Staff splitting and customer service

[Meliss214]

I'm a new grad who has just completed my 7th week as a psych nurse. My problem is that I'm trying to provide the best care for the patients, but am being accused of "staff splitting." Case in point, I tried to find a pt's personal medicine that, according to her, had recently been dropped off at the front desk by her mother. I took the time to check the front desk and go by the pharmacy to see if had been picked up, all to no avail. I then called the pharmacy the next day when the pt stated that the pharmacist and brought the meds and then took them back to the pharmacy. The pt was upset with the lack of service she was receiving from the morning shift and the supervisor had advised me to have the pt write down her complaint. Well the supervisor was upset with me when the pt exaggerated my attempts to help her by saying that I spent 3 days trying to recover her meds. I'm not sure what to do because it does appear that the morning staff is somewhat burned out. I just don't want to start ignoring pt's concerns out of fear of being accused of staff splitting or perhaps, making the complacent nurses look bad.

[psychRN2013]

I know exactly what you mean, and I've had pts do the same thing. It's not you who is doing the splitting, but the pt, and usually this is the pt with the borderline tendencies. You should do your best to serve your pts and you weren't wrong there, but when a pt starts singing your praises and calling the nurse on 1st shift a ***** because he/she didn't do what the pt wanted when she wanted, then it's up to us to redirect that behavior, not feed into it, and politely make it known that we're not going to speak disrespectfully about another staff and that if the pt has legitimate concerns you can direct them to your nurse supervisor.

[Meliss214]

Thank you for your reply. What advice do you have for working with a charge nurse who thinks it's appropriate for a pt to clean his feces that has spilled onto the floor with a towel when he empties his colostomy bag. The housekeeper and I think it should also be cleaned by the techs with disinfectant. I also wanted to call the supervisor to see if we could find a larger colostomy bag for him, but the charge nurse accused me of staff splitting by trying to accommodate the pt's requests.

[psychRN2013]

Sometimes its appropriate to have consequences for certain blatant disruptive behaviors, but this sounds more like just a medical need, and not only that, it's very unsanitary and a health hazard to be allowing the pt to just clean his spilled feces with a towel, particularly if he has a roommate that shares the bathroom. If he's teachable, maybe you could show him a cleaner method for emptying his bag, like maybe placing a towel underneath his bag as he empties it into an appropriate container. Maybe that would work as long as he's not actually just being trifling and doing that intentionally..lol...sometimes nurses can be a bit harsh and jaded, especially if they're burnt out and don't have a good attitude toward they're work, but don't be discouraged and don't start following suit by falling into a negative mindset and becoming condescending and apathetic toward your patients. It's not called staff splitting just because 2 nurses don't agree on how to handle a situation. You can be respectful of your charge nurse and still do what you feel is right toward the pt, and I understand that you may be questioning your judgment due to your brief experience, but if she continues to have a major issue and you feel that you're doing the right thing, I would go to your supervisor.

[Meliss214]

Thank you! Fortunately my supervisor returns from vacation on Tues. Hopefully this week will go smoother than the past 2 wks. I'm tired of crying at the end of the week. I didn't even bother to reapply my make-up after my last crying session.

[Whispera, MSN, RN]

I believe we should not do for patients what they can do for themselves or we encourage dependency and helplessness, especially in patients who stay with us awhile, as psych patients sometimes do. Does this particular patient clean up after himself when not in the hospital? Then, I believe he should clean up after himself while in the hospital. That doesn't mean I wouldn't provide gloves and ask someone (or do it myself), to disinfect the area afterwards, since it IS a hospital.

Depending on what kind of psych unit it is, my opinion might vary. If it's a geropsych unit and the people are confused or frail, they should be helped alot. They wouldn't be used to caring for themselves anyway. If it's a unit of medically stable, otherwise strong and healthy (but psych) patients, I see it as more of a dormitory environment, that could be seen as home to the patients while they're hospitalized. Why make it all medical if it doesn't need to be?

I'm so glad you advocate for your patients. You are the kind of nurse they need. Be strong, be proud, and keep on being the nurse you know you need to be, no matter what some burnt out ones might say.

You aren't staff splitting. You're advocating for your patients. If the patient staff-splits, all you can do is not be part of the words that fly about it.

I'm glad you tried to get a bigger colostomy bag, and teaching proper emptying of the bag is good too. Those bags can be a pain in the patootie, can't they?