Triage Nurse From Hell

[bryncvp]

Hi everyone..I just wanted to get everyone's opinion on what they would do to deal with a nurse with a stick up her butt.

The ER she works in is a level 2 trauma center in our tiny state of RI and it seems like every time I bring a patient in, she has something to say about something. One of the last times I took one in, she said...loud enough to the pt to hear.. " I hope this is legit..she is getting our last bed". Granted I know working in an ER is stressful and you have to deal with a lot of BS (maybe the RN's in the forum can comment), however, I think the statement she made was extremely unprofessional and just plain rude. Now maybe it is because I am with a vollie service and that is the root of her distain..I dont know. She is passive agressive most of the time with her attitude and there have been a few times when I have had to hold back any time of sarcasm to maintain my professional appearance. Another case, recently, was when I transported a female in her 20's...very small...around 5 feet ball..barely 100 pounds and she was dehydrated and was dealing with heat exhaustion. I sank a 20g in her forearm to try to rehydrate her...I tell you her size because, as you can imagine, her veins were pretty small and, in my opinion, a 20g was my best bet to get a line started (the AC and her hand were tough to find a vein)...we get to the ER this nurse pulls the IV out and says "I dont know why you put one that small in her..it is not going to do anything for her" (inappropriate comments aside lol) making me look like an ###hole.

The next time something like this comes up, I am going to have to say something. I work in sports medicine professionally and it is an environment where you speak your mind and do not hold anything back..so this situation and being civil has been a struggle.

What do you all think????

How would you guys handle this?

Any comments from the RN's on the forum.

I do want to be rude to her but there is a point where I have to stick up for myself and my pt.

 

[nwhitney]

Can you go to your supervisor who in turn can speak her supervisor? I'd bet you're not the only when who has concerns regarding this nurse.

 

[Elk Oil]

Work this one up the chain, for sure. I can only imagine what she's like with the patient when you're not around. Sounds like she has no business being in the business.

 

[sir.shocksalot]

In my experience sometimes its not your patient care, or who you work for, or really anything about you that is getting this RN bent out of shape. When some people aren't happy about... well, anything really, they tend to take it out on others including their coworkers and customers. I think if you discussed this with your coworkers and even other ER staff members you would find that most don't like her for the same reason.

Your best bet is to first address it with this RN in as politically and diplomatically correct way as possible. Say something along the lines of "Everytime I come in here and drop off a patient, you seem unhappy with something I am doing, is there something I am doing that you aren't happy with? If so what can I do to fix it?"

If she gets snippy with you or yells or whatever, then you need to take it up with your management and with the nursing supervisor as needed. Often RNs are required to be polite to patients and EMS providers and can (and often are) harshly disciplined when they receive complaints.

These RNs are everywhere by the way, every hospital ER has at least one (either RN, MD or tech) that will be a total pain when they get a patient and just accuse you of being a moron. Seems like medicine attracts the type of personalities that are prone to this passive-agressive BS.

 

[bryncvp]

The last sentence in my posts should have read.."I do NOT want to be rude..."


I think I might kill her with kindness too and maybe overkill it a bit. I get the feeling she has a superiority issue going on. I mean we are all there for the same purpose..we all work together.


I dont know..just frustrated I guess......

 

[nwhitney]

Sounds like signs of burnout and/or chronic stress.

 

[BEorP]

Your best bet is to first address it with this RN in as politically and diplomatically correct way as possible. Say something along the lines of "Everytime I come in here and drop off a patient, you seem unhappy with something I am doing, is there something I am doing that you aren't happy with? If so what can I do to fix it?"

Great point about talking to the person you have a problem with first and I think you suggest a great way of doing it. Just be sure that if you use that line that your tone of voice is sincere.

If that doesn't work, then get your supervisor involved.

 

[Akulahawk]

Sounds like signs of burnout and/or chronic stress.

This would be my guess as well. That Nurse is probably just burnt and taking it out on anyone and everyone she comes in contact with. Throw in a healthy dose of "I don't care" and...

 

[DrParasite]

Nurses are overworked... boo freaking hoo.....

I'm sorry, but I have little sympathy for nurses like this.

their job is to triage and treat the patients... just like I have NO sympathy for a nurse who tells me they are full, no beds available, short tonnight, etc, because, well, that's not my problem. Does it suck? absolutely. Do I wish the situation was better? absolutely. Should they complain to their management and get the situation fixed? absolutely. Would I support them? absolutely. But unfortunately, the patient needs to go to the ER, and the sign said "Emergency."

a buddy of mine worked in a system, which had a very interesting way of dealing with a nurse like this. they get a rude nurse, who treated an EMS crew poorly? then EVERY patient went to that hospital. they would pick up homeless people and offer to take them to the hospital. but EVERY SINGLE PATIENT went to that hospital, or was suggested to go to that hospital. Not that I agree with that plan, but that's what it did.

Personally, I don't lose sleep over rude nurses. I know they are often over worked, but we all have a job to do. They want to make me look like an idiot? whatever, it happens.

I take that back. there was one time a rude nurse got under my skin. It was an L&D nurse on a possible maternity related issued. I was so steamed, that when we took the patient to the ER (since they sent the patient to the ER back to the ER since she wasn't ready to pop), the nurse how steamed I was, asked what was wrong and brought me to the charge nurse, who brought me to the nursing director, who pulled out her cell phone, and told me to tell the person on the other end my story. it happened to be the nursing director of L&D. after that a policy was changed, the nurse was counseled on being rude, and I haven't had a problem since.

If a nurse doesn't like being over worked and understaffed, maybe a transfer to another floor is in order? but either way, we all have our jobs to do, and I don't give nurses an attitude when I have a bad day, and there is no reason to receive any attitude or rudeness from them.

 

[mycrofft]

I'm a RN, and a former EMT-A (er, basic)

Some nurses are very status oriented and will dump on people they feel safe doing it on/to. As I have mentioned, I have seen a lot of RN's who feel EMT's are all like furniture movers. I can get into the "they are characteristic of a disenfranchised minority" deal, but the crux of the matter is you've run up against a Queen Bee. (NOTE: I've known a couple nurses who were so disrespected by their co-workers and supervisors that they got put on triage to get them out of the treatment area).

If about three doses of acting apologetic don't work, start documenting and reporting it to your supervisor. Accent instances where it influences patient care. DO NOT enlist others to do the same, but if you drop mention that you just had to do something, others might start also. You can bet she will do the same to her boss about you when the bug bites her every now and again.

 

[mgr22]

I'm no expert in sports medicine, but I wasn't aware of any professions whose members have carte blanche to "speak your mind and not hold anything back" without consequences. Don't we all have some obligation to pick our battles, compromise, try to find ways of communicating, etc? I'm not saying that nurse is right, but maybe she also is used to speaking her mind.

Have you tried talking with her one on one, when both of you have a little downtime?

 

[Elk Oil]

Nurses are overworked... boo freaking hoo.....

I'm sorry, but I have little sympathy for nurses like this.

...we all have our jobs to do, and I don't give nurses an attitude when I have a bad day, and there is no reason to receive any attitude or rudeness from them.

Agreed. We tend to place ourselves in a submissive role with nurses -- especially ones with super-strong personalities. If we instead see ourselves as colleagues, we can begin to change our own perceptions of ourselves and not apologize for what doesn't need to be apologized for and having an expectation that we'll be treated better instead of hoping we'll be treated better.

 

[ArcticKat]

The last sentence in my posts should have read.."I do NOT want to be rude..."


I think I might kill her with kindness too and maybe overkill it a bit.

Not a good idea. I speak from experience when I say this. She will sense that you are being disingenuous, even if you are attempting to be legitimately friendly. It's just the sort of people these sorts are. I've had similar dealings with similar people and usually it works out best for me when I just straight out ask them...What the heck is your problem with me?

Explain to her how interactions with her make you feel and that she seems to have an issue with you. Ask her why? Maybe it's from something you did to her without realizing it 3 years ago and she is holding a grudge. Communication helps...or...she's just a :censored::censored::censored::censored::censored:.

 

[O 2]

Don't send it up the flagpole if you haven't tried addressing it with her first. It'd come back and be considered 'tattling', and really, transferring the responsibility without trying to solve the problem first is just as bad a her transferring her own personal sh*t on to you.

Catch her at a downtime, make sure she's not HALT (hungry, angry, lonely, or tired) and then try to casually work through the VOEP conflict resolution paradigm. I've found that it works with anyone who is the least bit self aware and receptive to feedback (which may not be her Each step can be brief and natural, consuming half a sentence or less.


Ventilate
Each person in disagreement needs to tell the other his or her feelings. Here the goal is to communicate effectively ones ideas. Each person needs to try to define the problem as he or she sees it. The individuals need to expect to hear differing views, and paraphrase the other’s viewpoints

Ownership & Empathy
After all parties have aired their feelings, the parties begin to contribute to either solving or inflating the problem. The individuals involved need to picture themselves on the receiving end of their actions. You need to set own experiences aside and understand why the others reacted as they did.

Plan
This is the resolving stage. Clearly state what you want, be open to differing ideas from opposing parties. Accept that the parties involved may occasionally slip on the approved solution. Also, discuss how to handle the problem on its next occurrence.

http://roggeheflin.com/projects/Downloads/RangerFieldBook.pdf
page 80

Good Luck. FYI The National Outdoor Leadership School (NOLS) has a book called the Leadership Educators Handbook, which goes into this process in depth. I've found it to be invaluable for all of life's problematic relationships.

http://www.nols.edu/store/product.php?productid=16308&cat=3&page=2

 

[mycrofft]

Nothing much more to contribute except watch your back.

Typically conflict resolution works on a peer->peer or adult->child model. If this is a "Queen Bee" (someone who finds a sheltered position in a hierarchy then develops strategies to protect her/himself and project influence), there will be no perception of anyone else other than the boss as being able to initiate anything of the sort.

I liked Arctic Cat's take; grin and ask "What can I do to make things smoother here?", or "Is there something I've said or done to make things sideways here?". (Remember, as a nurse in a hierarchy, admitting fault means being vulnerable. That needs a lot more trust building, if it really is needed at all).

 

[DrankTheKoolaid]

re

Going through the chain is just fine but ive got to tell you, Until you jump right back into her/his face and put them straight that you are NOT to be talked to that way in front of patient or in a condesending way that behavior will not change. Just make sure to do it tactfully and not in front of patients.

And NEVER and i mean NEVER appologize if you have done nothing wrong. I/We are not there to fluff their ego. If they have their own issues to work out so be it. But not at the expense of someone elses feelings. And if that does not work simply ask to see her supervisor and tell her you want to explain exactly why you are no longer bringing patients to that ER if you have more then 1 ED to choose from.

 

[Elk Oil]

And NEVER and i mean NEVER appologize if you have done nothing wrong. I/We are not there to fluff their ego.

Right on. We are not submissive, we are not subservient. Don't beg for anyone's forgiveness. People need to earn others' respect, and acting like we're automatically wrong only prevents that.

 

[usalsfyre]

Right on. We are not submissive, we are not subservient. Don't beg for anyone's forgiveness. People need to earn others' respect, and acting like we're automatically wrong only prevents that.

I have been known to give nurses and physicians who take serious issue with the care I provide my medical director's contact info. Strangely, I've yet to hear a complaint...

 

[Elk Oil]

I have been known to give nurses and physicians who take serious issue with the care I provide my medical director's contact info. Strangely, I've yet to hear a complaint...

Hmmm. I like that approach.

When I worked in the city, I could have used that. Now that I'm in rural EMS, we have pretty good relationships with the ER staff and so many of the problems I encountered in urban EMS simply don't exist out here in the sticks.