Support Staff???

Question to Ask the Workplace Doctors about staff refusing to take directions and get support from one’s superior:

I am a relatively new nurse (six months). I worked in my current place of employment for 3 years as a support staff before I graduated and was hired as RN. Initially, a few of the support staff seemed not to want to take direction from me. They seemed to thrive on my inexperience as I tried to ‘learn the ropes’.

One day, I had to page one b/c I had a patient who was incontinent, though I was in the middle of discharging someone to hospice. I saw her in the hall and asked if she got my page. She muttered and walked away from me. I went back into the patient’s room I was discharging; she followed me in there yelling at me. The patient was alarmed, as was I.  I told her this was inappropriate to discuss in a patient room.

She finally left (after my saying that three time). I heard her outside the room complaining about me loudly, where other staff could hear (Dr’s etc.). I then went to make copies of paperwork; she grabbed my arm and was trying to lead me into an empty room. I stated 3 x (again) that I was busy. She never let go of my arm. I finally went into the room to avoid a scene. She was loudly talking to me, but at that point I didn’t want to deal with it, and I said I would let the charge nurse know about this and she can deal with it. She then went to MY manager, and who knows what was said.

I went to my Manager, and she said I needed to “resolve this outside of work.” My chg. nurse was busy and didn’t care. I was really upset the whole day. I felt like quitting, as I had no support, and I was “freaked out” and I can’t function in intense patient care without support. I thought about it, and because I like the other aspects of my job, I stayed and switched to night shift only. I think this employee gossiped about me to others.

In particular, one that works the night shift treats me really disrespectfully; I think it makes them feel better about their positions. I even avoid asking them to do anything now as I just ‘get attitude’. Some of the other support staff take the victim approach to their job and say it’s too much, so they don’t do much of anything. They will do as little as possible, and sigh if you ask them to do anything. Others will try to act like the nurse themselves, and try to tell ME what to do. I have tried to talk to the current (and new) manager of the support staff, but she doesn’t have much to say, except, “Oh, so and so has a hard life.” I am all for helping each other out, but I am now a nurse, and have no support staff unless it is with an attitude. Please advise.

Signed, New Nurse

Dear New Nurse:

To be a nurse is stressful enough without the hassles you describe. It is apparent that you expected moving from support staff to RN would not be so difficult. Might the shrug of a shoulder or being yelled by one of the support staff due to her/him seeing you still in your former role and not as a RN with authority to give orders? Probably when you were in the role of support staff, you never complained about the way nurses gave orders; that they expected and required too much. You probably responded to nurses quickly and cooperatively, and now you expect that kind of response to you. Right?

From here, of course, it is impossible for me to know what are the cultural of your work environment. However, based on several things you say, it is clear you think the some of the support staff do not feel they are respected and consequently, because they know they are “indispensable”, they do only what they have to or want to do. Moreover, your attempts to have your superiors whip them into line got zero results.

With this background, I pose the following thoughts for consideration that might shape a civil and productive RN-Support Staff communication:

1. Begin by reflecting on what worked best when you were in your previous role as support staff. What RN orders were best understood and gained ready compliance? Were they from RNs that were feared or hated? Were they from RNs that exuded respect for and consulted with support staff? Were they given hastily or clearly spelled out and was feedback invited that allowed some modification?

2. See your role to build a cooperative RN-Support Staff relationship as a communicative on-going process rather than as something a superior can order. To make it an on-going process, two rules of thumb can help: · Misunderstanding is the rule and not the exception. Misunderstanding is the rule because we each defined our words based on different life and working experiences. Language is fragile and words can contain but a hint of the meaning and experience of their users. Meanings are embedded in a history of learning what one another thinks and ways of expressing wants and preferences. Therefore, clarity comes with careful articulation of what is wanted. Repetition, different phrasing, and multiple channels are sometimes necessary. Communication is best understood when there is ample opportunity for asking/answering what, why and how questions. · Ownership is derived from investment and stakeholdership. Support staff and RN alike willingly invest their time and energy in those tasks that have payoff consequences. The payoff for cooperation comes in different forms: in actions that make each others’ jobs are easier and more effective, in the payoff of on-the-job friendship, in grateful co-worker responses to each other and words of appreciation for specific helpful acts, from recognition of good work by superiors and patients.

3. Teamwork rarely flows from the sky. Rather it requires diligent talk about talk. How we communication with our superiors and co-workers too often has unspoken rules; rules that come from the way we got what we wanted or were taught to responds in our youth. Sometimes we grew up learning that yelling, pleading, tears, silent-treatment and/or bulling worked. In great places to work rules of good working relationship are spelled out in policy books and practiced by day-to-day.

In your situation, that is not the case. Therefore, might it be possible to come to an understanding with your support staff what would make a one-on-one communications mutually acceptable? In plain words, might it prove wise for you to arrange a time-out confrontation with your support staff in which you and they make explicit how you both want to be talked to? Hammer out the dos and don’ts that would make working together tolerable and civil, and hopefully more satisfying. Write them out, negotiate, and get a clear understanding and buy-in. Schedule a follow up to review how those rules work. Doing so is worth the time. Some superiors act as facilitators to their work units for this purpose. And you might request that your superior do so, but if yours doesn’t take to that request, you on your own can initiate a communication rule-making session with your support staff.

Earning work-friendly relationships are possible even with those you have had conflict. Conflict need not be forever. Rather conflict can motivate change. Please let me know if these thoughts make sense and/or spark action of a more creative sort. The mindset that I have proposed is found in my signature observation: Working together with hands, head, and heart takes and makes big WEGOS.

William Gorden