What to do about disruptive behavior?

[Mudwoman]

I have been a med-surg nurse since 1994. In January of this year, I left my beloved med-surg floor and moved over to ICU. Even with my experience, I knew that this would be like starting over. I don't know if the other nurses notice any growth on my part, but I feel the growing pains for sure. That is good! That is a large part of moving to ICU: to grow and be a better nurse.

I will not go into a huge amount of detail, but will be glad to answer specific questions if anyone needs me to, but I need some advice on how to move forward on a particular unpleasant encounter from last night's shift change.

I had 2 patients. One patient had been a 1:1 until my day shift on 7/19. Young (21) and still very critical, on vent. The other patient had been moved from LTAC during the early morning hours of 7/19, but had been cared for by another nurse on 7/19. Pt is older and with a long, long hx of chronic medical problems and on vent. He is also in BIG time isolation (the works). I had both of these patients on 7/20 and they had the highest acuity on the unit. 3 other nurses helped me as their time permitted. I was so, so grateful for their help. I thanked them all over and over, and one of the nurses that is also sometimes the charge nurse made the remark that she didn't know why, but when "L***" is charge nurse, I always get the hardest load.

At one hr prior to shift change, my young, critical patient had a STAT CT of chest ordered, and 30 min prior to shift change, we had her ready to roll to CT. I got back just after report was started. I handed off to 2 different nurses.

I gave report first to the nurse taking my older patient. She had him on the night of 7/19-7/20. I have never met or worked with this nurse prior to this. I then gave report to the nurse coming on for my younger patient, and part of that report was that I had placed a rectal tube for constant diarrhea during the day, but moving her around for the CT had caused some leakage and I planned to get help cleaning her up and getting everything else back in order (monitor, tube feed etc) before I left. I found a float tech that was willing to stay over and help me. This was all accomplished by 1930.

Now comes where I need help. The nurse for my older patient comes out of his room and started screaming at me in my face in front of everyone "You didn't turn this patient all day....he is in the same position he was when I left this morning...." She was right. I had not turned him. I had assumed that he had been turned by the nurses that were so generous to help me. The nurse that offered to give his AM meds was in the room for nearly 2 hours. I was in the room for over an hour catching up on his care while giving him blood. It was on my list of things to do, however, I got called back to my other pt's room by the physician....and time moved forward, but care for this older patient did not. I admitted to her very kindly, that she was right, I had not turned him. A sport bed had been ordered for this patient, but no sport beds were available, so turning him was something that was very important! I also did not follow up and check behind the other nurses that were so kind to help me. It was one of those days where you don't take a break, you don't eat, you just keep moving as fast as possible and at the end of the day, mark it down as one of the worst of your career; even when you did the best you could do.

The next 15 minutes, I spent with her yelling and calling me names and telling me what a pathetic nurse I was and how the care I gave this patient was totally unacceptable and would not be tolerated in ICU. "We give excellent care around here, not poor, substandard care around here, and you are NOT up to our standard for a nurse"...."They say nurses eat their young, well I guess we do to weed out the undesirables". There was so much more said and it was said with cruelty and hatefulness. By this time, I am crying (darn it) and I can't talk for the lump in my throat that hurts so bad I can hardly breathe. The only thing else I could manage to say was "You are right and I'm sorry." The night charge nurse finally had heard all the yelling and got between me and her, and said, "I've got this, you go home Kid-do". The charge nurse is one of those nurses that you find so easy to look up to, consider a mentor and when you grow up as a nurse, you want to be just like him. I clocked out at 1950.

So, we have an "EVENT REPORTER" that we are supposed to fill out if there is a nursing error, or disruptive behavior etc. I have already reported that I did not turn the patient all shift and I did not follow up and make sure someone else did when I could not.

Should I also write a complaint of disruptive behavior on this nurse?

Write a short note to my unit manager about what happened?....,or

Should I just let the extra large bowl of Ben and Jerry's ice cream take care of the collateral damage and move on?

I don't consider leaving an option. It is a wonderful unit. I'm learning lots. I have been at this hospital many years. There are lots of other nurses that do not agree with this particular nurse's opion.

Thanks for any input....good or bad.

Charlee

[maryw1212]

the other nurse was waaaaay out of line, i've had times when pts were left in a mess(incontinence, dry iv bags, empty tube feeds etc.) that i would be upset about and be angry at the nurse, but not being turned? big deal. that pt was alive when you gave report and you did your best, eat that ben and jerrys and enjoy. if her behaviour continues then i would file a report.

[nohika]

In the future, please read the OP original post, before commenting. There was no reference of that patient being"unstable". She simply did not turrned or "touched" the patient because she became busy with her other patient.

But that's what she's saying - if she has one patient that's circling the drain, or becoming incredibly unstable, how is she supposed to justify leaving the one that needs her NOW? She did state that she had coworkers helping her out, she was in the room for at least an hour, etc. It never said that she never TOUCHED the patient, just that she had not found the time to turn him.

When one patient's going to hell, it's hard to find time when you have two patients. It's why you depend on coworkers.

[springsong]

Do you have a policy on disruptive behavior? In my facility we have a zero tolerance on disruptive behavior. Anybody that bully, disrespect, hostile, and so on is written up and reported to the supervisor. The supervisor will make some fact finding and also the Board of Investigation. If you have done this once you will be given verbal counselling but if this is a repeated behavior especially if it involves assault and battery you will be terminated. Disruptive behavior in the workplace is unacceptable especially for health care profession which is very common. We sometimes get frustrated and work cannot be done. But there is no point of treating each other in an abusive manner. We should handle our differences professionally.

[8jimi8ICURN]

12 hours without turning is horrendous. I hope you learned that lesson. Write an incident report and request an arbitration with the disruptive nurse. She was out of line. You also need to write an incident report on yourself for providing substandard care. If this patient developed a dti. Likely that's on you.

[8jimi8ICURN]

But that's what she's saying - if she has one patient that's circling the drain, or becoming incredibly unstable, how is she supposed to justify leaving the one that needs her NOW? She did state that she had coworkers helping her out, she was in the room for at least an hour, etc. It never said that she never TOUCHED the patient, just that she had not found the time to turn him.When one patient's going to hell, it's hard to find time when you have two patients. It's why you depend on coworkers.

And in accepting and depending on help, one must make specific requests such as hey, will you please turn so and so for me. Then follow up.

[Mudwoman]

Part of the problem was an Intensivist physician doing constant STAT orders on the 21 year old trying to save her life and there were NO new orders on the 77 year old. The 21 year old had been a 1:1 patient until my shift. Sometimes your chain gets rattled and there is nothing you can do to control it. I did my best that day. The 21 yr old did live and did make it out of ICU 2 weeks later. It does not mean the 77 yr old was not important. He was. But a person can only do so much and as the day progresses you have to prioritize. I had a Dr prioritizing a lot for the 21 yr old. The 77 year old did get care. He did get cleaned up from 2 incontinent BM's He was unstable with a heart rate that went to the 200's everytime you touched him. I feel terrible that I couldn't give each of my patients everything they needed that day. On the other hand, I couldn't tell a physician ordering everything in the world to keep a 21 yr old alive that 'hey, first I need to go and turn my other patient. This Doc was in a panic because I couldn't get her to CT for 30 min because CT was in the middle of an emergency themselves. He informed me that when he said he needed a CT of her chest STAT, that meant NOW.

So, a person can point out something like this and be helpful and a mentor OR they can be hateful, cruel, and mean. This nurse took the latter choice. My unit mgr was not happy about her choice either. This job is hard enough. It is important that we are nice and helpful to each other.

Thanks for the support here. I am glad that I wrote her up and reported her. She is a skilled nurse, but it takes more than skill to be a really good nurse. I appreciate all the feedback.

THANKS!

[Mudwoman]

I DID touch the patient......several times. I was in the room for over an hour at one point and another nurse was in his room for over 2 hours. He was cleaned up X 2 from incont BM. He was unstable in that everytime you touched him, his HR went over 200. If left alone, he was stable. HOWEVER, there was also a 21 yr old that was in total system/organ failure that should have been assigned 1:1 AGAIN and she was not. I had a physician rattling off STAT orders on this patient constantly. The 77 yr old was assessed and he was touched. He just didn't get perfect care that day......the perfect care went to a 21 yr old that was dying before our eyes and no one had a clue why......and a physician that wasn't going to let her die without a fight.

So, I have to ask a question. Pretend that your 77 yr old father is in ICU and your 21 yr old daugher is in ICU. Your father has numerous chronic health problems that are serious and there is no cure. Your 21 yr old daughter became suddenly ill and if there is not aggressive treatment, she will die. Which one of your loved ones do you want to get the most attention? Do you care more about a possible decub on your dad or the daughter's life? I was NOT making these decisions.....a very dedicated physican was making these decisions for me.

I am not making excuses....just pointing out that I was doing orders in the priority they were being given and I was doing the best I could and others were picking up what slack they could. These 2 patients should have never been assigned together, but they were. So, one patient did not get the care that would have been exceptional. That care went to a young girl.....that did live because of it. The 77 yr old died after 30 days in ICU and he did not get a decub.

[8jimi8ICURN]

No one is judging. You DID ask for opinions. Part of Icu nursing is knowing when and how to ask for help. You didn't and a patients care suffered for it. Bottom line. Heartfelt analogies do not excuse your lack of care.I would have told another nurse or the house supervisor that I was unable to safely care for my second patient since it seems your charge nurse is against you. I've done it before. No one likes to admit they are overwhelmed but if you don't. People can die.

[SpEdtacular, MSN, RN, EMT-P]

As an earlier poster said, remember her behavior and never do it to another nurse because we all have days like that. While working on the progressive care unit at my hospital I've had plenty of nightmare shifts (largely because they want it to be ICU/PCU acuity with med/surg nurse to patient ratios and on top of that they allow 24/7 visiting hours). In life there will be no shortage of people who want to yell/lecture/demean/criticize you just because they can (or think they can) and there will be coworkers who get away with murder.

I was recently treated to one of these "because we can lectures". I was starting an IV on an old lady with dementia and was trying to keep her from falling out of her bed but while doing this one of my other 4 patient's IVs started beeping and the secretary who can be less than helpful in the best of times just overhead paged a dozen times rather than taking some initiative when I didn't respond (because I couldn't respond) and asking someone else to check on it for me. So I did not respond fast enough and was rude when I got to the room (I am sorry to admit that I was indeed a rude because after dealing with a difficult situation I walk up to a room and hear a b****y no it's STILL BEEPING! then find they've buried the IV pole behind so much clutter that I can't possibly reach it without rearranging all of the furniture). The patient wanted another nurse and so I swapped patients with someone. This has happened to other nurses before and typically that's where it ends. Not today, not with this charge nurse and so I was called into the office by her AND the nurse manager and got an earful (while I was on duty mind you).

But not about that incident, not really. No basically under the guise of concern and constructive criticism I was told that because of three recent "complaints" they wanted to talk to me. Right of the bat I admitted that I had been rude and shouldn't have but that wasn't where this conversation was heading. No, it seemed they were concerned that perhaps there was something deeper at the heart of this incident. They applauded my "technical" nursing abilities BUT thought that maybe I'm having difficulty with the more subtle skills that are encompassed by the art of nursing, the caring/nurturing aspect because after all I WAS a paramedic BEFORE I was a nurse (a rather insulting insinuation about paramedics). I was told I need to be more responsive to those needs because this is a customer service industry and people won't remember that you were a great technical nurse so I needed to concentrate on those things. This made me very upset (I think mostly because I was having a bad mental health day but also this was an attack on my character). I do try and do those touchy feel-y basic needs things myself, if I can, but often times I have to rely on the nurse tech because I can't do all of my nursing tasks and delegatable tasks myself.

So now that I'm all worked up, I was told I seemed overwhelmed and that if I need help I should just ask for it (unless of course it involves a task that I can delegate to the nurse tech I guess). I then pointed out that my fellow nurses as wonderful and helpful as they are (and they are) are as busy if not busier than me and I can't just ask them to do my work because I'm drowning when they are too. Then, going back to the original matter at hand, I also pointed out had the secretary shown an ounce of initiative this whole IV situation would not have happened and their answer was something to the effect of "pshaw! You know how ... is!" like it's cute when she's lazy or doesn't do her job (and IVs aside I mean her basic job, like entering orders).

Now some might read this and say well maybe you're not warm and fuzzy and I wouldn't blame you for taking it with a grain of salt. But I will add that I had worked on this unit for a year and nothing like this ever happened. I had never heard any complaints to this effect, I was never called in to the office for anything negative related to my job performance, and had a stellar yearly review. I should also add, coincidentally (or not...), this "problem" developed very soon after I put in a transfer to another unit (which I graciously agreed to put off for 4 months because the unit's staffing was horrible and I figured I'd be a team player. That'll teach me!). Although I like to think that people are inherently good, part of me can't help but think it was done out of spite for transferring because they went way overboard with this meeting and there was no obvious purpose to this talk other than to tell me I'm uncaring paramedic who doesn't "get" what nursing is about. There were no suggestions made on how I could have dealt with this problem or how to prevent it in the future, they had no intention of speaking with the secretary about doing something differently, so why did this happen? BECAUSE THEY COULD, plain and simple.

Sorry if my ranting went off topic a bit but abuse of power and intimidation really grinds my gears.

Unfortunately doing the right or "ethical" thing is never easy and almost always gives you more grief than not doing anything about it. You become a "narc" or the people you had a problem with may become more hostile because let's face it, we knew nothing was going to happen, at best maybe a verbal warning that doesn't go in their personnel file. Now as far as being yelled at, I would just turn around and walk away and if she wants to chase you down and continue making a spectacle of herself that's her business. You can't stop her from yelling at you but you sure as hell don't have to listen. When you don't listen, she doesn't have any power over you and will most likely quit trying to intimidate you. Other times you just have to grin and bear it. Try not to let her ruin this experience for you but if you're really miserable you can always look elsewhere because unfortunately problem people don't go away. They stay and scare off a lot of good people. It's really sad and sounds cynical but that's often the way things are.

[HollywoodDiva]

Wow!!! That is unprofessional behavior and uncalled for blatant horizontal violence. I would report her immediately.

[Mudwoman]

I suggest that you re-read my post. I did ask for help and got help. I guess based on your criteria all nurses that day in our ICU were incompetent. I would love to be like you and never have a bad day or not be perfect. Reading your reply, I had to wonder if you are the very nurse that felt entitled to scold me.

[Mudwoman]

No one is judging. You DID ask for opinions. Part of Icu nursing is knowing when and how to ask for help. You didn't and a patients care suffered for it. Bottom line. Heartfelt analogies do not excuse your lack of care.I would have told another nurse or the house supervisor that I was unable to safely care for my second patient since it seems your charge nurse is against you. I've done it before. No one likes to admit they are overwhelmed but if you don't. People can die.

See my post above for this.