Professionalism on the floor.....

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Specializes in Trama surgery and ER.

I've just recently accepted a charge nurse position on my floor (trauma/surgery), and I'm already regretting the decision. Nursing is my second profession, and I had promised myself I would never take another "management" type position. I wanted to be a nurse and take care of patients. Well.......I was basically the only person available or willing to take the CN position so I went against my better judgement (thinking I could make a difference - Right!) and jumped right in.

The problem is that we have a few very professional, hardworking, cooperative nurses who are truly interested in our patients and go out of their way to do anything necessary to provide the highest level of care to ALL patients on the floor - then we have everybody else.......

Everybody else is the problem. I would venture to say that 80% of the RN's, LPN's, PCT's, NA's, RT's, and unit clerks on our floor spend about 20% of the shift providing patient care, and the other 80% of the time gossiping, complaining, planning what they'll eat, off the floor, talking about what they're NOT going to do, and generally just doing nothing. They are very unprofessional with language, topics of conversation, discussions about patients and family members, etc. It's very frustrating. Our nurse manager always says "write it up", but nothing ever happens. I feel like I have to convince people to do their jobs on a daily basis, and I'm so frustrated at this point that I've applied for a position in another unit within the hospital. I don't want to leave my floor but when work begins to affect my health and personal relationships, I think it's time to make a change.

Does anyone have any suggestions? Is it possible to turn this type of situation around? I'd like to improve things and get to the highest level of care possible for out patients, but I'm truly at a loss as to how to go about it without support from higher up.

Also, does anyone work in a facility they feel is able to maintain a high level of professionalism and cooperation?

Thanks for any suggestions. :no:

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Specializes in NICU.

A management position with no actual or perceived authority? No thank you. I don't know how you can really have any impact when you're serving in a lame duck position.

I'd either step down from that position and stay in a unit I really enjoy, or move on and take a hard learned lesson with me.

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when i was doing supervision/management i said that 90% of my time was spent dealing with 10% of the staff. it is hard to reward the good employees for a job well done when you spend so much time writing up the issues of one or another of the "problem children".

can you confront one issue at a time. for instance, at a staff meeting tell staff that their responsibility is to be on the unit. if they are leaving they need to report off to you. on other shifts figure out a system that works for them. write minutes of meeting and make sure all nurses initial that they have read minutes. then confront the nurse when report is given as to reason to leave. deny authorization to leave if it is appropriate. write up offenders who leave without giving you report. you might even have to remind them it is abandonment of patient to leave without reporting. they should not be allowed to report off to each other unless you have given specific instructions for a specific period of time.

next month focus on a different issue. same deal, notify that the focus will be... spend time going over reasons for these changes. if congrats for behavior changes are in order for their improvement, say so. if problems still exist, go to management and push them to support you. if they fail to support you then you have choices. continue up chain of command and make yourself a target, or leave, or bite the bullet and accept you will get no support and things have little chance of improving.

when you write performance appraisals mention things that have not had changes. give credit without comment how it was changed for people who have changed behaviors.

good luck, i am sure you are doing all these things and more. this was just a llittle reinforcement that you are doing the right thing.:yeah:

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Specializes in LTC/SNF, Psychiatric, Pharmaceutical.
I've just recently accepted a charge nurse position on my floor (trauma/surgery), and I'm already regretting the decision. Nursing is my second profession, and I had promised myself I would never take another "management" type position. I wanted to be a nurse and take care of patients. Well.......I was basically the only person available or willing to take the CN position so I went against my better judgement (thinking I could make a difference - Right!) and jumped right in.

The problem is that we have a few very professional, hardworking, cooperative nurses who are truly interested in our patients and go out of their way to do anything necessary to provide the highest level of care to ALL patients on the floor - then we have everybody else.......

Everybody else is the problem. I would venture to say that 80% of the RN's, LPN's, PCT's, NA's, RT's, and unit clerks on our floor spend about 20% of the shift providing patient care, and the other 80% of the time gossiping, complaining, planning what they'll eat, off the floor, talking about what they're NOT going to do, and generally just doing nothing. They are very unprofessional with language, topics of conversation, discussions about patients and family members, etc. It's very frustrating. Our nurse manager always says "write it up", but nothing ever happens. I feel like I have to convince people to do their jobs on a daily basis, and I'm so frustrated at this point that I've applied for a position in another unit within the hospital. I don't want to leave my floor but when work begins to affect my health and personal relationships, I think it's time to make a change.

Does anyone have any suggestions? Is it possible to turn this type of situation around? I'd like to improve things and get to the highest level of care possible for out patients, but I'm truly at a loss as to how to go about it without support from higher up.

Also, does anyone work in a facility they feel is able to maintain a high level of professionalism and cooperation?

Thanks for any suggestions. :no:

I've been there, and heard the same response: Write it up. I did, and never heard anything about it again. Nothing seemed to get done. I even wrote up a couple of CNAs after they lacerated the fingers of a diabetic patient trying to cut her nails (they knew she was a diabetic and that was a big no-no) and caused the woman's daughter to come charging up to the nurses' station to chew ME out. They not only refused to sign the write-up, but they got a big male aide to come yell at me. I told them to NEVER threaten me again, EVER.

Dave Thomas (founder of Wendy's) probably had the best advice I could think of regarding difficult workers: when he was a staff sergeant assigne to manage the struggling NCO club in Ramstein, Germany in the 50's, he had a bunch of belligerent Germans working for him that resented him because he was much younger than they were, and they were diplomatically protected too. One night he got mad and told them off: that if they wanted to work for him, they could work hard, and if they didn't, he'd fire all of them and they could just leave and not come back. It was a risk, but it paid off: he never had trouble from the German workers again. Were it only so easy to deal with recalcitrant nursing staff.

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Welcome to management.

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Specializes in Staff nurse.

Be a role model.

Remind them you all are part of a team for the patients. You all may sit and visit when pt. care is done, "chores" are caught up, there are no assignments waiting to be done. Make sure to have at least 1-2 aides available to answer call lights.

Remind eveyone that pt. information is confidential and unprofessional talk or words are not appropriate. My example: If you wouldn't use that word or phrase during a job interview, then it isn't appropriate for work.

The above suggestion to highlighting an issue at a time at staff meetings is a good one. Go around and ask everyone what they would do to remedy the issue of the week, month, whatever.

Give it some time, be respectful but firm. You don't have to become Attila to get it done. And start counseling one-on-one with the warning of a write-up if it happens again.

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Specializes in Trama surgery and ER.

I don't want anyone to loose their job, but I really think that if our NM would just make an example out of the 2 worst offenders, it would have a real impact on the "followers".

Just an ironic note.....the 2 worst offenders are the ones our NM assigns to orient/train the new hires. Go figure.

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Specializes in Trama surgery and ER.

I've tried being a role model for the last 2+ years to no avail. It's just a environment that's been allowed to exist for far too long, and it's become SOP. It's just impossible to handle these issues on a nightly basis and provide patient care. It's frustrating.....

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Specializes in LTC/SNF, Psychiatric, Pharmaceutical.
I don't want anyone to loose their job, but I really think that if our NM would just make an example out of the 2 worst offenders, it would have a real impact on the "followers".

Just an ironic note.....the 2 worst offenders are the ones our NM assigns to orient/train the new hires. Go figure.

They probably feel protected due to their seniority and due to the fact they think they are somehow favored by the nurse manager, much like the workers I mentioned earlier. Unfortunately, they're right to a degree.

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Specializes in Staff nurse.
I've tried being a role model for the last 2+ years to no avail. It's just a environment that's been allowed to exist for far too long, and it's become SOP. It's just impossible to handle these issues on a nightly basis and provide patient care. It's frustrating.....

Well, dear one, maybe it would be better to seek a transfer to another floor or unit at your place of employment. When your NM asks why you want to transfer, you can be kind but truthful, of how the burden of pt. care is carried by a very few. Give specific examples of what is not being done by whom, or being done poorly. Give examples of the unprofessional and offensive language being used.

If you truly love your unit and want to stay, step down from being charge. Let the burden be on the NM, you gave it your best and it wasn't satisfactory for you for patient care...I'm sure you have many readers here praying for you during this stressful time. Hugs.

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Specializes in Trama surgery and ER.

I've already applied for a position in our IR department. I've always been open with my NM about issues, and I have always made a conscious effort to go to her with suggestions for improvement and change along with my complaints and write ups. I really feel like I've done my best, so if I go it's with no regrets. My husband (also an RN) has suggested that it's the few of us who do put patient care first who are holding the unit together and if we go maybe somebody will be forced to address the issues.

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Specializes in Trama surgery and ER.

Oh there are definitely a favored few. I normally work nights but I worked an extra shift one day a couple of months ago, and I actually witnessed the "head" PCT pitch a fit, curse, and throw an accucheck machine across a table onto a cart. All this was done in the presence of our NM. Nothing was done.

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