Negligent Charge or Endure?

**canoehead, BSN, RN** · May 7, 2020

You need to be very proactive and ask for help. Delegate tasks to her if you need assistance. Possibly the gruffness goes both ways, though it might not have started with you, you need to try to make things better.

ptadvocate5 · May 7, 2020

I have no issues with other staff -only good interactions and feedback that I’m a good addition to the unit with experience and helpful to others. It takes teamwork to thrive and I can’t motivate someone to have a better work ethic. My question was is she negligent? Should I document her lack of communication and assistance? I have tried one on one approach so need to plan step B. Unsafe working conditions - can’t delegate when they walk away from you and busy themselves in their patient’s room. She is now more unhelpful ever since I spoke with the manager 6 weeks ago if that is possible.

JKL33 · May 7, 2020

13 hours ago, ptadvocate5 said:
She is now more unhelpful ever since I spoke with the manager 6 weeks ago if that is possible.

100% predictable.

On 5/5/2020 at 2:46 PM, ptadvocate5 said:
I see her help other team members but we are a small unit and usually run with 3 RNs and often one is a pulled nurse from another unit such as a PCU. I fear in a code I will be left unsupported because she will not work will me in a professional manner.

Maybe you left out more of the story for the sake of brevity--you don't mention how you have tried to address your concerns with her directly.

Also, you mention a lot of frustration on your part, but not a direct refusal to help you on her part.

You sound like an experienced ICU nurse who is good at her job. Is it possible that you consider her behavior unprofessional but might be making a few assumptions about the whys?

For example, how would you feel if you found out that she doesn't offer you a lot of help because she doesn't see how she is capable of adding much to what you have going on as an experienced and capable ICU RN who manages patients very well? [I.e. what if she doesn't feel she could possibly be of much use?] Maybe she's simply more comfortable helping people who don't have it together quite as much as you do.

Or, maybe she has negatively perceived something coming from you that you're unaware of.

Things like these are reasons why we address our concerns with the involved individuals first if at all humanly possible. Maybe you already have, but you don't mention that.

On 5/5/2020 at 2:46 PM, ptadvocate5 said:
I fear in a code I will be left unsupported because she will not work will me in a professional manner.

I can almost promise that you will get nowhere (and you will damage you own reputation) by arguing what-ifs in order to support a dislike of someone's style.

You are going down a bad road with this. Many have tried it before you and found themselves on the outs while the person they complained about kept right on rolling. I'm sure you know that as a nurse with 20 years experience you are ripe for being painted as unwilling to work with newer nurses. Too rigid, too exacting, too perfectionist, too old school, too judgmental of the newer generation. These things have a way of turning on their heads.

I advise that you do everything in your power to have this take up less space in your head, not more. That is for your own good. Increasing the amount of time that you spend taking note of the things bugging you is very likely to be your undoing.

1) Stop worrying about what-ifs. Take care of your patients expecting nothing from her as much as humanly possible. Do everything in your power on your end to have her behavior not become your issue. IOW, don't let this be about the unfairness of it or the discrepancy in your assignment and someone else's, or how much she helps others vs. how much she helps you.

2) If you absolutely need help immediately, go to her dispassionately and say "I've got [abc] going on. Would you be willing to [do xyz] while I work on getting this stabilized?

3) If she says no, makes an excuse or disappears, stay very calm and call the upline (manager, supervisor, whomever) and state that you need assistance caring for an unstable/urgent situation. Make no accusations or complaints during the call. When they mention the CN and how you should seek her assistance, let them know that you have already informed her and she isn't available right now.

If there is going to be no follow-up or additional management interest in her behavior, then understand that they are not interested in it--and understand what that means for you: You either drop it or move on to a better situation.

ptadvocate5 · May 7, 2020

Thank you for your detailed reply and feedback. You make a lot of sense and I appreciate your candor and obvious pulse on human nature.
To clarify a few things I did not include in my first post was while I have over 20 years in ICU this charge nurse and I are almost the same age, I fact we both have children in the same grades (2 of them). I have made small talk about school to stimulate the conversation but she does inquire about me at all and if I say hello to her half the time there is no acknowledgment. After 3 months of speaking to her first I stopped. She actively talks to others so she is not a private person. Again it’s OK she does not want to be social. I still help her patients with call lights, IVs etc because I am doing my job to help the patients- they are all our patients. Bottom line - my work ethic is strong on responsibility but I am supportive not aggressive. Feedback from precepting and being a charge nurse has left me feeling that I show others respect and are approachable. My old manager begged me to stay when a gave my notice but I felt I needed a change after so many years. My old coworkers want me to come back -I have not shared my unhappiness except to two trusted friends. This lack of teamwork has been a new experience for me on many levels.

My new manager I have known for over 5 years and this is her first administration position. She told me she feels so lucky I moved to her unit, thanks me for mentoring the newer grads (we have two) and I have asked her if there are any concerns after I was there 60 and 90 days. Only positive comments from staff. I feel very comfortable with the nurses in their 20’s and 30’s -they actively seek me out with questions and we share recipes and general conversation. I look forward to my weekend when this other nurse is off. Interacting with others is a bonus and often strengthens bonds as a team but I try to accept others . I am definitely challenged here. While my experience level is higher than most here I have never been described as intimidating. I was raised to treat the cleaners person the same as the president.
This morning one of my patients got into respiratory distress and I asked this charge nurse to call the respiratory therapist while I set up suction and titrated an anti hypertensive. She called to me she had to “do staffing “ and walked away. The other RN was off the floor in CT. I called RRT and we stabilized the patient. The charge nurse never asked me about we did or how the patient was - Bipap, suction, etc. I was in that patient’s room for 45 minutes and then finished my other 2 patients that needed meds passed. No support offered and while I realize staffing is a element of charge nurse duties the priority was misplaced. I said to her after “ I’m glad we didn’t have to intubate her but they still might happen” she looked at me and continued to chart . WOW! - no concern at all. I guess I care that she is unconcerned about the patient’s status or being a team and yes it has gotten in my head. I am resigning myself to lower expectations from someone that has the capacity to do better but chooses not to in this situation. I am not accepting that my performance and response will be less than I can give because of her lack of interaction with me. Her behavior I had experienced has been documented according to one of the RRT nurses who responded to my call this am. Apparently this is not a new pattern. This makes it less personal for me but still leaves me unsure to how to address it constructively. Doing nothing and waiting for her to move to another position does not seem healthy for the unit and only lets a infection fester. I hope I am strong enough and brave enough to put my reputation on the line to bring this problem to the light. Thanks for letting me vent and again I appreciate feedback for my next step to resolve this issue

JKL33 · May 8, 2020

That does sound very frustrating.

I guess overall there seems to be a difference in performance expectations. Right now you don't know the reason for her behavior (maybe she doesn't care for something about you, maybe her own life is hard and it affects her work, maybe she is secretly not very confident...maybe it's classic jealousy. Lots of possibilities).

No matter what the underlying problem is, rise above. Continue to greet her and continue to ask how she's doing. Continue to ask how you can help her. Since you were raised to be polite and treat people well, then continue do that. If you are a good nurse and a good person, then make damn sure you aren't matching or reflecting her inappropriate behavior! ? You do you, and do what you know is right regardless what she does. Refuse to become so frustrated that you become part of the problem.

Stay in the moment and stay fact-based, not driven by emotion. It doesn't matter if someone could have coded. They either did or they didn't. You either called a RR/Code or you didn't need to. Don't make accusatory projections about how her behavior could have directly led to disaster. It either did or it didn't. You either handled a situation or you were unable to. Don't let yourself deteriorate into the emotional inflation of issues. If you literally and truly cannot handle something urgent on your own and she has refused to help, then, as above, call the upline immediately and say you need help pronto. [Keep in mind, if it isn't urgent enough to call your manager, then it isn't a serious enough issue to go to war with this other nurse over, either].

Facts, not emotions. No battles over philosophies and what others "should be" doing.

Steps going forward: Do all the things already described to make sure you're not part of the problem. Then, if/when the day comes that there is an urgency/emergency and she won't help and you need to call your mgr/supervisor, immediately after that is over ask for (and expect/demand) a meeting with the two of you and your manager where you can confront her directly. [I have done this/taken my own advice; it was not over petty matters, it was someone literally sabotaging my patient care.]

It takes a lot of smarts and emotional self-control to make it through some of these situations where a coworker seems to be messing with you (or is problematic for reasons that don't really involve you), but it can be done. Sometimes it isn't worth it and it's just better to move on.

I hope you can work it out. Don't sit back and wait for the bad thing to happen so that you can escalate this. Work hard to develop a genuine rapport with her. Best of luck ~

SineQuaNon, MSN, RN, NP · May 12, 2020

I would be very clear with her. If she says she has to work on staffing while you have a patient with acute respiratory issues that you need help with, your response should be "I'm sorry but that won't work for me. I need your help now in the best interest of this patient's safety. Or can I have a written note confirming your refusal to help with this critical patient?"

Document everything with dates, times and witnesses. Write it in an email and send it to yourself. That way it is time stamped. If necessary you can then forward these emails to management.

ptadvocate5 · May 15, 2020

Thanks that is a great suggestion. Thank you for your feedback