My Charge Nurse acts like I ask too many questions

[Prredneck25]

I'm a new nurse of 4 months. When my precepting time was over and I was put out in the floor on my own, the nurse manager encouraged me to ask him or my charge nurse questions if I'm ever in doubt. The nurse manager is a great teacher and is always dependable for advice pertaining to patient situations, but my charge nurse is another story. When I approach her with a question or even try to just report a situation such as a patient declining she will walk away from me and act like she doesn't want to be bothered and announce the advice with her back turned to me as she walks away. Now it's to the point where she makes comments like "What's your scary situation now?" when it may not even be a scary situation but just my reporting something like, "Patient ____, has had a declining change in health status, I've called the hospitality and the specialist, would you like to come and assess patient ____ and confirm the findings?" The thing is I've never worked in a hospital setting before becoming a nurse. It was always stressed to us in nursing school that a declining patient should be reported to the charge nurse, so I am just following the protocol I learned. Am I really bothering her too much? Please help me out here. Any advice would be appreciated.

[nursej22, MSN, RN]

Is it possible to have a conversation with your charge nurse about what he/she does or does not want to be reported? And this should happen in private, not in the hall or in a confrontational manner.

Yes, he/she should know when a patient may need to go urgently to a procedure, or need a higher level of care, or a rapid response. But if you are doing everything necessary, the charge may think you are seeking validation for just doing your job.

[TriciaJ, RN]

I've only been a nurse for four months, off orientation for 2 1/2 months and I work on a neuro step down unit. Generally I only go to her if I feel like the patient may be in a state of rapid decline. For instance the other day I felt my patient may have been experiencing a revolving stroke. I did my assessment and found new significant deficits, then called the neurologist, called the hospitalist, and then reported to her the situation so that she was aware of the situation at hand just in case this person needed to be wheeled off for acute treatment. Otherwise if it's anything less serious I'love usually call on my former preceptor or other nurse on the floor that act as preceptors.

Your charge nurse probably has more going on than you can be aware of and maybe doesn't mean to be unsympathetic. Or she may just be a rather abrasive person. Just concentrate on doing the right thing and don't take her behaviour personally.

You got good advice to run things by your coworkers so you're not burdening the same person. As you gain confidence you'll need less frequent input. But keep reporting things to your charge nurse that need to be reported to your charge nurse. Her lack of receptivity belongs on her evaluation, not yours.

[Ruby Vee, BSN]

Have you discussed the situation with that charge nurse and asked her what specifically she'd like reported to her and when? When you say she "acts like" you ask too many questions, it appears that you have not. I'd urge you to do so, the sooner the better. If you're pestering her with questions when there are other people available to ask and she's involved in trying to figure out her staffing or her transfer list or trying to contact a surgeon about that case that is rumored to be coming out soon but isn't on the OR list, that may make her somewhat disinclined to interact with you when she sees you coming. But you'll never know unless you talk to her about it.

Asking questions is encouraged when you're new. But you have to be smart about it, too. Don't ask stupid questions like "What is the number for Blood Bank again?" Yes, it would be easier if she just TOLD you, but you should be looking it up on your own, writing it down in your notebook if you can't remember and not asking that same question over and over. There's a big difference between asking "Mr. NoPeeum needs a Foley. What do I do?" and "I have an order for a Foley for Mr. NoPeeum. I've read through the procedure and gathered the supplies listed, but I've never done this before. Do you have time to go over this with me before I go into the room, or should I ask someone else?" Come to think of it, you probably should have asked someone else first, unless the charge nurse was on FaceBook or Amazon.

Informing the charge nurse that your patient is circling the drain is different from asking a question. So are you informing or asking? If you're not sure of what you're doing, run it past another senior nurse first, before you seek out the charge.

But first, TALK to the charge nurse. You're going to be working with her for a while, so don't start off on the wrong foot.

[milmom35]

I agree with the advice to reach out to other co-workers (hopefully someone with excellent skills). But also trust your instincts. Unfortunately, this can be part of the "nurses eat their young" scenario. When I was a new RN, I worked with charge nurses who seemed to have it out for me. So I learned not to involve them until I absolutely needed to.

The working world is not like nursing school where you have constant support and mentoring. A lot of times, you're on your own. If you ever has concerns about patient safety, you've got to speak up. Find a coworker you admire and observe how they communicate and handle things. Nursing practice is a team sport and even experienced nurses often reach out to colleagues when they have questions.

[RNNPICU, BSN, RN]

OP:

I have read your initial post a few times. What I am trying to understand is.. if your patient is declining there are usually specific protocols,, MD would be involved, your Charge should not be the last to know. If your patient is truly declining, maybe you should be initiating a Rapid Response.A declining patient is not something you just mention at the end of a shift.

From the Charge RN response regarding scary situations it is possible you may be running to her for any slight change in patient status. If you are always "crying wolf", meaning going to the Charge RN for any change, or for expected changes in a patient, it will become more difficult to sound the alarm when something truly big happens.

As others have stated, ask a neighbor or friend what there opinion is. Take some time to really think about your patient, side effects of medications, potential outcomes for your patient.

It just takes time to build your confidence and assessment skills. It takes time to learn what is "sick" and what is "really sick".