Nursing Role in a Multi-Disciplinary Team

[PsychNurseWannaBe, BSN, RN]

Hello Peeps!

Have any of you come across working in a place that seems to have no clear boundaries among multiple disciplines? Sometimes I feel my role as the RN is as clear as mud. Of course I do the meds, admissions and discharges...but after that it seems it is up for grabs. During my orientation I have seen this power struggle between the team. 2 of the job descriptions state they are under the supervision of the RN and yet, they pretty much do what they want. They don't have credentials. There are days when I feel like I have to kinda make myself known...then of course they get upset. There is one person who has no problem doing what they want and pretty much won't involve the RN and if an RN tries to get involved they become upset. I find it odd personally. These positions are equivalent to a CNA or Psych Tech and yet this behavior would never pass on a medical floor.

I understand that they want some autonomy and for the most part I am OK with that, provided I know what they are doing. Am I wrong for wanting to know or at least be updated on what is going on? I have no problem being a co-facilitator or even being the supportive person and letting them take the active role: provided it is safe and therapeutic.

I have yet to find a happy medium for this. If I try to play it cool and just keep an eye on it... they get upset. Or if I try to assert the role of the RN... they get upset. I know what they want... they want to basically practice nursing without a license, which of course is not acceptable. They would be quite happy for the RN to be seen and not heard... until crap hits the fan.

[Thunderwolf, MSN, RN]

This type of staff milieu requires the relooking at job descriptions and of your state's definition of deligation & supervision. It also requires a sit down with folks higher up the chain in your facility...because you will need backup. You are clearly in the right, but it sounds like your facility has been operating in the dangerous fuzzy areas for quite some time. Amazing that a patient hasn't been harmed by this practice. Even in Grad school and beyond, clinical supervision is considered the norm and expected for excellent clinical practice in a facility. These folks with less education have been turned loose way too long.

Hugs

[elkpark]

This type of staff milieu requires the relooking at job descriptions and of your state's definition of deligation & supervision. It also requires a sit down with folks higher up the chain in your facility...because you will need backup. You are clearly in the right, but it sounds like your facility has been operating in the dangerous fuzzy areas for quite some time. Amazing that a patient hasn't been harmed by this practice. Even in Grad school and beyond, clinical supervision is considered the norm and expected for excellent clinical practice in a facility. These folks with less education have been turned loose way too long.

Hugs

:yeahthat:

[PsychNurseWannaBe, BSN, RN]

Thank you for your replies.

Yes they have been operating in this fuzzy area for many years. They have all worked together for many, many years. I think over time the RNs where originally OK with it. The thought being, hey sure you can do it...frees up the nurses time. But being newer to the group is adding stress to me. For example I had one person who was becoming violent in his room, he admited he was having thoughts of killing himself. Also having thoughts of harming others, he was also unable to contract for safety. I got the attention of the Psych Tech and said I think this person should be placed in a refocus room. (seclusion room but door is not locked or closed but by the nurses station...) Well a CNA heard me and said, "well let me go in there and see if he needs to go in" I was really floored. I already performed the nursing assessment. I had already attempted to talk him down. I tried getting the patient to think of his coping skills that we have been working on in group...but he went completely silent and refused to make eye contact.

I was and quite frankly still am shocked by this over step on my co-workers part.

I don't know how to nicely say something without hurting her feelings or causing an uproar. But I feel it will come to a head soon.

[medsurgrnco, BSN, RN]

I've had similar struggles at my new job. Some MHWs think they know the patients better than the nurses, as they are around them more and some have more experience working in psych than the nurses. And some MHWs don't seem to want to work much, and/or appear a bit on the dense side. Anyway, the situation at my job has improved greatly over time as I've become more experienced & assertive in addressing pt issues and as staff have developed more respect for my judgment. And as we have talked more and they have gotten to know me more as a person rather than just as the nurse telling them what to do. I try to briefly explain my reasoning for decisions to MHWs. And think of ways to work around the MHWs that continue to be a challenge to work with. We have security guards that I can call on for help when needed, and they have always been great at following my direction. In your post, you said you told the MHW "I think..." Suggest you not use such tentative language with them, instead say what you want done. Hope this helps.

[aloevera]

It is a touchy situation at times for all of us. I have one MHT that has been there forever and really does know her duties. She does not and will not put up with anyone telling her what to do. She can be downright nasty to nurses and we all have discussed this. Complaints have been made about her but nothing becomes of them. As long as she does do her duties and treats the pts. well, we pretty much let her go. I understand that this may be quite frustrating to a new nurse to the unit but each situation is different, and as you will see it is very hard to find good MHT's. Each person is an individual and must be dealt with as such.