Please Help

[midmichiganRN]

Okay so I need help with this situation. (little background) I am a new grad from an RN program. I was hired into home health and I have one patient that I take care of and I work nights. I thought things were going well (the day nurse was giving me a bit of hassle but I wasn't too worried about it). So the family is constantly telling me how much they like me and the patient was telling me everynight that she loves me. All I hear about the day nurse from the patient is that she "hates ___" I do as I am told and really have just been trying to use this as a learning experience as much as possible. Anyway, I absolutely love what I do but I am finding it increasingly difficult to please this day nurse. She is constantly contradicting herself with her advice...literally one day I mentioned that pt's pulse was racing that night and she told me it was because she wasn't laying far enough on her sides...one week later I mentioned that her sats were low and she told me it was because I had her on her side and she doesn't do that. So then the other day she told me that she doesn't even turn her to her left side (I know this isn't true because she trained me and she turned her on her left). I am really struggling with this because I am new and I want to do everything correctly but she has been going to the owner (my boss) of the HH agency and has been complaining about my charting and I have been called into the office for meetings with her and I have made all necessary changes but I continue to get brought in for this. The problem I find with this is that I was taught to go to the person who is doing wrong first and let them know what is wrong before seeing a supervisor. No one has yet to come to me besides the supervisor and if someone did I would make the quick changes needed and continue on. I know that I am new, I'm not going to pretend like I am not but it is as if I am supposed to be perfect to start off with.

So the day nurse has also been putting Dr. Scholls foot powder on the pt's feet and mandates that we must do so also. #1 there is no Dr's order for this powder and #2 the pt began to experience breakdown under her toes. Along with this powder we put sponges (yes kitchen sponges cut into toe separators) in between her toes to keep them separated. In the morning they are wet, and smooshed so I don't know how well they actually work, so I decided to stop using them and I tried a different technique of cotton ball wrapped gauze in the upper part of the toe to keep them apart and it worked GREAT!! It allowed air flow and the toes began to clear up. Well the day nurse read my charting where I wrote this and went to my supervisor and again I was spoken to about this. I don't understand how what I did was wrong. I am truly looking out for what is best for this pt and it seems that the bacteria that would accumlate (even though we wash and dry the sponges at night) would be worse for open skin than cotton balls and sterile gauze...

Lastly and most recently I have now been scrutinized because the pt has had a headache 5 times in the last 16 days (all on nights that I am working) and they think that I am giving motrin when it isn't really needed because they think she is faking it. I was taught that when a pt says they are in pain that you must believe them, I actually believe her there are visual cues that I have been looking at on her (forehead rubbing and increased pulse). I know when she is trying to stay up later than she should and this has not seemed like one of those circumstances. Her pulse stays up around 100 when she is resting and she can't sleep. She always seems to fall right to sleep after I give it to her too. The nurse also has told the family the reason she has a headache is because I don't run the air conditioner at night so I was left ANOTHER note tonight informing me that I MUST run the AC all night long. Well I do, but when it gets under 70 in the room I feel it is time to turn it off for 1/2 hour and then restart it.

Oh and during my meeting about my charting I was told not to include some of the things that I did, for example "Brief's dry"...that was just "unnecessary". Well I was told that if you don't chart it you didn't do it and I would rather chart too much than not enough. Can they really tell me not to chart everything I do? I said that it seems that I am just writing the same thing over and over and they said..."that's fine."

Things have gotten to a point that they shouldn't have. I have turned in my 2 weeks because I can't take this anymore and to me this has become a toxic environment. But I am afraid that if I don't stick up for myself with the HHA owner and with this day nurse that they will do this to someone else. I really feel like I need to fully explain myself to my boss because she is only getting a onesided view of what is going on...what saddens me is that she hasn't even tried to find out what my side of the story is. The worst part is that I found out from the family today what she has been saying and that she has been trying to get me out of here...It really has me in tears that she has done this to me, especially after I have tried so hard and truly love what I am doing. She is convinced that she has the patient's best interest at heart and complains that the parents don't do anything with the child but then sets rules that don't allow the parent's to be parents. The father talked with me last night and told me that out of all the nurses he feels most comfortable when she is in my care and he is willing to go to the boss to talk with her about this. He said he has been seeing what has been going on and has gotten two different stories and knows the way this woman is. Also the pt has a "memory foam" type pillow that I use to support her back and side as I turn her on her side and the day nurse doesn't like me using it. Generally when I come in I find it in the closet under all her blankets but today it is completely missing. The family all went looking for it and it can't be found anywhere. So now she is hiding stuff on me.

So I really would like to know how to handle this situation because I really can't just sit here and let things go. I need to protect my good name and license. If anyone could please offer suggestions I would welcome any advice.

[hlfpnt, BSN, RN]

Wow...pretty sticky situation! For one thing it sounds like the day nurse has the supervisor snowballed. Also, (I could be wrong) sounds like what you're doing & charting states what she's NOT doing. "First do no harm"...if your care isn't harming the pt I'm not seeing the problem...only the fact that it's not done this day nurses particular way. Myself I think the fact that the father has voiced he's uncomfortable with the quality of his childs care should speak volumes. I won't tell you what to do...the decision is yours, but I'll tell you what I would do. It doesn't sound like talking to the day nurse has brought any results for you. I'd sit down & document everything you've stated here then, in a professional manner, present it to the supervior. Maybe setting up a conference with the father & the supervisor would help. If this didn't bring results I believe I'd start looking elsewhere, especially if I'm under 90 days. One thing employers don't say is the 90 day thing is also your opportunity to decide if they are right for you. I believe in taking care of my pts to the best of my ability, but I also believe in protecting myself. You've worked hard to get where you are. I guess what I'm trying to say is I'd try to plead my case & if that didn't help I'd let it go. Good luck to you.

[MA Nurse]

Sounds like you and the pt.'s father should go to the supervisor and talk to that person directly, together. For some reason, the day nurse has something against you. Has she been a nurse "forever?" Sometimes the older nurses get this way with a new grad, esp. day nurses...I know not all day shift nurses are like this...but a lot are.

[outcomesfirst, BSN, RN]

Please print out your post. Make an appointment with your Supervisor. Let her read it and then discuss it point by point. Stay calm. Do not blame. Ask your supervisor what you should do to make this job a fit for all stakeholders - Patient, family, co-workers, employer and you. If you and your supervisor cannot develop a plan, then it is time to move on - with a plan. Look for a position that you want, meet with the supervisor. Show them the print out, talk about the discussion and determine what works. Find a leader who will lead you, and your patients where you need to go. Do not give in, do not walk away - step up and empower yourself, your patient, family members, the employer and yes the other nurse - work it out. Before this gets to smarmy, let me just say - nurses and nursing are a reflection of their actions, still smarmy.....hmmmmm....what if......