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

[JKL33]

2 hours ago, Words Matter said:

Many times I've observed intelligent and experienced professionals going to their leaders to "fix it now".

And vice versa! I'm mentally throwing my arms up in the air here (which I would never actually do)....LOL ?

Come on, whatever plans, desires and flat out fantasies get dumped on leaders actually get shoveled right on down to the next stop as well. "Sorry, no more staffing, but you guys fix it. You'll just have to do abc....xyz because this what we have to work with..."

One leader was so proud of getting another nurse tech FTE. What leader-y thing was done to accomplish it?? Stole the FTE from another department and added the work of that role (in the other department) to the RN's plate (in the department that "gained" the FTE). Imagine something like stealing a dietary aide and letting them be a nurse tech on the floor and then telling the RNs (?) to assist patients with meal ordering, pass trays and deal with all meal-related issues. (It was worse than that, I've tweaked the example). Then people were absolutely begrudged for having an uncertain, less-than-congratulatory response to the leader's actions.

And that is my whole argument here. This ego-awareness requirement doesn't often go both ways. Kind of like it is rather rare to hear talk of the Code of Ethics when people are talking about what leaders do. As if there's a level of importance one can get to in nursing where it doesn't apply anymore and the entire foundational tenets of nursing ethics just magically change.

[Emergent, RN]

I think the speaker gives good advise about the preop scenario, even though she is one of the annoying, touchy feely types. She has a lot of insights into the dynamics of the healthcare workplace. 

[Jeff Keeth, BSN, MSN, RN]

My suggestion. As a lead nurse, if possible,  I think it'd be better not to take any patients yourself. Lead the floor in general, perhaps (depending on what's involved),  take care of most if not all admissions & discharges. Assist nurses with on-going care, etc. This also helps with your shift reports. There's always at least 1 nurse that thrives on bucking the system, complaining, gossiping,  etc. At some point you and the manager may need to have a meeting with her to explain the consequences of her actions. BTW, it sounds like you are very effective in your position. NOTE please my catch words.....if possible ;depending on what's involved.

[Words Matter, BSN, RN]

Thank you Nurse Beth! I'll let you know how the conversation goes, and will be certain to keep the focus on her performance. Sounds to me like you have rumbled with this type of employee. The good news is my manager completely supports my efforts, has faith in my abilities, and is available for guidance. 

[Nurse Beth, MSN]

6 hours ago, 760marie said:

Thank you Nurse Beth! I’ll let you know how the conversation goes, and will be certain to keep the focus on her performance. Sounds to me like you have rumbled with this type of employee. The good news is my manager completely supports my efforts, has faith in my abilities, and is available for guidance. 

You are so welcome. You are so fortunate to have a supportive manager and I'm sure she knows she is fortunate as well to have you.

Another tactic with a Negative Nelly is finding a way to channel her negativity by giving her responsibility. For example, making her a lead or chair in a unit-based council or ad hoc performance improvement group. This makes her part of the solution, not just the problem. She could be charged with finding ways to improve within set boundaries, such as budget and ratios.

Some employees respond very well and rise to the challenge.

Either way, I'm excited for your growth and development in your new role.

[Words Matter, BSN, RN]

On 10/5/2020 at 7:49 AM, Nurse Beth said:

Another tactic with a Negative Nelly is finding a way to channel her negativity by giving her responsibility. For example, making her a lead or chair in a unit-based council or ad hoc performance improvement group. This makes her part of the solution, not just the problem. She could be charged with finding ways to improve within set boundaries, such as budget and ratios

I'll keep trying on this effort. I have faith people will rise to the occasion. So far, recommendations I have made have been shot down by her, "I did that before, and nothing came of it". I encouraged her to try again. I have even coached her on the type of data she can document to support her effort for another FTE. We must have the data to back up any proposed changes and requests. I invite her to our monthly UPC which meets through Microsoft Teams, and request input on the agenda with an invitation to be part of the conversation. Currently, her personal annual goal is to attend a seminar on nursing management/interventions for the anxious patient, and I suggested I could request admin hours from the manager for her to prepare a brief presentation for her peers during UPC to apply interventions with our detox patients. All annual reviews are to be done a month early this year, so I hope the seminar is prior to her review. I would love to know her excited about the material she was exposed to in the seminar. BTW - no next level conversation yet. She was on PTO, then worked the following weekend when I directly observed  two instances of misconduct and defiance while she was charge RN and I was on admin. Per my manager's recommendation, I have reached out to HR for guidance on appropriate documentation leading up to and throughout the disciplinary process, if this is the necessary path. Everything must be just right, so we follow all union agreements and the law. I took this role because I was excited about the ways we could improve our patient engagement, care and programming. This whole experience with this nurse has been too much reality...

[Words Matter, BSN, RN]

On 10/11/2020 at 6:57 PM, JKL33 said:

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.

You are absolutely right. And we have had several 1:1 conversations at her request which end with her sending a text or email stating she appreciates feeling heard and supported. I want her to succeed and feel she's done good for at least one patient during each shift.

During the short time with my new team we have gained a person who is dedicated to patient rounds (in behavioral health, because the patients are engaged in milieu therapy and have varying types of safety risk factors, we must document each patient's location and affect/behavior Q30 minutes), and fast tracked RN's ability to assess an intoxicated pt at intake rather than waiting until they arrive on the unit, which will lead to a reduction in immediate ED transfers for medical clearance, reduction in Code Greens responding to belligerent patients, and hopefully decreased AMA's < 12-24 hours. RNs used to do the rounding until a few months ago. 

I like your suggested scripting in the last major paragraph of the referenced post. I am going to borrow that. 

[Nurse Beth, MSN]

5 hours ago, 760marie said:

 This whole experience with this nurse has been too much reality...

The reality is that one bad employee takes up 80% of your time, diverting your energies from your deserving, high-performing employees. I'm sure that leaders before you chose to ignore the behavior, using avoidance as their conflict management style.

But you are dealing with it. Trust me, this is all worth it in terms of your growth, your staff, and mostly, the patients you advocate for. Stay the course, it will be resolved one way or another. 

Remember, this employee is choosing her own outcome.

I love all the initiatives you are implementing! We need more leaders like you.

[JKL33]

9 hours ago, Nurse SMS said:

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

Anyone just want to have an all-out discussion with me? ?

I don't get what I'm not getting.

I've made it through 8 minutes of the above address and I can't help myself, this kind of stuff makes my stomach turn.

I've had an experience not unlike what she is talking about (in principle) in these first minutes of this speech and felt absolutely patronized by a similarly-enthusiastic non-nurse [in my scenario helpful people had reorganized our entire department to "streamline things" and it ended up with a piece of critical equipment not being at hand when I needed it a critical situation].

So here I am watching this address (above) and waiting for what wonderful way this speaker is going to handle this upset pre-op nurse and....

.....

SAME.

??

I'll try to keep watching and I am trying to have an open mind but this stuff makes me feel almost insane. Like I live on another planet or that the workplace has become some sort of alternate reality where a few people are supposed to constantly find their new best selves--always for the benefit of others, and always in order to facilitate what others want to do.

Anyone want to bite? I feel like talking it out...LOL

[JKL33]

I'm up to 28:00 and dying to understand the appeal.

Rules for thee but not for me...

The part I'm on now is literally about how others are to behave in an ideal manner despite things not being ideal. That would be decent if it were actually about people and their personal well-being. But it isn't. The reason people need to be encouraged and empowered to respond in her ideal way is so that some other people can avoid ideal behavior with complete impunity, since, no matter WHAT happens, they are only required to do the exact thing she is disparaging, which is pointing out what others should be doing about the not-ideal thing.

She completely patronized the nurse who was humiliated at the bedside related to the hospital's processes.

I'm sorry @Nurse SMS, she is utterly lacking in humility and too smug for my taste. So far she has told a nurse "BREATHE....you need oxygen" (hardy har har) and now compared her MO to dealing with a 2-year old.

She is wrong and part of the problem.

[Nurse SMS, MSN, RN]

On 10/16/2020 at 11:30 AM, JKL33 said:

I'm up to 28:00 and dying to understand the appeal.

Rules for thee but not for me...

The part I'm on now is literally about how others are to behave in an ideal manner despite things not being ideal. That would be decent if it were actually about people and their personal well-being. But it isn't. The reason people need to be encouraged and empowered to respond in her ideal way is so that some other people can avoid ideal behavior with complete impunity, since, no matter WHAT happens, they are only required to do the exact thing she is disparaging, which is pointing out what others should be doing about the not-ideal thing.

She completely patronized the nurse who was humiliated at the bedside related to the hospital's processes.

I'm sorry @Nurse SMS, she is utterly lacking in humility and too smug for my taste. So far she has told a nurse "BREATHE....you need oxygen" (hardy har har) and now compared her MO to dealing with a 2-year old.

She is wrong and part of the problem.

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

[Nurse SMS, MSN, RN]

25 minutes ago, JKL33 said:

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.

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". Freak outs and digging for root causes happens much more objectively and logically when the emotional part of it has been nixed. Overly emotional, "heads must roll" tactics at work, in my mind, are unproductive, unprofessional and absolutely not useful. I interpreted this as helping people get past their knee-jerk emotional reactions to a place where logic and purpose can take over.