Assertiveness

[motor_mouth, MSN, RN]

Here's the situation in a nutshell with as few specifics as possible.

I'm recently off orientation at a new job (~2.5 yrs of nursing experience elsewhere). There is something due 3-4 hours into my shift which the patient refused, stating she wanted it at the end of my shift. Come the end of my shift, I had no time to do it (toileting, passing meds, etc.)

During report, I tell the next nurse this and am told "Well, you have to." Even when approached by the next shift's charge nurse, the nurse insisted that she was not doing it, I should have to.

Last time I checked, nursing was 24/7. I did numerous things for my patients when I got in that shift that were due on the previous shift. I didn't give the previous nurse grief over it.

I am not an assertive person at all. How do I deal with this?

[Meeshie]

You're right that nursing is a 24 hour job. However, your next shift already has 12 hours of work to do. If you find that the shift previous to you is leaving a lot of things undone for you to do and it's a consistent issue then you need to say something. It can be as simple as "hey, don't forget to hang that mag that was due before you leave please?" If it keeps being an issue then the charge has to get involved.

It also helps to not leave patients with the expectation that something will be done at 6 if there's no logistical way that that's likely. "I'm sorry but there won't be time to do somerandomthing at that time. I could come back at 5 and we could do therandomthing or we could do it now while I have time." It they don't like either option then them refusing is also an option.

I realize that both the things I put down require some level of assertiveness and that they can make people uncomfortable to do at first. However, some assertiveness becomes necessary.

[motor_mouth, MSN, RN]

Meeshie - That was helpful.

It's usually not an issue with the previous shift leaving things undone. It just happened that multiple things were not done that day so I started out playing catch up.

Someone else had told the patient that it could be done at that time, so I came in to it being an expectation. Some days, it probably could be, but not every day. It just depends on the acuity/needs of the patients and the staffing that shift.

Whether right or not, I did stay and do it. I asked the patient when it would be best to do it, they gave me a time. I told them that it might not always be possible to do it then to which they basically said, "I don't know what to tell you then."

When I interviewed, I did let management know that assertiveness is a definite weakness of mine. They said they could work with me on getting better at it. Is it appropriate to ask for them help? Not in this specific case, but just in general?

[ArmaniX, MSN, APRN]

Patient refused their bath when offered. Simple as that. Done. Staying after your shift to do it should not be the option. You pass it off to the next nurse, what they decide to do with it is their choice.

[Here.I.Stand, BSN, RN]

Assertiveness is a skill that sometimes needs to be developed -- it doesn't come naturally to everyone. Start by refusing to stay over. Management didn't authorize that OT, correct? Don't ever EVER work after you have clocked out! For your own protection, just don't.

Patients have the right to refuse, but unless you are confident that you can fit the task in later, tell the pt that you can't promise anything -- so would they like to do it now to be on the safe side, or take your chances delaying it? Document refusals. Notify the oncoming RN that the pt refused, so if s/he finds time that would be great... but if s/he doesn't have time, since the refusal was documented the accountability doesn't fall to her/him.

You could also look at what treatments are scheduled for the next shift, and if appropriate do it yourself. That way you have taken something off her workload, so it is more reasonable to ask her to do this treatment.

Absolutely, you can ask management for advice how to handle this situation.

[Been there,done that, ASN, RN]

Whenever a patient refuses, (meds or treatments) the timing does not matter. Document the refusal and notify the physician.

It is no longer a nursing issue, it is now a physician issue. Oncoming nurse is wrong. You do not HAVE TO do anything to the patient. The patient can decline. You are covered by notifying the physician.

[Sadala, ADN, RN]

If it's a med and the pt consistently is insistent upon having it at a different time then I see about moving the time on the MAR (if it's ok with the provider, etc)