This person outranks me?!

[Aunt Slappy]

Since I started working in health care as a CNA nearly six years ago, I've had many experiences that have left me wondering how some people get into the positions they hold. I was not a youngin when I started this, I was nearly 20 years on from earning a bachelor's degree in political science and had spent more than a decade raising children at home before I began my health care career. I've worked enough to know that promoting people into leadership who shouldn't be there is not unique to health care by any means.

Lately I've a had a few interactions with a RN coworker that leave me again thinking, "How in the world does this person outrank me?"

#1 He's collecting an induced sputum sample in clinic. (I work in a public health clinic dedicated to TB testing, detection, treatment, and prevention.) He comes to me with the sputum sample tube, thankfully in a sealed specimen bag, holds it up, and says, "She vomited a little food when she coughed. Can we still use this sample?"

#2 He comes to me and says that the biohazard trash near the sputum collection rooms is full, and then asks what he should do. He's worked in this building longer than I have and knows exactly where the biohazard room is.

#3 During a case study presentation in a clinical staff meeting, in which the patient has been described as being 50 years old and 17 weeks pregnant via IVF, he asked what IVF stands for.

I just.......really?! This guy has, when you count RN prereqs I haven't taken yet, two more years of education than I do. He makes at least ten dollars more an hour than I do based on that fact. It's getting to the point where it takes all I have not to be extremely rude when he asks me these stupid questions (yes, there is such a thing).

Share your best "I can't believe s/he outranks me" stories!

[Purple_roses]

You tell me...if you hack up a AFB+ loogie and puke a little at the same time, is there still AFB in the sample???

I was going to say....true critical thinking should lead a nurse to this conclusion. I could see needing to get a new sputum sample from a policy and procedure standpoint, but critical thinking is what has made multiple nurses here ask OP if gastric contents would honestly disturb testing for AFB.

OP, if you're bringing this much snark into work, I'm impressed that the nurse from your OP is still asking for your input at work at all.

[amoLucia]

I am not so proud and self-inflated that I don't ask for explanations of abbreviations here on AN. I'm asking all the time!!! I asked for something yesterday.

Things that are simple to you, I may have NEVER heard. I remember asking what NOC was when I first started here. I worked the 11-7 shift for some half or so of my 35+ year career but I never heard it referred to as NOC.

And I looked at your 50 y/o case pt with IVF and pregnancy WAS NOT my first thought.

To macawake - I may have to ask you about half of the abbreviations you dropped.

And if I hack up a sput that might not be perfect, you'd better check with God to make 100% sure the specimen is not good before you toss it. I am not a good sput cougher-upper or urine pee-in-the-cupper.

You have a extremely lopsided view of people and their expertise. Cut the dude some slack.

[Tenebrae, BSN, RN]

Let's use a little critical thinking here. If you need a sample of pulmonary sputum for testing, and it now includes gastric contents, is that a valid sample?

Stop trying to be clever and answer the question

Given how vicous sputum is I suspect its easy to extract the for the culture.

But then again I'm an RN going into my sixth year since graduation and I would be the first one picking up the phone to the lab and asking them because i have no idea

[KRVRN, BSN, RN]

You have a collection of snippets of info that you know that he doesn't. You claim he should know more than you, but not knowing several snippets of info doesn't mean much. All areas of nursing have a body of info specific to it. As others have pointed out, "IVF" is an example.

The knowledge base of a RN is much larger than a collection of snippets. If you truly think he doesn't have a clue, you need better examples that these...

[rkitty198, BSN, RN]

You cannot accept a sputum sample collection with partially digested food.

[Jedrnurse, BSN, RN]

While I don't agree that the OP provided examples of it, I do agree that there is such thing as a stupid question...

[JKL33]

You cannot accept a sputum sample collection with partially digested food.

That would certainly be everyone's first guess I think, but it's just not one of those questions that is beyond the pale, especially when it involves throwing away someone's sample.

While I don't agree that the OP provided examples of it, I do agree that there is such thing as a stupid question...

And better ways to ask one ("I assume this sample is no good with vomitus in it. Correct?").

And then there are those who think someone's question or statement is stupid because they themselves are lacking knowledge. Such as a ridicule I read here on AN regarding a physician who ordered an HCG test on a male patient, or the fact that long ago I once thought a resident was a moron for using the word "obstipation."

[Gimilion]

Let's use a little critical thinking here. If you need a sample of pulmonary sputum for testing, and it now includes gastric contents, is that a valid sample?

Actually, you sometimes can use a sample like that. In patients who cannot produce a sputum sample, you can withdraw gastric contents from a salem sump ng tube first thing in the morning and test it. You are testing the gastric contents mixed with the sputum swallowed during the night. It's an interesting process.

[Been there,done that, ASN, RN]

"How in the world does this person outrank me?"

That person outranks you because they have more education. As you have more clinical experience, you need to assist the RN in any way you can.

[Aunt Slappy]

This person is a new nurse and is probably feeling unsure of himself.

I guess you missed the part where I said he has worked in this building longer than me? He's not a new nurse.

[Thought, BSN, RN]

As the saying goes, "the only stupid question is a question that isn't asked." It takes humility to go to another to ask a question. I'd much rather have a person ask me a million questions where I can answer those and point them in the right path compared to refusing to ask a question that could result in harm because of "injuring" their pride. Like other commenters have said, he might not have knowledge on some things (i.e. IVF). Medical terminology can have different meanings to different people. Who knows, it could have been an off day for him. Everyone has those. Your coworker sees you as someone he can go to to ask a question without fear of judgment or retaliation. Please don't prove him wrong.

[RJ 55]

When I was a new grad RN I started my career in a residency program in the ER. At that time we had ER techs (that were crosstrained as CNAs). We also had a handful of LVNs. I learned so much from them and developed do much respect. Many of these professionals don't get the respect they deserve. I learned tasks such as splinting, ekgs, drawing blood to talking down psych patients. In my early years I asked so many questions that one of the managers tool me aside and said that I was doing fine but I needed to stop asking so many questions. Well, I didn't really listen to that advice. You see, asking questions has gotten me out of doing things that could harm a patient or is out of my scope of practice. Now I'm seen as a leader in my unit. I precept many nurses. I not only teach that it is ok to have a question, I encourage it. You always need to know your resources. Maybe he shouldn't be using you as a resource. Some people don't like teaching and that's ok. I would talk to him and tell him to stop asking you questions. As a RN I don't look at my title as outranking anyone. Maybe we work a little different in the ER/Trauma unit but we are a team. I value everyone's work. Maybe you don't work in an environment like I do and people are hypersensitive under which rank they are. Maybe it would be helpful to find a new environment or new position where this mentality of rank isn't so profound. I wish you the best.