What do you think constitutes insubordination?

[Been there,done that]

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 assignment. 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.

[Been there,done that, ASN, RN]

Please re-read my original post. I did not ask her to perform any duty after her shift.

I would never do that.

Rather, I had to perform the write up.. on my own time , after MY shift was over.

[Imafloat, BSN, RN]

There was a PCA on my old unit like this. I worked in a level III NICU. Once I had a surgeon call and tell me he was on his way up to do a rectal dilation on a patient in 10 minutes and to gather everything. I went to the nursing station and the PCA was standing there, talking to someone about vacation. I said, excuse me, Dr. So and so is coming up in 10 minutes to do a procedure on Baby Jones, can you please go get an open bed warmer and take it to room 24? I've called CSS for the dilators and I'm getting the Fentanyl and Versed. She looked at me and pointed to the storage room and said, "see that door right there, it leads to the storage room, and there are all the open bed warmers you need in there, what you do is get one and roll it to your room." I was a new nurse and new on the unit so I thought that somehow I was a problem or had done something terrible to this person. I was flustered because the surgeon was rude and pushy and he would be obnoxious if everything wasn't ready when he got to the unit. I looked at her with shock and another nurse overheard what happened and told her that it was her job to do it and she needed to go get it set up. She went and set it up, she later came to me and told me it was her job to help me, but if she was busy that I needed to wait for her to be done.

Over time I realized that this is how this PCA was. She treated all of the new people like this. I finally sat down with her and our assistant manager and aired my concerns. Nothing changed except how I dealt with her. I learned to phrase things so that it was her choice to help me. I hated that I had to do that, but sometimes it's easier to deal with people like that than deal with their constant drama. Administration isn't doing their job by allowing that to happen, but it's not my problem anymore, I left that dysfunctional unit.

I feel like the equivalent of this behavior would be a nurse telling a doctor no when they wrote an order.

[nurseprnRN, BSN, RN]

well, actually, the nurse practice act and ana standards of practice mandate rns to refuse any part of the medical plan of care that is dangerous, and to pursue clarification prn, so yes, sometimes you can "tell a doctor no when they wrote an order ." cnas better have darn good reasons for refusing their parts in implementing a nursing plan of care.

[caliotter3]

Don't be so concerned with the category, as a concise description of the behavior. The incidents you describe sound like a form of insubordination. Make certain it is clear what she did, or did not do. And follow up. Good luck in dealing with this.

[KelRN215, BSN, RN]

I feel like the equivalent of this behavior would be a nurse telling a doctor no when they wrote an order.

Flawed analogy. The doctor is not the nurse's supervisor and the nurse's job is not to be the doctor's assistant. There are people specifically with those jobs... they're called Physician's Assistants. I have refused MANY orders that doctors have written over the years. If you have a patient with a known allergy to amoxicillin and the MD orders Augmentin, would you not question it? If you didn't, gave it and the patient anaphylaxed, "well the doctor ordered it" would not be a valid excuse.

[MrChicagoRN, RN]

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.

That is a perfect example of insubordination

[MN-Nurse, ASN, RN]

Sounds like the real problem here is with management.

There are a few absolutely freaking worthless CNAs at my job. Management knows about them but refuses to do anything about it. I could go to my old nursing school and in a single say fully staff my department with excellent CNAs....

In the words of John Belushi, "BUT NNNNOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO......"

[FutureRN_NP]

I also have a story to share. One of the float CNA worked at my wing the other week. During the busy working hour, I had a new admit. The has AKA on both legs. During the assessment process, I asked the CNA to help me turn the patient so I could look at her bottom. She said wait a minute I am busy now. I said okay. So she never shown up. I asked the admission aid to help me instead. She did. We turned her and did the complete assessment. After we had done, we removed all hospital garments, blankets including the dirty gown on the floor. We covered the patient with the clean sheet. I told the pt the CNA will bring her a new gown. What happened next was the CNA came and talked to me with a hostile manner. You should not take the pt's gown off and throw it on the ground. I told her the gown was dirty and she needs a new one. The CNA went off and tell the RN supervisor on me of what happened. To my favor the busy crazy night, the supervisor told her she has no time for this pity thing. You do what you need to do, give the patient a new gown. That was that!