Need help with boundaries with my charge nurse

[Lauraingalls, BSN, RN]

I am a newish nurse. I have been working on my unit since last summer and on my own since the fall. I pretty much get along with most of my co-workers. I love my unit and the teamwork atmosphere. It is a busy L and D unit.

I work nights. Nights are different than days because most of our admits are in active labor unlike the scheduled inductions for the day. We generally work as a team when someone comes in. One nurse starts the IV, one gets consents signed, one gets the medications for delivery and so on. This way if the patient delivers soon (and they generally do) we are ready to go.

There is one charge nurse in particular who I am having trouble with. Her method of teaching is letting you figure it out on your own. She doesn't jump in and help unless it is a true emergency with new nurses. The other night, I got an admission and I proceeded to do what is normally done. Another nurse stepped in to help me with the admission as well. I was told later by this charge nurse that I am to not accept help from anyone until I can quickly and accurately do the process by myself. I understand that I need to know all the steps in admitting a person (including the stuff our techs do). I was actually delayed in getting all the minute details done because she delivered a short time later and I had to stay late catching up on all my charting and inputting of orders.

I personally dont think its right to not accept help from other nurses. I truly believe in the team approach. The other charge nurses I work with understand that I am new but am trying to get my feet under me including time management. They dont coddle me but teach while they are helping me (or we are helping others).

This charge nurse is very condescending when speaking to me and feels the need to lecture me about how I am being taught wrong by other nurses. I dont say anything because I consider her my supervisor and I just put my head down and work. But it is getting to the point that I try to avoid working with her at all costs.

I just had an annual review and it was a glowing report from my other peers. The nurse manager is aware of my issues with this charge nurse and has offered to step in. I am hesitant because of fear of repercussions. I just want to tell her in a firm way to stop but still respecting the fact she is my supervisor. Help!

[Double-Helix, BSN, RN]

It sounds like you've done the correct thing by making your manager aware. It sounds like this charge nurse has a different opinion/teaching style than the others. You've got a few options for dealing with her.

First, you could ignore her feedback. Have a few well reheorificed responses such as, "I was taught here that a team approach provides safer and more efficient care." or "Accepting help ensures that my patient is well cared for while my documentation is completed in a timely manner. If you have concerns, we can discuss this more with *Nurse Manager*" While handing it in this manner may reduce her comments, it is unlikely to change your working relationship and, if anything, will only make it worse.

What I would suggest, though, is gathering your courage and having a real conversation with her. Before or after a shift, when neither of you are busy, ask to sit down and talk with her. Explain, "Hey Sue, I'd like to talk about the way we work together. I know I'm new here, so I may be reading to much into things, but I've noticed that the way you talk to me sometimes makes me feel like you think I'm not providing good care. I want us to be able to have a good working relationship, so do you mind if we take a few minutes to discuss these things?"

Then go on to give specific examples of what you mean:

"Last week, when you told me not to accept help from other nurses... that's different than the "team work" approach that I've been taught by other charge nurses. I do understand the admission process, and I recognize that I need to know all of the steps involved, but I believe that accepting help during an admission allows me to prioritize patient care without spending excessive time at the computer. Do you see it differently?"

Give her a chance to explain her point of view. Even go a step further and ask if she has specific advice for ways you can improve. Genuinely consider the advice that she offers, and she very well may have some insight or perspective that other nurses aren't sharing.

I think you'll find that, while having a real conversation might be scary, awkward, and uncomfortable, in the end you will both have greater understanding of the other's point of view, greater respect for one another, and your working relationship will improve.

[oceanblue52]

Don't have much to add as Double-Helix gave some GREAT advice, other than to frame this as a safety issue. It's all well and great that this Charge wants you to have things down and be independent, but if you admit someone in labor you may very well have a limited window to do all the admin and clinical tasks. What if you were left to your own devices and some type of emergency happened and you didn't have everything in order? Teamwork is key in an acute care setting for this reason. You never know when or if a patient will go down hill, and you better have all your ducks in a row if something does happen. Conversation might go better if you frame it in terms of the patient's well-being rather than as your own issue. Says a lot too that your manager is on your side.

[Lauraingalls, BSN, RN]

Thank you for your input. We had another situation in which I was left alone handling a complicated C-section and I felt patient safety was an issue and I directly addressed it with her. It didnt go over very well but I said that patient safety was a priority with me. She had said that she would attend every C-section I was doing personally and point out all the mistakes I made afterwards. She said she would only step in if I was doing something grossly wrong. To me that isnt helpful at all.

[davis468]

Enough of eating our young. It must definitely a patient safety issue. There is no "grossly wrong" in L&D. Don't be afraid to find your voice and use it. Like said before, it can be done in a professional manner. I really think it says more about her than you. We need to build each other up.

[keuka8]

I feel your pain. When I worked L&D, my first night off orientation it was myself and one other nurse (small unit). Something came up and I asked her a question. She told me 'don't ask me questions, I'm not your preceptor.' Things went downhill from there and I ended up leaving L&D. Teamwork is important, especially at night. Charge nurse is supposed to help not hinder.

[Here.I.Stand, BSN, RN]

I've never worked in L&D. I have been a pt 5x!!, with two of those babies being born within 30 minutes of my arrival, I might add. They didn't even have time to get an IV in.

My first thought when reading was similar to you and the previous replies.

The ultimate goal is a safe delivery-- not that one person do it all. Does she think that mom cares about how independent her nurse is or isn't, when something happens as a result of the RN clicking admission boxes and checking orders rather than focusing on her?

I do work in the SICU of an urban level 1 trauma center. When we get a bad trauma in, guess what? The assigned RN never ever works alone! The charge nurse helps, the other RNs whose pts are in close proximity to the new admit jump in (assuming they are not actively trying to stave off death in their own pt.) Again, the goal is not to demonstrate the one RN's multitasking ability. It is to care for that patient.