1-3 patients plus an admission (at least twice weekly).

We are not required at this time to facilitate any nursing education groups on my shift, though I would very much like to improve our evening programming by eventually adding one such group after dinner. I need guidance on how to cut out the negativity, and help her to see we are actually in pretty good shape overall. Either that, or how to document unprofessional behaviors and misconduct so that we can start an official disciplinary process. Thank you SO VERY MUCH!"

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35 Answers

Specializes in Tele, ICU, Staff Development.

Dear Needs Guidance,

Congrats on your new role and you seem to be doing a great job. You have a good working relationship with your team, and an excellent understanding of staffing requirements. 

This one nurse is a thorn in your side and you are wise to seek a solution. Often as a new leader, one or more staff members challenge and undermine you. You are doing well not to avoid the conflict, because you will be seen as a weak leader if you ignore her. Trust me, all of your staff is watching the dynamic between you and this nurse. Actually, they are watching you to see if you will establish your authority. This is your first major test.

Your current strategy is defensive and striving to get her to see the reasonableness of your argument but that will not work. Forget the arguments and debates over staffing.

The issue is not staffing, the issue is insubordination.

She has an emotional need to be seen as smarter than you. Her strategy is to bond others with her...against you. She needs to be seen as intellectually superior, or perhaps the Champion of Nurses' Rights, and she knows that her fellow staff nurses are not going to critically question her sweeping declarations of "high acuity", "safe staffing", and "patient safety". 

It's easy to undermine. It takes courage to lead.

You have heard her feedback and taken it under consideration. You have been collegial and respectful. You have had a verbal counseling with her but there were no teeth to the conversation, and she has not changed her behavior. In other words, you listened, you asked her nicely and she refused to change. She may even have felt that she prevailed.

It is time for a performance improvement plan (PIP).

The PIP will be documented and will reference the previous verbal counseling to show progressive discipline. Failure to meet performance expectations will be grounds for further progressive discipline. Be clear on the expectations.

You will listen to any constructive, measurable and positive solutions but the negativity will stop immediately. Negativity affects staff and ultimately erodes patient safety. It is your job to ensure a safe workplace and uphold professional behavior.

Make an appointment with her ahead of time rather than catching her on the fly. This sets the tone that this is serious. The conversation will be about her behavior and performance expectations. Do not by any means engage in a discussion on staffing. That is her trying to deflect the conversation. Be prepared to re-direct the conversation.

Her: "The staffing is unsafe and patient safety is at risk"

You: "We are here today to discuss your performance. It's come to my attention that you are expressing negative concerns at the nurses station. It is unprofessional and must stop immediately".

Note: when a manager uses the phrase "it's come to my attention" employees may demand to know "who said what". This is a move intended to put you on the offense. Do not let it steer you off course, and do not give names. It is OK for managers to evaluate the source and give credence to reliable employees. As a manager, once I hear the same complaint from 2 or more credible sources....I knew there was a valid problem.

You: "We are here to talk about your performance"

Tell her you will meet with her in 2 weeks to touch base regarding her behavior. A common rookie mistake is to have an initial follow-up with an employee, the employee grudgingly improves, and the manager (with relief) does not follow up. The employee shows some initial improvement because their job is at stake, but soon relaxes and falls back into previous behavior.

You must keep a close eye on her performance. She will either improve and sustain improvement...or she will not.

Understand that she may leave, and it might not be a bad thing at all. She basically has one of 2 choices- change her behavior, or decide that she is far too unhappy to work in this unit.

This will be a good learning experience for you, and increase your leadership skills. Loop your supervisor and HR in and follow their directives.

WADR, I will partially agree and partially disagree.

I do not think this poster has tried to have a real conversation with this employee (it isn't mentioned here, anyway).

I think you (@760marie) would be wise to take one more step. (Again, with all due respect) your effort to engage was not an effort to engage. It was an effort to challenge her and call her bluff. Might as well pour gasoline on a fire.

I think this is an important distinction because it isn't uncommon for people who don't have a better method (than to "complain") to actually have something legit that is anchoring their unhelpful pattern.

Your inquiry is very well-written and you sound like you are doing great in your role. Don't make the same mistake that innumerable so-called nursing leaders have made before you by finalizing your opinion and making your labels so that you avoid the inconvenience of having to understand the real deal.

Let's be fair here, there's no doubt that the situation you describe with this employee's actions is problematic, not helpful and overall unacceptable. But it is also unacceptable for nursing leaders to always avoid hearing what might be going on (which would be taking the risk that it's something legit you'll feel compelled to handle/improve) and instead choosing to engage on a superficial (and also rather juvenile) level by challenging someone/calling their bluff instead of hearing their concern.

I think you need to have a meeting and find out what this employee is concerned/dissatisfied with. It might involve having to explain the apples/oranges specifics again. After you have done that, say something like, "I think you understand these these differences in how we are set up (the apples vs. oranges)....so that makes me wonder if there is something else....or other workplace issues that are bothering you...." and see where it goes. Don't be afraid to let her know, "You are a valuable employee and I'll be honest...I'd love to have your support...."

Please consider. There's nothing to lose.

On 10/3/2020 at 12:17 PM, Nurse Beth said:

She has an emotional need to be seen as smarter than you. Her strategy is to bond others with her...against you. She needs to be seen as intellectually superior, or perhaps the Champion of Nurses' Rights, and she knows that her fellow staff nurses are not going to critically question her sweeping declarations of "high acuity", "safe staffing", and "patient safety". 

I forgot to add what it is that I agree with. I agree there's a good chance ^ this is true. I also agree with the PIP if the employee is not going to engage even after being given a bona fide, genuine opportunity to reconsider.

The convo I am suggesting is "going high" (when someone else goes low). It's the high road. It's confirming a suspicion before acting on it. There are a lot of people (maybe most, including leaders) who are not good at reading others and their psychoanalyzing of others is often just their own thoughts about themselves and they judge others right through their own lens. That's why it is important to confirm.

Secondly, failing to use caution in moving forward with discipline could very well backfire. You were told the staff was unhappy before you even arrived. It's possible there was this one RN who has been stirring the pot all along, but it's also possible that there are problems and the others are simply playing it more wisely with their new leader than this one RN is, or are choosing to be "nice" to you in hopes that things will change. If they see that you're someone like all the others who is just going to pick off dissenters....it might not look like the positive move you think it is.

Food for thought, I hope.

I agree that if she is indeed incorrigible then work on getting her out ASAP.

Specializes in Critical Care; Cardiac; Professional Development.

I will add in a suggested book - its not very long and it is VERY enlightening. It's revolutionized how I react and interact in the work place, both in terms of coaching others and in terms of caring for my own interpretations of challenging things at work.

1 hour ago, Nurse SMS said:

Interesting viewpoint. I have found applying her thought process to my own emotional responses to be extremely useful and literally has catapulted my career.

I'm glad your career has catapulted and I do think it's great if you were able to receive and apply something she said in a useful way. ?

There might be a sliver of what she says that I do believe, although as far as I can tell I apply it completely differently. For example, I think it's good to concern myself with being and doing my best despite what other people do. I think it's best to positively and proactively decide what I'm  going to do instead of simply reacting to what you have (or have not) done. It's just that the other side of it is that, in doing so, I do not and will not put myself in the emotional position that it is my duty to make good on the actions of another entity no matter what they may be.

I also don't believe that anyone gets to act with impunity and then turn around and demand what others' emotional responses should be. I see it more as "You had your turn to decide how to invest and apply yourself in this situation. Now it's my turn." So if you were the manager who said "suck it up" instead of staffing the unit properly, I will still be there and (because it is best for the patient and for me) I will still do my absolute best to take good care of the patients for which I am responsible. But when it takes me longer to answer a call light, I will not be telling the patient your preferred scripting such as, "I have the time...". Maybe lying to people to cover up someone else's choices doesn't make me feel whole and doesn't work toward the end of me doing my best. So I won't do it. Maybe, in order to respond to other entity's choices, I need to relieve myself from some of the extraneous preferred duties of the other entity. So, I will.

I will not be doing things angrily, sarcastically and spitefully, either.  It's just that I believe the other entity has lost their right to dictate how I will feel and suggest what my "best self" actions (in response to something I don't control) should look like. 

Her whole schtick is based in gas-lighting. It requires others to believe that it's just them and things simply aren't that bad. I'm not misunderstanding her, she gives the very example right off the bat: The patient is really close to being ready for surgery and is sitting in pre-op with a wrong chart. Ms. Wakeman's ideas require that the nurse not feel the *natural feelings of seriously frightening near misses*, and instead must BREATHE and then get right back in there like a champ and make sure the patient isn't freaked out [because *my* livelihood (or this business) depends upon you doing that!]

The best manager I ever had did teach us that we choose how we will respond to things around us; that things around us did not force us to respond a certain way. It took me a while to think through that and I ultimately agreed with her and it changed my life. **BUT** - - she also was not suggesting what one's chosen response would look like, just that however one responded, it should be understood that the response was a choice.

I do accept that idea.

3 minutes ago, Nurse SMS said:

I actually disagree strongly with your interpretation of the bolded portion above. I interpret that far more as "Yes, we are all freaked out that near misses happen, but reassuring the patient is the most important thing we can do right now".

I agree that a reactionary calling for heads to roll in a hotheaded manner is not productive.

I'm not sure I agree that reassuring the patient (that, 'hey, it's cool, I know it seems completely freaky but actually our system is working!') is the most important thing. It might be to the hospital.

What if my absolute best is performing an actual nursing assessment (VERY LIKELY) rather than proving reassurance whether it is appropriate or not? And what if my assessment is that, despite my careful explanation of processes we have laid out, the patient is not reassured and prefers to return on a different day (which might even mean that they choose care elsewhere)?

Is that okay with Ms. Wakeman?

Because her spiel sounds a lot like it requires certain outcomes to be achieved.

Call the response less than ideal. Well, sure it's less than ideal--the whole situation is less than ideal. So why is she there mocking only one portion of it?

She doesn't like the finger-pointing (and I agree that's not good)--but she's also pointing a finger.

 

Specializes in Critical Care; Cardiac; Professional Development.

From a humanitarian standpoint, providing reassurance and explanations is the right thing to do. I usually love the things you post, but sometimes your view of leadership and management is highly skewed toward cynicism and outright hostility based on your personal experiences. I just don't see the presence of matrix outcomes the way that you are in this situation. I see a nurse being encouraged to get past her overly emotional reaction to go take care of a patient who has been frightened to death.

3 minutes ago, Nurse SMS said:

From a humanitarian standpoint, providing reassurance and explanations is the right thing to do.

Just disagree. Reassurance is not always warranted although explanations and especially active listening almost always are.

Reassurance is inappropriately utilized as a tool over and over and over in numerous ways in this business. In fact, the off-hand "I have the time" example I already gave is one of said innumerable inappropriate reassurances, that is to say, those primarily meant to deceive.

Specializes in Psychiatric Mental Health, Addiction, RN-BC, CARN.

Thank you everyone for your suggestions, experience, and conversation. Here is the latest update:

I met with our interim HR manager for 2.5 hours. I was expecting no more than an hour meeting as the original intention was to review the current bargaining contract, review my documentation of anecdotal notes and get direction on future account documentation. The reason the meeting was so lengthy was a majority of the time was spent on the HR manager getting my perspective of the unit needs, complaints from other staff (r/t both staffing and said nurse), and solutions I or management have offered/initiated. It turned out the nurse had met with HR just two days prior to my scheduled meeting. 

I received good direction from HR specifically in regards to not labeling behavior, just being factual. She educated me on the disciplinary process, my involvement as a supervisor, and the responsibilities of management. I then met with my manager and learned of other reported actions by this nurse related to her now documenting timelines of my comings and goings during the shifts I work with her. My soul ached learning this because I want my team to be able to rely on one another. I have nothing to hide, and my manager voiced she knows I do my job and more each day.

My manager has given me a gift by calling an all staff meeting at which she and our Director of Inpatient services shared the timeline of what has been in the works for nearly a year to address our budgeting and staffing needs. Joint Commission survey followed by COVID put a halt on progress for a while, but an additional FTE has been posted meaning both AM and PM shifts have an aide for the full shift rather than 1 cross shift aide. Our current full-time and per diem cross shift aides chose to transfer to my shift over morning shift, so I can't be that terrible of a leader :).

Hopefully, this addition to staffing will squash any further complaints. Annual evaluations are due so there are a couple of points in regards to her performance which are necessary to address. I will be certain to help her to focus on the topic at hand being her performance, rather than who she feels is to blame. "...we are here to discuss your performance." 

Talking this situation over with my mom and a couple of friends who are also in leadership roles, I have identified for myself the most important actions I need to take right now is pray. I need to pray for peace and happiness for this nurse. I need to pray to gain compassion for this nurse. And I need to pray to remain focused on having an open heart so that I can serve as the leader I know I am and the leader my team needs. I will continue to document as needed, but rather than "coach", I will role model. I have been asked to trust there is a solution in the works. This is such a relief, because now I have more time and energy to channel into patient engagement and unit/program improvements; the stuff that brings me joy and a sense of accomplishment as a nurse.  

Words Matter said:

[...] so I can't be that terrible of a leader :).

Since I shared some strong opinions before, I want to say that you do sound like someone who is trying to be a great leader. I just happen to think that both sides have a history of quite the "us vs. them" mentality. Staff nurses aren't privy to all the pressures of management and therefore can be overly-critical, sometimes irrationally so, and (some) managers are quick to cross right to the other side and become rather dismissive practically overnight as if they instantly forgot the stressors of the staff RN role.

You are doing your due diligence and sound very much like someone who cares.

Neutrality (as opposed to defensiveness) and straightforward communications are some good principles to not let fall by the wayside as you go forward. It simply isn't that difficult to neutrally listen and evaluate whether there is truth in someone's complaint/concern, and just level with them about it. There is so much angst and an incredible amount of drama that could be eliminated in this profession if that could happen (it seems to me).

Anyway, I'm glad you've had some assistance and hope things keep moving forward in a positive direction.

Specializes in Psychiatric Mental Health, Addiction, RN-BC, CARN.
21 hours ago, JKL33 said:

Since I shared some strong opinions before, I want to say that you do sound like someone who is trying to be a great leader. I just happen to think that both sides have a history of quite the "us vs. them" mentality. Staff nurses aren't privy to all the pressures of management and therefore can be overly-critical, sometimes irrationally so, and (some) managers are quick to cross right to the other side and become rather dismissive practically overnight as if they instantly forgot the stressors of the staff RN role.

I appreciate your feedback and strong opinions. We all have so many experiences, personal and professional, informing our opinions, responses and reactions. I like what was said in one of the earliest comments about going high when someone comes in low. This is something I need to take ownership of to the point it is ingrained in my character. Honestly, I'm not there YET (AEB the thoughts and silent dialogue that sometimes occurs between my ears!), though at the very least I want my actions to communicate I am a fair and approachable leader. 

There is too much us v. them in the world in general. I appreciate the  awareness of this problem and direction toward collaboration in healthcare. Though I don't foresee getting away from "doctor's orders" anytime soon, interdisciplinary teams/councils/committees, patient centered care, trauma informed care, the care continuum are all the result of working together ?

Specializes in Psychiatric Mental Health, Addiction, RN-BC, CARN.
On 10/15/2020 at 12:09 PM, Nurse SMS said:

revolutionized how I react and interact in the work place, both in terms of coaching others and in terms of caring for my own interpretations of challenging things at work.

No Ego by Cy Wakeman

Here is a link to her keynote speech at the Magnet conference in 2018

I found Cy Wakeman humorous. What I got out of her talk was leading others to uncover they often do have the ability to create their desired solution to meet many challenges. Many times I've observed intelligent and experienced professionals going to their leaders to "fix it now". So many little fires need to be extinguished before making actual progress on projects which can have real long term benefit. I would love to get that time back! Maybe because I share the professional background in mental/behavioral health, one of the foundational statements she made about not being able to be in ego (I.e. self centered, self serving, blaming, judging) and higher self (e.g. serving others, collaborating, creative solutions) at the same time is a game changer. This is cognitive behavioral therapy applied to leadership!! I've been teaching CBT coping skills to my patients for years and never considered application in the workplace (mind. blown.).

Thanks for the recommendation - I just downloaded No Ego to my Kindle app. Since I have a brief hiatus from my Master's program, I am looking forward to this read.

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