Work situation, upset, opinions needed

[beeble]

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

[imintrouble, BSN, RN]

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.

I can resuscitate a patient AND be mindful of the needs of my fellow health care professionals. You'll notice I did not differentiate with the terms nurse or aide. "Either assist me or stay out of my way". It seems there was never a request made to the aide for assist. Respect, respect, respect. It would be interesting to know how the aide would have responded if addressed in the way minnimi suggested.

[Esme12, ASN, BSN, RN]

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.

Yes but nothing in Maslow's says you have to be rude when accomplishing your task. Everyone wants to be treated respectfully.

"I'm sorry, you're right...can you help me I'm up to my elbows"

Beats "I'm saving lives here back off" Right?

It's all about respect.

I think he was trying to help for if the tank fell and fractured and shot off like a rocket and injured you or the patient, the vent, monitor or someone else....what is you needed a tank stat for transport and that was the last tank available and now you have to wait.

Just giving another point of view....

[Cleopf01]

Yes but nothing in Maslow's says you have to be rude when accomplishing your task. Everyone wants to be treated respectfully.

"I'm sorry, you're right...can you help me I'm up to my elbows"

Beats "I'm saving lives here back off" Right?

It's all about respect.

I think he was trying to help for if the tank fell and fractured and shot off like a rocket and injured you or the patient, the vent, monitor or someone else....what is you needed a tank stat for transport and that was the last tank available and now you have to wait.

Just giving another point of view....

Good point. I agree with you. I suppose I just got caught up with what in my head became an "either - or" situation---making the CNA feel important vs. saving a life. And it's not, you can be respectful, while still making it about the patient.

[plaidnurse]

When a patient is de-satting your own adrenaline is rushing. You aren't in a relaxed state of mind for thinking through responses. Anyone who works hands on patient care or with basic knowledge of biology knows this. It's your own sympathetic response. You naturally feel sympathy for another human being who is in crisis. When you write the NCLEX, you are asked to choose the MOST CORRECT answer. There can be more than one that is right, but one is more so, in that moment. The tank was a POTENTIAL safety risk. The patient's condition was an ACTUAL safety risk. First things first. Of course there are better ways to store the tank and you know that now. You can analyze "until the cows come home" but truth is, your co-worker gave you a message that said "I am the most important person in this room". You say that many people in this work environment are aware of his attitude and behaviour. I think this workplace may have greater issues.

[minnymi]

Why didn't the tech just move the O2 tank?

i'm sure he would have had she called for his help and asked him to which would've been another better option than what happened.

[NurseLeeny]

Does your employer have a 'workplace discrimination and harassment policy'? If not, maybe they should get one? or have some employees start one up?? As these issues do come up in many work places that I have worked in.

Bullies are everywhere, and I think you need to step up to this person, and tell 'him' you won't tolerate his 'treatment', and that his 'interference' in your 'professional standards as a nurse' could have complicated matters as far as liability goes, and he would be a co-defendent in an inquest, if something unfavourable had occurred.

Good luck! Sounds like he needs to be put into his place!

[Esme12, ASN, BSN, RN]

When a patient is desatting your own adrenaline is rushing. You aren't in a relaxed state of mind for thinking through responses. Anyone who works hands on patient care or with basic knowledge of biology knows this. It's your own sympathetic response. You naturally feel sympathy for another human being who is in crisis. When you write the NCLEX, you are asked to choose the MOST CORRECT answer. There can be more than one that is right, but one is more so, in that moment. The tank was a POTENTIAL safety risk. The patient's condition was an ACTUAL safety risk. First things first. Of course there are better ways to store the tank and you know that now. You can analyze "until the cows come home" but truth is, your co-worker gave you a message that said "I am the most important person in this room". You say that many people in this work environment are aware of his attitude and behaviour. I think this workplace may have greater issues.

Still....I have been coding people for a long time and it is not an excuse to be rude. I'm not saying at some accident scene someone would be directly obtunded and interfering and they will definitely know I am not pleased and become very clear what my expectations are........but I am not rude.

Please and Thank You go a long way. Before you panic and shout take your own pulse first.

[Esme12, ASN, BSN, RN]

Good point. I agree with you. I suppose I just got caught up with what in my head became an "either - or" situation---making the CNA feel important vs. saving a life. And it's not, you can be respectful, while still making it about the patient.

:hug: Well said.

[Been there,done that, ASN, RN]

When a patient is de-satting your own adrenaline is rushing. You aren't in a relaxed state of mind for thinking through responses. Anyone who works hands on patient care or with basic knowledge of biology knows this. It's your own sympathetic response. You naturally feel sympathy for another human being who is in crisis. When you write the NCLEX, you are asked to choose the MOST CORRECT answer. There can be more than one that is right, but one is more so, in that moment. The tank was a POTENTIAL safety risk. The patient's condition was an ACTUAL safety risk. First things first. Of course there are better ways to store the tank and you know that now. You can analyze "until the cows come home" but truth is, your co-worker gave you a message that said "I am the most important person in this room". You say that many people in this work environment are aware of his attitude and behaviour. I think this workplace may have greater issues.

Absolutely the most correct response to this post!

Of course she was fired up on adrenaline.

Simply not able to react " politically correct".. when being badgered over bs by an aid!

[BuckyBadgerRN, ASN, RN]

Exactly. A tank falling on the OP's foot is going to bring her patient care efforts to a screeching halt as well!

[cjcsoon2bnp, MSN, RN, NP]

Still....I have been coding people for a long time and it is not an excuse to be rude. I'm not saying at some accident scene someone would be directly obtunded and interfering and they will definitely know I am not pleased and become very clear what my expectations are........but I am not rude.

Please and Thank You go a long way. Before you panic and shout take your own pulse first.

I could not agree more Esme! I think this whole situation really breaks down to how we communicate with other people in our workplace.

I understand that the OP was responding to a critical situation with her patient and so that can be very nerve-racking experience, especially for a new nurse, but I think it could have been handled better. I also understand that the way the CNA approached the situation was wrong and both the OP and the CNA need to discuss what happened and how to avoid it from happening again. On a side note, I did notice that throughout the OP's first post she included a few details that give me the impression that she has probably never liked this CNA or at least thought very little of him and perhaps that has come across to the people she works with as well.

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.

And the OP goes on to say...

Appreciate your response. Cant deal with exchange like that when patient is actively crumping. 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 didnt 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.

After reading this it gives me the strong impression that you think very little of CNAs. Perhaps that is just how you come across in your posts and that doesn't represent how you feel but your writing does give that impression. The fact of the matter is that whether your in a Code Blue situation or not, everyone needs to treat others with a certain level of basic human respect. When the OP said,

"I can't talk to you right now I am dealing with this situation"

That comes across as "I don't care what your saying. I'm too busy to deal with you." But if you had said "Would you mind moving it for me? I've got my hands full." it would have let the CNA know (in fewer words) that you were busy while acknowledging his concern and not dismissing him.

To the OP, I would suggest you speak with the CNA and discuss what happened and how to avoid it again. I would apologize that the situation got to the point that it did (not saying that you were wrong, just that your sorry it got to the point that it did) and see if there is anything you can do to improve the communication between you both. If you leave it up to your manager to deal with it will come across as you are not mature enough to deal with conflict resolution on your own.

!Chris

[jack2637]

Early in my nursing career I went through an experience simular to yours, I still get upset when I think of this particular aid. He went out of his way making it difficult for others and he seemed to enjoy getting to me. I needed to hang a Procain Drip for a Patient with a HR of 170, The aid wanted me to help him move some beds, I told him I couldn't and probably in a rude way because of my resentments and being in a stressful situation. I argued with him in front of others, still thinking I was right because I was the nurse in a emergency situation and his concerns were of no importance as to mine. But the fact is I was in the wrong, yes I did get the drip up and the Patient responded well, but I didn't handel my situation in a professional manner, there is always more expected from the professional then then the ancilary staff. My self righteous anger and my excitability made a already stressful situation worse and it was my responsabilty to remain calm and focused and keep others around me calm and focused. Look I know its easier said then done, but I have seen others do it and decided I wanted to be more like them and learned allot from this experience. Again this dosen't make the aid right, and those issues can be dealt with in a more proper forum, and not in front of others during a Er situation. Its what makes our job so easy!!LOL