I can’t fire my awful assistant

A reader writes:

I’m a nurse and I work with several nursing assistants. I have no authority to hire them, fire them, or implement any kind of substantive rewards or consequences, but I am responsible for their work.

Most of them are great. One, however, is extremely unpleasant to deal with. If I ask her to do something, she will scowl and mutter darkly about how busy she is and how unreasonable I am. Sometimes she yells at me and sometimes she outright refuses simple requests. I do a lot of work that should be hers because it’s easier than having a fight every time. She also bullies the other nursing assistants, talks inappropriately to patients about her personal problems and weird conspiracy theories, and the entire atmosphere of the unit is tense and miserable when she’s around.

I am at my wit’s end. Every time I try to initiate a conversation about her attitude, she scowls and mutters and walks away. I have talked about this issue with my manager and the director of nursing, but all they ever do is talk to her, and it doesn’t change anything. I would fire this woman in a heartbeat if it were my decision, but it’s not, and I don’t know what to do. Do you have any ideas?

I answer this question — and four others — over at Inc. today, where I’m revisiting letters that have been buried in the archives here from years ago (and sometimes updating/expanding my answers to them). You can read it here.

Other questions I’m answering there today include:

  • Am I being a doormat?
  • My company just hired back the person I replaced
  • My boss was about to promote me, and then he got fired
  • Should I be paid for my whole resignation period if my employer has me leave earlier?

{ 148 comments… read them below or add one }

    1. Zona the Great

      I did it for three years. Still have anxiety and insomnia from it and I have been out now for over two years. Ugh indeed.

      Reply
    2. BRR

      Me too. I sort of have that going on except it has not been made clear to anybody (including me) what and who I should have responsibility over. The kicker is on my last performance review the area that my manager said I needed to work on was solving problems. I’m not exactly sure how to solve the problem when the problem is someone needs to be put on a PIP and I can’t put them on a PIP.

      Reply
      1. Life is good

        Are you sure you didn’t take my old job at dysfunctional ex- employer, BRR? Wow, your comment pretty much sums up what I went through that made me get out. I feel your pain. What the hell are employers thinking when they give someone responsibility without authority? I just couldn’t wrap my head around how I was going to produce the desired results without being able to make decisions about how to get there. It kept me up at night.

        Reply
        1. Bostonian

          A scapegoat. That’s what they’re thinking/looking for. It’s the #1 reason I would never take a management position at my old job. No input over hiring/firing/disciplining, but all the blame when things go wrong!

          Reply
    3. Anonformeow

      If Alison ever writes an even broader article about this situation, I’m so there. My partner and I are both in similar situations at work though his situation is worse now that all of the people with authority are a few thousand miles away.

      Reply
    4. OBMS

      Being responsible for someone’s work without the authority to discipline them or fire them is very common in the medical community. As a physician I am often responsible for what my nurses do, but as hospital employees, I have no authority over them regarding discipline. The same is true for nurses being responsible clinically for the nursing assistants that work under them. It is not quite like it is in most other business situations.

      Reply
      1. JenRN

        I came here to say this. Worse, it’s not just responsible like “if this doesn’t get done, it’s on Jen not the NA” and I just have to get it done …sometime. What it means is
        1. Having it not done or done poorly means a patient may very well have been inconvenienced/suffered/put in danger
        2. Their inconvenience/suffering/risk puts added strain on finite resources in the system costing all of us more money (either through insurance or government depending where you live)
        3. It’s my responsibility under my license—as in the NA can screw up but if it’s my responsibility within my scope of practice then the complaint goes to my regulatory college against me. I could lose my license. It could also go up to the most responsible practitioner, i.e.: OBMS *even if they weren’t there* for [incident/oversight ].

        Reply
        1. TeacherTurnedNurse

          This is such a critical part of understanding this situation, and drastically changes the options available to the OP. If that work doesn’t get done, the RN is ultimately responsible for the condition of the patient, and is therefore responsible for the incomplete work. So it isn’t a case where the advice to avoid doing the work to cover for the insubordinate employee will work.

          Reply
          1. RUKiddingMe

            Yup. My mom was an RN. She was actually the DNS for way toi many years and bore the brunt of *anyone’s/everyone’s* stuff.

            Lucky us she brought her work home with her which effectively spread the “joy” around!

            Reply
            1. Recent Anon Lurker

              My mom was also a nurse, but the only stuff she brought home were the crazy stories of what some of the Surgeons would say to each other.

              There was a reason she enthusiastically volunteered to work the “Vampire Shift” (which is what her floor called the night shift).

              Reply
        2. Ben

          This. The writer needs to be thinking about how to protect her license. Is there an ethics/safety officer for the facility?

          Reply
      2. Urban teacher

        It’s also common in education. I’ve had horrible paraprofessionals and told I had to make it work. I’ve also had great paras and could not reward them. Bottom line, kids with special needs suffer.

        Reply
      3. Recent Anon Lurker

        Agreed, hospitals have their own structures and procedures – but you can’t just leave work undone like you potentially could elsewhere. You also can’t always rely on OT to get stuff done that the coworker won’t do.
        Since the shift or floor manager (I’m basing this off of my mom’s nursing experience in a hospital) doesn’t want to address this NA, is there anyone above those managers you can report the problem to? Also – DOCUMENT, DOCUMENT, and DOCUMENT some more all the issues that are stemming from this NA’s refusal to do her actual job. Maybe with everything being verbal it’s easier Ron sweep the problem under the rug – but a paper trail might make it harder for the PTB to ignore.
        Finally, can you report her conduct to the licensing board? I know every state where I have lived has required a license to be a LPN or CNA.

        Reply
        1. Recent Anon Lurker

          Okay, that should read “easier to sweep.”
          Autocorrect on mobile devices is not very intuitive to syntax or context at times.

          Reply
        2. JenRN

          Where I love LPN/RPN is licenced/registered and has nearly the same scope as RN. CNA/PSW (personal support worker) is unregulated and usually ununionized. It is a mess really.

          Reply
    5. Kms1025

      You absolutely need to focus on the things she is doing that are contrary to good patient care. Those are the failures that are monitored and will get more attention. I’m sorry…this sounds like an awful employee and an awful situation! Good luck to you.

      Reply
      1. SMH RN

        Speaking as an RN who’s had to deal with a similar situations the only option may be to document and officially report every such occurrence…and definitely tie it back to how it affected patient care/safety, especially if the time you spend completing her tasks takes away from time the writer should have spent completing more complicated nursing care. Unfortunately doing this can cause tension on the unit and may make the situation worse but there’s little else you can do. Depending on union situations/contracts/etc even that may not be enough to change anything but at least there’s a paper trail showing your concerns.

        Reply
  1. New Job So Much Better

    Question for “Doormat:” Are you positive the others are getting raises and other perks? Or just think so?

    Reply
    1. Antilles

      To be honest, I’m not sure it changes the situation much.
      For OP, the situation basically has three key facts: (1) Her salary is way below market value, (2) she’s performing well, and (3) The company has done nothing but vague promises of ‘some day’. Those facts are the same regardless of whether they’ve given out raises to nobody, few people, or literally everybody except OP.
      Even if she’s wrong and nobody gets raises, it doesn’t really change those facts – OP would still have to decide whether she’s OK with the current sub-par pay level or not.

      Reply
      1. I Work on a Hellmouth

        Yeah, this is basically what I was going to say. Also, if she is being paid under market value, and a raise is “never in the budget” but this has presumably come up ahead of ahead of at least a few budget planning sessions, and she does great work and her role has significantly expanded since starting… dude, I would be firm about a timeline for a raise, AND I would be leisurely looking for another great company with a great culture that might also want to pay me what I’m worth.

        Reply
        1. Artemesia

          This company has made it crystal clear that they consider her a doormat and have no intention of rewarding her adequately. It is long past time to look for a job elsewhere. There is no rush; she can take her time exploring and considering what changes she might like to make and also what kind of career path she would be looking for — more pay or a place where promotions are likely etc. When you are not in a hurry you can wait for something really good. But waiting has no payoff here; they have no intention of rewarding her and even if they give her a raise it will not bring her up to market rate. It is common for organizations to dump more and more work on people without paying them or acknowledge the greater demands and people who accept it get lots more of it. She is long past that point. Don’t threaten to leave when asking for a raise; just be exploring how to leave on your own terms while asking for a raise. And don’t let anyone know about it until you are ready to give your two week notice; don’t accept a counter offer from a place that didn’t care about you when you were a sure thing.

          Reply
      2. Uncertain

        This was my situation this year. I was being paid far below the typical rate for my role, all my feedback had been effusive, and yet whenever it came to discussing salary I was told “we’ll look into it” or “we want to see more from you” (but couldn’t outline exactly what it was that they wanted from me). I arranged multiple meetings with my line manager to try to work out a plan, but nothing ever came of it.

        In the end, I started interviewing at other companies. I hated the thought of leaving, because (salary aside) it was a great place to work, but it had become clear that they were never going to pay me what I wanted, and that I needed to get out before the resentment took over. Once I made that decision that I was going to leave it became easier to deal with, though, and in the new year I’m starting a new job with a substantial salary bump.

        OP – if you feel you’ve done everything you can to make a case for a raise, and they’re still refusing to engage with you in a meaningful way, I think it’s time to start looking at other options. No need to rush (you still have your current job), but in your head you need to accept that you’re not going to get what you want unless you move.

        Reply
      3. media monkey

        i have been that person and i will never be them again. my old boss used to say “if you want something done, ask a busy person” and then give it to me. I would get it done and then he would turn me down for promotions and give them to other people in the team, because i was stuck doing all of his urgent crap and so wasn’t able to take on the flashy showy projects that help people move up. it never changes. he then complained that the person who replaced me when i moved into another team (who was a level up from me) wasn’t nearly as good as I was and complained all the time about the workload. SMH.

        Reply
    2. MLB

      If it’s true, it sucks, but it really doesn’t change things for the OP. This is why salary and raises should never be discussed among colleagues. It only creates hurt feelings and animosity. There can be many factors involved when salary and raises are determined (I was pushed into a new job that I didn’t want with my last company. Thankfully it was a lateral move with my salary, which was 10-15K more than what the position generally paid). OP needs to have a discussion about what SHE deserves, regardless of what others are making.

      Reply
      1. Chameleon

        Discussing salaries and raises among colleagues is nearly the only way to see systemic sexism or racism. They absolutely should be discussed.

        Reply
      2. Nobby Nobbs

        Woah. Salary and raises should absolutely be discussed among colleagues. That’s how you find out whether the company is cheating you because they think you’d accept less, or because you didn’t negotiate, or worse, because of your gender or race or other protected class. It’s so important your right to do so is protected by law.

        Reply
      3. DeColores

        Yeah that’s what my boss tells people too, with the same “resentment” type argument on why it’s bad. It’s really because management doesn’t want people realizing that some employees are underpaid.

        Reply
      4. I Work on a Hellmouth

        Dude, if my colleagues and I hadn’t discussed salaries I might still be working for the company that was paying me (5 years experience, working in a management position) 4 dollars less an hour than the less-than-a-year’s-experience-and-working-in-an-entry-level-position new hire. Jeez.

        Reply
        1. sheworkshardforthemoney

          The exact reason I left a job this year. Six years experience and every year I got a small raise. Last summer a new person was hired at the same rate that I was getting. They had zero experience and I had to train them. It was time for me to leave.

          Reply
      5. Rhymes with Mitochondria

        It only causes those feelings if there are inequities. So by saying it shouldn’t be discussed, you’re saying you’re fine with gender pay gaps, racial pay gaps, all kinds of problems.

        I disagree. Talking about these things between coworkers brings the ugly crap out into plain sight. Yes, that’s ugly. Yes sometimes it hurts people’s feelings. But getting rid of that crap is worth the pain of the process.

        Reply
        1. selena81

          This.
          No reasonable employee is getting jealous about the fact that recent-graduate makes less then 10-years-experience-girl. But if you find out you make half of what someone with roughly the same responsibilities makes then there is good reason to be angry.

          I think it’s unhealthy if coworkers discuss salaries all-the-time (you should have motivations beyond money to work there), but if the company has nothing to be ashamed of they have no reason to actively discourage that discussion either.

          Reply
      6. beth

        Discussing salary among coworkers is presumably how OP is so sure that there is room in the budget for raises, it’s just not being allocated to her. And I do think that’s worth knowing. There may not be a practical difference between a company that can’t pay you what you’re worth and one that can but won’t–but I’d much rather be at a company that values my work and is doing their best to compensate fairly than one that straight-up doesn’t value me, if I had to choose between the two.

        Not discussing salary pretty much always works to the employer’s benefit rather than the employees’. In your example, I actually think it was unfair that you made so much more than your coworkers. If it was worth paying you that much, then I think there’s a good chance that the role was actually worth that much to your employer (even if they usually got away with paying less for it). Otherwise they would have either cut your pay or hired someone else instead of pushing you over there. If your coworkers had known that, they could have advocated for raises for themselves as well, since they were presumably doing the same work–but it’s hard to ask for what you don’t even know is an option, which is exactly how companies end up getting to underpay for positions.

        Reply
        1. selena81

          Yeah, it makes a huge difference wether your company wants to pay you but can’t versus can pay you but won’t. In terms of how much i want my departure to inconvenience them.

          If all her colleagues were getting raises while she only gets empty promises then LW has every reason to feel resentful.
          Although i am curious how sure she is: did those colleagues actually discuss monetary amounts (‘thanks to my raise i can go on vacation’) or are they also kept hanging (‘the boss said i am getting a promotion…eventually’)

          Reply
      7. SW

        Strongly disagree. A colleague and I had the same job title with similar education + experience, and I was being paid drastically more than she was. Because we talked about our earnings and identified the disparity, she was able to get her salary adjusted (with back pay). Following antiquated etiquette about not discussing money empowers employers, not workers.

        Reply
  2. Karyn

    It sounds like she’s had a lot of talking-to’s. Is there a formal write-up policy at your work? Can you do that, and if she accumulates X number of them in Y timeframe, it escalates?

    Reply
  3. AK

    Oof. At the risk of suggesting someone keep a notebook, I’d be keeping pretty clear records of the nursing assistant’s issues. Information only and without emotion, and if management didn’t respond to “November 30, 10:05am NA refused to do basic task A; 11:45am NA spent 15 minutes during patient exam trying to convince them the earth is flat, 1:30pm NA threw a pen at another assistant” etc I’d be out of there.

    Reply
    1. Christine

      We’ve been trying to do this with the faculty we work with in my office–we work directly with them on projects, but an entirely different office is responsible for hiring/firing/evaluation. And because they’re not working with the faculty day-in and day-out, they don’t feel the negative impacts of faculty missing deadlines or refusing to do work or skipping meetings or verbally abusing staff members…

      So we’ve started compiling SBI reports, Situation/Behavior/Impact. It’s the same kind of thing you’re suggesting, but with a little more detail. Here’s the situation or context, here’s the behavior the person engaged in, here’s the impact on the rest of us. In this example, it would be “NA was asked to complete Required Task A. NA refused to complete the task and yelled when reminded about it. I had to spend 45 minutes completing her task in addition to my own work.”

      It’s time-consuming on top of all your other work, but it does result in a whole heap of evidence for your managers. Depending on how many notes you take, you could send them weekly or even daily reports on your assistant’s behaviors. They’re not taking action because they’re not feeling the frustration. You have to transfer some of it to them.

      Reply
      1. miss_chevious

        I did this for someone who I was in a similar situation with. Even though I had no authority over her work, when I went to the manager with a log indicating that she had a successful completion rate of only 50% over the last three months, they were much more willing to get her on a PIP.

        Reply
        1. AK

          I was being a little flippant about the notebook thing, there’s a huge difference between stalking someone’s bathroom breaks and keeping a record of times when they’ve been needlessly combative or their negative actions have had an impact on someone else’s actual job. Especially in a position where you’re leading a team/project, or rely on their actions for some portion of a task, the SBI strategy Christine mentioned can be important information to facilitate change. As long as it’s all work related, and valid information only with no emotion or judgement, any blowback from management would just be another sign for me that it’s time to go.

          Reply
    2. nonymous

      In addition to the notebook strategy I would work with management for a plan to deal with the extra workload. I personally don’t know any nurses who are salary, meaning that any incomplete work this CNA is creating should translate directly to OT hours for someone else. With the documentation there should be a clear cause-and-effect case for management to do something.

      Maybe they are so anti-confrontation that OT will be the long term solution. But at least OP will get some extra money for the aggravation. More likely they will be unhappy about blowing through the OT budget.

      Reply
  4. Nurse Ratched

    Oof, I’ve been there. In a worst case scenario, like massively unprofessional conduct or patient safety concerns, you can also try reporting them to whatever authority governs nursing assistants in your state, like the Board of Nursing.

    Reply
    1. vw

      That was my thought too! I’m concerned about scope of practice here if the CNA is not taking direct orders from the RN. And talking inappropriately to patients is another reportable problem, potentially to boards outside of the health care org.

      Reply
    2. OBMS

      Also, if she is doing something egregious with patients, have the patient or patient’s relative make a formal complaint to the hospital patient representative. Nothing gets results in a hospital like a formal complaint from an angry patient. Employee complaints, not so much.

      Reply
  5. Cordoba

    Depending on the specific laws where LW#1 works, it may be feasible to establish video/audio record of this assistant doing the following:
    -Muttering darkly and yelling
    -Bullying other employees
    -Having inappropriate conversations with patients

    I’d be inclined to establish this record as my first step. The necessary hardware is inexpensive and readily available.

    Being able to just video proof of the behavior would make it impossible for the manager with firing authority to deny or minimize the problem. If they do then they are bad at their job, and LW should take the complaint to the next level up.

    They probably won’t have to go very far up the chain before they find somebody who is both reasonable and empowered, and who will respond to a video of the assistant yelling and bullying people with proper consequences.

    Reply
    1. Parenthetically

      I’d agree with this, except that it could be seriously illegal or in violation of policy to do so. OP would have to carefully check state law and workplace policy first.

      A written record with timestamps should suffice.

      Reply
    2. Matilda Jefferies

      I’m not in the US, so I don’t know a lot about HIPPA, but I do know a lot about the health privacy legislation in my own jurisdiction. Something like this would almost certainly be an unauthorized collection of the patient’s personal health information, as you would necessarily be recording their conversation about the patient’s health care.

      Reply
    3. MassMatt

      Oy, whenever the suggestion to record people comes up there is a big discussion about legality in various jurisdictions. IMO recording this is overkill, the assistant is unpleasant and unprofessional but that isn’t illegal.

      Reply
    4. anon today and tomorrow

      They probably won’t have to go very far up the chain before they find somebody who is both reasonable and empowered, and who will respond to a video of the assistant yelling and bullying people with proper consequences.

      Or OP would find themselves out of a job for potentially illegally recording someone. I blame smartphones and social media for people thinking they can record anyone freely, but that really isn’t the case in a lot of situations.

      In my state it’s illegal to secretly record interactions or meetings with someone, and since this also takes place in a hospital, I think OP would have far bigger problems than her problem employee if she recorded them and it ended up being against workplace and state laws.

      If I was a patient who was recorded talking with a hospital employee so their boss could have a conversation with HR, I’d definitely be talking to a lawyer about my privacy being violated.

      Reply
      1. fposte

        I think it’s also based on the theory that if higher ups really knew how bad it was, then they’d take action. But often they *do* know how bad it is; they just think it’s not as bad as dealing with firing and hiring.

        Reply
        1. TeacherTurnedNurse

          If the OP has already taken the issue to the Director of Nursing, it sounds like higher ups already know how bad it is. Whatever is preventing them from firing her, I doubt it would be changed with a video.

          Reply
          1. fposte

            Yeah, I think that’s generally true. It’s just really hard to wrap your head around the fact that a failure to fire is an informed decision.

            Reply
      2. pcake

        Recording people without their knowledge has been illegal in many locations decades before cell phones or social media.

        Reply
    5. LadyPhoenix

      Recording a video or audio in a place where privacy is supposed to be a major thing?

      Oh HELL no! Not only overkill on thos witch (just record the incodent in a notebook), but bound to get the recorder in a heap of trouble.

      Reply
    6. Where’s my coffee?

      At best, this would get a nurse fired. At worst, look out for your license. Don’t record anything in a healthcare facility.

      Reply
    7. Arctic

      That can really, really backfire even in places where it isn’t illegal. The recorder can come off looking nuts and that may overshadow whatever she records.
      Also, in this case, there is no suggestion that management doesn’t believe her. They do talk to the assistant. It just isn’t enough. No reason to think they’d be different if they saw evidence.

      Reply
    8. beth

      Audio recording is almost definitely a bad idea in a healthcare setting, legally speaking, even if state law generally allows for recording. There’s a reasonable chance that it will end up catching some patient information (especially if you’re recording conversations with patients!), and records of patient info are pretty tightly protected.

      Reply
  6. Cheshire Cat

    Being responsible without authority is awful!

    The assistant’s behavior is clearly out of bounds. I wonder if her treatment of the patients would push the nursing director to fire her? If a hospital staff member treated me or someone I love like that, I’d file complaints with the hospital and any applicable state boards in a heartbeat.

    Reply
    1. bluephone

      It still might not help, unfortunately. I’ve been dealing with this recently thanks to a resident’s poor treatment of my mother (which has had lasting effects). Despite numerous documentation, letters to the hospital, letters to HIPAA, calls to the hospital’s patient advocacy department, calling them out on twitter (that’s how desperate I was), they…kind of don’t care at all? The most they might do is a token firing of a nurse (who had nothing to do with the incident) b/c hospitals love to throw nurses under the bus for anything and everything. But they’ve made it clear they won’t actually reprimand the actual resident or even admit that he was an ass :-(

      Reply
      1. Bazinga

        Have you reported him to the state Department of Health and/or The Joint Commission? These two are accrediting agencies and usually get a hospital to jump to attention.

        Reply
  7. The Man, Becky Lynch

    Oh…I wonder how she acts when the regulations people are auditing your unit, #1

    CNAs are a high stress, high turnover position in most places. She’s dragging patients into it. I would say they aren’t properly cared for and you fear regulations may be an issue. They’ll be in a mess once a patient’s family starts seeking her blood for being a poor caregiver. That tends to get managements attention faster than “staff don’t like her attitude and she isn’t doing her assignments”.

    Reply
  8. MassMatt

    LW 1, sorry you are in this awful position, it’s terrible how often it happens that a supervisor is held responsible for someone’s work yet has no authority to effect a change.

    With that said, your assistant’s behavior is letting her get out of doing work. This will only encourage her to complain more, and will further demoralize the staff. Why would she stop muttering under her breath and complaining when it gets her what she wants? I would make sure she does everything she is supposed to, and all complaints get met with a steady stream of “this is part of the job, assistant, if you cannot do it maybe it’s not the job for you” and “no one wants to hear you complain about having to do your job, assistant” and “are you unhappy? Maybe you should consider if this job is for you”.

    Try to get your supervisors more involved, if you are the only one dealing with the problems bad managers are usually happy to let bad situations continue as it’s someone else’s problem. And as Alison said, if the managers don’t take action you have a systemic problem and should consider moving on.

    Reply
    1. Flash Bristow

      Right, this. Of course I’d love to say “present videos! Whistle blow!” but it is unlikely to work, or at least more likely to blow up in yout face.

      But do document. And I realise nursing is fairly practical / hands on, but assuming you do also use email, sending some that say “Today you did X. Just to be clear, you’re expected to do Y” will help create a paper trail.

      This colleague sounds exhausting but, as far as you can, rise above it.

      Document meticulously, and then consider where you will present the evidence. Don’t forget to include actions you have taken, so you don’t come over as weak or incompetent – even though you don’t have the authority to take action.

      What a horrible and exhausting situation! Sympathies.

      Reply
    2. selena81

      i don’t think ‘just ignore her tantrums’ is going to work when she flat-out refuses to do assigned tasks.

      Reply
  9. I Work on a Hellmouth

    #1:
    I am dealing with this kind of situation (among every other terrible thing that I am dealing with at my current job), and ooooooh boy, do I feel for the OP. In dealing with my unpleasant-simple-task-refusing-coworker-that-I-am-over-but-have-no-real-authority-with I’ve actually already tried everything Alison listed. Reading “If this gets you nowhere, you’re dealing with horrible management, and they’re actually more the problem than your nursing assistant is” weirdly made me feel so much better.

    Reply
    1. MatKnifeNinja

      I worked in a hospital as an LPN, and had fun working with this type of person.

      One hospital was union, and there were a zillion excuses why they couldn’t turf the nasty coworker.

      The other hospital was non union, but said person was someone’s (I’ve had a few coworkers like this) nephew, niece, MIL of some higher ups. I put in for a transfer because I knew nothing was going to change. I was right. Everyone transferred out except two full time straight day shift RNs and a 3 other support staff.

      Nursing manager did not cared. She got contract RNs until they could find some other poor souls to plug in.

      A sh*tty attitude and crap work ethic was not enough to get a PIP or fired at either hospitals. I’d look around for a transfer out.

      I’m wondering who is this person’s big deal friend or relative at your place. Those people never ever get removed unless it’s a lawsuit in the making.

      Reply
    2. Ben Thair

      Same. Only mine was in a field where I can loose my license for the poor work of the underling and I was unable to get my manager to allow me to do ANY discipline. So I fell into the “dealing with horrible management” category.

      The answer I had to choose: walk away. I put my notice in sans new job because my license is my livelihood and I cannot risk it for an underling who cannot be trusted.

      Reply
      1. Mongrel

        Is it worth contacting the licensing authority?

        If the job requires the license and you’re unable to fulfill the requirements because of lackadaisical management then isn’t that something that bought to their attention?

        Reply
  10. Helena

    LW1, incident report everything (papertrail, plus management will get sick of doing the root cause analyses). Encourage patients to complain (strangely management care far much about disgruntled patients than they do about disgruntled staff!). Report her to her regulator if she is any kind of registered healthcare professional (depends on where you work and her exact job title). Be prepared for her to accuse you of bullying her (I have seen a mid-fifties ward manager accuse a brand new intern of bullying because she objected to an unsafe bed move. It’s a deflecting tactic that works unfortunately).

    Yes it’s all petty, and yes in an ideal world she would just get sacked, but you have to play the cards you have not the cards you would like to have.

    Reply
    1. KimberlyR

      Also, are there doctors who are affected by her attitude and not doing her work? When doctors complain, things happen much faster than when nurses complain! Its wrong but true.

      Reply
      1. Sled dog mama

        In reality there are probably no doctors affected, if LW and other NA’s are picking up her slack the physicians aren’t noticing who does it just that it’s done.
        I’m basing this statement on my read that this is a facility where nursing staff do a lot and physicians aren’t necessarily there to see what they are doing.

        Reply
        1. Recent Anon Lurker

          This is what the situation was at the hospital my mom was at – nurses and assistants did most of the work and doctors were around to check things at normal intervals. The doctors would only have noticed or asked about undone things, they would have had no way to check or know if work loads were balanced or if a specific NA was refusing work.

          Reply
    2. Augusta Sugarbean

      Yep. The best advice I’ve ever heard about this (probably from around here) is “make the problem visible to management”. Once it’s starts impacting TPTB, it’s more likely to get addressed. And keep hammering on the impact to patients as well. That’s the one thing that gets notice from management in my agency. Good luck OP!

      Reply
    3. selena81

      Be prepared for her to accuse you of bullying her (I have seen a mid-fifties ward manager accuse a brand new intern of bullying because she objected to an unsafe bed move. It’s a deflecting tactic that works unfortunately).

      This is why i’m always sceptical of tales of bullying (even though i have been by bullied myself): awful people love painting themselves as the innocent victim.
      Of course it’s good that our society nowadays has the tendency to side with the victim, but if you aren’t familiar with the situation you have no idea how justified complaints about crappy work are.

      Reply
  11. Où est la bibliothèque?

    For #3: I think one concern is that although the woman who is being hired back is not going to be in LW’s position, is that higher-level role something that they might have otherwise considered training the LW to take on, particularly as they gave her the impression that they cared about her professional development? Does this lessen her chances for promotion?

    Reply
    1. Crystal

      Yeah and I also think it’s naive to think someone coming back who once had your job isn’t going to interfere and be all “well, when I was teapot manager we did it this way, etc. etc.” especially if she went over her former boss’ head to the CEO (!) to get hired back. Red flag to me.

      Reply
        1. Où est la bibliothèque?

          I agree, especially for someone without some solid resume-building. But I’d say there are some questions for the boss about it beyond the immediate “what impact will this have on my work.”

          And the 6-month mark is actually a really good place to start asking about professional development and eventual opportunities to advance, so that can be part of the conversation.

          Reply
        2. Hey Karma, Over here.

          Yes, I wouldn’t go as far as planning to look. OP should start with her boss and what expectations she has for new person coming back. Was this thrust upon her by the CEO? Is is a completely new and completely separate role from OP’s? Get as much info as possible.

          Reply
      1. Lucille2

        Not necessarily. She was probably ready for a change and didn’t see that happening in her current role without leaving the organization. Or perhaps she was paid under market rate and leaving the company was her best option to get a pay raise (this is pretty common), then opportunity she really wanted opened up. She didn’t necessarily go over the manager’s head if that person was not the hiring manager for the new role. Going to the CEO directly might have made the most sense in this context. I’m not discounting the possibility that she was not on good terms with this manager leading her to go over his head. Regardless, I don’t think this impacts OP. If she was pushed out and has any ill-will about the situation, she wouldn’t be likely to return.

        Reply
        1. nonymous

          I was thinking – since she had previously turned down this role when it was offered as a promotion previously – that she took a new job, realized it was a bad fit and turned to her existing network at the company to remedy the mistake.

          That said, six months into a new job, OP may be getting lingering interest from recruiters and slow responses from her previous job search. It might be worth following up on any leads that come from that.

          Reply
  12. Lucille2

    #1 – My question on this to Alison is if it’s ever appropriate in situations like this for the OP to handle the assistant on her own since management has shown no ability or desire to deal with a problem employee. OP, do you have any standing to give the assistant constructive feedback where you are responsible for assigning tasks? I agree management is the real issue here, but leaving a job over it is no easy task. There are likely other issues at play and worth exploring other opportunities, but in the short term, what would be a professional and appropriate way of handling this in the day to day? I’m afraid I would be the person to call her out in the moment on her bad behaviors, whether or not I had the authority to do so. But what I think is worse is accepting her behavior until one day you just lose all patience with her and let it all out.

    Reply
    1. Asenath

      The thing is, this must surely vary by location, but in my experience, hospitals are very bureaucratic, which means they have procedures for everything, including firing people. What sometimes happens in such places is that some people in management don’t want the hassle of documentation; they’d rather just give a few verbal warnings and then say they can’t do anything more, which is generally not true. Getting the documentation, laying it at management’s feet and then nagging them to take the next step is about the only way to deal with such a situation, and if management is really recalcitrant and you can’t bypass them to the next level up, you may be stuck with the worker.

      Reply
    2. fposte

      It sounds like the OP has tried to handle it on her own but the NA has just walked away. This is a pretty outlier response, though; plenty of employees will respond to feedback from a supervisor even if the supervisor can’t fire them.

      Reply
  13. uranus wars

    When it comes to raises I’ve found there’s a huge difference in “I’d like to make more” and “If I don’t get a raise by the next quarter I am going to start job searching.”

    This has worked for me more than once. I have great bosses who I can be that blunt with, but just saying “I’d like to…” doesn’t always translate to “I NEED to” or “I SHOULD”

    How clear are you being in the conversations?

    Reply
      1. uranus wars

        I don’t think she should threaten to leave and not leave. I think she should say she’ll have to start looking and look.

        I never think someone should use a new job for leverage. I think, though, employees should outright say what they mean/need. Some managers think “I’d like to get paid more” is a passing statement and don’t take it further up the chain.

        Most people “would like to make more” and it takes explicitly saying “I am not being paid fairly for my position” and laying out your plan going forward to do what is best for you and your career. That plan includes being paid market value somewhere – preferably there but somewhere else if necessary.

        Reply
        1. TootsNYC

          maybe you don’t literally say “I’ll have to start looking,” but you might say, “I’ve been very happy here” or “I’d hate to feel that I needed to leave in order to be properly compensated”

          Reply
          1. Bostonian

            Yup. Similar to any situation that an employee would leave over: “I would need X in order to be continue to be happy here.”

            Reply
  14. Quickbeam

    RE#1 the nursing assistant problem…I am an RN with 30 years of experience. I’ve been in this situation with NAs as well as fellow RNs. I’ve always found creating a paper trail most effective. Nurses are in an odd position of not being managers but responsible for staff supervision. I’d document the behavior, the refusals and the attitude in neutral language and submit it to the manager.

    Think of it this way…should patients have to put up with a surly, miserable NA? No.

    Reply
    1. Artemesia

      The problem is shifting the misery to the people who have the power to effect change. By doing the grump’s work, she wins and you lose and the Manager doesn’t care because she is not inconvenienced. By documenting and reminding (nagging) and by leaving work undone, it becomes inconvenient for the manager to continue to do nothing. If you can channel patient complaints, all the better.

      Reply
      1. Thomas E

        In a hospital setting this is not an option because:

        1. Leaving work undone or poorly done may result in the patient dying or substantial physical detriment, and,
        2. Legally and professionally you are responsible for that detriment; the licensing board may disbar you even if the ‘fault’ happened because of an assistant.

        Medical settings are actually a case where quality of work literally has life or death implications.

        Reply
    2. Where’s my coffee?

      Yep. Paper trail. If you work at a reputable healthcare org and you report this to compliance or hr as a potential patient care issue (which it is) a paper trail will be generated.

      Reply
  15. Nursingnotes212

    I was in #1’s situation when I worked in SNF/LTC- except my ineffectual manager was friends with the aide. I was really hoping Alison would have better advice, but the answer does reinforce the fact that I was right to leave that job. I hope OP is fairly experienced; this will make it easier for her to find a new job. It sucks, I don’t have hopes of the job changing, and the best thing to do is to find a job that lets you be a nurse.

    Reply
      1. TootsNYC

        (I always wish that didn’t have a contraction in it; the “not” would be more powerful, plus it would be a better acronym: YBSAINGTC)

        Reply
  16. Amy Farrah Fowler

    Ultimately, I think you should stop covering for the NA. If she’s not doing requested tasks, and you’re covering, you’re making it easy for management to believe there isn’t a problem. I can imagine in healthcare there is a great deal of pressure to do what needs done to make sure patients are cared for. I think I would contact management every time she refuses to do something. I would send an email saying “NA has refused to do X, I need a staff member to do these things. The rest of my staff and I don’t have capacity. Please let me know how we can handle this so our patients don’t suffer” Make it more uncomfortable for management to not deal with this situation. Or at the very least, make them deal with how unpleasant she is.

    Reply
    1. nonymous

      Yeah, I suggested upthread that OP should look into using OT to cover for this extra work. Even if blowing the personnel budget doesn’t get management moving in the right direction, it could quickly add up to a nice weekend getaway for OP or some other self-care that serves as a coping mechanism.

      Reply
    2. TeacherTurnedNurse

      The problem is that, for nurses, it doesn’t quite work this way. We can delegate elements of patient care to a CNA or tech, but it’s ultimately still our work. If we leave it undone, then (just as an example) vital signs don’t get taken, or patients go uncleaned. It’s not work that can be left undone, and is something we have to have completed in order to do our own jobs.

      Overtime doesn’t work this way for us, either. We still have to get that work completed in the necessary time frame; otherwise it’s either left for the next nurse to complete (not a good way to get on your coworker’s good side), or it means important patient care is incomplete.

      To make this a little more clear: on the floor where I used to work, CNAs were responsible for taking vital signs at 11am And 3pm. Patient care is directly affected by the information I get from those vital signs. If the CNA doesn’t complete them, they still need to get done at the allotted time so that I can complete my work. Everything in nursing is technically time sensitive, so it’s hard to leave anything undone or just take overtime to do it.

      Reply
  17. agnes

    I hate the entire concept of being responsible for someone without authority to hire/fire/discipline. I have been a manager my entire working career with a really good track record until I took a job as a COO with an organization where the CEO would not let me fire or discipline anyone he had personally hired–which was just about everyone in the company. He would not back me up with disciplinary issues either. Instead , he wanted me to do things that were frankly either illegal or incredibly unethical to “teach people a lesson” –stuff like docking their pay, changing their bonus structure, taking away earned leave time, making people cancel their scheduled vacations–rather than following professional disciplinary action protocols.

    I had such a bad experience with this before that I promised myself I would never again accept a management job. And I haven’t. I have a job now that I like a lot that doesn’t involve any staff supervision. I have refused other opportunities here in “management” and even though I could make more money, I like my life a lot more now. I make a little less money, but I make it up in serenity.

    Reply
  18. LadyPhoenix

    OP 1: STOP DOING THEIR WORK.

    It is their job to do the thing, and if they can’t be bothered to do it, then you get the person who can make then do it, plus include an attitude write up.

    If that higher up can’t be bothered, then it is a sign to start abandonibg the ship.

    Reply
    1. Kat in VA

      I have nothing useful to add other than she is covering to care for patients and for that, she has my deepest respect and gratitude. Even at cost to herself, her patients are being cared for. Signed, a veteran of 12 surgeries

      Reply
    2. Jennifer Thneed

      It’s amazing how many people aren’t seeing the difference between an office job and a nursing job. See what the nurses here have been saying — if they leave things undone it directly affects patient care. There just aren’t any “slack” items in nursing work. In the hospital’s offices? Sure, lots of slack. But not on the floors.

      Reply
    3. J Kate

      You do realize that the fallout is on a nurse when their assistants’ work is not completed? And nursing boards do not consider insufficient manpower to be a legitimate excuse for negligence in patient care. The nurse needs to document everything, but simply leaving work undone will A) leave patients uncared for, and B) result in as many problems for the nurse as for the lazy assistant.

      Reply
  19. Argh!

    The beginning of my dissatisfaction with my boss was when I followed all of her instructions on how to deal with a person who really does not have what it takes to do the job, and then said “Well, I’ve done everything I can. Now it’s time for a written warning leading to a grow-or-go PIP.” To which my boss responded “No, don’t do that. The next person could be worse.”

    No, the next person would have been someone in our organization who was waiting for that job to open up and then gave up and went elsewhere. He would have been so much better….

    Years later, still dealing with the same stuff, HR says a lot of what my boss had me do isn’t consistent with organizational unwritten rules, I have a disengaged, unhappy, inept person reporting to me, and I have become disengaged and unhappy.

    The person who really needs to grow or go is my boss, but she knows which side her bread is buttered on, and her boss loves her. *ptui*

    Reply
  20. Jen

    1) I always find that in situations where you have no authority over the person, simply standing up for yourself, can sometimes make the person back off. It works best in the moment when you say things like “I’ve asked you not to speak to me this way” or “speaking to your manager this way is NOT ok” or “what you just did, is not acceptable”. etc.. and using a very firm tone is important and even better if you can make eye contact with a very serious “I mean business” look on your face.

    Reply
  21. Mommy MD

    Document everything. Catch her in a HIPAA violation. If she’s running her mouth with this bad of an attitude, she’s probably talking to one patient about another. She should not be in health care. Watch her during tasks. Is she disposing of hazardous waste/sharps/blood correctly? Is patient info being shredded? These violations are tens of thousands of dollars and management won’t turn a blind eye.

    Reply
    1. Bazinga

      And if management does ignore it, you can report her/the hospital to the state Department of Health and/or The Joint Commission.
      Plus most hospitals have a compliance hotline where you can report issues-anonymously if you prefer, though in this instance giving your name so they can follow up with you would probably be better.

      Reply
  22. Bazinga

    LW1,been there, done that. If this is a hospital odds are you have an incident reporting system. Often they make it primarily for safety issues but this certainly applies. I would use that system to write up major incidents-refusing to do her job, yelling/cursing at coworkers, treating patients poorly, etc. That may get it to HR/someone who isn’t your manager who is ignoring it.
    I would continue to communicate the issues. Keep going until someone will listen. Write down specific incidents. Make it factual, as if you were writing a documentary and not emotional. Bring that to whomever you speak to. If others will join you, even better.
    At some point this will get old, if it hasn’t already. At that point, move on. Hopefully you live in an area with other hospitals/health centers, and you can work at one of them.
    Maybe even a different unit at your current place. Obviously the DON is useless but if you have an efficient unit manager that will make your life easier.

    Reply
  23. Roz

    #1 – If this has not been said, I would report her behaviour to the regulatory body that approves her ability to work in health care. In Ontario, there are regulatory Colleges for that, but I don’t know the system the LW is in. That said, most nursing roles, including assistants, are governed at a minimum in legislation and usually, there is a body responsible for setting professional expectations and regulating the profession. Complain. You may also have a legal duty to report her depending on your legislation. In Ontario, this would be reportable behaviour.

    Reply
  24. gmg22

    LW #1: I’m sorry you are having to deal with this because this colleague sounds awful. (If she hates her job this much, she has her own set of issues she should be dealing with.) Seems like good advice being shared re documenting and reporting via other avenues than your non-responsive bosses.

    On a lighter note, I now want to open a traditional English pub and name it “The Scowl and Mutter.”

    Reply
    1. Recent Anon Lurker

      I agree that this NA just sounds like she is miserable – like she is being forced to be in this job for some reason. Doesn’t change the advice I have given on another thread about documenting everything in a non-emotional way. As the child of a nurse, a nurse (or assistant) who is miserable isn’t one who is fully able to do the job.
      Caveat: there is a difference between just having a bad day/week but getting everything done for the patients under your care and always being miserable. It sounds like this NA is in the always miserable category.

      Reply
  25. cheluzal

    1: This set off my spidey senses, and I am very uncomfortable about this because guarantee she is horrible to the patients. She hates her job and probably life. I had to deal a lot with nurses et al during my brother’s 4 year illness and subsequent death. One in particular was so nasty for no reason, being rude to us when we tried to say hi and shake hands when first met, was so rough with him I complained to the night nurse in charge, etc….it still gives me rage and frustration 7 years later. I was told, “That’s how she is” and I pitied any person who did NOT have a family member staying overnight like we did. I hope patients are complaining.

    Reply
    1. Jennifer Thneed

      I’ve heard so many bad stories about night nurses. There’s a reason I think that nobody should be in the hospital alone.

      Reply
      1. Recent Anon Lurker

        My mom was a night nurse for about 85% of her career. She volunteered to work nights though. I think the miserable night nurses are the ones that were assigned to work nights instead of choosing to work nights.

        Reply
      2. Hey Nonny Anon

        As much as night nurses get a bad rep, I want to say that the best maternal/child ward nurse I ever had was a night nurse when I had my oldest. I’d decided to bottle-feed, and the daytime nurse would not accept that decision and put a note in my chart saying that I really wanted to learn how to nurse. No one would bring me an actual bottle to feed my daughter, and breastfeeding was just not working (the reasons I had stated for not wanting to nurse had all come to fruition, despite my day nurse saying that my reasons were “all myths.”) This one nurse in the middle of the night comforted me about my struggle, then realized in conversation that my chart had been falsified. She was super nice and apologetic and got me a bottle so that my baby and I could both relax. She also left a smiley note on my room’s whiteboard before she left (I was dozing at the time.)

        Reply
  26. The Shawnster

    I guess my comment is that a nursing assistant in a clinical setting is no more an assistant to the nurse than a nurse is an assistant to the doctor. They are both part of a care team.

    Perhaps this is the root of the problem. Your attitude is creating strife where there need be none. This employee knows who she reports to and it isn’t you.

    Reply
    1. Jennifer Juniper

      No. Don’t blame the OP for the assistant’s weirdness. The way she treats the patients is unprofessional and boundary-violating.

      Reply
    2. RNtyougladididntsaybanana

      This is really not a good analogy. It sounds like the OP works in LTC or a SNF which means there is a medical director, not usually on site. Nurses are not doctor assistants. CNAs are nurse assistants.

      Reply
    3. Mommy MD

      There is a definite hierarchy in both nursing and medicine. This analogy doesn’t always work. CNAs and MAs can indeed be under the authority of a licensed nurse and have to follow orders and any nurse is required to follow the reasonable orders of the attending physician.

      Reply
    4. zaracat

      That’s quite an unhelpful comment. Even in a care team, there are people whose job very much IS to act as an assistant to another team member. That may or may not be reflected in the person’s title or their reporting chain. It depends on the clinical setting, and if OP says that her role includes setting tasks for the nursing assistants and being held responsible for the overall outcome then we should take her at her word when offering advice.

      Reply
  27. Jennifer Juniper

    Sounds like the assistant may be not well. Maybe the OP can refer her to EAP if the org has one. That would start a paper trail, if the OP hasn’t already begun documenting. EAP may also help this woman get the help she needs. It is not normal to talk to patients about personal problems, and the conspiracy theories do not make her look any more stable.

    Reply
  28. G Baker

    Re #4: I know this is a US-centric blog, but in most developed countries where you can’t simply be let go without cause, and assuming that you have resigned in accordance with your contract, your employer is not free to terminate your employment earlier than the date you specified. They can send you home (because maybe you’re a bad influence or they want to restrict your access to information or any number of other reasons), but they need to pay you until your final day, the one you said in your resignation. Failing to do so would constitute illegal termination from their side.

    Reply

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