Staff splitting; disrupting unit; need opinions please

[MollNick]

I recently had a situation I am not sure how to handle "the next time". Scenario: 14 adult patients, me (RN) and 1 MHT. Patient A is diabetic, manipulative, intrusive, frequently asking for extra breakfast, snacks, extra juice, milk. For AM med pass, pt. A wants Xanax which is scheduled for 2100. Pt. A told they will see Dr. today and to ask for it. Pt. A did not appear to be anxious. Pt. A slept through AM smoke break. When pt. A found out they threw a fit at nsg. station demanding to go smoke. They were told the next break will be before next group therapy as scheduled. Approx. 30 min. later, house sup. is in room with pt. A for about 1/2 hour. Then, sup. comes to station and inquires about situation. Sup. updated and informed of the scheduled smoke breaks. Sup. tells us that pt. is very upset about not getting to go for smoke break and instructs the MHT to give pt. a smoke break at 1st opportunity. After the sup. left I instructed MHT to wait until scheduled break for taking pt's out. . A little while later, another pt. is at station throwing a fit about going to smoke (who did go out for break in am). About 20 minutes before the scheduled smoke break, pt. A wants to go smoke and again gets very upset when told it will be in about 20 min. Shortly before lunch, pt. A wants a snack and told lunch will be soon. Pt. A becomes upset about it then said "she told me I could have one" referring to the sup. I also learned that the sup. promised the pt. a unscheduled smoke break. The sup. didn't even bother coming to talk to the MHT and I about the situation before going to talk with the patient and making promises to the patient for a special smoke break and a snack. She did not know the pt. was diabetic.

I often see sup. in hallway cajoling with the patients. We have had patients get upset because they can't have something they want then they want to speak to the sup. I think this sup. is disrupting our unit and undermining my role as a charge nurse. I am very upset about it. There have been many other times this sup. does something to disrupt the unit. A while back, a pt. was frequently asking the only MHT (the same one as above) on the floor to go get a soda for them. When the sup. arrived in the unit, the pt. hit them up about it. The sup. tells the MHT to go get a soda for this patient. After the sup. left, the other patients were asking for a vending machine run which would leave me on the unit alone.

I am thinking about finding another job before I get written up for telling this sup. off and to stop undermining my charge role and getting the patients upset (what I am thinking about doing the next time).

[elkpark]

Is this supervisor a psych nurse, or is this a psych unit within a general hospital and the supervisor a med-surg nurse who is responsible for the whole house? Can you address this issue with your unit manager? Perhaps this individual doesn't understand that there are lots of things done, and taken for granted, on med-surg units (like getting an individual client a soda because s/he asks for one) that are not done on psychiatric units.

Also, this scenario is a great example of how much easier life on psych units becomes when you just go entirely "smoke-free" and eliminate smoke breaks altogether.

[caliotter3]

I agree with elkpark. I would try one stab at talking it out and getting things on track before I would chuck the job. Getting work in this economy is easier said than done lately.

[MollNick]

Unit is a locked down acute adult unit. The sup. is a psych nurse for psych hospital. We take E.D's, detox, pt's too sick to be in reg. adult unit. I spoke with mgr. about the sup. once. Sup. still doing the same things. After thinking about it and after calming down, I decided that I will professionally and politely tell this sup. they will not undermine my role as charge and "no, we will not.... because ....". If sup. threatens to call mgr., I will suggest they use unit phone so I can speak to mgr. also. So, basically, I am not going to take any of their stuff anymore.

[elkpark]

Unit is a locked down acute adult unit. The sup. is a psych nurse for psych hospital. We take E.D's, detox, pt's too sick to be in reg. adult unit. I spoke with mgr. about the sup. once. Sup. still doing the same things. After thinking about it and after calming down, I decided that I will professionally and politely tell this sup. they will not undermine my role as charge and "no, we will not.... because ....". If sup. threatens to call mgr., I will suggest they use unit phone so I can speak to mgr. also. So, basically, I am not going to take any of their stuff anymore.

Sounds like a good plan. Best wishes!