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.

[Gilamonster]

I hear ya. It seems like the tech wanted to get out of having to do anything you delegate. By starting this with the manager, it seems she found a way to do that. i would think about leaving this job as well.

[Here.I.Stand, BSN, RN]

I was taught during my CNA class, way back as a senior in high school, about negligence. My RN-instructor and my textbook said that if a CNA willingly leaves a resident soiled, that CNA is negligent. If a CNA saw a spill on the floor and left it there for someone to slip and fall on, that CNA is negligent.

It is no different than if we as RNs choose not to do our tasks. Take the simple example of med administration: by prescribing a med for a pt, the provider is in a way delegating to us to give that med. It is not an independent nursing intervention, as we don't have the ability to prescribe meds, and providers don't give the med to the pt, but we do have the training and knowledge to safely administer it or not administer it. If we in our nursing judgment deem it unsafe to give the med, we report back to the provider our assessment and the fact that the pt did not get the med.

It would never ever be okay for us as an RN to choose not to give a med because we're lazy, or for any reason other than safety. And especially not to discuss our actions with anyone.

Why is it okay that this tech refused to do a task appropriately delegated to her, and then not even discuss it with you? It would be one thing if she came to you and said, "I can't turn this woman by myself, and the other tech is on her break. Can we do it together, or can it wait until the other tech comes back?" But you had to find her and ask her, "Did you turn and change the pt?"

Not okay. It's negligent, and it's stealing in a sense--she's not doing the job she's being paid to do. I'd be writing an incident report personally.

[nursingaround1]

I would say it's too soon to tell. There's always ups and downs when starting a new place, and sometimes the unpleasant people turn into allies after a bit of time. Sometime someone who has been there a while may feel threatened by a new nurse, I truly don't know. But give it some time. If the job is as good as you hope, then give it a fair go. In new jobs, it's not just you trying to fit in, but others also getting used to the change.

Wait and see.

[hawaiicarl, BSN, RN]

Personally to me it sounds like manipulative behavior that the tech uses to her advantage. She complains, says why didn't you do it? In the future I bet a lot of nurses don't even bother to ask her for help they just do it themselves to avoid similar situations. Makes the techs job a lot easier ....

Cheers

[Karou]

I strongly suspect the tech has a victim mentality/persecution complex problem, they probably have a history of targeting new staff and making wrongful accusations about colleagues who delegate tasks to them. I don't agree with those who are advising you to write the tech up, because this disciplinary tactic doesn't work with this personality type (I wish it did). I recommend you have a private discussion with the manager, if they are a seasoned manager, they should have some suggestions on how to manage this type of colleague, if they don't offer advice, speak to human resources.

But "writing someone up" isn't just a disciplinary tactic. It's documented proof of the incident that occurred, and with additional proof/documentation could allow a manager to terminate an employee. The OP didn't go to the manager, the tech did, and the manager already failed the OP in that situation. Human resources can't do anything without that documented poof, otherwise it's just he said she said.

[dishes, BSN, RN]

But "writing someone up" isn't just a disciplinary tactic. It's documented proof of the incident that occurred, and with additional proof/documentation could allow a manager to terminate an employee. The OP didn't go to the manager, the tech did, and the manager already failed the OP in that situation. Human resources can't do anything without that documented poof, otherwise it's just he said she said.

I'm well aware that the reason to write the tech up is to gather evidence for termination, the problem is, that cola is dealing with a person with victim mentality. I anticipate that if cola starts writing the tech up, whenever there is even a whiff of an issue between the tech and cola, the tech will file a complaint against cola first and the tech's complaints will be used to build a harassment case.

[Been there,done that, ASN, RN]

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.

This is the answer. Write them up EACH and every time the professional nurse's delegation is not followed. However, in this case the assistant ran to the unit manager (aka MOM) and tattled.

OP's concern is MOM is not handling this correctly.

[Been there,done that, ASN, RN]

You now have a head's up on the insubordinate assistant... and how the unit manager handles conflict.

Write an incident report on this encounter. This will be viewed over the manager's head. You have two separate problems. Document..document.. document. This not the first time, or the last that your immediate supervisor mishandled an issue.

[Karou]

I'm well aware that the reason to write the tech up is to gather evidence for termination, the problem is, that cola is dealing with a person with victim mentality. I anticipate that if cola starts writing the tech up, whenever there is even a whiff of an issue between the tech and cola, the tech will file a complaint against cola first and the tech's complaints will be used to build a harassment case.

I don't understand how anything can actually be done about the tech without documented evidence (write ups). Can HR take any kind of complaint seriously without proof? What can they actually do if the OP goes to them, and she has no evidence? If the tech were to retaliate (I believe you're right that she could) then it's pretty obvious that it's retaliation and that makes any claim she makes a little less credible. If staff were to all start writing her up for similar incidents, then there would be enough proof to do something.

I don't know. It's a difficult situation. I pick my battles wisely, but would choose this one.

[Been there,done that, ASN, RN]

I don't understand how anything can actually be done about the tech without documented evidence (write ups). Can HR take any kind of complaint seriously without proof? What can they actually do if the OP goes to them, and she has no evidence? If the tech were to retaliate (I believe you're right that she could) then it's pretty obvious that it's retaliation and that makes any claim she makes a little less credible. If staff were to all start writing her up for similar incidents, then there would be enough proof to do something.

I don't know. It's a difficult situation. I pick my battles wisely, but would choose this one.

Well said. This needs to be taken out of the department to HR. OP should not "quit".

[Ruby Vee, BSN]

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.

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.

No, it's not worth quitting over. You sought out this particular company for it's nice benefits and decent pay. So assuming those things are still important to you, you need to figure out how to work as a team with those employees who have been there longer.

Your nurse manager has known you for a couple of months; she's known the aide for a few years? Why should she take your side? You're an unknown quantity but that aide has been coming to work regularly for years, doing a difficult and demanding job for very little pay. She is probably harder to replace than you are.

You have failed to get along with a member of YOUR team. It doesn't matter whether you're right or not; what matters is the best patient outcomes. In order to achieve good outcomes, you have to work as a team. It seems that this aide isn't getting what she needs from you in order to be a productive member of the team. The relational aspects of her job are more important to her than the actual patient care, and perhaps more important than the patients. You have to work with that.

It doesn't matter if you don't like her; if you're convinced that she's wrong. What matters is that she believes that you like her and value her contributions. Work on that. It only takes a few moments to greet her in the morning and ask about her kids, her cat, her mother -- whatever is important to her. A few moments of chit chat will have a positive affect on your relationship and therefore her willingness to accept your delegation.

In the workplace, it's more important to be LIKED than to be RIGHT. You don't believe that now; nor did I at one time. I learned it slowly and with difficulty. Perhaps you can learn it faster and benefit from my experience. Being right is not a wrong thing; but it's not the only thing and it's not even the most important thing.

[Dachshund9]

I have worked at the same hospital for close to 18 years, and it's my observation that CNAs (we don't have Techs on our units), are getting more of an attitude simply because management doesn't back us up. Depending on how the unit is set up, on my unit we have 2 CNAs down each wing, that comes out to roughly 6 patients per CNA. So if I delegate a task, I would expect that it get done. Not always the case, there often times is an excuse why it wasn't done or management gets involved and seems to almost side more with the CNA. If the hospitals continue allowing their managers to do this what's going to end up happening is a bunch of ancillary help that thinks they can pick and chose tasks they want to do.