Advice for handling dingus RNs

[Fox800]

Could use some advice from the hive-mind.

Currently off-service, having some real heartburn due to one of the charge nurses in one of the ICUs.

Had a piece of monitoring equipment in a patient that wasn't working and was giving inaccurate readings that were freaking the nurses out and didn't correlate clinically with how the patient looked (think "incompatible with life" kind of inaccurate). Chief Resident asks us to remove the monitoring device. Charge nurse inserts herself and basically states that it's a safety issue to remove...says the nurses are worried "because the numbers are so high", they're concerned. Their logic: if we pull it, they have no way to monitor the (totally inaccurate) readings. Chief Resident acquiesces to make the nurses happy and we remove it the next day. Strike 1.

Yesterday, coming out of a patient's room with the team, charge nurse (behind the nurse workstation desk) loudly asks us if we all "foamed out". We're all professionals, we all know how to wash our d*mn hands and we do it 840 times a day. Very passive-aggressive like, trying to assert herself. It was very awkward. OK, you're now the hand washing police. Strike 2.

Today, same crap. Team is coming out of a patient's room and she barks at us to all foam out. Not a request, but a demand. Like a manager would give to a subordinate, except we're all residents, attendings, and an NP. No unit nurses or students in the group. Some of the team hadn't even made it to the door when she did it. Strike 3.

Later in the day, still on rounds, we are discussing as a team (with the patient's nurse) how a treatment plan changed. Charge nurse inserts herself into the conversation, loudly announces that our treatment decision was "totally inappropriate" in front of myself, another resident, NP on our service, and 1-2 unit nurses...and in earshot of other residents, unit pharmacist, etc. Trying to play doctor, trying to second guess us. I just said "OK" and quickly walked off to keep rounding. That really got me heated, and I feel it was grossly unprofessional. If you have beef with a treatment decision, talk to us in a polite way and we are happy to explain it. Don't just start mouthing off in the middle of rounds and in front of a bunch of other people.

I'm half-tempted to write this RN up, but I'm sure some kind of passive aggressive ****storm would ensue. "They can always hurt you more".

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[mauricekenter]

By the fact that you are "off service" I am assuming this means you are a resident.

Therefore, I would ask the ICU doctors what's going on with this charge nurse and what they think of it. Ask them if they think she is being unreasonable, etc.

I would leave it up to them to make formal complaints or whip her into line.

 

[Angry Birds]

Generally a good idea to lay low in residency, especially on off-service rotations.

 

[The White Coat Investor]

Not your circus, not your monkeys

 

[anbuitachi]

Write her up.

 

[shoal007]

Write her up.

absolutely not. unless u like fire.

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[GeneralVeers]

Who cares? You are off-service and will never have to deal with this person again in a month or so.

 

[anbuitachi]

absolutely not. unless u like fire.

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absolutely yes. if you reverse the situation, i bet 100% the RN would write you up.

Actually you did the best thing you could have which is to just barely acknowledge her and walk away. People like this have a complex and they thrive on validation, both positive and negative. If you get into it with her or write her up, it will make her a martyr in her own mind.

By just keeping your cool and walking away, you're effectively telling her that she's not even worth your time or energy. Which, believe me, will drive her more crazy than anything else you could do.

thats funny. meanwhil shes thinking in her head 'hes so scared of me he ran away with his tails between his legs'

 

[WilcoWorld]

Agree with Mr Hat and most other posts above.

Just wanted to jump in here to say that I think the hand sanitizer at the doorway is probably more harm than good. Here's why:
1 - People rarely use that stuff as directed, so they are often doing suboptimal hand hygiene.
2 - Left to their own devices, most people will wash their hands well with soap & water after touching a sick person.
3 - When people bark at you to "foam out", even when you didn't touch anything in a room, or washed your hand before leaving the rom, you are likely to stop hand washing.
4 - So now we have people "foaming out" of c diff patient rooms and the like.

 

[anbuitachi]

Agree with Mr Hat and most other posts above.

Just wanted to jump in here to say that I think the hand sanitizer at the doorway is probably more harm than good. Here's why:
1 - People rarely use that stuff as directed, so they are often doing suboptimal hand hygiene.
2 - Left to their own devices, most people will wash their hands well with soap & water after touching a sick person.
3 - When people bark at you to "foam out", even when you didn't touch anything in a room, or washed your hand before leaving the rom, you are likely to stop hand washing.
4 - So now we have people "foaming out" of c diff patient rooms and the like.

I see this very often in the hospital and a LOT of doctors, and other healthcare workers do not sanitize despite touching patients, especially surgeons from my experience. And there is often someone hiding somewhere keeping a record of % of people foaming in/out in the ICU at least, they aren't gonna look if all of you touched the patient or not

 

[deleted109597]

I see this very often in the hospital and a LOT of doctors, and other healthcare workers do not sanitize despite touching patients, especially surgeons from my experience. And there is often someone hiding somewhere keeping a record of % of people foaming in/out in the ICU at least, they aren't gonna look if all of you touched the patient or not

The same group of clipboard nazis also doesn't look and see if you wash or foam in the room either. So it's a ridiculous metric.

 

[WilcoWorld]

I see this very often in the hospital and a LOT of doctors, and other healthcare workers do not sanitize despite touching patients, especially surgeons from my experience. And there is often someone hiding somewhere keeping a record of % of people foaming in/out in the ICU at least, they aren't gonna look if all of you touched the patient or not

I often wash my hands with soap and water in the room, then don't sanitize on exiting. So I would count as a "miss" in your metric.

 

[Fox800]

I often wash my hands with soap and water in the room, then don't sanitize on exiting. So I would count as a "miss" in your metric.

Also, why the F does it matter if you don't even touch anything? Walk in, talk, touch nothing, walk out.

 

[bravotwozero]

Agree with others. This is not the hill to die on, trust me. Just lay low until the rotation is done and move on...


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[Angry Birds]

I finally actually read the entirety of the OP's post. Even though the nurse in question sounds like a total b, there is really no clear offense that you could write her up for. She will simply claim that she was advocating for the patient. So yeah, don't say anything. Just let it pass and know that you will continue to be talked down to during residency, but residency is but a few years.

 

[TooMuchResearch]

Agree with Mr Hat and most other posts above.

Just wanted to jump in here to say that I think the hand sanitizer at the doorway is probably more harm than good. Here's why:
1 - People rarely use that stuff as directed, so they are often doing suboptimal hand hygiene.
2 - Left to their own devices, most people will wash their hands well with soap & water after touching a sick person.
3 - When people bark at you to "foam out", even when you didn't touch anything in a room, or washed your hand before leaving the rom, you are likely to stop hand washing.
4 - So now we have people "foaming out" of c diff patient rooms and the like.

Anyone on enteric precautions at the residency hospital had all foam removed and signs on the door reminding staff to wash hands.

I'm not even sure where the inpatient beds are at my new job main site, so couldn't say how they do it there.

 

[engineeredout]

It's not worth the grief you'd create for yourself. Plus, "on paper" I'm sure everything she said/did she could fly under the banner of "patient safety", and the people who would be in charge of reviewing the complaint (other RNs) would have her back, not yours.

Breathe deep, do what's right for the patient, and go out with your co doctors drinking and laugh about what a tool she is. Nothing else is worth your time.

 

[deleted480308]

You are a visitor in their dept. if the attending doesn't do anything about, let it go

 

[anbuitachi]

Also, why the F does it matter if you don't even touch anything? Walk in, talk, touch nothing, walk out.

The reason is because germs can jump. they are excellent high jumpers. it's like, why wear a mask in the OR when you are across the room. why wear a hat. why wear scrubs in the operating areas? cause germs jump far. strong legs

 

[anbuitachi]

You are a visitor in their dept. if the attending doesn't do anything about, let it go

Unless you specifically requested to be a visitor in their department, you aren't just a visitor. if you are a resident rotating on another service, you are cheap labor, not a visitor. our residents rotated thru one of the surgery department as one of our required surgery months. they didn't treat us well, so we pulled all our residents out.

 

[deleted480308]

Unless you specifically requested to be a visitor in their department, you aren't just a visitor. if you are a resident rotating on another service, you are cheap labor, not a visitor. our residents rotated thru one of the surgery department as one of our required surgery months. they didn't treat us well, so we pulled all our residents out.

Which is an attending doing something about it (or maybe a chief?). The resident themself is better advised to keep their head down and let their superiors decide how to proceed.

 

[anbuitachi]

Which is an attending doing something about it (or maybe a chief?). The resident themself is better advised to keep their head down and let their superiors decide how to proceed.

yea and why would they do anything if you dont report it

 

[VA Hopeful Dr]

yea and why would they do anything if you dont report it

You mean how the 1st reply to the OP said to do...

 

[anbuitachi]

You mean how the 1st reply to the OP said to do...

oh i was referring to lower posts hahaha

 

[deleted480308]

yea and why would they do anything if you dont report it

Just to clarify....I'm saying to let the residency chief/director know via conversation if you think it's an issue. It seemed like some were suggesting full on official complaint through the hospital which I would propose is a risky move

 

[HooliganSnail]

Could use some advice from the hive-mind.

Currently off-service, having some real heartburn due to one of the charge nurses in one of the ICUs.

Had a piece of monitoring equipment in a patient that wasn't working and was giving inaccurate readings that were freaking the nurses out and didn't correlate clinically with how the patient looked (think "incompatible with life" kind of inaccurate). Chief Resident asks us to remove the monitoring device. Charge nurse inserts herself and basically states that it's a safety issue to remove...says the nurses are worried "because the numbers are so high", they're concerned. Their logic: if we pull it, they have no way to monitor the (totally inaccurate) readings. Chief Resident acquiesces to make the nurses happy and we remove it the next day. Strike 1.

Yesterday, coming out of a patient's room with the team, charge nurse (behind the nurse workstation desk) loudly asks us if we all "foamed out". We're all professionals, we all know how to wash our d*mn hands and we do it 840 times a day. Very passive-aggressive like, trying to assert herself. It was very awkward. OK, you're now the hand washing police. Strike 2.

Today, same crap. Team is coming out of a patient's room and she barks at us to all foam out. Not a request, but a demand. Like a manager would give to a subordinate, except we're all residents, attendings, and an NP. No unit nurses or students in the group. Some of the team hadn't even made it to the door when she did it. Strike 3.

Later in the day, still on rounds, we are discussing as a team (with the patient's nurse) how a treatment plan changed. Charge nurse inserts herself into the conversation, loudly announces that our treatment decision was "totally inappropriate" in front of myself, another resident, NP on our service, and 1-2 unit nurses...and in earshot of other residents, unit pharmacist, etc. Trying to play doctor, trying to second guess us. I just said "OK" and quickly walked off to keep rounding. That really got me heated, and I feel it was grossly unprofessional. If you have beef with a treatment decision, talk to us in a polite way and we are happy to explain it. Don't just start mouthing off in the middle of rounds and in front of a bunch of other people.

I'm half-tempted to write this RN up, but I'm sure some kind of passive aggressive ****storm would ensue. "They can always hurt you more".

I 100% guarantee you that everyone else knows this person is a pain in the ass. Nothing she is doing or saying is that bad, she just sounds like an irritating person.

ICU is an infamous place with lots of drama and personalities, and you will be gone in 30 days.

I would just let it go, not every battle is worth fighting.

 

[Groove]

Residency is like high school. Lots of peer pressure, ego ruffling, difficult personalities and unrealistic fears. You'll forget half of these people and never see 99% of them again. It's hard to keep your eyes on the prize but that's what will get you through with the least amount of pain. The only thing that matters, and I mean the ONLY thing that matters.... is finishing. You can flex your ego and play House of Cards in the hospital all day long AFTER you're an attending and have your boards under your belt. That's all that matters right now. Don't make yourself a target, don't rock the boat, and for the love of God don't start nursing wars while off service.

 

[emergentmd]

Not your battle esp as a resident. Piss her off, she sticks around, then your life will suck.

Put your head down. The attending knows, higher residents knows. If they dont' do anything, there is a reason.

I would put her in her place if I were an attending. As a resident, ignore and do your time

 

[WilcoWorld]

Residency Survival Guide, Rule #1)

[D]on't start nursing wars while off service.

 

[Angry Birds]

Residency Survival Guide, Rule #1)

I agree but I wouldn't place it as rule number one. Gives them too much importance. Such people are nobodies and just ignore them and let them enjoy their small-minded power trips. You are off to bigger and better things in life.

 

[BAM!]

Even 5 year old girls know what to do, Let it go.

 

[Soccer171983]

I would just brush it off. It looks to be in poor form if you get into a pissing contest with the charge nurse. I am not saying your are wrong and I am not saying the charge nurse isnt being petty and picking on you either. You piss the queen bee off and every nurse is up your butt. I personally wouldn't want to be called into the icu for the smallest things at 2am because they can do that. I would shrug it off. If she is doing something grossly inappropriate or wrong, then maybe bring it up to an attending who could smoothly deal with the situation. Doesn't matter how you look at it, a charge nurse is not going to take it from a resident and will likely make hell for you. The day you graduate, if you still are at the hospital, you can make your presence felt if necessary but as a resident I would do anything but make my presence felt.

 

[Birdstrike]

Advice for handling 'dingus RNs'?

Wash your hands. Before and after.


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[jw3600]

Not your circus, not your monkeys

I laughed so hard.

 

[Old_Mil]

Not your circus, not your monkeys

The brilliance of this statement cannot be measured.

Residency is sort of like standing in front of the monkey cage watching feces be slung. Just don't let it hit you.

Don't fight with or sleep with anything remotely related to your program.

 

[W19]

The brilliance of this statement cannot be measured.

Residency is sort of like standing in front of the monkey change watching feces be slung. Just don't let it hit you.

Don't fight with or sleep with anything remotely related to your program.

What if she is hot?

 

[Groove]

What if she is hot?

Bad things will happen. Krampus will be unleashed. I speak from experience.

 

[Old_Mil]

. our residents rotated thru one of the surgery department as one of our required surgery months. they didn't treat us well, so we pulled all our residents out.

Your program director is a god. I don't know where you did your residency, but this fact alone should vault your program to #1 on everyone's match list.

 

[Birdstrike]

Your program director is a god. I don't know where you did your residency, but this fact alone should vault your program to #1 on everyone's match list.

Mine did same. No Gen Surg rotations at all. Trauma (multiple), ortho, plastics, hand, sicu but no general. Same reason. To punish gen Surg department for EM resident abuse and deprive them of the extra scut help & call coverage. Not sure if the program is stuck with this.