Work situation, upset, opinions needed

Nurses Relations

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Hi! I currently work in critical care, on this unit since last fall. There is a lot to learn.

I worked last night. There is an aide who has worked there for 30 or so years. He is very set in his ways, and for example, starts his day at 0630 (no one does that anymore) and punches out at 1500. Takes his lunch at 1100, NO MATTER WHAT. Will get frustrated if you bring fresh towels in the room for a clean up "Why are you doing that, there are towels in the drawer" (in the room)). I know several of the longer term staff roll their eyes when speaking of him. They say he used to really be crabby until an accident about a year ago. But I always respected his longevity, and got along, and was always really nice to him.

I worked overnight last night. I had tried raising the head of a patients bed and noticed a crunching sound, it was an O2 tank wedged in the foot pillows of a Kinair bed. I took it out and propped by the wall. I was changing lines. My patient decided very suddenly at 0630 to drop his sats, while on a vent, to 73, and raise his BP to 200. My charge RN was notifying RT/MDs while I was giving O2, suctioning, ect. and wondering if he was having a PE.

Just then, the aide was in the room stocking washcloths, and saw the O2 tank and said to me, "This is very dangerous, this shouldnt be like this, ect" I said "I can't talk to you right now I am dealing with this situation" "This is equally as dangerous, AND YOU WILL TALK TO ME" "I WILL NOT TALK TO YOU NOW" ""YOU WILL TALK TOME NOW" "No, I WILL TALK TO LATER" "YOU WILL TALK TO ME NOW" this excange went back and forth while I am trying to get the pt's sats up and see if RT was called. The MDs were in the room at this point. He SLAMMED the washcloth drawer, and STOMPED out of the room, waving his arms in disgust at me. I was so shaken I could hardly focus on pt and MDs and their questions.

The sats slowly came back up after several long minutes, and BP down, still dont know what happened, but was still shaken a little while later when MDs rounded and were asking me questions.

I went to asst nurse mgr, and told her the above, and she said that O2 tanks were this guys "pet peeve". She said she would talk to him, and it was right my focus should be on pt. I did see him and her casually and calmly chatting a few mintutes later (as I was charting).

I am worried this guy will go off on me in the future, or get 'mad' at something, like a request for a turn, and really honestly would prefer never to see him ever again, but since I know that won't happen, what should I do? How should I handle this, and what do you think of this situation? Very upsetting for me!! Thanks

Specializes in Med Surg - Renal.

I would have called a Code Green and had security haul him out of there.

It is easy to say what you should have done after all is said and done. I think in the future I would just ask him if he could move it. Save yourself all of the headache and frustration you have right now.

Your description of this person paints a picture of someone who, for whatever reason, is probably not open to the normal give and take of human interaction. I am not convinced that his behavior is entirely within his control. Talking with him seems a waste of time. Since it is apparent that TPTB have been satisfied with his presence for years, I would avoid him as much as possible. Realize, beforehand, that he is prone to negative confrontations and be ready to continue your actions in spite of him.

Specializes in LTC.

Why'd you waste time arguing with him about whether you could talk..just say ok...can you take care of it please? And ignore the rest.

Specializes in HH, Peds, Rehab, Clinical.

Haven't read the other replies, so just offering my own "take" on things.

I get the impression that you just set the O2 tank on the floor/propped it without it being secure in some sort of base or cart. This is an OSHA violation and goes back to "scene safety" and if the scene is not safe, NOTHING else happens until it is made safe. Maybe this guy is/was a medic and knows this from training rec'd outside of the facility? IF this is his train of thought, I'm with him =)

Specializes in Obstetrics.

I think the only thing that could have been handled differently on your part was to stop his bickering when in the room (the back and forth banter) by saying "X, I understand but right now, my patient needs my attention more than the tank. Could you please help me out and put it where it belongs?" but hindsight is 20/20 and I think his behavior was ridiculous. Slamming things? Grow up. I do think you should approach him but perhaps ask your manager to mediate so that you have someone who will hear what both of you have to say so there's no question on either side. Just my thoughts but I don't think you have anything to be criticized for. Sorry that happened.

I think whether you are a new nurse or have been working as a nurse for a long time coming now, one of the hardest things to deal with in itself is not the patients but those you work with.

I put myself in your shoes and the above situation you told us about. Probably the aggravating thing here is how he probably thinks it's OK for him to act the way he did just because of how long he's been working there. I can't say this for sure but it seems like it is easy to get a few passes for the way he acts around the unit just because he's been there for so long. To me, personally, his reaction was inappropriate and in any situation like what you had to deal with, no body should be coming into a room and saying that to you in the first place...even if you did misplace it, he could come back later and tell you when things have calmed down. How was him saying that at that time and place helping the situation? If he knows and can easily put the tank elsewhere, he should have done so without all that commotion and approach you later.

You also have to understand that it's hard for other people who don't have the same title as you do, to understand your role as a nurse. I appreciate the majority of my CNAs around my hospital, and know I wouldn't be able to last through the day without their help, but there are some who I feel really don't understand the RN's role as a nurse. When I was still externing at my local hospital, we had a confused and SOB patient who did not follow any given instructions and kept getting in and out of bed to use the bedside commode next to his bed when we told him not to by himself (I was the one who put this next to his bedside in the first place). I ended up putting the bedside commode back in his rest room to prevent him from getting up and to instead call for help. Maybe I could have handled this a different way (had someone come stay with him, leave the commode at the bedside) but he ended up walking with an unsteady gait to the restroom to use the commode without assistance. The problem was the CNA saw this entire thing.

I had no idea what the CNA was trying to do but she called both me and the RN I was assigned to for the day to come to the room. I got there first and she said to me "He almost fell down because YOU put the bedside commode back into the restroom!. And when she called my RN on the phone to come, all she said to my RN is, "Look, come look how he's walking!" Instead of worrying about the patient falling and getting the patient back to his bed right away, her focus was for the nurse to see how he was walking. The RN and her had a go at this and it was not pretty.

Writing this story just so you don't feel like you are the only one who have to deal with situations like these. To me, one of the hardest things I have to deal with is gaining respect from those who you can delegate to that have worked there longer than you have. I am a new nurse and I am also much younger than many of the LVNs or CNAs so I know this is a tough challenge to gain for me.

I hope you have talked with him and resolved the situation. Good luck.

This is an OSHA violation and goes back to "scene safety" and if the scene is not safe, NOTHING else happens until it is made safe. Maybe this guy is/was a medic and knows this from training rec'd outside of the facility? IF this is his train of thought, I'm with him =)

This is actually a pet peeve of mine. (And not just because it's something that I see ALL OF THE TIME working on a respiratory unit that has a ton of O2 tanks.) If that tank falls and shoots across the room, THAT won't be very good for the patient either. The first response to this thread was EXCELLENT.

I've been a critical care nurse for 15 of my 17 year career and while having an O2 tank sitting propped against the wall is wrong it sounds like you were in the middle of getting the patient situated and were going to take it out as soon as you left the room. He got into a resp. crisis and you had to tend to your patient first. If this CNA was a good CNA he would have kept his big mouth shut and helped you seeing that you had more important things to tend to at that moment! Sounds like he has some insecurity issues. It would be a good idea to go to him and tell him that the next time he sees a patient in a crisis situation to do a better job at helping you out and you do not need his badgering while tending to a critically ill patient. All the other comments on here that are so worried about getting an O2 tank out of the room are obviously not bedside nurses or have not worked in Critical Care where you have these crisis situations. We have many people working in a hospital and we all need to work together as a team! If he was a good team player he would have seen that helping you out would have been top priority and to quietly remove the tank himself! Who left the O2 tank in the bed in the first place? Maybe you just got back from a procedure? Who knows but he needs to realize his role and job and it is not to go around bossing around the nurses. I know that when you are fairly new to the critical care area it can be quite intimidating but don't let a bossy, insecure CNA disrespect you like that and privately, kindly, but firmly let him know that for the future. Obviously he has been a problem for a long time and no one has had the guts to deal with him. Put him in his place kindly and that is what he may just need! Someone that shows they are not going to put up with his disrespect and stands up to him. I have had to do that before with fellow nurses and once I stood up to them they were definitely more respectful! Sounds like everyone else has enabled him too long!

Remember we all work TOGETHER for the sake of our patients who deserve the best care possible. Not to lay there in a bed listening to bickering with others who need to shut their mouths and do their jobs. Stand up to the CNA and do not let him bully you anymore!

Specializes in LTC Rehab Med/Surg.

You were entrenched in your role as nurse, and the aide was entrenched in his role as aide. Wouldn't it have been nice if you both could have behaved as a team. Since you are technically the boss, it was up to you to enlist his help. To include him in the emergency. You dismissed him as unimportant. Or that's the way he may have viewed your verbal exchange with him.

I completely agree with the first response. It's exactly what I hope I would have done.

I believe certain users need a debriefing on Maslow's hierarchy.

Physical needs come before psychosocial, people!

If a CNA is arguing with me about something of considerably less significance, while I'm trying to save a patient's life, darn right I'm going to kick him to the curb. Priorities, people! If I'm trying to resuscitate a patient, either assist me or stay out of my way.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Appreciate your response. Cant deal with exchange like that when patient is actively krumping. I was the only one there for my patient and had to figure out what I should do and do it, not deal with this aide, seconds count. Exchange was for me to get him out of my focus so I could stay focused on pt., which didn't work, obviously. Slamming things is NEVER acceptable. I did say to him I would address this later, which he did not accept. I was concerned about my patient at that time, not his idiosynchasies.

Sounds to me like he's seen one take flight. I saw one go through a cath lab door. (they have lead) It's AMAZING how fast they fly.

Do you know how to tell the new staff from the old staff? The new staff try to grab the tank the old staff duck and take cover.

Personally, I would NEVER "PROP" an O2 tank against the wall....lie it on the ground but NEVER PROP...that is the making of a very dangerous situation.,

I understand your patient was crumoing and it sounds like one of those situations that escalated quickly. You kind of bit an answer to him, then he retaliated, you retaliated back. You unintentionally demeaned his job, position on the team buy inferring that what he had to say wasn't important.

"I can't talk to you right now I am dealing with this situation" inferred to him that what he has to say isn't important...... and it is important. I mean, We ALL know that the patient is more important....... but so is preventing a death from a projectile O2 tank.

I probably would have said "Oh wow...(probably holy crap) you're right, I'm sorry. Can you do me a huge favor gab it for me...this patients gonna code/crump/circling the drain and I can't leave....Thank you so much" Sometimes you just have to give it up...and give in to keep the peace.

He didn't accept what you said because you didn't hear what he was saying. I am sure that wasn't your intention but that is what was perceived. Communication is a 2 way street. There is a give and take that has to occur to have communication/conversation. So, he has a ton of quirks...he must be doing something right he's been there for 30 years.

You have to give those employees their due.....they have earned the right to take the lunch precisely at 1100. His start and stop time is between the manager and HR.....if that is what is agreed then that is what it is....peroid. Taking out extra linen is not cost effective. The hospital pays by the pound. Once it is in the room it's dirty. Besides it is his job to stock the rooms by doing it yourself infers that he is not doing his job. W

What if he decided to restock your IV's? You'd ask "What are you doing that for?" right?

An ounce of patience and compassion goes a long way. Just try to view it from his point of view and word things the way you would like them worded to you. I am positive he meant you no harm. In high stress environments...emotions run very high and there are frequently exchanges of barely veiled hostility. But that is the nature of the environment. YOu need to develop a think skin and not sweat the small stuff. I think it's the thick skin ICU/ED nurses develop is what gives off "witchey" meanness to others.

I wish you the best..:hug: look at it from his point of view.

There but for the Grace of God go I.

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