Mayhem of a PICU unit

KatyM · Jun 13, 2005

Eeek! I'm really sorry. I must have missed one (auto message). I have had one non-obscentity censored though....maybe it was that?

Katy

KatyM · Jun 14, 2005

Edited the first post so it's less of a handful.

Katy

kmchugh · Jun 16, 2005

A senior staff member on my PICU unit is overzealous...

My first thought after reading your post was not that this woman was "overzealous," but rather that this woman was seriously mentally ill. Perhaps that judgment is a bit too harsh. However, I think it is fair to say she has serious control issues where patients are concerned. (Don't we all, to one degree or another.) However, tapping a patient simply because the patient expressed a desire not to be touched goes beyond control. It could even be said to border on assault. Whenever you choose to call it, this woman's actions can in no way be considered therapeutic. If I understand you correctly, you are in an intensive care unit which makes her actions even more questionable.

This woman needs to be reported to your supervisor immediately. Personally, I think it's critical to do so before her actions harm a patient or create complete chaos within the unit. This is exactly the kind of nonsense an intensive care unit does not need.

Kevin McHugh

suzanne4, RN · Jun 16, 2005

I definitely agree with Kevin on this one.

KatyM · Jun 17, 2005

Thankyou. Yes I am in an Intensive care unit.

The whole situation has been stressing me beyond belief. I've waited years to find my niche, and have finally found my 'calling', and really want to make a difference. I've not worked much in my past (teen mum) have battled mental health issues myself, and when I finally embark on something I've been waiting to do for years, I encounter this. I've only been there for eight weeks, and have hardly had time to build my own confidence with the basic issues within the job, but I can't ignore this, yet I suspect that such are the staffing levels, and the demand to supply a qualified member of staff each shift, that sometimes a blind eye is turned. I don't know.

A qualified member of staff tenatively touched base with me last night about Zealous' behaviour, and we swapped notes. It was also hinted that I should 'watch my back', and was told to make sure I kept accurate logs on incidents.

it's not so much the 'official' responsibility I carry, or not as the case may be, but the moral one which is chewing at me, my current inaction and how that effects the patients, but on the other-side of the coin a good working relationship is fundemental to the team in this kind of environment, and I'm not convinced the Z is disliked enough on a personal level among the team for me not to be sent to coventry (so to speak) as a result of being the new upstart who has made waves. If this happens I will never cope in the environment and won't be able to offer my strengths to the system in the longterm.

This is what I am going to do. I'm going to chat with my Clinical advisor and tell her exactly how I feel, and suggest (and I think she will back me up on this) that I request that I am not put on the same shifts as her as much as they are able to cater for that.

The guy who draws up the shift pattern is my favourite member of staff, and has been absolutely invaluable to me as my unofficial mentor (I never received one, there has been a staff turnover, my official mentor was off sick when I joined, and no replacement organised, so they all kind of mentor me), he doesn't consider himself my mentor I'm sure, but I see him as such. I shall simply tell him that although I realise that I am being unorthodox, that unless I am able to avoid working with her as much as possible then she is likely interfere with my confidence and progress in finding my feet with this job, and that I want to be able to build this confidence before I have to deal with working with a member of staff I find difficult. I shall tell him that I have no intention of going into detail with him as I realise the conflict of interests involved in airing such concerns among team members of the same level or lower, and that I'm simply asking that he cater for my reservations by taking the fact I have difficulty on board whilst drawing up the rota in future.

Meanwhile I will have aired my concerns with my clinical advisor who happens to be an extremally close friend of my 'mentor' and is on a different team, and I shall give my permission for her to discuss this with him if need be. I know he dreads working with Z too! He is also my Union representitive, so any concern I have will be taken extremally seriously by him, but I think he is a lower grade than Z.

I am hoping that between him and my advisor, Z will be watched/considered more carefully and hopefully a more senior member of staff will report an issue (and there's always plenty of them) that they get to witness first-hand.

The latest shift involved a disorganised schizophrenic with learning disabilities (the guy who goes through periods of not liking to be touched) who, whilst on his unescorted time out for the first time brought a lighter back to the ward, which is he is not allowed to have, she demanded he hand it over, and he refused. She asked him several times, and eventually told him that if he didn't hand it over that she would restrain him. When he looked as though he was going to continue to refuse, she hurriedly put down the papers she was holding, and jerked toward him as though she was going to restrain him, her body language suggested she was being emotive. I was the only member of staff in the immediate vicinity, and I do not yet have C&R training. What was she going to do? Grapple him to the ground herself?! Luckily he decided at this point to hand the lighter over, but never once did it occur to her to say for example.....

"Now you know you are not allowed a lighter on the ward, how about we put it in your box in the storeroom, you can come with me if you like and put it in there yourself and then maybe you would like to go for a cigarette?....or

Now come on M, you've been so good, you managed to get your unescorted time out, and we are really proud of you, you came back on time and everything, I don't want to see you lose that over something as silly as a lighter...."

Later there was a potentially violent issue between him and another patient, and as I just managed to persuade him to back away from the situation, and was calming him down/reassuring him, she approached him and said;

"I'm going to tell the day staff you had a lighter"

He responded that he didn't want to get into trouble and that he had only just managed to earn his time out, to which she replied

"Yes, yes, you WILL get into trouble"

This immediately after a volitile incident :angryfire:

Later still he promised to buy her chocolate when he had his time out the next day, and when she excepted, he became excited and asked what chocolate she wanted, whether she wanted a bar or a box of bars (she said a bar would be suffice) and could she write it down so he wouldn't forget, and looking pleased with herself she then pointed to her cheek and asked for a kiss, which he became uncomfortable with. She stuck out her cheek for ages, saying "come on, come on" and when he eventually summoned the nerve to say he didn't want to, she pointed to me, and asked whether he'd give me a kiss, he said "No", so I told him it was ok, and that he didn't have to. She simply laughed at him.

This is what happened before during and after the touching incident with Zealous

I took the overtime last night on the basis that Zealous wasn't on the rota but she turned up regardless. Someone must have called in sick. I am unbelievably beside myself with rage after what she pulled last night. M was pretty much on the edge anyway, since whilst he was walking down the corridor our 17 year old who is on constant level 3 obs, kicked him whilst he was walking past. After an initial 'spat' I was able to persuade M to come talk to me, and reassurred him that I did see what had happened, and was aware that he didn't start it. He became smiley and told me he had superpowers. I went to shake his hand, and he retreated saying he didn't like to be touched (always a shame when I don't quit whilst ahead). Sometime afterward he was waiting at the clinic door for his meds, which Zealous was preparing, when I squeezed past him. He repeated that he didn't like people touching him, so I apologised and told him that I wasn't trying to touch him, I was simply trying to pass. Zealous said, 'you don't like being touched?!", to which he defensively replied 'no, I don't like people touching me', to which she promptly reached out and tapped him on the arm!
My chin must have hit the floor. What was the point of that?! He complained, and she told him not to be so silly. I'm pretty sure she thought she was only teasing, or is control freak enough not to respect someone's personal space no matter how daft it may seem....I suspect the latter. I don't think she is really manipulative enough to have done it to provoke the following, but that is not the point.
I'm told by her to take over with B (dementia patient) who is wandering around the ward, and by this point M is also stomping through the ward, and the two came face to face. Now I'm not sure if M was immediately aware it was B or not, but when he's in this kind of mood he will stomp up to people, fists clenched, glaring, and will jerk towards them in order to seem as if he's going to attack so as to intimidate them. B just blundered in his path, so this is what M did. He's never threatened B before, I think even he realises there would be no point, which leads me to think that it was reactionary on M part before he clicked it was B standing in front of him. Now there is an unspoken respect for B among patients on the ward, as they can see how ill he is, and they see him as vunerable (he shouldn't be on our ward, but there is nowhere else for him), and understand that his violence is not his fault. I shouted at M, and D, who has a history of violently trying to protect staff and others he deems vunerable, jumped up and all hell broke loose, then the 17 year old joined in, and I had to try to retrieve B from the midst of a three way punchup. D was shouting in righteous indignation, the 17 year old was smirking, and M was clearly upset shouting that he didn't hit B, and that it wasn't fair as he was dragged off to the SCA room, showering us all with gob as he went. D was extremally upset that M would take a pop at someone so feeble and ill. He's not so feeble, believe me! But on appearance B is a shuffling feeble and confused old man (he's a wasted 51 year old), the idea that someone would assault him is abhorrant.

The incident which followed, may well have kicked off anyway, but it makes me think, especially when Z has a reputation of violent incidents occurring more often when she is on shift.

Another thing she does is every time I request members of staff with C&R training to help me deal with a potentially volitile patient, she offers herself and rarely asks for another. As far as I am aware C&R is worthless unless there are at least two members of staff with this training. She seems to think she is a one man army. The amount of times we have has to bolt from a room is beyond count.

I need to be more assertive, but it's difficult when I've not worked, and am finding my feet, and my confidence is becoming battered each time I work with her (she tends to nanny me/ pull me up on stuff on the main ward). Ironically I am becoming more capable of being firm with the dangerous patients on my ward, but she is a nightmare, she never stops to listen.

Katy

Cute_CNA, CNA · Jun 23, 2005

Z sounds like a very sick woman. When someone threatens, violates boundaries, and manipulates and controls patients like that, she is not being therapeutic to anyone. This woman actually reminds me of Joan Crawford on that movie Mommie Dearest. She sounds like she just wants people to cater to her, and make puppets of those around her.

I suspect that by being nice to you, she's also manipulating you, because you'll feel guilty if you turn her in. It sounds like she is trying to make a trade-off with you: I'll be helpful to you, and you'll let me act however I want. She sounds like she's doing it with other people, too. That's not right.

You should be able to work in an environment that is enriching to both you and your patients. This woman should not be in any kind of patient care, period.

MacNurse · Jul 19, 2005

You need to call your Board or College of Nursing. This is abusive behaviour. She sounds seriously mentally ill, and should be removed from dealing with patients.

Any update? How are things going?