Unsupportive boss? Is it worth quitting over??

[Cola89]

So, let me start by saying that I *think* I work for a good company. It's a non-profit health care company, an umbrella company for the largest health insurance corporation in the U.S. Heard they offer nice benefits and decent pay, so that's why I sought them out.

That being said, they know all of the SCIP protocols and every other reimbursement rule very, very well and basically pay these unit managers to nag the floor managers to check on all of our charting and the doctors' orders and have US call the docs and whatnot to get things 'corrected' and up to their standards all throughout the day on top of non-stop admissions, discharges, transfers, testing, and calls from everyone in the hospital.

Well, so I'm working in this new very busy environment (employed two months), only got 9 days of floor orientation (and that's because I asked for a little more than 7 days when I saw how busy and demanding of a floor this is)...

And what happened yesterday just might be the straw that broke the camel's back! It was about 0935. I was right in the middle of getting orders to transfuse a patient in need, address medicating a fresh post-op patient with a new PE, and getting another's things in order to discharge around noon. When I was passing one of my patient's medications (turn and check q2h), she says 'oh, I think I need to be changed.' I said, 'ok, I will call the tech and get her in to help you.' Did just that. She said: 'yeah, I was going in there to give her a bath.' Ok, good.

Well, the tech doesn't check turn, or change the patient, she just sets her up to eat her food. I said, did you reposition and change this patient? 'She got very nasty and rude and said 'if you saw that the brief needed changed, then why didn't YOU change it?!' I said: because I delegated that task to you. I am busy doing other things right now, such as passing meds.

So, this tech goes straight into our unit manager's office and complains. Claims she thinks I "hate her". So, my boss pulls me into her office and rehashes this nonsense. Basically aide insubordination and says that most nurses would've just changed this patient's brief. I said: yes, I would have without any problem. It's just that I had X, Y, and Z to do at that very moment, so I called the tech in to assist this patient with this matter (patient had no complaint btw). Boss says she sees both sides, and that if this happens again maybe we can both go into her office for "mediation".

I said: why don't we just do that now, because I will need to feel like I can communicate with my techs and vice versa.

So, this tech comes in and repeats that she "thinks I hate her". (WHAT?!) I say: No, I don't hate you and have no reason to hate you. She wouldn't be honest about the verbal interaction we had, that's just about all she said. I was at a loss for words, and not to be rude, but I was thinking that I wasn't talking to an emotionally mature individual at that point, so it was pointless.

The boss didn't help or "mediate" at all. She said ok, now the air is cleared and we can go back to work! Nothing more!

I feel very unsupported and wonder if this seems normal or a little out of line. I don't see the point in having techs if they will not take direction, or if they don't understand that they need to take direction from us without a bunch of attitude and resistance.

Shouldn't the unit manager back us nurses up? Set some expectations for us other than -- If an order wasn't put in right, you must call the doctor incessantly (and it's our fault if nothing is accomplished?!)

Or, if a tech doesn't feel like accepting your delegation, you just need to do it (what about MY prioritization of care ---like my PE patient and the one who needed blood?!)

Feels like she is tying our hands.

[dishes, BSN, RN]

Is it possible that the tech has a problem with persecution complex?

[Cola89]

Is it possible that the tech has a problem with persecution complex?

Well, I have observed her to seem to require a lot of praise. I say please and thanks but she seems to maybe used to getting recognition from some other staff? I have noticed that she takes frequent breaks without letting me know, doesn't communicate much with me, doesn't ask me anything which is unlike the other techs I have worked with at this hospital and elsewhere. Actually, I had one other tech who didn't ask or tell me anything... she was another one who was buddy-buddy with some of the other nurses.

Anyways, I am most disappointed with my unit manager for not backing me when this tech was making such an outrageous accusation toward me (HATE? lol). It seemed like childish, dramatic, attention-seeking behavior and I am surprised it was tolerated by management!

[VANurse2010]

Your manager is an idiot and that tech needs to learn her job role.

[dishes, BSN, RN]

If the tech has a victim mentality/persecution complex, the manager may know which style of management suits this tech best. It can be tricky to work with an employee/colleague with this problem, because if the manager acts heavy handed and autocratic towards them, it confirms the persecution in their mind.

[CBlover, BSN, RN]

Wow. As far as the tech goes...Been there, done that. I used to work with the tech that acted just like that. If I was in a patient's room and the patient commented that they needed anything that I could delegate, if I left the room and ask CNA to do it she was very offended just as your tech. I WILL do it if I have time. But sometimes you don't!! It got to the point I was afraid to ask her to help me do anything!! You know what? She quit. Some people just don't like to work. It goes on EVERYWHERE.

[Karou]

I don't know what to say, because it sounds like you handled the situation as best as possible. It wasn't realistic for you to put your other tasks on hold to change the patient (you are prioritizing), so it was absolutely necessary and appropriate for you to delegate it. The fact that the tech not only ignored something you delegated to her, but more importantly left a patient soiled and set her up to eat while she is soiled still, is in my opinion grounds for some punitive action. It's really disappointing that your manager didn't back you up.

I don't really care how the tech feels. We work in a high acuity fast paced healthcare world right now and if she can't do her job correctly without crying that someone hates her for asking her to do it, then why is she here? She knowingly left a patient with urine or feces on her skin. That's poor care and I am so sorry your manager didn't punish her for it.

I hate tiptoeing around sensitive coworkers, and being afraid that if I try to delegate anything I will get my head ripped off. If I can do the task myself then I will. If I can't because I have other things I must do (nursing tasks that the PCT can't do) then I will delegate it. That shouldn't be met with offense or aggression.

Sorry, OP. I am disappointed in your manager on your behalf.

[Karou]

If the tech has a victim mentality/persecution complex, the manager may know which style of management suits this tech best. It can be tricky to work with an employee/colleague with this problem, because if the manager acts heavy handed and autocratic towards them, it confirms the persecution in their mind.

Do you think that this type of employee would benefit from some counseling rather than coddling? Is it fair that staff have to tiptoe around them to avoid hurt feelings? My concern is that we don't always have time to play nice. When patient safety is priority, and acuity in healthcare is rising (making every employee too busy and stretched too thin), it is unrealistic to me to expect all staff to cater to one persons emotional immaturity. We should be kind to each other within reason. But if someone is to take offense each time they are asked to do their job (and they wouldn't need to be asked if they were doing it) then is a high acuity healthcare setting even the best place for them? If nurses are afraid to delegate (and therefore try to do too much themselves) will patient care suffer?

Sorry I realize I am talking about more than the OP here, and am venting a lot.

[KeepItRealRN, BSN, RN]

The boss didn't help or "mediate" at all. She said ok, now the air is cleared and we can go back to work! Nothing more!

I feel very unsupported and wonder if this seems normal or a little out of line. I don't see the point in having techs if they will not take direction, or if they don't understand that they need to take direction from us without a bunch of attitude and resistance.

Shouldn't the unit manager back us nurses up? Set some expectations for us other than -- If an order wasn't put in right, you must call the doctor incessantly (and it's our fault if nothing is accomplished?!)

Or, if a tech doesn't feel like accepting your delegation, you just need to do it (what about MY prioritization of care ---like my PE patient and the one who needed blood?!)

Feels like she is tying our hands.

Because in this say in age of zero tolerance for bullying, the tech accused you of just that.

GUILTY AS CHARGED! Zero tolerance means no common sense can be applied to this situation. If the Tech says you bullied her then you did. Case closed.

If the manager had backed you up she to would have been accused of bullying the tech and caught up in this zero tolerance for bullying nonsense. Thus that is the reason she was such a limp noodle.

Look at it this way at least your manager didn't write you up for asking your Tech to do her job. If that were the case I would start looking today for a new unit to work on.

[calivianya, BSN, RN]

Do you think that this type of employee would benefit from some counseling rather than coddling? Is it fair that staff have to tiptoe around them to avoid hurt feelings?

Honestly, I feel like counseling isn't enough. I feel like write-ups are in order if a nurse asks a CNA to clean up a patient and the CNA chooses to leave the patient soiled instead.

I used to work as a CNA. I know it's hard, I know it's grueling, I did it myself. And I worked on a floor that was a designated "hell floor" and actually every time I floated I had an easier job because the other floors weren't so heavy. Nobody had to ride my butt; I just did my job.

Thankfully I don't work in an area with CNAs because they would really think I hated them if I had one act like this around me.

OP - I would be writing incident reports every time you asked the CNA to help clean a patient and they did something else like just sit the patient up instead. People like that have no business in healthcare if they're not going to get their jobs done. If nobody's documenting her refusing to do her job there's no proof. If you start documenting it there's going to be proof, and the manager can do something about her.

[Jules A, MSN]

In my experience many nurse managers just don't want to hear it or deal with it. The nurses they like and respect the most take care of their business without bothering them. Its a shame the tech drug you in but it sounds as if you handled yourself appropriately especially by not engaging in that baby drama. Like calivianya suggested just document everything including this incident. I wouldn't bother the manager with it but if the tech comes at you again I'd have it ready to throw down on the desk.

[Cola89]

Do you think that this type of employee would benefit from some counseling rather than coddling? Is it fair that staff have to tiptoe around them to avoid hurt feelings? My concern is that we don't always have time to play nice. When patient safety is priority, and acuity in healthcare is rising (making every employee too busy and stretched too thin), it is unrealistic to me to expect all staff to cater to one persons emotional immaturity. We should be kind to each other within reason. But if someone is to take offense each time they are asked to do their job (and they wouldn't need to be asked if they were doing it) then is a high acuity healthcare setting even the best place for them? If nurses are afraid to delegate (and therefore try to do too much themselves) will patient care suffer?

Sorry I realize I am talking about more than the OP here, and am venting a lot.

It's true... I don't have time to coddle staff either. We work in a fast paced environment. I am constantly busy doing my job (without attitude) and I think I should be able to delegate to techs when need be. As I said, I do help with changing, turning, and toileting when I can, and when techs are busy doing other things with patients. If they are sitting around, socializing I think I should be able to delegate at that time also. Maybe? I delegate more than some nurses on this unit because #1 I'm still getting my time management up on this floor/hospital (all new docs) and #2 I know what needs to be done and expect good care for my patients. With only two months on this unit, I'm shocked at what I'm seeing because it looks like a few of these techs (who are nurse*aides*) don't realize they work as part of a TEAM.