Manager Retaliatiin

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Ive been employeed @ the the same acute care facility for 24 years. The manager I recently submitted an incident report for her recent recccomendation to chemically sedate a patient d/t lack of staff available to do 1:1. In addition, at out facility the night shift has only 2 nurses & no techs. The only additional help we have is from lab & radiology (if they aren't busy). Lately the acuity of our patients have been high. 5 of 10 patients require minimum of 2 people to transfer which leaves the other 9 unsupervised while we are those patients rooms. Our manager sees no reason why we cant take additional admissions through the night. At the last unit meeting, I told her i was concerned about the patients safety seeing as though we had 2 falls in last 3 weeks. I also told her that on those nights of 10 high acuity patients with only 2 RN's, I will inform ER that we cant accept admissions as to not risk patient safety or jeopardize my license. She wrote me up for being verbally abusive. Do I have any rights in these situations?

Specializes in Psych, Addictions, SOL (Student of Life).
24 minutes ago, MunoRN said:

You could potentially argue to HR that your manager is creating a hostile workplace by writing you up for an invalid reason, although you may have less of a case for that if you also wrote her up for an invalid reason.

Generally, a 1:1 sitter is for patients with a medical or psychiatric condition that is causing behaviors that justify being controlled. Treating the symptoms causing these behaviors is not a form of chemical restraint, and if anything failing to treat these symptoms without a valid reason is potentially neglect or abuse. It's pretty rare that a person would have symptoms that justify a sitter but don't justify medical management, so it's possible your write-up of her equally invalid.

Without knowing exactly what was said I am not sure about the write - up but the law that addresses chemical and physical restraint these things should only be used as a last resort and never for the convenience of staff. Always confer with the physician and thoroughly document everything. A person who is trying to get out of bed and has been sedated might still try to get out of bed and fall so may still need 1:1 supervision. There is some very good evidence based studies on fall safety after sedation.

Hppy

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Specializes in Critical Care; Cardiac; Professional Development.

Advocating for patient safety is not verbally abusive. However, you have not really answered as to whether you got very mouthy while doing that advocating. Did you call names? Did you get loud? Did you use phrases like "This is stupid" or "Only a moron would do this" or "You are an idiot"? Did you swear or imply swear words (ie: F..this)? Did you toss, drop or slam anything? Were you professional or were you visibly angry? Your motives were above reproach but you have not really answered as to what your method was like. Method does matter even when the motive is noble.

If you remained calm and respectful in your dissent, then you should go above your manager. If you didn't, take it as a lesson learned.

Some infractions go right to written final warning, so no, a verbal warning is not necessarily required.

Either way, you probably won't want to work there anymore and should consider seeing what else is around. I am sorry you are going through this. Thank you for working to protect your patients.

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Specializes in ICU, trauma, neuro.

There are two important (maybe more) take away lessons from your experience:

a. EVERY nurse needs a union, not for better pay or benefits (although these are always nice), but just to help insure that basic due process and fairness is present. Otherwise, you are at the mercy of capricious management.

b. If you are going to stay in bedside California is essentially the only state where it is somewhat reasonable. At least there you have ratio and break laws that are somewhat enforced.

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Specializes in Ortho, Med surg and L&D.

I want to share a link here that lists out some options at the end, (it also lists some traits of toxic bosses.)

https://fairygodboss.com/articles/signs-of-toxic-boss

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Just some comments.

1) Not sure if all states do this, but Texas BON has a 'Safe Harbor' form that a nurse can give to the supervisor before their shift starts. It is paper informing your employer that the shift is unsafe and you would be granted immunity if something happens (this is somewhat a summary of the policy).

2) You can report her to her supervisor (or the board of nursing) for suggesting chemical restraint, and she seems like she would throw you under the bus.

3) You can document that you requested a 1:1 sitter for a patient and that you were denied that request.

It seems they are first to give you a patient, but not take the patient themselves.

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Specializes in Psychiatry, Community, Nurse Manager, hospice.

What was going on that you felt like a prn was a chemical restraint? It may have been. I am just not sure. If the patient was agreeable to something to help him sleep and you are working night shift, it is not a chemical restraint, no matter how much of a pain in the *** he is. If the patient was so anxious or psychotic that he was behaving in a way that could cause harm, then a prn anxiolytic or antipsychotic is necessary. If the patient is not at risk of self harm or harm to others, but wanders into other people's rooms to chat that is something that you probably need a sitter for.

You certainly have the right to make the decision on whether or not to use a prn for your patient, and your manager can't override that.

I think you were wrong to write an incident report for this because it was not an incident. I'm not saying don't document it. You should document in your note that you requested a sitter and were told none were available.

An incident is an event. It would have been an incident if the patient ripped his line out, threw poop at staff, etc. Then risk management can get involved and they may identify the lack of 1:1 staff as a cause of the problem.

You used the incident report to write up your manager's behavior. Whether or not she deserved a write up, you should not have used an incident report to do it.

You felt the manager gave you bad advice, and you were upset that you did not have 1:1 staff. These are important concerns. If you felt like you needed to do more you should have told her that you feel its important enough to go up the chain of command. If she was really unable to get you 1:1 staff, this helps her too. She could choose to advocate for you in that situation. Or she could say, "Okay, I understand. Let me go to my boss first and see if I can get you a 1:1."

Did she retaliate? Maybe. Your relationship with her is damaged at this point. She felt like you went after her and she turned around went after you. Maybe she really did feel like you were being verbally abusive, just like you thought she gave you bad advice. But you are now in a tit for tat with your manager and even further from solving the real problem which is that you are not getting adequate support on the unit.

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7 hours ago, FolksBtrippin said:

If she was really unable to get you 1:1 staff, this helps her too. She could choose to advocate for you in that situation. Or she could say, "Okay, I understand. Let me go to my boss first and see if I can get you a 1:1."

She said she worked night shift, administration is usually available during the day. If she needed a 1 to 1, it may have been an immediate need and 'waiting for the boss' may not have been an option. This is when falls or safety concerns happen.

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On 6/27/2019 at 12:58 AM, MunoRN said:

You could potentially argue to HR that your manager is creating a hostile workplace by writing you up for an invalid reason, although you may have less of a case for that if you also wrote her up for an invalid reason.

Generally, a 1:1 sitter is for patients with a medical or psychiatric condition that is causing behaviors that justify being controlled. Treating the symptoms causing these behaviors is not a form of chemical restraint, and if anything failing to treat these symptoms without a valid reason is potentially neglect or abuse. It's pretty rare that a person would have symptoms that justify a sitter but don't justify medical management, so it's possible your write-up of her equally invalid.

While I hope this to be true. I don't believe you could win this argument with the state board of health when they do their survey. I think they would tag it as chemical restraint.

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Specializes in Ortho, Med surg and L&D.

I agree, as far as I understand it medicating someone as you described is a chemical restraint.

Jen

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On 6/26/2019 at 1:51 PM, Djadia said:

Ive been employeed @ the the same acute care facility for 24 years. The manager I recently submitted an incident report for her recent recccomendation to chemically sedate a patient d/t lack of staff available to do 1:1. In addition, at out facility the night shift has only 2 nurses & no techs. The only additional help we have is from lab & radiology (if they aren't busy). Lately the acuity of our patients have been high. 5 of 10 patients require minimum of 2 people to transfer which leaves the other 9 unsupervised while we are those patients rooms. Our manager sees no reason why we cant take additional admissions through the night. At the last unit meeting, I told her i was concerned about the patients safety seeing as though we had 2 falls in last 3 weeks. I also told her that on those nights of 10 high acuity patients with only 2 RN's, I will inform ER that we cant accept admissions as to not risk patient safety or jeopardize my license. She wrote me up for being verbally abusive. Do I have any rights in these situations?

I would look up the policy on what is considered verbally abusive and see if it fit. If it did then just take your punishment and move on, if not then I would address it with HR. I bet your manager is miffed for sure. Probably a good time to look for other work. She's not going to forget it.

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Specializes in Psych ICU, addictions.
On 6/26/2019 at 10:51 AM, Djadia said:

Ive been employeed @ the the same acute care facility for 24 years. The manager I recently submitted an incident report for her recent recccomendation to chemically sedate a patient d/t lack of staff available to do 1:1. In addition, at out facility the night shift has only 2 nurses & no techs. The only additional help we have is from lab & radiology (if they aren't busy). Lately the acuity of our patients have been high. 5 of 10 patients require minimum of 2 people to transfer which leaves the other 9 unsupervised while we are those patients rooms. Our manager sees no reason why we cant take additional admissions through the night. At the last unit meeting, I told her i was concerned about the patients safety seeing as though we had 2 falls in last 3 weeks. I also told her that on those nights of 10 high acuity patients with only 2 RN's, I will inform ER that we cant accept admissions as to not risk patient safety or jeopardize my license. She wrote me up for being verbally abusive. Do I have any rights in these situations?

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Since I wasn't there to hear exactly what words you said and--just as importantly--how you said them, I can't say whether you were verbally abusive.

You can certainly pursue the matter with HR if you feel that the write-up is unfair and in retaliation.

However, I would also consider looking for another position. Not only does this sound like it's not the safest place to work, but it also looks like you've got a target on your back. And if you do report this to HR, I expect your manager will be gunning for you even harder than she is now.

Best of luck.

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