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?
Nobody gives perfect report, not even the most experienced nurse. What I do is I let the other nurse bully me a couple of times. And then around the third time when I get report from that person, I start to ask them the same detailed questions in the same manner they ask me in. I give them their own juice strong and don't give up until they cool down. This is not good advice, but this is what I do.
Isn't it preferable to just address it head on? My belief is that the "good-for-the-goose/gander" approach contributes to unnecessary negativity.
Rather than respond as a bully to a bully, I'm in favor of assertively (and privately) hashing it out.
Let's say that you're just sitting down for report and the patient begins to crump right then and there (don't you just hate that?), so you jump up, do some stuff, and page the attending as the other nurses grab the code cart. Well, seeing as though it's now 2330 on a Friday, a different doc is on call for the weekend and nicely says, "Oh, okay. I don't know this patient ... tell me about him"
Well, it sure would be nice to know the results of that echo now!
I think you learn what details each nurse wants during report. Some nurses (not just new ones) are paranoid that they will get burned somehow and want every single detail, yet others (usually the ones who have over 20 years experience) won't even sit down as you talk to them. Don't take it personally, not everybody gets along like best friends. Tell them what they want to know, if need be - walk them through how to use the new equipment in the room, or show them that dressing you've reinforced twice but the doc refuses to do anything about it. Then, go home and drink yourself to sleep.
The doc & I can have an extended conversation about the patient after we've finished coding him ....
And no, I don't feel the need to look up the results of an echo to code someone. Whatever the results were, it's beside the point until we get a rhythm back. Your mileage may vary.
Let's say that you're just sitting down for report and the patient begins to crump right then and there (don't you just hate that?), so you jump up, do some stuff, and page the attending as the other nurses grab the code cart. Well, seeing as though it's now 2330 on a Friday, a different doc is on call for the weekend and nicely says, "Oh, okay. I don't know this patient ... tell me about him"
Well, it sure would be nice to know the results of that echo now!
Which is when I will take the 20 seconds needed to grab the chart and read the results to the doc. I'm certainly not going to play "telephone" and relate to the doc what I think that the offgoing nurse told me in relation to what they thought that the echo actually said. IMO, that's a recipe for disaster. I'll only pass along to the doc lab/test results which I've read for myself.
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.
no, it shouldn't be done in front of patients - not that i said it should. here's an example for you:
posted by BluegrassRN:
Him: "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."
You: "I didn't know I needed to hold your hand and spell out every little detail for you. Do you not know how to use our computer system to obtain routine information? Would you like me to show you how to look up all these little details for yourself, so you won't be so dependent upon others for your information?"
i find it funny that you ask what sarcastic humor IS and then talk about when it is appropriate to be "sarcastically humorous." yes, you should get out more.
I got her and there was no sign of bleeding, hgb was 11.4 and had an EGD done which showed an old healing ulcer and no sign of bleeding. This nurse wanted to know where exactly the patient had been bleeding from and I wasn't sure which I stated and I got the eye rolling and she said "i shoulda know better than to ask you" and walked away
Amazing isn't it? Physicians couldn't figure out where she was bleeding after doing an EGD...and you couldn't either. When you went back the next shift to relieve her I'll bet she had that bleeder identified and stuck a Gelfoam on top. All ready for discharge. What a gal.
I meant to say in the psych unit I work at every week, they REALLY stress doing short, taped reports (orders of the NUM and hospital for that unit), because it was taking too long to get handover. They don't even want names, only bed numbers (unless patients/beds get moved around) and very brief, concise information. We are expected to grab all our patient files after h/over and get the info ourselves, as management want us to spend more time with our psych patients (a big and very important component of our job).
So I meant to say check your hospital's policy as well, and write important things for handover (as someone else said) in a red or green pen, that also helps me remember.
And you should be getting into the habit of checking all your charts, meds, IVs and sites, drains, etc after you get handover anyway to see all is OK and IVs are running at the correct rate.
I think that on pretty much any unit, there will be at least one nurse who is a report beast. A dear friend of mine is like this: she's a bit OCD and demands a rigorous, lengthy, detailed report. Heaven help the new grad who doesn't anticipate her questions or instantly know all the answers. Even the more experienced nurses hate giving her report, but the newbies are outright afraid.
Since she's a friend of mine, I know she's not the monster some people think she is, but I can see how they've come to that conclusion.
Even when report is somewhat standardized, each nurse will have a slightly different approach to giving/getting report. I try to adapt a bit to the style of the particular nurse I'm reporting to: some want more information, others will get bored and wander off.
I used to work with one nurse who only cared whether or not the patient had been bathed. Nothing else mattered to her. I once said to her, "Did you miss the part where I told you this patient coded three times? And I had to give him ten units of blood products? Hell, no, I didn't have time to give him a bath!"
All that being said, you will learn with experience to recognize the big picture. The details will come together to paint a meaningful and concise picture of what's going on with the patient. Some details are just details; the same kinds of details on a different patient could be crucial.
Some nurses (like the one you described) are just jerks, possibly as a cover for their own insecurities. Criticizing you for the thyroid medication was a jerky thing to do. Criticizing you in front of patients/families is never acceptable and I agree with the others here that you should call him out on that privately and assertively.
It sounds like you are already doing a great job and it speaks volumes in your favor that you're willing to improve even more. You will become a shining star, while that jerk will always be just a jerk.
One piece of advice: when giving report, always end by (together) going over the new orders that have accrued during your shift. On my unit, this is mandatory. This way, you're sure no orders were missed and the oncoming nurse is clear about anything that needs to be handled. Our docs have a way of sneaking in just before shift change, writing important orders, and sneaking back out. You don't want this to reflect badly on you.
Specializes in Med Surge, Tele, Oncology, Wound Care.
I swear when I am giving report, I have to give so many details to the point where why is it even necessary for the night shift to even go do an assessment?
Ugh so frustrating. I used to cry after giving report to one of the night nurses who was known for being abusive to the nurses. She ended up going to days and working with us and after seeing how hard we worked, she said she had to go back to nights. She was never abusive to me again when giving report.
I feel the pain and yes you are right the worst nurses are the most nit picky in report. They are lazy and want to be spoon fed. For me just hit the most pertinent info. I used to be a floor nurse now I work in the ER and have to give report when we transfer people to the floor. It amazes me what other nurses place emphasis on. I am going to assess my patients when I get them, I am going to look at their labs and tests. It takes 5 minutes on the computer. Its all there. Give me a quick rundown and go home. I remember certain nurses staring off into space, rolling eyes, acting disinterested and even starting conversations with other nurses while I was trying to give report to them. There are some real winners out there. Any nurse worth there weight is going Assess diagnose plan implement and evaluate. Don't need someone else to do it for me. When I get report I actively listen to what the nurse reporting has to say, then check the chart. I know that every shift is hard. I have worked nights, days, floor, ER, Oncology, its all tough. Nurses are supposed to be super human, we get criticized, by doctors, patients, families, administrators, and other nurses. That's just the way it is. Don't let some haggard old floor nurse ruin your day. Just the fact that you are concerned enough to ask about what you can do better means that you are ahead of the game in your nursing skills. Be the best you can be never quit learning and shrug off the people that would tear you down.
Specializes in Hospice, ONC, Tele, Med Surg, Endo/Output.
Let him know next time that he is so bright that you needn't patronize him by spoon-feeding him information that he could find out himself. Or you could tell him, "Oh, i'm sorry, but if i told you everything or did everything before your shift begins, then what would you be doing the rest of the night, surfing the web?
If that nurse is exhibiting this behavior toward you in front of a patient and/or family, you need to nip it in the bud. The next time he does it, I suggest you calmly give your report, ask if he has any questions, then ask if you can speak with him privately once report is finished. Tell him ever so calmly that you are working hard to give a complete report and that you do not appreciate his unprofessional behavior toward you, especially in front of patients. Tell him that you expect the eye-rolling and the attitude to stop, then leave. If it continues, you need to go to your supervisor and explain that, despite your attempting to resolve the problem directly, the rude behavior persists. That kind of behavior is completely unacceptable.
Of course, that's hard to do when you're a new nurse. I went through this myself about a year ago, when an ICU nurse to whom I gave report complained about me to a tech in another department. The tech then repeated the gossip to another nurse right in front of me, unaware that it was me she was talking about. I didn't miss a beat; with the charge nurse standing right there, I picked up the phone, called the ICU and very pleasantly asked to speak with the other nurse. I told her that I understood she'd expressed some frustration about something I'd done, apologized for the problem, explained that I was new, and said I wanted to make sure that she understood I needed and appreciated her direct feedback. Tech was speechless, charge nurse beamed, and the ICU nurse got the message that I will not be bullied. That's what the other nuse is doing to you, OP; he's testing you to see how much you'll let him get away with.
How about finding a colleague and practicing how you will stand up for yourself the next time it happens? It'll make it easier.
Wish I could give a bizillion kudos on your handling of that situation. I've got to remember that!
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?
I haven't graduated yet, so take this with a grain of salt :)
I constructed my brain sheet so that on the back (which can be folded over to match the names) has two columns... one is the report that I receive and the other is my own report. I have learned to write all of my base information on the whole brain sheet (IE: report given, meds to give, etc.) in black, everything I do in red and then when I am giving report, I go back and cross everything out in black. So even if I have read everything off of my own report column, I can scan back over my brain sheet (such as in the labs/orders column) and see if I forgot anything.
For question #2, I don't have anything magical to say except don't get into a ******* match with a skunk. You are doing the right thing by reflecting back, seeing how you can improve and then wa-lah - move forward. You can't please everyone - some people will say you give too much, some people will say you give too little. I think with experience and maybe a little more organization, you will find a happy medium.
Music in My Heart
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Rather than respond as a bully to a bully, I'm in favor of assertively (and privately) hashing it out.