yikes! new nurse/old nurse conflict

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Hey guys. So today was a rough day. It was one of those I dont want to go back to work days. A seasoned nurse got in my face to the point two people had to hold her back and escort her out the room. Sigh...I absolutely hate conflict. I need some advice though. But first, let me try to make a long story very short:

I've been orienting as a new nurse with a certain nursing home for a couple of weeks. I was told that this is rare, but I love the job so far. Every person who have trained me, and every unit i've worked on has been rewarding in some way, until today.

I began orientation today on the unit im supposed to be working on permanently. Orienting on a new unit always feels like starting fresh because i dont know the patients, the med cart is different and each mentor has their own way of doing things. Well this mentor literally just gave me the cart, told me to go do the med pass, as she retreated to the nurses station. So here I am, 1st day, by myself with a cart I've never worked on and patients I'm not familiar with. Not only that, but the cart was in a hot mess! There were all kinds of hippaa violations on the cart etc.

So while I'm slowly passing meds, one of the CNAs came to me and told me that I need to give a certain pt all his meds...including his 6, 8 and 10pm meds all crushed in one...and put it in his chocolate milk at 4pm. I told her that its not safe to do so and that I will give him the meds that's due at this time. She goes and gets my mentor who came, crushed all the meds including the ones due at 10pm, and put it in his milk. Now the CNA is looking at me like im stupid lol. Fast forward...

I'm in the managers office crying because I'm so overwhelmed by everything that's happening on the floor and I felt like I was alone. I had no intention of bringing up the med incident to the supervisor but I did. The supervisor then insists on bringing it up to the nurse because we all know that you need an order from a Dr to do something like that. She goes upstairs then 5 mins later, I hear the nurse/mentor, angrily page me over head to come to the floor...that's where she got in my face, saying how dare I call her actions unsafe...she has 30 years of experience etc etc. I kindly and calmly asked her to move her hand out of my face, and that's when two people grabbed her and took her out of the room. As she is leaving, she says that she was going to bring this up to someone and write a report on me. Now I don't know what she's going to say, but the only thing she can do is lie, or throw herself under the bus.

As I was leaving the floor with the supervisor, I see her at the end of the hallway with the other nurses talking. Problem is, I now feel like an enemy, because nurses/women/people tend to form bonds at work that no one can get through, no matter how wrong the person is. I have to go back on that floor and train with a different nurse. I do feel intimidated and afraid of what's going to happen. I dont want to work in a hostile environment. I do not want to be that nurse on the floor no one likes because one person in the clique has an issue with them. Its just not healthy. Im wondering if I should go to the DON and ask for a transfer to a different floor, or what should I do. Im so clueless right now. And I'm honestly afraid. Help!

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Specializes in Med-Surge, Tele, PCU, CVICU, NSICU.

Speak with the supervisor...if they are not going to back you then you may want to find a new job. You've already mentioned HIPPA violations and medication errors (because thats what they are to give them at times they aren't due)....what else do they have going on?

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The thing is, I didn't see or experience any of that on other units. Everyone so far has been so awesome. I would hate to leave because of one person but it kind of looks like I may have to if things continue down an ugly road :unsure: Not what I wanted to hear but you're probably right.

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Specializes in Med-Surge, Tele, PCU, CVICU, NSICU.
The thing is, I didn't see or experience any of that on other units. Everyone so far has been so awesome. I would hate to leave because of one person but it kind of looks like I may have to if things continue down an ugly road :unsure: Not what I wanted to hear but you're probably right.

Can you work on one of the other ones?

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Specializes in Peds/outpatient FP,derm,allergy/private duty.

What an awful thing to have happen so soon on the job!

I think it's pretty clear that if you show up for work in this lady's domain without some sort of remediation regarding what happened it won't work out well for you.

The mentor isn't a mentor, even if she is of the "sink or swim" school of mentoring sending a CNA to tell you how to give meds is inappropriate.

Unless there is a thorough airing of the incident with the nurse and you feel that both sides have understood what happened and make a fresh start I don't see how you can avoid asking for a transfer.

My advice would be to write down what you remember. Focus on the fact that you are a new nurse, reluctant to take shortcuts but avoid being overly emotional, defensive or even to assign blame. Be calm and professional so that those higher up will want to keep you and more likely to give you a transfer. Best wishes!

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You did the right thing, first and foremost. I am curious as to how the nurse explains that she signs off 10pm meds in the afternoon. If it is imperative that the resident receive all of his medication with his supper at 5, then perhaps the MD will change the time.

Look at it this way, the CNA says "give all his meds now" which as mentioned is highly inappropriate, and you do and sign them off. The DON comes around to check on you to see how you are doing, and says "why the heck is a 10 pm med signed off at 4pm?" Then you are the one who made the error, which as you know, in orientation is never a good thing.

I would write down everything that you remember, as a pp suggested. I would then ask for an appointment with the DON, and ask that due to the confrontational nature of the exchange, you would like to know if possible to work on one of the other units you oriented to.

If a suggestion is made that you all hash it out with the DON, I would hold my ground and really say " I get that it is easier if all of the meds are given at the same time for some residents. However, I can not justify why I am giving a 10pm scheduled medication at 4pm. That would be on me as a medication error. I get why it is done, however, there must be something that can be done to change the timing of the meds so that we all are in compliance". "I understand Nurse Meanone that you have practiced for 30 years, and I admire that in any nurse. However, you can surely see my point in that by doing as the CNA asks is not only highly inappropriate, but is on me for making a med error."

It sounds to me as if they don't want residents woken up for 10pm medications. If that is the case, then the MAR needs to reflect a new time, per the MD. And that would be medication dependent. If you are giving a sleeper at 4pm, that is just not right. Have all the residents in bed and sleeping by 6pm and it is "smooth sailing" for the rest of the shift. That way the night shift is responsible to get the residents up and dressed and ready for the day when they wake up at 4am.....

It is not worth anyone's sanity to be surrounded by people who's goal will be to throw you under the bus. If they can not accommodate you working on an alternate unit, then I would start a new job search.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

How sad that this nurse is so inappropriate AND giving meds you YOUR patient. Write it down now while it is fresh. Speak with the DON how threatened you felt NO NURSE should have to be physically restrained and removed from a situation. She sounds poisonous. Your bet bet would be to move to a different floor. Clearly this is not an ideal situation. Is this LTC?

Why does the patient need all of his meds at 4 PM? Does he then sleep/doze the rest of the shift and be up all night? Jade and 156 have given yo good advice.

I am so sorry this happened to you.

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This is ridiculous. It makes it even worst because you actually like working here. I agree that if this lady had to be physically restrained against another employee, can you imagine what she does to the patients?!? ::shudders:: Listen, there is always someone above her and there is even someone above THAT person. You have to find your voice and speak up when someone has treated you unfairly. You shouldn't have to come to work and be verbally and almost physically abused when your trying to do the right thing. We are behind you, girlie!! Good luck!

Sent from my iPhone using allnurses

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One bad apple....don't risk your license because another nurse told you to do something you clearly know isn't right. We are ALL held accountable to the six rights of medication administration." Right time" is one of them. She instructs you, you do it, you will be held accountable if something ever happens or even if the facility were to question why you did what you did. "Because she told me to" won't go very far with your State Board of Nursing. She could ask you to do other things that are against protocol or scope of practice. I am sorry you were put in this position.

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Specializes in NICU, PICU, Transport, L&D, Hospice.

I agree with the recommendation to write down all of the information and facts surrounding this incident now. Sort through them to clarify your thoughts as separate from your emotions.

There is something wrong when the experienced nurse has to be restrained and removed from the area, IMHO.

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Thanks guys. Awesome advice. I'll try to answer all the questions because somehow my phone is not allowing me to use the quotes.1.why she did it? Because the patient refuses his meds so they usually have to crush them and disguise them in the food. Still does not make it right.2. I'm currently working on going to another unit but when I spoke to the supervisor at work yesterday, she assured me that when I got off orientation, I will be going to that unit. That particular unit do not have any permanent nurses (only part time and agency, hence the reason why the med cart was so crazy and disorganized) and since I'm a permanent nurse...3. The reason I wanted to avoid going to the DON was because I wanted to respect the supervisor and her work. Going to him would say I'm not satisfied with how she dealt with the situation so I'm going over her head. What do you guys think?4. Yes its a LTC skilled nursing facility.Other than that I think you all are right. I will write things down. I thought I was continuing orientation on that unit yesterday so I went there at the beginning of my shift. The nurse wasn't there but I could still feel the tension with the CNAs as they stood there looking and whispering lol. I dont want to be paranoid, but like someone else said who wants to work on a unit where some people's goals will be to throw me under the bus? I feel like anything, and I mean any little thing I do will be reported. I was willing to stay on the unit and orient regardless of it all but the supervisor said she told the DON that I didn't like how the nurse trains, so he said I should finish my orientation with the mentor I started with.I also want to point out that that nurse was technically not a mentor. Somehow, because there were no permanent nurses, they just kind of use the most experienced person to train me. Obviously that didn't work out. Sigh...I will keep you all up to date with what's going on. I really would like to reconcile because it would at least provide a healthy start, but thats def a two way st and she also has to be willing to do so. I understand her pain. I mean the new girl reported you for doing something wrong so you're angry. Thats a natural consequence for doing the wrong thing. But can she put her emotions to the side and work in harmony? Not sure. We'll see.

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Wow, what a bad way to start a new job. In our state you need an MD order to hide meds in food. There has to be documentation of refusals and the risks of not taking the meds to outweigh that you are now not following the resident rights which allow them to refuse their meds. We also need approval from the family if we are concealing meds. In our 80+ bed facility we hide meds for 1 resident who needs his Risperdal or becomes a danger to himself and others.

That being said, hiding pills is something that was done a lot years ago, like restraints, side rails, bed alarms, we are changing the way things are done in LTC. Change is hard for everyone, especially when you have been doing something for 30 years.

I would recommend sitting down with the supervisor and asking for some guidance on how to deal with that nurse if you are going to be working with her, especially if she becomes violent again. That will get the conversation going and give you a chance to talk to the supervisor again without going to the DON.

If you aren't comfortable with what the supervisor is telling you to do then you can ask if they mind if you 2 both talk to the DON and get their input.

Hopefully this was an isolated incident but good luck, sounds like you will need it.

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