Looking for advice from nurses in Leadership roles with my current situation...

[Cali_RN18, ADN, BSN, RN]

Hi fellow nurses! I have been a nurse for almost 3 years in an outpatient dialysis clinic. I am still learning and growing myself as a nurse and about 9 months ago I stepped up to the positions of clinical coordinator and became a preceptor in my clinic. We are trying to grow the clinic to admit more patients which translates into having to hire and train new nurses.

My boss hired a new grad RN prior to me being me being a preceptor which meant he had to be trained at a clinic with a nurse who was a preceptor before coming to our clinic. This RN is in his early 20's and this is his 1st Job as an adult. He is extremely smart and knowledgeable of the nursing process and he even made an effort to try to get to know our team of nurses and PCTs prior to starting. He has memorized every P&P in our company and is obsessed with being perfect. When it was time to transition to our clinic he was given 2 additional weeks of training to get to know our patients and acclimate. He was doing okay for about a week and then his whole demeanor changed.

He started quizzing the PCTs on their role, started micromanaging them and criticizing them. The team started to get real mad and complained to me. As clinical leadership I had to speak to him about why he was treating the staff like he was and that they felt disrespected and all he could respond with was a laundry list of things they do wrong and the other techs where he trained were perfect.

He has been working with this kind of attitude for almost 6 months and it keeps getting worse. I have had several coaching conversations with him and he does not take constructive criticism well. He comes up with a defensive responses each time instead of having active listening or offering solutions

We hired another nurse whom I did train. She is an amazing nurse. He constantly is checking her charting when she goes to break and watches her like a hawk. If he feels like she is breaking policy, he will tell her what she is doing is wrong. This behavior is making her question her abilities and I don't want to loose her!

I don't know how to get through to him at all. He refuses to see any fault in his delivery/behavior. I have tried to give him examples on how to make his day go better and he just will stare at me with no responses. Since he is more concerned with what the PCTs are doing vs trying to learn and grow as a nurse he has had minimal growth. He has even made 2 major med errors.

Every time I show him another task within his role he gives me 10 reasons why he does not have time to do it and complains about how busy the clinic is. I have gotten to the point where I snap at him or speak to him in an annoyed tone, but I am so over trying to help. He is miserable working in our clinic. I feel like it is his own doing. If anyone has any advice on how to get through to personalities like this please share!

[CritterLover, BSN, RN]

Do you have the ability to terminate his employment? If not you need to talk with whoever does, because I don't think this is going to work out.

I think you're going to have to have another meeting with him.

Lay out your expectations for behavior. Be clear. Do not soften the information. No more "suggestions" (suggestions are optional). He needs to do the new tasks (he might have time for this if he'd stop auditing his coworker). He needs to stop monitoring his coworker's work. While he might still need to monitor the PCTs' work, he needs to limit what he is monitoring -- only what impacts him. Turn some of your suggestions into instructions. Call him out on his defensiveness.

If you are able (meaning that if you have firing authority or the backing of whomever does), be explicitly clear that if his behavior does not change, he will be terminated.

Lay out expectations of how long he has to make changes:

• As of now, I need you to stop monitoring your coworker's work.
• As of X, I need you to start doing Y (a task he says he can't complete).
• As of Z, I need you to start doing A (another task)
• When it comes to monitoring the work of the PCTs, my expectations are that you will ______
• and so on

Start the disciplinary process/get a PIP going if your company has them.

Loop HR in on this if needed.

Good luck.

[K+MgSO4, BSN]

Agree with above but also write file notes for everything either electronic or by hand. Tell him that you are keeping notes and provide him with a copy of each note.

[JKL33]

On 2/27/2020 at 5:08 PM, Adri0418 said:

He is extremely smart and knowledgable of the nursing process

He really doesn't sound like either of those two things. He sounds like someone focusing on minutiae which he can criticize as a means of distracting everyone from his own deficiencies (real or perceived).

On 2/27/2020 at 5:08 PM, Adri0418 said:

even made an effort to try to get to know our team of nurses and PCTs prior to starting

This sounds nice but it's somewhat likely that it was just manipulative. He tried to preempt everyone's scrutiny by disarming them, then when the rubber hit the road and he actually had to perform he freaked out and went into "distraction as a tactical maneuver" mode.

He's either fairly inept or just thinks he is. Truly capable people rarely behave this way...they're too busy actually doing what they're capable of.

Unfortunate situation.

[TheLastUnicorn]

You may also want to inform him that chart checking another nurse is not his job and counts as a HIPAA violation. Assuming, he has no business being in that patient's chart.

As the other's said. I do hope you have been formally keeping record of all of this, because if you haven't up to this date; none of it matters. You can't say "well, I've spoken to him on multiple occasions" unless you've formally written him up and had him acknowledge there was a verbal reprimand.

You're management. You tried to be nice. It didn't work. This employee is toxic to your work environment. You can either protect him and his "first adult job because he's just young and new", or you can protect all your other employee's. If I was one of your other employee's and I kept reporting and having to deal with this nurse and nothing seemed to be done and he kept getting worse? I assure you they are looking for other jobs. It's very clear he's not going to change. Get rid of him.

[Wuzzie]

He is exhibiting narcissistic and bullying behavior. He is creating a hostile work environment and probably has people fearing for their jobs. This will not improve. Trust me on this one. A written work improvement plan must be developed with clear consequences for failure. You will need this to prove cause for termination which this situation is going to come to I just hope it’s his and not one of his victims. You definitely need to loop in HR and upper management now otherwise he will do his best to ingratiate himself with them and you will be in the cross hairs.

Please note there is a difference between identifying narcissistic behaviors (which all of us demonstrate from time to time but most manage to suppress) and saying someone has narcissistic personality disorder which, since I am not a psychiatric provider, I am most certainly NOT doing!

For funsies Google “narcissistic employee” and enjoy the read. It’s hair raising unless you are experiencing it.

[Cali_RN18, ADN, BSN, RN]

Thank you all for the responses. I think the best move for me is to meet with this nurse and all the higher ups who do have the authority to terminate him and have a final written warning regarding his behavior. I truly appreciate the feed back!! I will update this post at a later date.

[caliotter3]

Just wanted to address the new nurse that you have concerns about leaving, due to the problem nurse's influence. Approach her and give her a short input on how well she is doing in addition to a very important emphasis that she is to look for performance feedback from you. Be careful not to discuss your problems with the behavior of the other nurse with her, you don't want to make matters worse. But make it clear that you are pleased with her performance and that she needs to seek feedback from you. Then, follow up on this short talk, on occasion, by giving her unsolicited positive feedback to keep the proper supervision lines of communication open. Do this especially if the problem does not leave. He could be a negative influence for quite some time, so you want to try to minimize his bad apple effects on others that you want to retain. Good luck with this.

[Jory, MSN, APRN, CNM]

Classic case of wrong person in the wrong position.

The nursing pool is not so bad that we can't do better.