Staff splitting going too far?

[Maine]

I'm posting this on the general discussion board to get a wide variety of opinions, sorry it's so long!!

I work at a residential psych facility and of course care for a number of borderlines. I work with one other nurse who is normally charge. Every member of the staff is expected to follow care plans regarding behaviors. This one nurse in particular (who I happen to like a lot as a person) is very hard to work with.

She consistently sides with residents when other staff tries to redirect them and rewards negative behaviors. Residents tend to be very very abusive to staff when she's on and when you try to redirect them they all know to just throw a fit and yell things like "why are you even talking to me? I hate you! I only like Ann!" then of course Ann runs in all protective of the resident and throws me under the bus in front of them.

She also touches residents a lot, holds their hands and hugs them and stuff which we're not supposed to do, but I do understand she means well. People really do like Ann but some people don't want to work with her because she allows and often rewards abuse towards the staff. She is desperate to be liked by the residents and won't really let anyone else handle anything.

I once grabbed a drink for a resident with a dangerously low blood sugar and warned her we were out of her favorite, the resident said that was fine but the nurse said "no, she doesn't LIKE that kind!" and sent her outside alone to smoke while we waited on more juice to be delivered.

I think it's become too important to her to know the residents the best and be the favorite, and good nursing care is getting put second. Last week one resident who manipulates this nurse very well was yelling in the hall and I asked her to stop, she became verbally abusive. I asked her to go into her room for 10 minutes of quiet as her care plan states and she kept screaming. Ann allowed this to continue until the resident was getting out of control and I had to go tell Ann quietly that she needed to back me up.

All she did was ask the resident why she was yelling at me, let the resident scream and yell at me some more, and start in on other staff, all ignored by the nurse. UNTIL she decided the best plan of action was to take this borderline out on a special one on one smoke with her (reward?) and disregard that I had asked her more than once to please go into her room. While they were outside there were two assaults, one on staff and one on a resident. She wanted only to "remind" the resident who assaulted staff of appropriate behavior, and allowed the resident who had assaulted another resident to go outside alone to smoke immediately after, which is not what her care plan states.

Ann later agreed with the resident that I may not have understood the situation and maybe thought it was an assault when it wasn't, she held this conversation right in front of me. Most of the rest of the night was dominated by the first resident who had to keep upping her behavior to keep the attention on her, until, as borderlines do, she saw we were busy, and proclaimed she was going to kill herself. She was laughing and joking and smiling all night with all the attention she got for that. (I know I sound negative about this resident but I really like her, I don't think any of this would have happened if her care plan had been followed to begin with).

The thing that worries me the most is that this resident started proclaiming her love for Ann, which she'll do sometimes jokingly, but she seemed so serious and really was getting kind of romantic about it. I'm starting to wonder if she's confused about the relationship they have and thinks that the nurse dotes on her because she has romantic feelings for her, when really the nurse just dotes on her because staff splitting works exceptionally well on her.

I don't want to get Ann into trouble, and it will only get harder to work with her if she thinks I reported something, but this staff splitting is going so far that the unit is unsafe. Should I report it or maybe try and talk to the other nurse? Or am I just wrong altogether and I should just stay out of it?

[OnlybyHisgraceRN, ASN, RN]

Report her. She is crossing boundaries and creating an unsafe environment for the patients and staff.

[caliotter3]

Her behavior is contributing to an unsafe as well as less than therapeutic environment. Waiting until something bad happens is too late. The more of your post that I read, the more I thought that perhaps this nurse should not be working in this area. She does not seem to have the aptitude for this kind of nursing.

[Maine]

Thank you for the feedback.

My other concern is (and not to start a debate) she is an LPN and I am an RN, so while on the floor working with a supervisor who is an LPN as well, is she under my license? I only ask because some of her judgment is so off at times, but she has worked there longer, so I didn't know if I could possibly end up on the chopping block if something happened... even though she is charge. If she is not under my license I will probably just tell the manager about my concern with this one resident and let her take it from there, it's not really a secret that this nurse acts this way. If she is under my license I may be a little more detailed in my concerns, making sure to mention the low blood sugar. I just really don't want to seem like I'm tattling or trying to get her into trouble, but I don't want to be a part of any huge drama that may occur if this continues either.

[VivaLasViejas, ASN, RN]

No. She is responsible for her own practice and has to abide by the Nurse Practice Act governing her license, just like an RN. And since you are not her supervisor, there would be even less reason to be concerned about your own license. This woman needs to be reported; you are not "tattling". And the sooner the better!

[ddunnrn]

I quite agree with the other commenters, and the only thing I would add is Document! Document! Document! --both what she does and how you responded, and who you reported it to. Unfortunately, over my years in psych, I have found that the one who brings a problem to light is often the one who winds up getting disciplined. Keep us informed of how it goes!

[caliotter3]

I quite agree with the other commenters, and the only thing I would add is Document! Document! Document! --both what she does and how you responded, and who you reported it to. Unfortunately, over my years in psych, I have found that the one who brings a problem to light is often the one who winds up getting disciplined. Keep us informed of how it goes!

This is the reason why many people have learned to keep their mouths shut. All it takes to learn this behavior is one time to be burned royally, while the person in the wrong walks around unscathed.

[Guest2010]

2 words: REPORT HER. Not only is her behavior causing you danger, but her behavior is causing dangerous situations for residents.

AND

DOCUMENT.

Best wishes

[Meriwhen, ASN, BSN, MSN, RN]

Ann may think that by her actions, she's trying to be helpful to and taking care of the patients...that's not uncommon to see from someone who's new to psych nursing--they don't understand the concept of boundaries in psych and how they differ from those in non-psych settings. But sometimes established psych nurses fall victim to this too.

However, her misguided attempts are instead disrupting the milieu, causing major staff splitting and putting all of you at risk for harm. Borderline personality disorder patients are notorious for taking any angle they can get and working it...even worse, so do antisocial personality disorder patients and addicts. They don't care what it does to other patients or staff...and the more the milieu gets out of control, the harder it is to bring back under control.

Document and document meticulously. CYA.

Also, her actions need to be reported as they are affecting the milieu and therefore can seriously impact how other staff do their jobs. Though be careful how you report her because you know the old saying about messengers, plus Ann may try to shift some of the blame on you. That's why you need to carefully document.

Hope this can be worked out for you. Best of luck.

[lindarn]

And, as with my usual mantra, after you document, document, document, make copies for yourself!!

JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN

Somewhere in the PACNW

[NO50FRANNY]

Badness mate. I didn't even need to read your entire post- she has sociopathic issues of her own and I suspect, does not realise how her behaviour is re-enforcing other manipulative behaviours. As other posters have said, document, document, document. She is crossing BIG lines. It is your responsibility to notice, which you have and you need to intervene. You said you really like this colleague as a person- remember, most social manipulators are incredibly nice, it's part of the game, don't play it.

[jadelpn, LPN, EMT-B]

I would ask your supervisor if you can begin having regular staff meetings, for the purpose of educating and talking about splitting of staff as part of a borderline trait, talk about how the care plans need to be consistently followed, and most importantly negative counter-transference on the part of the staff and how it is that it impairs a person with borderline personality disorder to be able to try and acheive a goal of more "independent" living. (ie: to a high intensity half way house, to a low intensity half way house, etc) The need on the part of the staff to be "liked" should have not a thing to do with someone's work, and by engaging in counter-productive behaviors, they are in essence hurting the patient's progress. Then make sure that all of the notes and education from the meeting are signed off as understood by all of the staff. That way, any discipline towards staff can be verified as nurse (staff) being educated, and understand the risk to the patient. This could be generic and not directed to this nurse, however, examples such as : patients with BPD will use and manipulate staff that is seemingly "on their side" as a means to an end ie: more cigarette breaks. Care plans need to be followed without personal emotion. BPD is created by early trauma, so in essence, patients need to re-learn positive coping skills, as often their reasoning is much like a toddlers. Firm direct and consistent rules, discipline and coping skills are key to the success of a BPD patient to try to be successful.