Staff splitting - Help!

[RedWhiteBlue]

Okay, I need HELP! I've been in nursing for many years, but I've only been working in psych for about two years. I recently cared for a patient who was depressed because of a recent romantic breakup. This patient pulled me aside and told me that the charge nurse had been very rude to her. She was very upset and asked to speak to the director of our unit Since the complaint was about the charge nurse, and I did not feel like the patient was just trying to get sympathy, I told the director that the patient wanted to speak to her. I aksed the director to please keep my name out of it because I didn't want any trouble with this nurse. Well, the director told the nurse, following which the nurse called me at home, telling me she didn't appreciate me telling the director about the complaint against her and that I should have come to her because she was the charge nurse and because she felt she should have been told so she could talk to the patient. She said that I was malicious and unproffessional for speaking to the director and that I was just feeding into the patient and causing staff splitting. She said that this was just BPD behavior (patient did not have a diagnosis of borderline personality) and that if hadn't been so inexperienced that I wouldn't have done this. I did not see the borderline type behavior of he said, she said, I don't like you, I don't like her.... I have asked two other nurses their opinion of this and I've gotten two different answers. One says I should have spoken with the nurse directly and the other says I did the right thing. I've tried to keep the facts to the basics, because I need answers. What do all you out there think! Thanks

[Frankcah]

I must agree with psykoRN, there should be a clear and adequate complaints procedure in place which should provide the patient with a forum to make complaints. Of course people will say, "but everyone will be making complaints about the most trivial of things", maybe, but, the parties carrying out any substantiation/investigation should be able to assign the complaint to the most appropriate person to deal with the complaint and therfore take the most appropriate action.

Just because someone is a charge nurse does not mean they are untouchable. Your director has a lot to answer for for divulging your name despite the fact that you made the complaint on behalf of a patient in confidence.

Also the charge nurse seems to have also adopted what might be interpreted as bullying tactics to yourself. What is to say that if you did inform your charge nurse, that she would not employ the same tactics with your patient.

Stop beating yourself up about it, you did the most appropriate thing given the circumstances. You had to make a decision based on what was presented to you. I feel you did the right thing!!

[RedWhiteBlue]

Thank you all for your help. I have definitely learned a lot. I will have a lot to think about if this situation ever occurs again.

We do not have a clear complaints procedure in our facility, but I am going to suggest one.

Thank you, Frankcah for what you have said. You seem to have nailed this particular situation right on the head. I have not seen this particular situation happen, and I thought I did the right thing at the time. Most complaints from patients are just nit picky nothings, but I really felt this situation was different. The patient was smart and was not delusional or paranoid. She had no complaints about any other staff member, and other than this one nurse's behavior, she was very pleased with her stay. Like you said, I have beat myself up over this. And, yes this nurse has a history of bullying people.

Hey, I mentioned this once before, but I will again - not many of you have commented on the nurse's behavior toward me. She called me at home, and this was not a nice call, either, as she was screaming at me. I think calling me at home AND screaming at me were very inappropriate. I can understand that she was upset, but I rather thought this was a big overreaction to the situation. What do all of think about this?

Oh, and by the way, on our unit, when we work as charge, there are only one to five other people working (usually two others) and that includes one to two therapists. Our charge nurses are not responsible for any type of employee evaluations, suggestions for employee improvement, etc. Our charge nurses still do patient care and so they are not considered the type of charge nurse that that is in a supervisory position (our job descriptions support this). I would say most people would call this a team leader. I have worked in hospitals where the charge nurses were responsible for much, much more and definitely were supervisors.

All of your comments have been immensely appreciated, and I welcome and want more. Thanks!

[laurenkst]

Sounds like you are dealing with a patient with a Borderline Personality Disorder. There is a reasonably new Therapy called

DBT-Dialectical Behavior Therapy where all blame is removed and

the patient has limits set by each individual as to what behaviors will and won't be tolerated by you in your relationship. If you go

by the old mandated or mandatory rules system you are setting

yourself up for manipulation and staff-splitting by the patient. With DBT we don't blame patients for staff-splitting and there are

no rights or wrongs when staff members disagree. This prevents the two or more staff members from having to be absolutely correct in the situation. You handle the patient in a manner--when it doesn't break mandatory unit rules--the way you feel

comfortable with relating to them. For instance: I might not feel

comfortable with a patient touching me in any way--so for me when a patient does touch me i let them know that I do not feel

comfortable with the behavior. If they tell me that Mrs. So and So lets them do it. I tell them that that is the limit on touching that

she has set, for me I am uncomfortable with touching. That way

I do not fall into the practice of judging other nursing staff and they do not judge me. It also prevents the patient from using one

staff member against the other. Try to see if there is anything valid in the response from the patient. As much as we try to deny it there is always a kernel of truth somewhere in what the patient is saying--focus on that. And please remember you need to have a staff member treatment team where you support one another, discuss the things that are not working with patients and help people deal with these very difficult patients who will

drain you if you are not careful------------Lauren

[Rapheal]

RedWhiteBlue,

You posted that you wanted some thoughts on how the charge nurse treated you by calling you at home and screaming at you. I think it was innappropriate and unprofessional. Perhaps it would have been better for you if you had not allowed her to speak to you like that. You might have told her that she sounded very upset and that she could call you back when she was calmer. Or maybe you could have suggested that since this was so upsetting to her that you and she could sit down together with your unit manager to discuss the situation. This is what I would have done(If it was not PMS week. If it was PMS week I probally would have given her a really good reason to scream lol). Anyways, I give you psych nurses credit. I don't think I could do this type of nursing.

[nursethis]

The first clue was, " I recently cared for a patient who was depressed over a recent romantic break-up," .... and your staff has just been split! Live and learn:)

[athomas91]

i am primarily by hx an er nurse, i am now doing crisis intervention service, and am also a new SRNA ..... however -

i think a basic principle that I have always tried to follow is - address the person first - if that doesn't solve the issue then go further - of course if this pt was demanding it be reported than you have a responsibility to do that whether the claim is bull or not..

the pt may not have had a dx of BPD - that doesn't however mean that she isn't - and on top of that - the majority of the personality disorders have very manipulative origins.... staff splitting is a very common phenomena... i would readdress that nurse and explain that perhaps you could have spoke w/ her first, but that her behavior could have also been handled differently - and perhaps you both could start over...... you never want a charge rn as an enemy - or any other nurse that you work with - it makes for unhappy work experience.

[RedWhiteBlue]

Hey thanks for all the comments. The nurse in question and I did have a talk, but she is still a bully. She leaves me alone now, though. For the person saying I should have reported this if the patient requested and insisted on this being reported - that was the case. The patient was adamant that I report the situation to the director. Hey, Raphael... We all know that's what we should do, and that's easy to do with patients, but not so easy with some other folks (especially this particular nurse). She has pretty much caused everyone on the unit to dislike her and to not trust her. Fortunately we no longer have a charge nurse. We are now responsible for our own team of patients.

laurenkist -- I think this Dialectical Behavior Therapy sounds great and I am going to research it more.

[renerian, BSN, RN]

I just now saw this thread pop up. I hope I did not make you feel offended? I thought the person was BPD and I sure was not tryind to diagnose him/her LOL. I would not like being called and screamed at either.

I just know some patients like to staff split and if you cannot see that which sometimes we may not, it can cause a heap of trouble.

renerian :)

[RedWhiteBlue]

No, renerian, you did not offend me. I wanted to learn. I think the whole thing upset me so much because of the nurse's subsequent actions. And, hey, I did learn a lot. :balloons: :rotfl:

[renerian, BSN, RN]

Yep we all learn every day. As long as you have that mindset you should be fine.

renerian :)

[Hellllllo Nurse, BSN, RN]

I think that the charge nurse reacted unprofessionally, and that your NM should have left your name out of it, as you'd asked.

[Eviene]

I think your charge nurse has borderline traits.