CrazyCatNurse

I work a high acuity 24/7 PDN case. I like the family, my client, and the situation here. It's a positive home and I'm appreciated here. I have low self esteem, depression and social anxiety due to an overly sheltered background leading to awkward social skills. I'm very direct by nature. I tell the person straight up what I have issues with and try to be nice but occasionally (about once every six months) I offend someone. Then I apologize profusely and best myself up mentally over it and feel even more socially awkward. So I have a hard time confronting people with issues I have. I have an issue here. The night nurse I follow is lazy or careless or improperly trained. I don't know which. Today, for instance, she: 1. Left a mix of dirty and clean clothes piled on a standing frame that I had to sort through/put away before using said standing frame. 2. Bedside suction machine was unplugged, its battery was low and it didn't suction well. 3. Towels and draw sheets were folded/stacked poorly--I had to refold and restack them so a door would shut. This door needs to be shut for me to work properly. 4. Night drainage bag's nozzle was open and touching floor. 5. Powder to patient's groin folds was dumped on top of the folds. It caked and didn't reach the bottom of the folds (where it's needed most). This powder was caked deeply into the suprapubic stoma. I had to dig it out with a qtip and wash the powder also dried onto catheter tubing. It was like this last time I followed her too. 6. Tray used for giving meds was dirty and sticky. 7. Living room suction machine was unassembled. I don't know if she's being passive aggressive. It's possible. I approached case manager with concerns after I first followed her--that time there was unflushed urine in the toilet in client's bedroom (it smelled), a towel with crusted tube feeding was put away with clean towels, and catheter nozzle was also open and touching floor plus many small things I'm scared, honestly. The former DON (now works in management at this company) personally dislikes me (Every 3-6 months she calls and tells me what I'm doing wrong. I have the "wrong attitude", I use the "wrong tone" when speaking to her, I "really know how to make her feel bad". Never any issues with my skills or with me in the home.) I don't want to rock the boat and get in trouble with her again. I've gotten in with her trouble for re-arranging my work schedule, for taking three sick days in one year, for making self-deprecating jokes, for complaining about no MAR or charting notes in the home. I like this case! At the same time, I don't want my client getting an infection from this nurse's carelessness. So far, I have notified the case manager about the caked powder in catheter stoma and urine drainage bag left open. I've silently cleaned up/fixed all the other mistakes as they are small things and aren't likely to cause infection. I also texted the nurse about proper application of powder to creases. I honestly do not know how to handle this situation besides what I've done. Other relevant info: The case manager and family *really* like me. The former DON was reassigned to some other function in company and hasn't called me in about a year. Still I'm afraid my name will be mentioned in the office and she will say negative things about me that affect my employment with the company. It's entirely possible I'm overly anxious about this. tl/dr: Former DON dislikes me for no good reasons. She scolded me every time I did anything she decided was wrong. She was reassigned to other position, hasn't bothered me for a year. Current coworker is doing a very poor job. I'm afraid making an issue of it will bring former DON down on my case. I also wonder what's best way to handle it. Go directly to nurse or approach case manager?

Well, things seem to have worked out. I was already doing books on tape! Great minds think alike. The family likes that. The mom gives me a bit of a break--I just try to look busier when she is around. I switched to saving my charting for when Mom is around. Seems to have (mostly!) done the trick--in addition to books on tape, singing, telling client what I'm going to do...etc. Thanks for all your advice and support!!

Talked to DON. Turns out they promised the family we would read/provide stimulation to the kid during down times. Great. There is no other case at this agency. I'm looking elsewhere, but what they're hiring for out here is LTC, case mngt, or nights. DON suggested I take breaks by going outside. This kid's head flops out of headrest in 5 minutes, and he randomly vomits and aspirates. No, I will not be going outside.

Ok then. I was assuming a new young nurse like I was, not a life experienced confident and capable lady like yourself. That makes it better for you. Talk to NM, if that doesn't work, try and get out of there ASAP. Similar thing happened to my mom, second career nurse like yourself, on my mom's first job. NM didn't help. Mom got out of that floor/hospital as soon as she could--and she's enjoying nursing very much now.

"Employ modesty in your actions"... It seems plain to me from the original post that she does employ modesty in her actions. She's trying to carefully figure out what's happening, and how to handle it, and she's being bullied. I feel your vague advice places blame on the original poster for the bullies' actions. I think "trying to understand" them and "perhaps they are displacing their stress" gives the bullies power to bully more and excuses their inexcusable actions. It is possible I misunderstand you, but having personally followed all of this advice--including the "pray for them" bit... And it seriously did not help. It wound up placing blame on myself. "Watch your tone of voice. Be careful what you say. Oh, she's having a hard time in life, that's why she refused to give you report." In trying to understand them, I excused their actions. I felt I deserved to be treated like dirt.

Having experienced an incredible similar situation--my words were twisted, I was written up for everything and nothing, I was given positive feedback from all my preceptors then 5 weeks into work on floor they had a 4 nurses plus me meeting and gave me a half-inch stack of write ups--read them to me. Then while I was weeping from shock and shame (I believed their opinion of me must be right.), the Director of Nursing told me "This is nothing personal, but your hair looks greasy unkempt and unprofessional." I was told I "had attitude", but never what exactly made them think I had attitude. A preceptor insisted "I will not work with you on this." My questions were never answered. I was given vague advice like "be careful what you sound like" and "you don't see the big picture". Anything I told anyone came back to bite me later. I became physically ill--throwing up, weeping. I believed I was an incapable nurse. It was an understaffed floor, and allegedly self scheduled. They scheduled me on days I had other plans. My vacation days. My church worship days. Things I had asked off. I wasn't allowed to get off on these days, and when I reported the situation to a higher up nurse, I was confronted by the scheduler herself. "You're trying to make me look bad!" she said. Seriously, all the higher nurses had it in for me and it went all the way to the top. I was always being escorted to the DON office, and scolded. For having attitude, charting too accurately, not charting enough, and of course having attitude and then for crying in the office. I stuck it out for a year on that floor. It still messes with my head nine years later. I fight fear and tears whenever a supervisor talks to me in their office. My advice for you would be to get out of that situation as soon as possible. Confide to no one. Document every single incident in your own notebook. Keep your head down, your mouth shut, get your paycheck and experience and leave that floor as soon as possible. Of course, it's possible that the head nurse isn't part of the corruption. I'd be quiet and watch for before talking to her/him. See if you can figure it out. I'm glad that you can recognize that you are being bullied. It won't mess with your head so much if you're aware of what's going on. Oh. And don't apologize to her for her alleged perception of you. Unless its along the lines of "I am sorry that you feel/think/believe this way..." That way you're being assertive.

I am full time on a home health pediatric case. It's physically demanding--there are frequent dirty diapers and the kid weighs 150 pounds or so. So it's transfer him to bed, change him, back to wheelchair--five times in five hours yesterday. Anyways, the family expects the nurses to be always interacting with their child. I understand their point of view--they want maximum stimulation with this child so hopefully the comatose state goes away. But they want me massaging, doing range of motion, talking, reading to, rubbing the head of, singing to, stretching...something all the time. For 12 hrs. Yes, they let me eat and have bathroom breaks but that's about it. I'd just transferred the patient to bed, undressed him, inserted suppository, started tube feeding, put splints on feet... And I sat down and was catching my breath. Mom comes in with a fat stack of papers for me to read to her kid, "instead of sitting idle" because "nurse so and so would do this!" she cheerily suggested. She demanded my cell number. She didn't even ask if I was comfortable with it. Since she will get it anyway--I'll have to call her on my cell sometime, I gave it to her. And I read to her kid. I don't want to tick her off, but I can't do this all day. I feel the family has unreasonable expectations; plus I'm not good at one-sided conversations. And my throat gets sore talking so much. How can I tactfully set boundaries and appropriate expectations?