New grad RN in psych, encountering difficulties...

[JentheHen]

Hi. I graduated last May and was thrilled to find a job a year after graduation at a big city hospital (I wanted to work at a public hospital, not private) in a psych unit. My preceptor was wonderful, my orientation was 3 months and seemed extremely thorough, and I liked most everyone I encountered, from doctors to fellow RNs to patients. I was learning a lot, working very hard but enjoying it. We were always short-staffed but I was glad to experience primary nursing, from making beds to med-passing.

Then my preceptor went on vacation and chaos ensued. This was at the last two weeks of my orientation, when I was expected to do charge nursing and run the unit, do admits and discharges, make the schedule under Nurse X. Nurse X could not be bothered to explain anything or answer any questions. She would not inform me about changes in patients conditions or if she gave narcotics to anyone on my lunch break, making me look stupid and neglectful. Under me/her, psych techs exchanged duties without telling anyone, abandoned their 1:1 and COs, other nurses took 2 and 3 hour lunches and violent, psychotic patients were literally running amok in the hallways, scaring other patients, while Nurse X chatted with her boyfriend on the phone. Nurse X was also very territorial. I hadn't done an admit on my own, so my nurse educator explicitly told her that I had to do one. I was in the midst of talking to a suicidal young Japanese woman about why she had taken an overdose of pills (it took a while to get her to talk because she wanted to give me the "right" answers) when Nurse X ran in, said, "What did you take? How much? Did they pump your stomach?" and the girl clammed up and wouldn't talk anymore. This nurse also tells paranoid patients that we have cameras in the nurses station that monitor their every move. Etc etc.

Until Nurse X took over my supervising, I had felt (and been told) that I was doing a great job, from my preceptor to docs, social workers and psych techs. But now the nursing supervisor thinks I need another week of orientation and I feel like the biggest loser. I've tried to ask Nurse X why she seems to be sabotaging me, like "Why didn't you tell me you gave Ativan to Patient Y? I need to know stuff like this." She gives me a sunny smile and said, "Oh, I forgot...it's just been so crazy.."

My preceptor will be back next week, I will enjoy working with her and learning from her and an additional week of orientation can only help me (even though it may make me look bad to the unit I'm going to). But how do you handle working with someone who actively sabotages you like this? I am not one of those know-it-all grad RNs. This is my second career and I've been unemployed for a year. I told everyone how green I was. I told everyone how grateful I was to learn from them. But I now feel like she has poisoned the other RNs against me (although non-nursing staff has noticed what she is doing and tells me it's typical politics).

[gnursjr2]

Welcome to the world of nursing. Be aware that even though your co-workers may be nice to your face, and say you are doing a great job, they will throw you under the bus if need be. Don't let your guard down, keep quiet, do your job. I hate to tell you this, but there are Nurse X's around every bend. You will also find as a new grad, you are going to be watched like a hawk, and judged constantly. I wish you the best of luck. Just keep your head down, learn as much as you can, and pray! I'm sorry if this sounds negative, but I've been thru the ringer since graduating 2 years ago.

[JentheHen]

Thank you for responding, gnursjr2. That's what I'm trying to do, but the judging and scrutiny (exactly right!) makes me nervous and anxious and just compounds my feelings of incompetence. I need to get a grip and think positive and thought posting would help. I know my friends from nursing school have been bullied far worse than me. I've had it pretty good until now. Thanks again. I'm still so grateful to have a job.

[metal_m0nk, BSN, RN]

All I can say is, sometimes the line that separates the unit from the nurse's station on a psych floor is very, very thin...

[Mommycakers]

I also graduated last May. I work 12 hr. night shifts and we work more like a team taking care of all the patients together. We get more admissions on evenings and nights so we have to work that way because the other nurse may be busy with an admission. I can suggest when you have to work with this one nurse see if it is possible to divide up the patients. That way if she gives a PRN medication or encounters a change of condition in a patient she has to take responsibility and write the progress note for that patient and reassess that patient. Day shift tends to do that on the Psych floor I work on. We also have a shift to shift book where we can write the daily updates and PRN's given on a patient. Maybe if she can't bother to tell you she can at least write it there.

It would be an immediate incident report if we had a 1:1 abandoned on our unit. If a tech was taking a 2-3 hr. lunch break the nursing supervisor would know about it and deal with that person. I always understood it that as nurses we are responsible for the tech's that work with us. If a Dr. wrote an order for a patient to have 1:1 observation and the tech abandoned that patient then the order was not being followed and ultimately the nurse is responsible. Just like if the Dr. ordered a 1:1 to be within arms length of the patient. If as a nurse I noticed the tech was not remaining in arms length it would be my responsibility to educate the tech as to their responsibilities.

I feel lucky that I work with very supportive nurse's and tech's. We have to have each others back especially when you are dealing with psychotic patients. I understand it must be very frustrating not to be supported by this one nurse. I wouldn't be surprised if the other staff on the unit are already aware of this nurse's behavior. Unfortunately, some people try to make other people look bad just to make themselves look good. You can not change her behavior. You can only control your behavior. Kill her with kindness. Maybe she will come around or just stay out of your way.

I know it is hard but put out of your mind whatever you think nurse x may have said negative about you to other nurses. You can't control that but you can let the other nurses know what a great nurse you are by providing excellent patient care and support to your fellow nurses. Let these other nurse's form their own opinions. You worked to hard to be an RN to let nurse x get in your way. Believe in yourself!! You will do great!!

[Davey Do]

There are many things I enjoy being part of AN.com. Your post, JentheHen, and the subsequent comments are indicative of why I enjoy this site: We are, as nurses, struggling to do our jobs, get support, and learn.

Much too often, personalities get in the way of merely meeting the responsibilities of our work. Bummmer. I can empahtize with you...

I'll give you a short run-down on an experience I had which was similar to yours. I had been an RN for less than a year when I landed a position at a large Psych Hospital. In the first six months, I was voted Employee of the Week, twice. I worked so much overtime, that I ranked high on list not to have to work mandatory overtime. I regularly worked all of the Units and was comfortable with all of them. I believed that I had a good working relationship with Patients, Peers, Co-workers, Psychiatrists, and Administrators.

Then, something happened and everything changed- One of the Docs got miffed at me, wrote me up, and an investigation ensued. I was found guilty of Patient Neglect/Abuse and suspended for 15 days for this, and other reasons. It was truly the beginning of the end and made it ever so difficult to work there. I went through a stressful time, to say the least. I worked there until I couldn't stand it anymore and got a position in a small Hospital working ER and Med/surg.

(As a side note, I filed for, and recieved, Unemployment Benefits for those 15 days of suspension. Later, through the Nurses' Union, I was monetarily reimbursed for those days I was suspended, and had the Neglect/Abuse thing sponged from my record.)

So, you may ask yourself, what can I learn from his experience? First, as previous posters have already relayed, this kind of thing happens all the time. Next, try to work your way through the situation. You're taking a good step in sharing and gathering data. Stick to it, do the best job you can do, and if it doesn't work out, well, at least you tried.

It has been said that nothing was ever changed by a quitter. This may be true, but you need to look out for your greatest resource, JentheHen. and that greatest resource is your own sanity and well-being.

The best to you.

Dave

[JentheHen]

I am so grateful for these great responses--thanks to everyone. Mommycakers, I envy the support you enjoy. It sounds like the hospital where I did my psych rotation in nsg school--enough staff, excellent management, a collaborative environment. My current hospital is extremely different. Dave, thank you for sharing your horror story. I'm glad it's over but it sure must have taken a lot of courage to go through all that.

I don't want to be a whiner; as I've said, I'm so happy to be employed and in many ways this hospital is exactly what I was looking for, a place that serves an underserved community in heroic fashion much of the time. But my life and

previous career did not give me much experience in dealing with this sort of situation.

I will take all your advice--be the best nurse that I can, look out for patients as well as I can, politely ignore the bull as much as possible and employ healthy coping strategies for stress. So glad to be here. Thanks again!

[morecoffeepls, BSN, RN]

What a horrible situation. Disgusting, really. CYA is the first thing that comes to mind. She sounds like the type of person who might do some real damage to your career. It's dumbfounding - how certain people make what could and should be a wonderful job miserable at times. I work nights, alone, but I still encounter the BS of dealing with other nurses on my unit who can't help themselves. It's not enough to try to understand what motivates their outlook/behavior because it really doesn't matter when it comes to situations where your professional integrity is questioned or patient care is compromised because of some idiot's insecurities and ineptitude. Telling paranoid patients that there are cameras at the nurses station and their every move is being monitored? It seems to me that it would be entirely appropriate to speak with your nurse manager about what you've been experiencing. Get in on the record, at least. CYA; because, whether you are charge or not, the other staff on your shift are a reflection of you.

I used to be the type of person to let things go, and as long as I know I'm doing a good job then that's all that matters. But at some point in time I started feeling the need to address what bothers me when it happens. it shouldn't matter if you're new to an environment - if you see something that's fundamentally wrong, it should be addressed. I'm not the type of guy to say things like, "Grow a backbone" or "Put your foot down" or "Nip it in the bud." But to preserve your personal and professional integrity, it seems like you may have to put a bootheel on this Nurse X's neck before you become completely discouraged.

I know I'm overstating my take on the issue, but it's just really sad that "Nurses eat their young" instead of supporting them and fostering camaraderie. In my experience, the seasoned nurses who have tried to put me down by being hypercritical or perform little acts of sabotage or have been unable to keep my name out of their mouths are pathetic for various reasons and could really use some "unlearning", both as nurses and as human beings. I'm not bitter, really.

[Yiggs]

Hi. I graduated last May and was thrilled to find a job a year after graduation at a big city hospital (I wanted to work at a public hospital, not private) in a psych unit. My preceptor was wonderful, my orientation was 3 months and seemed extremely thorough, and I liked most everyone I encountered, from doctors to fellow RNs to patients. I was learning a lot, working very hard but enjoying it. We were always short-staffed but I was glad to experience primary nursing, from making beds to med-passing.

Then my preceptor went on vacation and chaos ensued. This was at the last two weeks of my orientation, when I was expected to do charge nursing and run the unit, do admits and discharges, make the schedule under Nurse X. Nurse X could not be bothered to explain anything or answer any questions. She would not inform me about changes in patients conditions or if she gave narcotics to anyone on my lunch break, making me look stupid and neglectful. Under me/her, psych techs exchanged duties without telling anyone, abandoned their 1:1 and COs, other nurses took 2 and 3 hour lunches and violent, psychotic patients were literally running amok in the hallways, scaring other patients, while Nurse X chatted with her boyfriend on the phone. Nurse X was also very territorial. I hadn't done an admit on my own, so my nurse educator explicitly told her that I had to do one. I was in the midst of talking to a suicidal young Japanese woman about why she had taken an overdose of pills (it took a while to get her to talk because she wanted to give me the "right" answers) when Nurse X ran in, said, "What did you take? How much? Did they pump your stomach?" and the girl clammed up and wouldn't talk anymore. This nurse also tells paranoid patients that we have cameras in the nurses station that monitor their every move. Etc etc.

Until Nurse X took over my supervising, I had felt (and been told) that I was doing a great job, from my preceptor to docs, social workers and psych techs. But now the nursing supervisor thinks I need another week of orientation and I feel like the biggest loser. I've tried to ask Nurse X why she seems to be sabotaging me, like "Why didn't you tell me you gave Ativan to Patient Y? I need to know stuff like this." She gives me a sunny smile and said, "Oh, I forgot...it's just been so crazy.."

My preceptor will be back next week, I will enjoy working with her and learning from her and an additional week of orientation can only help me (even though it may make me look bad to the unit I'm going to). But how do you handle working with someone who actively sabotages you like this? I am not one of those know-it-all grad RNs. This is my second career and I've been unemployed for a year. I told everyone how green I was. I told everyone how grateful I was to learn from them. But I now feel like she has poisoned the other RNs against me (although non-nursing staff has noticed what she is doing and tells me it's typical politics).

It's unfortunate that this is happening to you, but to be honest ... welcome to the real world of nursing!! That is why they say nurses "eat their young." Some experienced nurses do want to frustrate new young nurses and many of them succeed. Sometimes I think it is jealousy and plain envy. You have to be assertive, when you are leaving the floor say something like this to the nurses, 'I am going on my break...if you happen to medicate any of my patient or do anything for them while I am off the floor please leave a note on my cart or let me know as soon as I am back." Also, there should be a policy that someone has to cover you when you are off the floor, so make sure you give a thorough report when you are going off the floor and if it is critical document the status of the patient before you leave and document what you endorsed to the nurse covering you. Just say your prayer and do the best you can and know that your experience is not singular. Stay focus, you have the knowledge and gradually you will have some experience under your belt! Yiggs

[JentheHen]

Thanks for these replies. Yes, morecoffeepls, the camera thing crossed a line for me and I mentioned it to the nurse manager, who shrugged it off. Unfortunately bad patient care is often shrugged off as staffing is such a problem. (Why do people who think the mentally ill are lazy malingerers and leeches on society become psych nurses and techs? Thus miserable nurses and techs.)

I'm in my permanent unit now and I really like it. It's smaller and we all work as a team. Nurses and techs are generous with their teaching and sharing experiences. I even have mentors now whom I cherish. Hallelujah! But because the census is so low, we get floated a lot so I will encounter more Nurse Xs. Fortunately I now know who to be careful around and am learning how to avoid acts of sabotage and backstabbing.

There's a lot more good than bad, though--I'm pretty happy. Thanks to all who replied--I've learned a lot. You all sound like fantastic nurses.