What do you think constitutes insubordination?

Five&Two Will Do · Apr 5, 2011

I am in the process of writing up a patent care associate.Through a computerized form the hosptal uses to report issues.
When asked what the nature of the incident is.. I had to choose a category. Insubordination does not quite cover the nature of the problem.
I am an R.N. with a very heavy assisgnment. My PCA is supposed to be working under MY direction. #1 on their job description is...
"Under the direction of a registered nurse.".. and so on and so forth. I am ultimately responsible for the care they deliver.
This PCA consistently refuses to collaborate with me regarding patient care. I asked for an EKG and a troponin to be drawn. I was "talking to the hand". She flat out refused. It is her JOB! She will Not take any direction, rather give it.
Patients note her rude, loud and hostile demeanor.. and share their observations/ concerns with Me!
"why is she tallking to you that way?"
Any insight will be greatly appreciated.

Sorry that you have to deal with such a poor attitude. I think what you said happened certainly constitutes insuboordination. Probably one of those people that just hates RN's because they are licensed and make more money. Most of those people will always be hateful and complain, but they are never willing to do anything like go back to school and make their lives better. I say write that PCA up! :cool:

Bbo.W · Apr 5, 2011

I am a brand new CNA, looking for my first job. I would NEVER be rude to my supervising nurse! My scope of practice is, first and foremost, to take directions and instructions from my supervisors in order to support the nurse in the restoration of my patient's health. Without a supervising nurse, I am not allowed to provide care. I am a certified healthcare worker, not a licensed healthcare worker. Write her up. That is definitely insubordination and the time and energy that you spend on that PCA's issues take away time from your patients. No one has time to waste on spoiled, difficult colleagues who refuse to take instruction. She could learn a lot from you if she would take advantage of the opportunity to work with a great teacher.

GM2RN · Apr 5, 2011

Sounds like insubordination to me.

chelynn · Apr 5, 2011

That would definately be insubordination. We discuss this at work all the time. Ours are CNAs, ceftified nursing assistants, which means they are at work to assist us. They do need to work with us and do as asked. Definatley write her up. A couple weeks ago before I got off work at 6am I put a resident on the vital board to get orthos. When I came in that night they hadn't been done. I asked the CNA why and she said to me because he can't stand. I said she could do all the rest anyway. She said she didn't have time. I said, "Well why don't you have one less cigarrette today and get my orthos done?" She then slammed her water bottle on the counter and yelled, "Yes Maam" Then she went into a residents room and slammed the door. The two getting off work just stood there stunned. I did not write her up but I did complain to the CNA manager. Then just the other day I was told by another CNA that the insubordant one said, "I told her Yes Maam but I should have said **** you!" Needless to say, I did mention that to my DON and she told me to write her up. I don't act like I'm God but I do deserve some respect and you do too.

rn/writer, RN · Apr 5, 2011

When asked what the nature of the incident is.. I had to choose a category. Insubordination does not quite cover the nature of the problem.

Here are some legal definitions of insubordination found with the following link:

http://www.duhaime.org/LegalDictionary/I/Insubordination.aspx

Employment law: a willful failure to obey a supervisor or an employer's lawful orders.

"A constant or continuing intentional refusal to obey a direct or implied order, reasonable in nature, and given by and with proper authority."

Based on your report, this employee also displayed "insolence":

"Haughty and contemptuous or brutal behaviour language; lacking usual or proper respect for rank or position; presumptuously disrespectful or familiar towards equals or superiors.”

Insubordination is the refusal to comply with your direction and fulfill appropriate orders.

Insolence describes the attitude.

The fact that she consistently refuses to cooperate and do what you ask coupled with her ongoing rudeness and hostility suggest that she is guilty of both behaviors and needs some strong "encouragement" to change her ways if she wants to keep this job.

Hope this helps.

ANNIENURSEANGEL · Apr 5, 2011

This is definitely insubordination. You need to go to the director of nurses. Her behavior will continue, if it is not stopped. She needs to be more professional.

ShionRN · Apr 5, 2011

I would have to agree with all the above postings. If the behavior is not addressed in the form of a written reprimand, then she will continue to display these unprofessional behaviors, hopefully it will not be to the detriment of a patient. The primary reason why we are all there.

canesdukegirl, BSN, RN · Apr 5, 2011

Write her up EVERY time you see her refusing to do the job that is outlined for her to do. Your DON can listen to complaints all day long, but unless there is documentation of each event in which she refuses to do a task that you or any other nurse asks her to do, she will continue to get away with it. HR must have specific and written factual documentation in order to get the termination ball rolling.

There are PLENTY of unemployed CNAs that would take her job in a skinny minute!

birdie22 · Apr 5, 2011

from your post, I agree with the above comments and would classify it as insubordination. i just cant help but wonder what her side of the story is....i'd suggest trying to talk to her directly in private about the situation to get her side. and if that doesnt go anywhere, document it! then your supervisor will at least know that you gave it your best shot.

GHGoonette, BSN, RN · Apr 5, 2011

I wouldn't waste time trying to talk to her or counsel her; she clearly has a problem with authority and it needs to be addressed. If you are assigning tasks that are within her scope of practice it is her duty to accept the task, or submit a written reason as to why she unwilling or unable to accept the assignment. The process should be addressed as a formal disciplinary procedure, during which you will present your case, and she will present her defense.

Insolence, as m/writer has described, would (under the definition in my country) be addressed under a grievance procedure, which is not the same as a disciplinary. She was rude, you are aggrieved, therefore you launch the grievance against her. This is usually handled through HR.

Quick question; have other RNs had the same problem with this PCA? Is there, perhaps, a large age gap between you in that you are much younger than she is? I'm just trying to wrap my mind around the concept of a junior refusing an assigned task by a designated senior...

CNABESS · Apr 5, 2011

UMMMM, that is some serious insubordination. Also, if pts. are questioning you on her conduct and attitude towards you, that could be considered a hostile work environment, but I am not sure about that. If I ever refused to do what my nurse asked, I would simply be fired, unless it was an unreasonable or dangerous request. I work under the direction of a Registered Nurse...period. It is not for the pca to decide what she would like to do for a pt. Seriously, sometimes I wonder if people have ever even read their own job description.