May I vent a little?

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Specializes in ICU.

I'm so sick of the "report guilt" that some of the oncoming shift nurses try to place on me.

Yesterday was a very busy day. Aren't they all?

I work 0600-1830 shift in ICU. I'd like to think that I bust my a$$ all day and try my darned best to get as much done as possible. But, we all know that just isn't the case sometimes.

Yesterday, around 1615 I had to talk with a new neurologist who was consulted for a second opinion for one of my patients. By 1630 I was faced with a huge code brown "explosion" and by 1645 I was back out to see what orders the neurologist had written. One of the orders was "begin kaofeeds if ok with primary MD." I immediately paged the primary MD and by 1650, I had my order for kaofeeds, with enteral feedings per dietary. I paged the dietician, who was very nice and told me that even though she was on her way out, she was going to call me back with some recommendations. By 1710, I had her recommendations written down. I went in the patient's room around 1615 to find both IVs out. The pt was on a Heparin drip so I made it a priority to get another line in. He was not an easy stick. I was in there for at least 20 minutes trying to get another peripheral in. Long story short, I came out of the room, realized there was less than a half hour before the next shift comes in, and decided to make sure all of the orders were in, did a quick pain re-assessment in my other patient's room, and tried to get a little charting done to tie things up.

When the night nurse came in, and we were reviewing the orders, I told her about the order for the kaofeed. I had our Enteral Feeding order sheet there in the chart with the dietician's recommendations written in. After looking in the room, she immediately had this look on her face like she was annoyed. She says, "you know, you don't have to wait for the tube feeding to insert the kaofeed." I said, "I know." I tried to not let anything bother me and kept on giving report (I could feel where this was going. She did not have a very nice tone of voice).

She then says, "So, the kaofeed's not in." I said, "I realize that. You can put it in." She goes, "Well, I HAVE to don't I." I said, "YES, you do. Are you kidding me? Seriously? Yes, you have to put the kaofeed in. I think you can handle that." She then looked at the time of the order (1645), and goes "Oh." And we continued with the report.

I am just so frustrated with this type of thing. Do I have to EXPLAIN myself to these people why I dont do every little thing or am I going to maybe be treated like the PROFESSIONAL we are supposed to be? I don't EVER belittle someone giving me report about petty things like that because I know that they have worked hard during their 12 hour shift and if something's not done (within reason), there's a good reason for it. Isn't this supposed to be a 24 hour job?

And what if I had gone in there and inserted the kaofeed right away, without the tube feeds, instead of starting a new IV? The patient was on a Heparin drip. He needed a darn IV!

UGH! :o

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Specializes in Dialysis, Home Care, Hospice.

You did the right thing as far as I'm concerned. I think we all try not to "leave" anything for the oncoming shift but sometimes thats the way it goes. Some things are not worth arguing about and you handled yourself professionally. You shouldn't HAVE to explain yourself. Unfortunately there is always going to be someone who makes you feel as if you have to.

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Specializes in ER/EHR Trainer.

I don't know your crossover period, but ours is 1 hour. Usually the nurse coming on picks up new stuff and the nurse going off tries to tie up loose ends. However, I will give you the piece of advice I was given after a similar experience in report. Nursing is a 24 hour job, that's why we change shifts, the patient's needs are always there, orders will always need to be instituted, and time tables will always go around the clock.

I wouldn't worry about it, next time just state the obvious. Anyone who doesn't like it...tough nuggies! You shouldn't have to account for every minute of your time. It sounds as if you were plenty busy!

Just MHO.

Maisy;)

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Specializes in Utilization Management.

I hear ya. I hope I would've done what you did, because it was the right thing to do.

The other night I had a patient who was so nauseated, she turned green if she even moved her head. Patient came up from ER at around 2000, and last dose of Zofran was within the past 4-6 hours.

I finally got her nausea calmed down enough to start the Mag Citrate ordered, but it was close to 2300 by then. I'm just starting to explain in Report when the nurse interrupted and she actually told me, "You should've started that right away. Why was that not given? Look, the order's written at 1430. Even if she threw it up, she should've gotten it."

I said, "You're kidding, right? You mean you'd actually give that stat to a nauseated patient who's been throwing her guts up for three days and is so dehydrated I can see my fingerprints in her skin?"

I was too shocked to tell her to read my progress note but was all right there.

Incredibly, the next night the patient told me, "You know, that nurse told me you didn't give that drink right away like you should have. But you didn't do anything wrong. I just thought that was totally unprofessional of her to badmouth you like that in front of us patients."

It takes all kinds, doesn't it. :madface:

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Have we all noticed that the "guilt queens" tend to be the ones that will do as little as possible during their shift, leave tons of stuff for the next shift, and will be the first ones out the door when their shift ends?

I gave report to a "guilt queen" one morning, who without fail, first thing after report would set her butt down in front of the computer to read her e-mail. She started in on me with the guilt trip about something I hadn't had the opportunity to do and how (insert huge great big sigh) "I suppose I'll have to do it." I told her: "Yep, you suppose right. I guess the first thing you do today is this, instead of reading your e-mail."

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I've been a nurse 17 years and I've seen this happen occasionally. This is part of nursing. I usually just brush it off. It's a sign of a immature person. But if I see a pattern with the same person I make note and next time when they have something they couldn't get to I usually say "no problem" or "that's alright I'll get to it". I kill them with kindness. Most of the time the person will respond with kindness next time there is something I couldn't get to they will respond appropriately during report. If they don't learn with that method I give them a dose of their own medicine and that usually works. I seldom leave things undone but it happens to all of us.

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Specializes in Med-Surg/Tele, ER.

Oh, I totally feel your pain! This has happened to me a lot recently as well. I REALLY do my best not to leave orders, and I frequently stay late so that I don't. However, when I get a bunch of orders dumped on my head at 1830 (my shift is supposed to end at 1900), which happens a lot, I just do my best.

All we can do is be gracious when someone needs to pass something along to us, and when we are in this situation we'll do our best to explain why an order is there.

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I hear ya. I hope I would've done what you did, because it was the right thing to do.

The other night I had a patient who was so nauseated, she turned green if she even moved her head. Patient came up from ER at around 2000, and last dose of Zofran was within the past 4-6 hours.

I finally got her nausea calmed down enough to start the Mag Citrate ordered, but it was close to 2300 by then. I'm just starting to explain in Report when the nurse interrupted and she actually told me, "You should've started that right away. Why was that not given? Look, the order's written at 1430. Even if she threw it up, she should've gotten it."

I said, "You're kidding, right? You mean you'd actually give that stat to a nauseated patient who's been throwing her guts up for three days and is so dehydrated I can see my fingerprints in her skin?"

I was too shocked to tell her to read my progress note but was all right there.

Incredibly, the next night the patient told me, "You know, that nurse told me you didn't give that drink right away like you should have. But you didn't do anything wrong. I just thought that was totally unprofessional of her to badmouth you like that in front of us patients."

It takes all kinds, doesn't it. :madface:

That makes a lot of sense! Not.

What good would it have done her if you had given it to her and she threw it back up? You might as well not have given it.

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Specializes in Cardiac Telemetry, ED.

I've only been nursing for a few months and I've already run into this as well. Fortunately it's been the exception, not the norm. I just don't let it get to me. I know how hard I worked, I'm new and inexperienced, and I'm doing the best that I know how. I've been getting very positive feedback from supervisors and coworkers, and if one person decides to take issue with me over something small, I see it as their issue. It's not really about me. They probably do this to everyone.

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Specializes in ICU.

Yeah and I keep thinking about how she would have reacted if I had told her the pt. had no IV access for the Heparin gtt because I was inserting the kaofeed.

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Specializes in Utilization Management.

OOps. Posting error.

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Specializes in Utilization Management.
Yeah and I keep thinking about how she would have reacted if I had told her the pt. had no IV access for the Heparin gtt because I was inserting the kaofeed.

Heh.

But then you'd have to treat her for apoplexy. :devil:

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