giving report

[melisgood]

Hey Everyone!

I just had a very frustrating experience last night while giving report to one of the night shift nurses. He was very rude to me and has been this way before. Apparently he doesn't like the way I give report and gets annoyed if I leave out details and he has to ask me questions. I was giving report on a patient diagnosed with a near syncope episode and leukocytosis/UTI. I told him I didn't give the patient's thyroid hormone until the afternoon because pharmacy was waiting for a shipment and that's when they delivered it. He looked surprised and said, "well, you know you're supposed to only give that in the morning on an empty stomach right?" and rolled his eyes and then said "ok...anyways....keep going..". When I was done giving report he said. "Hmm, this interesting, (as he scanned what he wrote down) you seemed to have given me all the information except for what I actually need to know." He then went on to list questions about if the patient had had a CT scan or troponins drawn and if she was on antibiotics. I told him sorry I left that out, and that the troponins were negative, and no CT scan was ordered. He looked over on my sheet and said "I notice you have written down the patient had a 2d eccho done today?" I told him yes but that the results weren't back yet. I realize I left out important information, but once prompted I knew the answers! It's not like I had no clue what was going on with the patient. The truth is that my other patient's were sicker and this patient was probably going home the next day. I gave a less than perfect report on this patient, but in the end he had all the info he needed. I have less than 1 year experience as a nurse and I am still learning.....I hate days when I work so freakin hard and then the night shift just tares me to shreds!

Question #1: What can I do to improve my giving report skills? Books? Suggestions?

Question #2: How should I handle a co-worker being rude to me in front of a patient/family in a situation such as this?

TIA!

[NaKcl, BSN, RN]

I too had those type nurses during the beginning of my nursing career. I hated them. They acted as if they were born with nursing experiences. Do not be hard on yourself. it will get better as time goes.

*Do not focus on their expectation. you can never satisfy their wants. you focus on your work and self expectation.

[tablefor9, RN]

1. Complete report is a must. If your facility doesn't have a report sheet they use, do a standard SBAR, on a sheet of paper if you have to, reviewing hx & presentation, head-to-toe review of systems incl how this has changed over last 24hrs, your shift in particular, and a review of the last 24 hrs of orders and labs. *I know* this sounds like a lot, but with practice, you find your stride and it takes like = 2 min to complete per pt. If wise*** starts to interrupt you, you say, "pardon me, I'm not finished, If you have questions when I am done, I'll be happy to answer them for you," and move on.

2. The unprofessional behavior of your colleage is unacceptable and must not be permitted. So, call him on it. If in front of a pt, smile and say to the pt, "excuse us please?" and pull the jerk into the hallway, or to a empty room. Then, explain that his behavior is unprofessional, unacceptable and will no longer be tolerated. And explain why. Namely, that it damages the foundation of the nurse-pt relationship for you and your patient, and therefore is not in the best interests of good pt care. You may also add that you will not be belittled in front of patients, and that if, in the future, he has a personal issue with you, he may address it, as an adult, with you. Not with coworkers or patients.

[melisgood]

Wow....so many responses! Thanks! I will try using a form going system by system to get report and then use the pre-printed sheet with all my patients listed as my todo list and note taking during the day. At the end of report I will update my report sheet on each patient and end by skimming my paper to include highlights of the day. And yes, I will find my inner shark! What bugs me the most is that this nurse was a new grad hired at the same time as me a year ago! He has his bachelors and I only have adn, but we both passed the nclex and work on the same unit!

[MeTheRN, BSN, MSN, RN]

Hey there, it sucks that this nurse was being such a douche. I'm a new nurse too and here's what I do. I go start off with the patient's chief complaint, followed by any pertinent things that happened upon admission (surgeries, CT scans, labs, etc). I then do a head-to-toe report starting with neuro and ending with skin. I then go on to labs and infectious disease processes. I finish up with any recommendations I might have. Of course sometimes I leave things out of course, but for the most part this lets me get everything in there without too many holes. Another thing that's really helpful is writing down your report an hour before night shift arrives. I don't mean write a script, but a fresh set of vitals and maybe printing out the H&P would be helpful.

If the nurse were being rude in front of the patients, I'd ask him to follow me and chew him a new one. It's unprofessional and unacceptable to act like that. If this nurse knows so much about what you should've done, they should work days instead of nights.

So smile, it will get better and it will get easier. Good luck :)

[Cardiolyte]

Your last sentence says it all.. Try to use SBAR or what ever works for you. I work in a unit, 2:2. We have these same nurses on each shift. Telling the nurse to look up results, that they have all night would be inappropriate. I'm guessing they haven't worked a 7p-7a shift. We have a 30 minute window to call critical results, changes in pt condition, et. I want to know the result AND if it's been called to the attending. Some nurses do get carried away with wanting test results from 2 or 3 shifts prior,THEN tell them to look them up, and go ahead AND ask them if they are going to get that urine sample or what ever lab before they go. We are mostly anal in the unit, IV sites are a big issue, gotta have them. If my pt's able to get out of bed then we need to be moving them out ASAP. Try not to develop a inner shark if you can.

[Orange Tree]

I love to screw with people who act like that. Just leave out information that you know they'll ask for, and when they ask, recite it like one of Shakespeare's sonnets. Impressions one through four of a patient's abdomen/pelvis CT scan would work well, but my memory is not so great, so I go with something like morphine PCA settings. Once they realize that you know the answers, they stop asking the questions. Jerks.

[DC Collins, ASN]

"Question #1: What can I do to improve my giving report skills? Books? Suggestions?"

I am fairly new too. What I try to do are two things: Work out an SBAR format that works for you, then do your damnedest to plan out what you need to say ahead of time. The rest comes with practice.

Question #2: How should I handle a co-worker being rude to me in front of a patient/family in a situation such as this?"

The best method I have found for dealing with this, specifically when it happens in front of the family / patient is to say something like, "You know I am a relatively new nurse, so if you want something specific from me you should be helpful and give me suggestions, rather than tear me down in front, and I am sure the pt/family does not want to hear you do so either."

If they know you are going to make them look like the idiot to the patient / family, it tends to make them think twice :)

[backatit2]

just for the heck of it, what if he is just joking with you? only you know his tone/demeanor, etc., but the part where you said he's like, "hmm (scans the sheet) it seems like you've told me everything except what i actually need to know!" that he could just be joking around. is that a remote possibility?

i have a sarcastic sense of humor, and the people who get it REALLY get it and i can say anything to them. the people who don't just DON'T and i usually end up apologizing when they get goofy over what (to me) is an OBVIOUS joke and never having anything but serious conversations with them from that point on. just a "what if"

[nyashan]

Could someone please explain to me exactly what is a "sarcastic sense of humor"??????

Maybe I need to get out more, but personally I don't think 'sarcastic' and 'sense of humor' should be used in the same sentence especially in front of patients and relatives. There are more appropriates times for one to be sarcastically humorous and whilst receiving a handover report is not one of them.

[ANNIENURSEANGEL]

I am on the night shift, and at my hospital, i do the 24 hour chart checks. So, i find out about alot of the information when i do the 24 hour chart checks. I ask questions, if i have given blood or they had chest pain, and like to know they hgb. level, or if they had a MI. Did this guy plan on opening the chart? I used to work dayshift, and i know you are on the go. They only thing that is frustrating about dayshift giving report is when, they say were giving this patient 2 units of PRBCs, and i ask,"what is their hgb?" they respond with,"i dont know." very frustrating. otherwise. keep giving report. you will get better. I suggest that you throw some of their own medicine back at them. I am sure being up all night, he will forget something important, so stay alert, and catch him on it.

[llerkl, ADN]

I am sorry this happend to you, I know you were feeling hurt and frustrated becuse you busted BUTT and he made you feel like you didn't. Keep on going though!

I have to say, when you only work one shift (like the offender, a night shifter) you sort of lose perspective about what the "other" shifts do. I have been on nights for 30 yrs (by choice). I think we tend to be a bit nit picky, as we may have more time on some nights (NO, you KNOW the patients don't sleep the night away every night!!!). I also have very high expectations for myself, so unfortunately sometimes it transfers over and I expect a lot from others too. I am ashamed to say I have done this very thing you describe to other nurses I work with.I am not proud of it. I work very hard, to communicate in a clear, polite, and pleasant manner. I am, however, quite direct which is hard for some folks. ...... I don't beat around the bush, I am right OUT with it.

Bottom line= keep doing your very best. If the behavior continues (from the other person), think about having a private discussion with him, as long as you don't feel threatened. I prefer dealing with stuff person to person, rather than dragging the manager into, if possible.

HANG IN THERE and be confident !!!!

[RiverNurse]

Wow....so many responses! Thanks! I will try using a form going system by system to get report and then use the pre-printed sheet with all my patients listed as my todo list and note taking during the day. At the end of report I will update my report sheet on each patient and end by skimming my paper to include highlights of the day. And yes, I will find my inner shark! What bugs me the most is that this nurse was a new grad hired at the same time as me a year ago! He has his bachelors and I only have adn, but we both passed the nclex and work on the same unit!

I'll put in my 2 ...

I currently have my ADN - and am 2/3 way to getting my BSN. In retrospect I wish I would have just gotten the BSN up front - although it may not have impacted the salary - in terms of education and understanding - it would have gotten me much further along as I had NO CLUE to what hospitals and nursing was all about. No doubt, I probably would have had a better clinical experience during school (but that's another story).

Secondly, it took me a good two years to really get my report skills down. This is partly due to my nature - slow and methodical - which has paid off with persistence. In addition, the level of stress I encountered on this floor - a floor which is similar to yours (without the vents but having 6 - 7 patients at that time) - contributed to my ability to formulate a good report at the end of the shift. However, that improved over time.

During report, I often had to give report to a very good but occasionally obnoxious nurse - the anticipation of giving report was enough to rattle my cage to the point where I could barely speak at times - and forgetting pertinent info until prompted.

Here's what I do:

I have a document sleeve I purchased from your basic office supply store and I cut it down so that 4 X 6 notecards would fit into it - cards are protected yet easily accessible.

One notecard per patient, pt label in the upper left, report written in the upper half of the card. On the lower half are things noted that either have been done for the past 2 days as well as those things that need to be done "tomorrow", for example, labs, procedures, tests...

In addition, I have one more notecard. On this one, it's divided into 3 columns and two rows. On the upper three columns, I use that for vitals (nurses do our own vitals) for 2000, 2400, and 0400. On the bottom half of the card, I use the first column to write down which patients are receiving accuchecks and when, the second column for meds, and the third is the "to do" list during that shift. I cross these off as they're done. I also use the chem7 shortcut for writing out lab values on my notecards. That actually impressed Mr. Obnoxious one morning as he'd never seen a nurse use it.

In addition, I check my charts right after I've looked in on my patients. You wouldn't believe (!) the orders missed! Like the time there was an order to give two units of PRBCs and the previous nurse failed to tell me. Yikes!

These days, I am told (as I whip out the proverbial notecards) that, "You are SOOO organized" - accompanied by wistful sighs... My response is, "Hey, I only look organized. If I am organized, it's because I'm really not... you should see my house...".

I hope this helps - hang in there. If you truly love nursing, you'll find your pace.

And finally, an inspirational quote:

"Seasons don't call for balance. They call for rhythm. Each requires a pace and a motion for moving through it that best matches that season's demands, its limits, its opportunities. Just as kayaking requires a different rhythm from mountain climbing, and that from wood chopping, so winter requires a different rhythm from fall, and that from spring."

http://intouch.org/magazine/content/topic/ripened_for_harvest

Take care,

RiverNurse