opinions on a nurse/patient interaction

[livintall]

So recently I was requested by a family to take care of their father on any shift that I worked. I built a strong rapport with them and they were very comfortable in asking questions. One day the family approached me with the staff working that night and asked me about one particular nurse that they did not know. They asked what my thoughts were. I gave them a simple indifferent shrug. The family then asked me if I would want this particular nurse to care for my family member. I stated no. The family asked me why and I responded with that I don't care for her demeanor and her frequent lacking of complete patient care. The next day this family once again asked who was working that shift (I was not there) and in that discussion the family stated to the supervisor that they did not want this person caring for their family member. They further told the supervisor that I had said that I would not want this nurse caring for my family member. The other nurse in question has no idea any of this went on. So now I'm facing a disciplinary action with my facility. They have not been specific yet as to what they are disciplining me for and I will clarify it when I meet with HR.

So, what are your thoughts on this? I did not seek out an opportunity to demean someone nor did I do anything malicious. My perspective is that I honestly answered a specific question that was presented to me by a family member. To have answered otherwise would have been not only a lacking of honesty and integrity, but a compromising of my own self integrity and values. It was mentioned that this "disciplinary action" was happening because I had not up managed another nurse. I countered that it was wrong to compel someone to talk up another nurse if they do not feel comfortable doing so. It's no different than being a job reference for someone. Would you lie just to "talk them up"? Would an employer appreciate that quality about you or them? If I told a patient that the nurse taking over for me was "going to take great care of you" knowing that my past experiences that RN have shown otherwise, then I risk losing all that rapport that I earned with that family due to me looking dishonest or not forthcoming. Further, avoiding this would have required me to compromise my morals, ethics, and values. I would hope that others would not compromise their values to talk me up when they don't feel comfortable doing so. This other nurse has no idea any of this has happened so there is no damage done really. So please tell me what you think.

[elkpark]

This has got to to be an HCA facility- they are so big on that ridiculous "up managing."

I've worked a lot of places over the years, none of them HCA facilities, and I've never heard the term "up managing" before, but, any place I've ever worked, a staff member would be formally disciplined for doing what the OP did.

[wooh, BSN, RN]

"Well thankfully I've never been a patient here to really know how any of the nurses treat their patients!"

"We have so many great people working here!"

You can deflect without lying. Not to mention, if this is a nurse that your patient or your family member can't make it through a shift without ending up in worse shape than when the shift started, then you need to be talking to management, not defaming them to your patients.

[edmia, BSN, RN]

I'm sorry, you said what?!?

No matter what your personal opinion of a colleague may be, you never share those thoughts with a patient or family member. You crossed a professional boundary and are being called on it. I'm sorry this will be a tough lesson to learn, but best to learn it than continue down this road.

Good luck with your co-worker. I might start looking for another floor or hospital to work for...

[jadelpn, LPN, EMT-B]

It is annoying to have to "manage up" another nurse. Especially if you are feeling less than thrilled over their practice. Nurses should stand on their own practice, and others shouldn't have to talk them up to patients.

With that being said, here's where I think you made an error in judgement. First off, you should never, ever get in a boundry issue with patients and/or their families. You can be a stellar nurse, practice well, show compassion and all the other parts of nursing that show you are ethical and have high standards and not get emotionally involved in caring for a patient.

Secondly, if asked the question, i would respond with a "I am not really sure how to answer that, as I am not sure what the question means. Nurse XYZ has been with the facility for ____years. Should you have any questions, each shift has a charge nurse--this shift it is Nurse PDQ, so if you need to speak with someone regarding your father's care, questions can be directed to the charge nurse."

If you have malpractice insurance, call them for guidance. If you are a union facility, speak with a delegate. At the end of the day, this patient will still be in the facility requiring care, and you may be in a position where you will not be given that patient as an assignment.

Never base your nursing practice on the fact that you are the preferred nurse of a certain patient/family. It can make a nurse feel good that patients have so much trust in their care. But it can and does backfire, mostly at the expense of the nurse and possibly their job. Learn to set boundries in your practice. It does not make you any less of a nurse.

[Esme12, ASN, BSN, RN]

Welcome to AN!

Well...that is quite the story. Typically facilities do NOT allow nurses to make disparaging and liable statements about other staff members. It is not professional to bad mouth fellow workers to the patients or families. Just because the family "LOVES" you doesn't make you the better practitioner. I fact I have seen many times, especially physicians, that are "LOVED" by their patients are amongst the scariest of MD's.

The proper, professional way to handle these situations and keep your self proclaimed integrity intact...is to respond politely.

You say things like..."We have many great nurses here...what is making you concerned? Let me get the supervisor/patient advocate for you to discuss your concerns" But never and I repeat NEVER do you say that someone isn't competent and walk lawsuit in the from door....administration frowns upon this kind of behavior.

I hope you learned from this.

[mama.RN]

Nursing, or any field for that matter is not just about mastering the technical knowledge, but also having some degree of social grace and political savvy. Your rationalizations for having done this will not fly with HR or others that will be looking into this, so I'd just take it as a learning experience and think back on it should a similar experience present itself in the future. Your job is to take care of your patients and keep them safe, but your allegiance should be to your employer and colleagues.

[psu_213, BSN, RN]

From the OP:

"To have answered otherwise would have been not only a lacking of honesty and integrity, but a compromising of my own self integrity and values."

……..

"It's no different than being a job reference for someone. Would you lie just to "talk them up"?"

There is no Quote button for the OP, so I had to copy and paste. Anyway, I would like to second just about everything that has been said so far, but the two quotes have not been commented on specifically, so here it goes.

As for the former, sorry, but you can't just hide behind integrity, values, honesty, etc. for every bad decision. If you want to say you ethical principles would be violated by "talking up" a nurse you think is a "bad" nurse--why would you even work on a unit with any staff member you think is subpar? If you have such a close relationship with this family, shouldn't you then make a list for them so the patient is not cared for by any nurse whose practice you do not like? Wouldn't it violate your integrity to allow a nurse to treat him/her when said nurse might not provide good care? You wouldn't let that nurse care for your family--why would you let that nurse care for anyone?

As for the latter, a job reference is a lot different that the scenario you describe. If a coworker comes to you and asks you if you will be a reference--if you think they are a good nurse you say "yes, I'd be glad to do it for you." If you are not thrilled with that nurse just say something to the effect of "Sorry, I just really don't think I would be an effective reference for you." If they don't ask you, but put you down as a reference, then that other nurse is taking the risk and you are honest about it. However, your situation is not a job reference. Your unit saw it fit to hire this other nurse. This other nurse must be doing something right because she works there. If you actually witness bad practice by this nurse, bring it to the attention of the unit management. Otherwise, she is fellow nurse on your unit. You owe it to her and to the rest of the unit to speak well of her. Say "yes, she is a good nurse" and redirect the conversation back to the patients care right now--and try not to become so attached to your patient and his/her family.

[ktwlpn, LPN]

You fell victim to the manipulation of this family due to your inexperience and immaturity, you failed to recognize the game they are playing. It's a common one in LTC, the patient and family members alike often have borderline personalities and ineffective coping skills and thei actions can throw an entire unit into chaos without early recognition and intervention.

I question YOUR integrity and values.If you felt this nurse was unsafe you should have taken action long before this incident and reported your concerns appropriately though your chain of command.In my opinion you don't like her, you threw her under the bus to build yourself up. Now you are trying to make it into some moral play....NOT.

You can't control the actions of your co-workers nor is it your place to apologize for them. "Up managing" be damned. If a patient of family member has a question or concern about another staff member you encourage them to speak to your manager.

[serenitylove14]

I would have told them every nurse has different personalities, but we are all able to care for their family member.

[LadyFree28, BSN, LPN, RN]

It sounds to me like you had already crossed professional boundaries with this family. You are not friends with them. Yes, you can have a great rapport with some people, but you aren't supposed to be sharing confidences. You are first and foremost a professional. Plus, you owe a loyalty to your employer and co-workers. Instead, you allowed yourself to be emotionally manipulated by this family who, then, essentially threw you under the bus.

THIS THIS THIS!!!

[LadyFree28, BSN, LPN, RN]

You fell victim to the manipulation of this family due to your inexperience and immaturity, you failed to recognize the game they are playing. It's a common one in LTC, the patient and family members alike often have borderline personalities and ineffective coping skills and thei actions can throw an entire unit into chaos without early recognition and intervention.

I question YOUR integrity and values.If you felt this nurse was unsafe you should have taken action long before this incident and reported your concerns appropriately though your chain of command.In my opinion you don't like her, you threw her under the bus to build yourself up. Now you are trying to make it into some moral play....NOT.

You can't control the actions of your co-workers nor is it your place to apologize for them. "Up managing" be damned. If a patient of family member has a question or concern about another staff member you encourage them to speak to your manager.

...and THIS.

Hopefully moving forward, you can learn to

1. Have boundaries, and

2. BE Diplomatic.

[HappyWife77, BSN, RN]

Again.....what Sally says about Susie, says more about Sally than what she said about Susie.