Wednesday, May 8, 2013

The Latest Workplace Conflicts Keeping Nurses Up at Night

The Latest Workplace Conflicts Keeping Nurses Up at Night

Carolyn Buppert, NP, JD
May 03, 2013
Carolyn Buppert, NP, JD

Attorney, Law Office of Carolyn Buppert P.C., Bethesda, Maryland

The Many Workplace Conflicts Faced by Nurses

If queries to Medscape Ask the Expert are any indication, nurses are bothered, upset, frustrated, or irritated by many things going on in their places of work.
The conflicts faced by nurses include the following:
A nurse can't count on working when he or she is scheduled;
A supervisor calls the nurse during sleeping hours to remind the nurse to leave the house early on snow days;
A nurse is fired for writing up another nurse who is favored by the facility, after the favored nurse harassed the reporting (now fired) nurse;
Electronic medical records make it appear that the nurse administered medications, when in reality someone else did it; and
Nurses are forbidden to nap on their breaks, even though they do it in a private place and there is some evidence that naps are beneficial to productivity.
What follows are details about some of the conflicts faced by nurses, and my comments and recommendations.

The Shrinking Workweek

A Medscape reader wrote:
I read your article on shift cancellation ("Must Shift Cancellation Be Fair and Equal?") Is it legal (or practical) for administrators to cancel salaried employees? We are a small staff, and it seems impractical to ask us to go home at will. Our schedules are totally unpredictable, working in a surgical environment (which is the reason we were salaried in the first place -- to be available as long as needed, whenever needed). We do not receive overtime or call pay. Now we are being asked to log our time (we don't clock in and out), and the most recent insult is that we must log our minute-by-minute activities during the day to validate our existence. Any ideas where this is going or what we should be looking at? We have all complied and are willing to do our share as hospital demands change with the changing medical climate. We are all longtime employees, and this feels demeaning and degrading. Is there anything we can do?
Another nurse asked, "Is it legal to continually cancel staff on the same unit owing to low census?"
To answer the first question, I suspect that where this is going is a reduction in force, if the logs show that there are more salaries being paid than surgeries needing nurses. If the logs justify your existence, then I suspect that all will return to normal. To answer the second question, yes, it is legal, and I suspect that the unit is ripe for extinction unless the census turns around.
The facilities' or supervisors' actions may seem unfair and harsh, and in fact they are. However, hospitals are subject to the same ups and downs as other businesses. For example, if large segments of the population have lost their jobs and their health insurance, they are going to delay surgery if they can. Fewer surgeries mean that fewer nurses are needed. Sometimes, a drop in admissions or procedures is a matter of predictable downturns: For example, people typically don't have surgery during the winter holidays. So, fewer nurses may be needed at certain times of the year, and more nurses at others. When the hospital hires nurses on salary, the hospital is making a commitment that they will have enough work to justify the expense of the nurses. Sometimes hospitals misjudge their needs and are surprised by an unpredictable downturn.
The nurse who posed this question has been put in a difficult position. He or she has been hired at a specified salary for a 40-hour work week, and the nurse expects to go to work on the days scheduled. The nurse counts on having that regular salary. He or she probably pays a set rate for monthly parking or childcare, and has made whatever arrangements are necessary for supporting a full-time job. He or she can't take on other jobs during the times that he or she is scheduled to be on duty.
The questioner didn't say whether the hospital was docking the nurses for hours not worked, or whether the nurses are working 20 hours one week and 60 hours the next. Either way, the nurses are put in an uncomfortable and unpredictable working situation that is stressful and ultimately may be unbearable.
So, yes, the schedule changes are legal but are contrary to job satisfaction. Not only nurses, but many other employees are experiencing unstable work schedules. You need to step back and look critically at the situation, and if it seems that the facility or business is going to be permanently diminished, look for another job where the facility or business is thriving. Meanwhile, inform the supervisors about how the erratic schedule changes are affecting you.

The Inconsiderate Manager

A nurse wrote:
I work 12-hour night shifts from 6:00 PM to 6:30 AM. Our manager routinely calls night- shift staff in the middle of the day, when we are sleeping, despite being asked to not do this except in emergencies. Calling us at noon is like calling a day- shift worker at midnight. Recently, there was severe weather coming into our area, and it had been in the news for several days, so it wasn't a surprise storm and the area was prepared. Yet, the supervisor called all of us at noon to make sure we knew bad weather was approaching, and to encourage us all to leave home early so we could arrive to work on time. We are all experienced nurses and responsible adults. Three of the nurses working that night were unable to get back to sleep after her call, resulting in them going to work after fewer than 3 hours of sleep. That poses safety risks not only to the nurses but also to the patients. We have considered filing a group grievance with our human resources department but prefer not to take it to that level. Yet, in an environment where the staff works 24/7, we feel that we deserve the same respect as our coworkers on the day shift. We have asked the supervisor repeatedly to either call us before 8:00 AM if we worked the night before or after 3:00 PM if we work the following night, but she ignores our requests.
Your request is reasonable. I can think of no defense that would justify this supervisor's behavior. It is bad management. My advice is to keep asking. Get together as a group and present the issue, face to face, with the supervisor. Ask her to call before 8:00 AM or after 3:00 PM. Point out that the nurses aren't going to perform at their best if awakened in the middle of their sleep time. Show her this column if she won't agree to stop calling night- shift employees at noon.

File a Complaint, Clean Out Your Locker

A nurse wrote:
I was recently fired from my job as a medication nurse for filing a written complaint of harassment against another employee and the nurse manager. The harassing nurse was a new graduate with long ties to the facility, a favorite with nursing management, and the wife of another staff member. I have no intention of trying to get my job back. I have had a 3-month battle with the human resources department and a new supervisor, trying to get them to listen to me. I would like to see this brought out into the open. I cannot file a complaint of discrimination because I am not a protected class. I believe that my firing was retaliation, but sadly, I have no recourse. It is very suspicious that the day I filed a written complaint (I made previous verbal complaints), I was terminated. A complaint letter is in my file and the human resources department states that it will remain there for 5 years. Should I pursue legal action? The incident will be swept under the rug until the next time this nurse bullies someone.
The federal government stipulates that harassment occurs "when an employee is subjected to unwelcome verbal or physical conduct based on the employee's race, color, religion, national origin, sex, age, disability, or sexual orientation that adversely affects the work environment of the employee; or when an employment decision is contingent on an employee accepting or rejecting the unwelcome conduct."[1] Individuals who are covered by this definition may file a complaint with the federal Equal Employment Opportunity Commission. The guidelines are available here.
Harassment is difficult to prove and has few legal remedies. We have published some previous Ask the Expert columns on harassment and bullying.[2,3]
I don't have enough information to get a sense of what occurred in this questioner's facility. Because I can't get the facts of the situation and haven't taken the questioner on as a client, I cannot say whether the firing was justified and can't give legal advice. If the fired nurse believes that he or she has a case, or wants to know whether he or she has a case, the investment of an hour with a local employment attorney would be worthwhile.
What I can say, and know for sure, is that it is miserable to work in a hostile environment. It makes sense to try to change the environment, but if you can't, then the best solution is usually to take your talents to another setting where you won't have to face hostility. It's not fair that you have to disrupt your life, but sometimes it must be done for the sake of your well-being. Yes, you have an unfavorable letter in your file and you may not receive a good reference from your old job. But surely you can explain to a prospective employer, during an interview, that you left that job because of a hostile environment, you were trying to change it for the better, and that you learned something from the experience that will make you a better employee in the future.

You Did What Under My Login?

A new nurse wrote of this experience:
I just got a job in a nursing home as a new nurse. On the second day of my orientation on the floor, I was told to sign in and pass medications, which I felt comfortable in my ability to do. While I was in the residents' rooms, my preceptor began to pull medications and give them to other residents, charting under my name that they were given. I did not speak up until later, when I mentioned this to a supervisor. I was told that I was responsible for everything charted under my login, despite the fact that I was on orientation and that I had not entered the documentation myself. Can I be held responsible for my preceptor's actions during my training? How should I deal with this?
Ask your preceptor to sit down with you during a break and discuss this situation. Explain your concerns. Listen to his or her response. Ask whether it is possible to share documentation of medication administration in the electronic medical record by logging out/logging in, or whether the system supports a choice for documenting a medication given by another person (look through the pull-down menus). If available, you could use this option to document that another person (the preceptor) gave the medication.
Many legal and semi-legal problems are arising out of electronic medical records. One is the problem that you have described, that sometimes the record misstates who actually performed the service. It is a serious problem that needs to be worked out with your facility's IT department. Meanwhile, try to work it out with your preceptor so that it doesn't happen that you are signed off on medications that you didn't administer. If you are unable to work out a solution, you should log out when you walk away from the computer (a good practice in any case).

It's My Break, and I'll Nap If I Want To

A nurse wrote in with a question that we have heard before:
Many nurses have said that they take naps during their breaks, when they can, but others say that their hospitals do not permit them to nap even on their official break time. What do you think of this? Can a hospital have a "no-nap" policy?
Yes, a hospital can have a "no- nap" policy. But does that make sense? Not according to some experts. Some managers believe that it is in a hospital's interest to support naps during break time. Naps can improve performance and alertness.[4,5] You might show these articles to your supervisor and offer to help set up a napping policy.

Don't Just Stew About It; Resolve It

For all of the nurses who wrote about their frustrations at work, I have the same general response, which may be unsatisfying but which I believe is true: One of the toughest things to do at work is to resolve conflicts with others, whether they are with superiors, subordinates, or peers. We have all been there. It's not only nurses -- everyone who works experiences such conflicts. Usually, there is no legal remedy; it's a matter of the affected parties working it out on their own.
It is best to work conflicts out directly, face to face, with the individual with whom you have a conflict. There are scores of books on how to do this. Some people even enlist coaches to help them prepare for conflict resolution meetings. I encourage nurses to talk directly with the individuals who are responsible for keeping them up at night, calmly and carefully, so that both parties can rest easy.


  1. US Department of Labor. Civil Rights Center. Guidelines for Implementing the Policy to Prevent Harassing Conduct in the Workplace. Accessed March 23, 2013.
  2. Buppert C. What constitutes a hostile work environment? Medscape Nurses. December 20, 2011. Accessed March 23, 2013.
  3. Buppert C. Can I sue if I am bullied at work? Medscape Nurses. September 14, 2010. Accessed March 23, 2013.
  4. Clavreul GM. Why power napping might be right for the nurses at your hospital. Working Nurse. Accessed March 23, 2013.
  5. Casey K. Should employees be allowed to nap at work? MintlIfe. December 21, 2010. Accessed March 23, 2013.

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