Dealing a Borderline "cowrker" with passive agressive tendencies.

[ronin12]

Subject tells it all.
coworker i.e nurse or Social worker,with above mentioned tendencies.You have to deal with that person on daily basis and there is no way out of it . it has started affecting how you practice, due to ""control", "triangulation" and "Manipulation" issues.

Experiences,suggestions ,"precautions" and if possible "solutions" are eagerly welcomed.

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[kugel]

try desperately to do exactly what you would do if that person was on vacation or had quit. State/document your reasons just as you would otherwise, and try, try, try to avoid playing any of the games, avoid the power struggles any way you possibly can. Even when you see that perfect opportunity to nail that person and put him in his place and simultaneously show everyone else how manipulative and power hungry that person is - DON'T PLAY.

All MUCH easier said than done. I've failed at this very advice many times.

 

[ronin12]

try desperately to do exactly what you would do if that person was on vacation or had quit. State/document your reasons just as you would otherwise, and try, try, try to avoid playing any of the games, avoid the power struggles any way you possibly can. Even when you see that perfect opportunity to nail that person and put him in his place and simultaneously show everyone else how manipulative and power hungry that person is - DON'T PLAY.

All MUCH easier said than done. I've failed at this very advice many times.

thanks for your insight. I tend to avoid power play at all cost, but problem is, it is realted to pt care and especially disposition after psychiatric hospitalization. No matter how much you try to set boundaries by politely deferring his/her ideas,suggestions,orders, manipulations, lies, control attempts,intimidation, it just does not go away. it definitely creates difficult working enviorment and effect professional duties. ironically the very person has great reviews and appreciation from nurses, and previous psychiatrist!!!(biggest shocker for me).

 

[kugel]

there are times when I can't MAKE happen the things I think need to be done. In those cases, I often write very specific orders and leave it up to others to figure out how to accomplish those orders.
E.g. "Upon discharge,
1) provide pt w/ appt with psychiatrist at outpt clinic within 1 week
2) fax H&P, Dictated DC summary, DC orders to outpt clinic MD
3) provide pt with local NAMI contact info
etc., etc."

or "pt requires 1:1 Psychotherapy at least 50 min 5x per week with psychologist"
or "pt must be asked for 3 reasons to go on living at least 3x per day, each time at least 1 answer must be different from the 3 reasons given on the previous questioning"

I do this because A) it provides clear direction as to what I want for the pt
B) it takes me out of much of the process, therefore, out of the power struggles C) if it doesn't get done, at least the chart clearly shows what I thought was needed and my efforts to get that done are clearly documented (aka CYA).

When I put a pt on 1:1 supervision for suicide or assault risk in this fashion, it is no longer a struggle b/w me and the staffing office as to whether they want to provide staff for it. "I'm sorry. My job is to write orders for what I feel the pt needs in terms of meds and any other treatments. If you can't provide it, I understand. I just need you to document in the chart why you can't provide what was ordered."
i.e., just do what I would do if none of these problems existed - I just do it in the form of orders.

Still not perfect, but it's the best I've got.

 

[ronin12]

there are times when I can't MAKE happen the things I think need to be done. In those cases, I often write very specific orders and leave it up to others to figure out how to accomplish those orders.
E.g. "Upon discharge,
1) provide pt w/ appt with psychiatrist at outpt clinic within 1 week
2) fax H&P, Dictated DC summary, DC orders to outpt clinic MD
3) provide pt with local NAMI contact info
etc., etc."

or "pt requires 1:1 Psychotherapy at least 50 min 5x per week with psychologist"
or "pt must be asked for 3 reasons to go on living at least 3x per day, each time at least 1 answer must be different from the 3 reasons given on the previous questioning"

I do this because A) it provides clear direction as to what I want for the pt
B) it takes me out of much of the process, therefore, out of the power struggles C) if it doesn't get done, at least the chart clearly shows what I thought was needed and my efforts to get that done are clearly documented (aka CYA).

When I put a pt on 1:1 supervision for suicide or assault risk in this fashion, it is no longer a struggle b/w me and the staffing office as to whether they want to provide staff for it. "I'm sorry. My job is to write orders for what I feel the pt needs in terms of meds and any other treatments. If you can't provide it, I understand. I just need you to document in the chart why you can't provide what was ordered."
i.e., just do what I would do if none of these problems existed - I just do it in the form of orders.

Still not perfect, but it's the best I've got.

great solution. it's a good idea to minimize verbal interactions with the SW and make everything official i.e on pt record. the dilemma i run into is usually post discharge placement of pts' i.e nursing homes, assisted living, substance abuse settings. where my recommendations are intentionally undermined, due to territory or control issues. it causes undue delays and disruption in pt care. by writing recommendations in orders will minimize personal biases.

any bright ideas about flamboyant personality issues in "work setting" like triangulation, manipulation,excessive emotionality, fear of abandonment,attention seeking and control are also fondly welcomed.

 

[whopper]

I had a nurse who I'd described as passive aggressive with cluster B traits at work last year (and an attending too when I was a resident, though he was just passive aggressive. Not so much with Cluster B traits though with strong Cluster A traits).

I noticed she tried to spead false stories or exaggerate ones with some shred of truth. It was to the point where it affected the quality of the care. E.g. I thought a patient was not psychotic, but was dissociating. While I was not present, she'd make comments like "Oh my God, what an idiot, what is he thinking?" (turned out I was right she was wrong). I never had a problem with a treatment team member disagreeing with my diagnosis so long as they told me upfront what they thought was going on. I'd also encourage debate about a diagnosis during treatment team meetings if we were in a grey area. However that below the belt type of complaint was pretty much how she acted on an everyday basis. She actually had a rep as the worstnurse to not get fired from the facility.

She also blatantly disregarded orders she was supposed to do and tried to dump them on the next shift.

I tried to build up a case against her before I complained to the administration. The administration don't want to hear about every single complaint you have. They can only act on something with credible and consistent evidence.

At the same time, tried to just do my job, but also made sure I dotted my i's and crossed my t's. Of course all doctors should do this, but I had to be sure I did it in a manner where she couldn't make up false stuff against me. That for me was one step above responsible documentation. I figured there had to be a reason why she was not fired even when everyone who ever spoke about her mentioned she was a terrible and bitter person who did not do her job well.

I took it to that level only because I foresaw a realistic possibility that she would screw up and try to nail it on me or others. If someone was borderline and passive aggressive, but at least did their job with competency, I'd just tolerate it.

In the end, I didn't make any complaints other than to 1 boss who is a friend of mine, but I told him I didn't want to make an official complaint. I was only working at the place for 1 year so I knew my tour of duty would come to an end, and that issue was one I wouldn't have to deal with anymore.

Remember: when you make a complaint, you can be put on trial just as much as the person you accuse, and with good reason. There are plenty of people willing to complain, but less people willing to establish the evidence. If and when you complain, it has to be for a good reason and for your own protection with some good evidence to back it up.

 

[jettavr6]

I tried to build up a case against her before I complained to the administration. The administration don't want to hear about every single complaint you have. They can only act on something with credible and consistent evidence.

At the same time, tried to just do my job, but also made sure I dotted my i's and crossed my t's. Of course all doctors should do this, but I had to be sure I did it in a manner where she couldn't make up false stuff against me. That for me was one step above responsible documentation.

I took it to that level only because I foresaw a realistic possibility that she would screw up and try to nail it on me or others. If someone was borderline and passive aggressive, but at least did their job with competency, I'd just tolerate it.

In the end, I didn't make any complaints other than to 1 boss who is a friend of mine, but I told him I didn't want to make an official complaint. I was only working at the place for 1 year so I knew my tour of duty would come to an end, and that issue was one I wouldn't have to deal with anymore.

Remember: when you make a complaint, you can be put on trial just as much as the person you accuse, and with good reason. There are plenty of people willing to complain, but less people willing to establish the evidence. If and when you complain, it has to be for a good reason and for your own protection with some good evidence to back it up.

Very useful information. Anytime something can't be worked out and you are considering making a complaint, then it is very important to have documented everything. Nowadays, with productivity in the workplace being emphasized, management is more apt to try and deal with those who may be affecting the work climate. Of course, if one person is disrupting the work place resulting in many peoples work being affected, it would be more of a sell than if it was specifically against only one person. Stay firm and consistent.

 

[ronin12]

this person is similar to the one whopper experienced. I have not made a formal complaint, but informally discussed with administration. they have asked me to observe few more weeks, if things don't change,we will see what else can be done.
Being a team leader psychiatrist has responsibility and authority to maintain professional boundaries among different disciplines, Aim being providing best health care to patients.Anything which jeopardizes these goals needs close scrutiny.

 

[whopper]

The thought did cross my mind to bring it to the administration in an official manner. I didn't do it for the following reasons.
1-she's been there for years, and has a rep as a bad nurse. I figured there was some type of politics I wasn't aware of as to why she wasn't fired. I figured I better know what that was before I made a move.
2-a nurse who highly respects me told me not to do it. He mentioned a previous attending tried to get her fired, but it ended up backfiring in his face.
3-It wasn't me or the patients who were getting the brunt of the problems. It was her fellow staff. In that case its the nurse manager's job, not mine to get something done.
4-she wasn't doing her job well, but wasn't crossing the clear and dangerous line.
5-I was a new attending, and didn't feel I established my rep there to the point where they knew if I complained, my word was good.

I had in residency complained to my program director about an attending in a formal manner when I was chief. It got to the point where the GME office actually demanded I come to the office and talk about it in detail. In that case the attending was over the clear and dangerous line, so while I was not comfortable with it, I felt I had to do it.

 

[jettavr6]

Interestingly, I think we are more apt to "put up with it" than rock the boat in Psychiatry. This is just my observation. On the other hand, if something like this was going on in Surgery.... that's a whole different story...

 

[ronin12]

Interestingly, I think we are more apt to "put up with it" than rock the boat in Psychiatry. This is just my observation. On the other hand, if something like this was going on in Surgery.... that's a whole different story...

you are right being a psychiatrist we are more tolerant of coworker's personality issues , because we can better understand the psycho dynamics involved. But if it comes to a point where it is effecting how we practice psychiatry, professional duties/boundaries should supersedes everything. At the end of the day, bucks stops at psychiatrist .