got in report... pt in with confusion. Reality. post op hip. What to do?

Virgo_RN, BSN, RN · Nov 10, 2009

I would think long and hard before pointing out the omissions of others. You just never know if it will blow up in your face. I admire your strength of character to be direct about it, and will be curious to hear how it goes.

Vito Andolini · Nov 10, 2009

I have always advocated going to the person involved first, the direct approach.

See what happens. Best to you. Let us know.

YankeeHater · Nov 10, 2009

ugh.. I can emapathize with you! We have someone who gives reports like that too.. following people like this makes for an incredibly rough shift. It's like you just have to figure everything out yourself. The report serves no purpose becuase it's BS. scary to think that he/she is actually responsible for these pts lives isn't it?

Good luck with the direct approach. It's not easy but I agree that you should at least try that way first before going to your manager. Here's to better shifts!!

mamamerlee, LPN · Nov 10, 2009

Why not ask for a quick walking round from this nurse? If she balks, tell her you are unclear about some things, and would like her to point them out.

RNperdiem, RN · Nov 10, 2009

Next time you get report, you are just going to have to ask more questions than usual if this is a pattern from this particular nurse.

PostOpPrincess, BSN, RN · Nov 10, 2009

Next time, do rounds report. Actually walk around in the patient's room while getting report (if feasible of course). Nothing can be omitted then.

jessiern, BSN, RN · Nov 10, 2009

Just because she is new doesn't mean that she doesn't have a bad night, and doesn't get frazzled. Have you had experience getting report from her before? Do you find this is a common occurance, or just a one time thing? Sometimes nurses, no matter how much experience, have bad days and just can't get it together. If this isn't a trend you see often from her, I'd leave it alone.

luvmy2angels · Nov 10, 2009

Do you do actual verbal reports or are they taped/written?? I always liked a verbal report cause it gives you the chance to ask questions. I would suggest switching to verbal is possible, more clarity for giving report but that is just my opinion.My last place of employment we were supposed to tape report and hand it off to the next shift, I hardly ever did this. I would always ask the the nurse taking over if she/he would mind a verbal. I was never told no either. Hope things work out for you!!:redbeathe

el_peon · Nov 10, 2009

ya thats right. Just got report on a 88 year old lady. report stated that she was in with confusion and vitamin b 12 deficiency. lung sounds clear, not attempting to get oob.
After assessing the patient and reading the h/p patient actually had a right hip replacement 2 days ago, with a dressing to the right hip that was saturated. Report from other patients from her were just about as bad.
She has been a nurse for a few years to so its not a case of a new nurse being frazzled.
I think the approach I will take is direct conversation to her tomarrow and tell her what was missed.
what would you do?

I think "taking the direct approach" will be taken more as confrontation. After years of experience, I never take what i get in report as the gospel truth. I always make a round as soon as report is over and find out the real scoop directly from the patient. Give them the once over and check dressings. Then come back later for the full head to toe and meds. It wont be the last time you follow a good nurse thats been horribly busy, and at the end of the day,doesnt remember which of her patients is which. Or is just a bad nurse that has been at the desk all night and hasnt laid an eye on her patients all night and has documented by looking at the documentation of the nurse before her. (yeah, i've charted dressings on the right that were actually on the left.....come back in the next morning and the night nurse has written exactly what i did). Just learn to be self-reliant.

Sirapples · Nov 10, 2009

No, its actually pretty common with her. I can be frazzled at times too, but I dont forget too include things like the fact that my patient has a recent 2 day right hip replacement.

Ill give an example. Another patient was in a MVA report sheet said multiple trauma. I asked her if he had any injurys and she looked at me like I just asked her why snakes are coming out of her mouth. I had to ask her again, and she replied.. well he was restrained. I had no idea what that meant. I had to ask her 3 times before she finally said he was fine. Then I assessed him right away and he was satting 88% on 5 liters with rib pain. He had multiple rib fractures. I came back out and asked if he has always been 86% on 5 liters and she had no idea. NO idea he was on oxygen, no idea of nothing.

I can be very diplomatic. How Ill play it is if I follow her again, chances are she will have the same patients, and Ill figure out a way to include those details she missed... like the fact that my mva patient had fractured ribs, and the fact that the little old confused lady had a left hip replacement.

rn/writer, RN · Nov 11, 2009

I guess I'm in the minority here, but while everyone is tippy-toeing around trying to avoid offending the reporting nurse, what about the patients???

I'm all for being diplomatic and looking out for a co-worker, but this goes far beyond cutting someone a break now and then. This nurse does not appear to be running on all cylinders. Maybe there is something wrong with her, and she needs somebody to take notice. She might be in the early stages of dementia or have some other illness that is messing with her cognition. She could be grappling with depression or the side-effects of a prescribed med. She may be dealing with addiction. Who knows? Whatever is going on, while her lapses are being covered up, her patients are at risk and so is she. Kindness isn't always taking the path of least resistance. Being "nice" to someone can end up costing everyone.

If we were only talking about minor omissions in report, this would be serious enough. Any exhausted nurse might leave out a lab value or the latest I&O. But who skips the patient's chief complaint, their primary diagnosis? Yes, doing a rounding report and mentioning the lapses at a future encounter could address these issues. But, again, what about the patients?

I know nurses who give less than stellar reports, but their actual care is adequate. There are gaps in what they have said, but not in what they have done. They are candidates for broaching the subject with tact and consideration and hoping for the best afterward.

But what if this nurse is messing up when it comes to patient care? What if there are holes in report because she isn't functioning on some level, and her patients aren't getting what they need? It is all kinds of wrong to look the other way in such a situation.

I understand that we nurses sometimes adopt a siege mentality. We feel like we have to look out for each other because no one else will protect us. We're often the first to get it in the chops when anything goes wrong, and we certainly don't want to be accused of eating our young or our old or anyone else in between. Many nurses fear confrontation and the caretaker in them just wants us all to get along. And here's the big bugaboo--we don't want to blow the whistle on every mistake because we've made a few along the way and we don't want karma biting us in the backside down the road.

But turning a blind eye to a possibly dangerous situation is not the answer.

I suggest you do the following:

Talk to this nurse. Do rounding reports with her, and if you see major lapses like the ones you have mentioned, tell her you are concerned--about her and about the patient's care. Be kind in your tone, but firm in your expression that this is not a safe situation. Ask if she is all right. Tell her the kinds of things you are seeing, not to beat her up or overwhelm her, but to paint for her the picture you are seeing. People who are under stress--whether it's medical or otherwise--can convince themselves that they are covering themselves and their problems adequately (and why would they think otherwise when no one is willing to confront them, even gently?). They need to know it's not working.

If she is not receptive to your concern, you can discreetly approach other nurses whose discernment and maturity you respect and ask what they have seen when following this nurse. If several of you are noticing similar problems, it's time to do something before patients are harmed and/or this nurse incurs negative consequences.

Most facilities have some kind of Employee Assistance Program at no or very low cost. I recommend you use their services yourself. Information is confidential, and they are trained to give all kinds of advice and encouragement for employees in challenging situations, including those connected with the job. They might be able to offer you some strategy and ideas for how to handle the bind you're in. And you might be able to give this nurse a referral if she is willing to admit there is something wrong. Saying that you have used the program yourself can make it seem less threatening and judgmental.

If the problems continue, you'll need to go to your manager. You don't have to present any theories--just offer objective observations. Then let her take it from there.

This may get worse before it gets better. Even the most necessary and delicate confrontations can get ugly. But how will you feel if you say nothing, and a patient is harmed? Or if this nurse gets herself in a heap of trouble because no one was willing to say, "Hey, there's a problem here?" What you are describing is too serious to ignore.

I feel for you. I really do. But if this nurse is impaired, whatever the reason, she needs help. And so do her patients.