So, I have been an RN for a few years, with both hospital and home health experience. Let's just say I am well aware of my strengths and weaknesses by now. Currently, I am a private duty nurse at night, and only have one other nurse to give report to during the day. Since I have started, this LVN (not that the title matters to me, as I see us both as equal in the nursing world) has made condescending remarks towards RNs (even after acknowledging that I'm one of them), such as "yeah, I thought she was an RN, so I ASSUMED she would have her s*** together, but apparently not!", and "As an RN, [insert numerous insults here]". Anywho, her background is a few years in private duty nursing and a short time in psych. We seemed to get along ok at first, even after she made the first RN comment, but then I soon felt as though she started bullying me. She has been with our patient (her only current patient) for about 2 years. I don't know if it's bc this is her only pt that she chooses to nit-pick every aspect of this patient's care in a very derogatory manner, or if she feels some hatred toward me as an RN, but she loves to leave me little "love notes" almost every shift, basically pointing out every. Single. Thing. That she thinks I did wrong. Not only will she point it out and write a novel about how it NEEDS to be from now on, but she always includes a whole paragraph attempting to teach me why it needs to be done that way....
I'm sorry, not only do I find this annoying, but I feel insulted that she feels the urge to teach me something I already know, as a nurse. Perhaps I left something not exactly perfect or to her liking by the end of my 10 hr shift, but I have never done anything to jeopardize the patient or to constitute a written lecture on how to be a nurse. I honestly don't know if she means well or if she is trying to bring an RN down to make herself feel superior as an LVN. I normally would never think that (as I have respect for ALL nurses alike), but the way she has exuded such a negative perspective of RNs, she makes me feel so bad for being a peasant RN, like I don't deserve the title, since I can't meet her ridiculous OCD standards.
Everything is magnified in PDN. The same person in a hospital/floor environment is annoying, move them to PDN and they're really, really annoying. The nurse in question may not realize the disproportionate focus on less important details because she has no job experience to compare it to.
Most of the time boundary-setting in a direct but non-confrontational way works well, but the way you describe the cozy relationship between the Case Manager and the LVN, it raises flags that could cause concern beyond a personality conflict.
Before I worked in PDN I had no idea there were people who would go out of their way to sabotage someone, but I've seen it and more than once.
Anyway, thought I'd add my to the already great advice here.
Best wishes!
I very recently experienced a relationship between a "senior nurse" in management and a LPN in a role that was kind of cushy below her...and it was a friendship that started outside and it continued inside. The result was not good. Two bad apples. If this LVN really is friends with the CM, it might be a good idea to get another PDN job.
Specializes in M/S, Pulmonary, Travel, Homecare, Psych..
First off, you are not equals and you should not look at that way. you have more experience, education and training than the LVN. If she belittles you in front of a client again I would simply say "You are an LVN, you don't have the education and training to understand why I do .... this way. If you would like to learn I would be happy to teach you or perhaps you would like some information on becoming an RN so you can understand why I do things a certain way."
I have to respectfully disagree.
When I was at my first job ever as an RN, my preceptor, a gentleman who is now the DON in another state gave me a bit of advice that I've carried with me throughout my career. It's made a world of difference.
"Don't be short or condescending to other workers, because you are going to need them at some point or another."
Rank and title wise, I'm certainly higher up than a housekeeper (on paper anyway). But, oh gee, I have a new patient admit who wants a private room and said room is dirty. Think that housekeeper I pulled rank on last week is gonna be in a hurry to do me a favor and clean that room first?
I have more education than the average phlebotomist. At the last hospital I worked at, more than a few of the phlebotomists were girls who failed nursing school, so you could even say I'm probably "smarter" than them. Do you think that phlebotomist I told "Be quiet, you don't have the capacity to understand what it is I do" is going to make a special trip up to the unit to draw that lab I forgot to have ordered?
Respiratory Therapy loves giving their opinion on a lot of things. If I proceed to point out to them that "We're not equals" whenever they do, do you think I'm at the top of their list to "make happy"? Probably not, and I'm a bit of a PIA for them but they don't mind, cause I avoid saying such things. So, when it's the end of their shift, they're about to punch out and I need a stat breathing treatment, they do it, no complaints. If I had to wait for the next shift to get their stuff together and get to it, I'd have one unhappy patient on my hands and lower review scores.
I believe we are all equal. I'm a part of the healthcare delivery team, they are a part of the same team. The team can not win without my contributions, and the team suffers if their part is lacking as well. The fact that I am compensated more is a reflection that I am willing to take on more responsibility, not that I'm "better".
Specializes in ED, Cardiac-step down, tele, med surg.
I might agree with her to shut her up and keep the notes, but if she belittles you in front of people, I'd let her know not to do that again. I've had to set boundaries and limits with people at work. It's uncomfortable, but well worth it. If it doesn't work, then I'd consider mentioning it to someone in charge.
I love that idea, immortalessence! Haha! Wish I could, but I'm sure she would just write me a longer note next shift, telling me why I NEED her notes and how I didn't even crumble the note correctly prior to tossing it in the trash. I'm glad you can understand my annoyance on this one. Not to mention, she starts out every note with "MAKE SURE..." -_-
"Thank you so much for your input!! I shall take it under advisement". Do not engage any further.
Novels are written so that LVNS can say "RN aware" and cover some sort of "thing" that is perceived to be a potential issue.
and MAKE SURE you have malpractice insurance. This one sounds like it is going to be one heckuva LONG assignment!!
As a complete aside, make sure that if these are little post it note wonders, you shred them. You do NOT want this as part of a record, you do NOT want patient privacy violated if a licensing person/agency case manager drops in. Also, a gentle note to remind this LVN that in fact one of the standards of most LVN scopes in most every state is very facility/agency specific--but the one thing that all of them say is that an LVN can not direct an RN clinically. So I would really HATE to see a case manager/licensing person/department of whatever person get wind of the "notes" and see the poop hit the fan.....and the LVN be out of a license due to working outside of her scope.....
Thanks, so much, for all of the feedback. Especially to those of you who are currently working in PDN/have PDN experience and were able to enlighten me about how common this is. Since I posted this, I have just been taking the notes with a grain of salt, and just continued to be civil. I have not thrown them away (Lord knows I want to), but I have simply closed the communication book (instead of turning over the next page)at the beginning of my shift, so she has to go through more trouble to find her last love note to leave another, AND so I can ignore it easily throughout my shift. (Hehe) I've found that having my bag ready to go and on my shoulder helps create a sense of urgency to get through report faster, and making my reports specifically highlight the things I already did to make her day easier (like I would do with any day nurse) has made our interaction more bearable. Mostly because I don't give her any more time to say much or practically do her assessment while I'm talking. (Lol)...anyway, I am awaiting a callback from another agency (not PDN) and hope to land a position where I no longer report to anybody :) wish me luck!
Specializes in Pediatrics, Geriatrics, Geri-psych.
If you keep doing it enough, maybe she will stop. It has worked for me in similar situations. I am in LTC now, but was in peds home health for 6 years. I know your pain! I would either crumple it and toss or leave it aside and ignore it.
When I was at my first job ever as an RN, my preceptor, a gentleman who is now the DON in another state gave me a bit of advice that I've carried with me throughout my career. It's made a world of difference.
Rank and title wise, I'm certainly higher up than a housekeeper (on paper anyway). But, oh gee, I have a new patient admit who wants a private room and said room is dirty. Think that housekeeper I pulled rank on last week is gonna be in a hurry to do me a favor and clean that room first?
I have more education than the average phlebotomist. At the last hospital I worked at, more than a few of the phlebotomists were girls who failed nursing school, so you could even say I'm probably "smarter" than them. Do you think that phlebotomist I told "Be quiet, you don't have the capacity to understand what it is I do" is going to make a special trip up to the unit to draw that lab I forgot to have ordered?
Respiratory Therapy loves giving their opinion on a lot of things. If I proceed to point out to them that "We're not equals" whenever they do, do you think I'm at the top of their list to "make happy"? Probably not, and I'm a bit of a PIA for them but they don't mind, cause I avoid saying such things. So, when it's the end of their shift, they're about to punch out and I need a stat breathing treatment, they do it, no complaints. If I had to wait for the next shift to get their stuff together and get to it, I'd have one unhappy patient on my hands and lower review scores.
I believe we are all equal. I'm a part of the healthcare delivery team, they are a part of the same team. The team can not win without my contributions, and the team suffers if their part is lacking as well. The fact that I am compensated more is a reflection that I am willing to take on more responsibility, not that I'm "better".
We are all equals, but on paper, in most states, if not all, RNs are not permitted to take clinical direction from LPNs. It's not about being better or having someone subordinate to you. These rules are in place for a reason and you are not only jeopardizing your license, but, possibly your patient's or resident's safety if you're taking clinical direction from an LPN.
I, in general, am not a confrontational person, which I know is something I need to overcome in the face of adversity. However, this particular person, I feel, is not one to take criticism lightly herself (can dish it but can't take it). I basically have just been doing my job to the best of my ability while keeping in mind I still have room for improvement. Wasn't till just this week I started getting more offended. Plus, if you see my other post above, she is friends with the main CM, and I'm not trying to stir the pot.
I've been working PDN since January, and finally 'landed' a day job where I work with just one patient. The night nurse (we both work 12 hour shifts) is a 'lite' version of your 'adversary' lol. I too am not aggro or confrontational, but over the years I've developed my own 'style' of being assertive, direct and honest with difficult co-workers. There is not just one 'right way' to deal with difficult co-workers -- there are hundreds of effective ways, not that I can provide a list. It's the idea that you can (and will) develop your own personal way to deal with nurses like this. I've been a nurse a long time, and I'm telling you, there is 'one' wherever you go.
The night nurse (an LPN) has been with the patient for years as well. I worked part time with this patient since January, and full time since June, so I 'granted' her the "O Significant One" title because she's been with him so long and knows him so well. She is also a classic Chart Nazi, and can find a missing comma or missing set of initials with her eyes closed.
She is also generous with her 'why we need to do it this way', and it always concludes with "what if the state/auditors/God Himself were to see that you put 240cc for his tube feeding instead of 237cc, like it says in the orders?" Every day, there is something. The day before, it was "I know this is silly, but could you please fold the end of the tape over when you take off a piece, I hate to spend all that time hunting for the loose end" and yesterday, she found the lid of a saline bullet in his bed and 'just wanted to remind me to make sure I clean up my garbage'. These included 'explanations' as well .
The patient's mom intercepted a two page 'love note' she wrote me when it was discovered that a doctor's order to increase the nightly melatonin got lost in the chaos that is our local agency office. It wasn't her fault, or mine, or anyone but the nurse manager who quit work that same day and probably threw the new orders out her car window in her mad dash to escape her job, but she is so insecure and terrified of 'getting in trouble' that she threw the patient's mom under the bus already, and was trying to stuff me under there, too. The mom chewed her out for the 'love note' and I never saw it lol.
Anyway, how I deal with her is to deliberately consider what she says, and then 'file' it. When she's right, she's right, and I tell her. When she is OCDing due to her insecurity, I give her my whole attention and do active listening. It shuts her right up . Fortunately for me, her insecurity is so enormous she backs down.
To some degree I understand her protectiveness, and forgive her for that because I am rapidly becoming close and protective of the little guy too. I get that. But I wasn't born to help her manage her anxiety disorder, which often comes disguised as being demanding, nit-picky and critical.
You have every right to do your job as you best see fit, and to continue to do so regardless of her commentary. I have crumpled quite a few 'love notes' myself. Not my problem. If she has a point, that's fine. When she doesn't, not my problem. What you do is emotionally detach from her. She doesn't have YOUR permission to criticize or judge you unnecessarily -- and you decide where that line is.
You don't have to get into a whoop-n-holler cat fight to set boundaries with her. Do what comes naturally, try different things, and -- relax. She doesn't have your permission, remember? Blah blah blah blah. Crumple the 'love notes' . . . and compliment her. I've found that to be very effective with the night nurse. I don't mean make stuff up, but genuine realistic compliments. Usually people who are hard on their co-workers are compensating for insecurity. It may be the last thing ya want to do, and it may shock her at first, but if you are attached to your patient and want to keep working with him (as I do), whatever you can do to help her TRUST you (another major deficit with difficult people).
It's not like I don't have my . . . revenge, though. She has these 'special butt pillows' and the chair I sit in his HER special chair she brought in herself. Yesterday, I had bad gas. Sorry!
I would either crumple it and toss or leave it aside and ignore it.
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NursesRmofun, ASN, RN
1,239 Posts
I very recently experienced a relationship between a "senior nurse" in management and a LPN in a role that was kind of cushy below her...and it was a friendship that started outside and it continued inside. The result was not good. Two bad apples. If this LVN really is friends with the CM, it might be a good idea to get another PDN job.