Mean nurse?

Okami_CCRN, BSN, RN · May 23, 2020

I’ve worked 5 years of critical care and I don’t normally ask many questions when I’m getting report as I can read the chart quickly and figure it out most times.

When giving report I only go over pertinent specialists such as GI for a GI Bleed and ID for a septic patient, as for meds I only go over drips and IV fluids, not their routine meds as that prolongs report more than necessary.

NotMyProblem MSN, ASN, BSN, MSN, LPN, RN · May 23, 2020

It depends on your unit's policy. For us, we give only pertinent information pertaining to the current admission. Anything else you'd like to know, you'd need to look it up at your leisure. There are so many nurses who'd like a thorough enough report so that they don't actually have to go down and assess the patients for themselves. Our managers want us done with report and off the clock 30 minutes after the oncoming shift arrives. With bedside reporting, an in-depth report is not always possible, especially since there is a 99% chance that the patient will say, "since you're here, I need or I want...".

Additionally, some patients have such an extensive history that there is not always time to sit down and read a patient's chart like we did in the old days. Nowadays, the phones are ringing; visitors, patients, and other departments are always calling for this or that; admissions are arriving; blood transfusions require your time, and list goes on and on. The basics of what went on with the patient during the shift and what's upcoming (lab tests, procedures, IV restart, possible discharges), are sufficient because on med-surg units, the majority of nurses enter on duty with skates on.

With the way staffing is and the never-ending added nursing responsibilities, if the previous nurse managed to get everything done without leaving a grocery list of tasks for me to do before I even begin my scheduled tasks, I'm good.?

Sour Lemon · May 23, 2020

1 hour ago, will_power27 said:
So I recently got report from a nurse that is new to our unit. She didn't know the patients history (intubated/surgery ect) or why specialists were consulted. During the report, I asked questions as I assumed she wasn't mentioning these things because she wasn't sure how much information I wanted. Midway through, she simply got up, said bye and left, without going over the new orders, brady and apnea history, and medications as is expected on our unit. When talking with a coworker about the new staff on the unit I mentioned this experience as I was a little shocked. My coworkers response was to tell me I was being mean and as the new nurse was used to ward nursing it was unfair of me to expect her to know how we give report.
The new nurse did receive our normal training, and has been on the unit for 4 months. I received report from another girl who started at the same time and her report was great.
Am I out of line? I like to think I am good with new staff and many staff members routinely come to me with questions, but this has me doubting myself.

Were you out of line? That's a hard question to answer without observing the actual interaction. If she got up and walked out, then someone else said you were being "mean", maybe there was a better approach you could have taken?

**CalicoKitty, BSN, MSN, RN** · May 23, 2020

I tend to ask questions, and sometimes people don't know. With working on the Covid unit, I find that more stuff is being "slipped by". I had report on 2 patients, both transferred from the ICU (she did mention that).. But, not much info. Looking into the chart, I found both had been septic within the last week and had MRSA (one lung, one blood). I asked the nurse about the MRSA history (listed on my printout with no details) and she didn't know... I realize it happens, but in these cases, both were thankfully testing Covid negative.. So, knowing they still required contact precautions is kinda important, especially when choosing which rooms to go to.

It happens. As a more experienced nurse, I kinda ask questions related to what's going on. I don't care where their IV is. But, I do wanna know why they're getting anticoagulants and antibiotics.

I don't wanna be the jerk to new nurses, so if they don't know the answers, I'll find out/fix it. Nursing is 24h, and I usually work nights so somewhat more time to look stuff up and dig through notes.

will_power27 · May 23, 2020

1 hour ago, BSNbeDONE said:
It depends on your unit's policy. For us, we give only pertinent information pertaining to the current admission. Anything else you'd like to know, you'd need to look it up at your leisure. There are so many nurses who'd like a thorough enough report so that they don't actually have to go down and assess the patients for themselves. Our managers want us done with report and off the clock 30 minutes after the oncoming shift arrives. With bedside reporting, an in-depth report is not always possible, especially since there is a 99% chance that the patient will say, "since you're here, I need or I want...".
Additionally, some patients have such an extensive history that there is not always time to sit down and read a patient's chart like we did in the old days. Nowadays, the phones are ringing; visitors, patients, and other departments are always calling for this or that; admissions are arriving; blood transfusions require your time, and list goes on and on. The basics of what went on with the patient during the shift and what's upcoming (lab tests, procedures, IV restart, possible discharges), are sufficient because on med-surg units, the majority of nurses enter on duty with skates on.
With the way staffing is and the never-ending added nursing responsibilities, if the previous nurse managed to get everything done without leaving a grocery list of tasks for me to do before I even begin my scheduled tasks, I'm good.?

Unit policy is to go over these things. The surgery and consults were all for the current admission as the patient was a couple months old. She didn't seem aware the patient had lung surgery which was when I got concerned. Full report takes us about 5 minutes per patient. Maybe I was expecting too much as she does come from a med floor, but information always passed in report wasn't.

1 hour ago, Okami_CCRN said:
I’ve worked 5 years of critical care and I don’t normally ask many questions when I’m getting report as I can read the chart quickly and figure it out most times

I've been in this unit for 3 years and nursing 4. I really wasn't asking the questions for the information, more the assist her with giving a proper report. She stated the pt had surgery and id following and I asked her why, which she didn't know the answer to. I didn't call her out, just asked if it was for a + culture and if the pt had lung surgery and she said she wasnt sure... Maybe I haven't worked adults in too long, I just assumed info on the current admission would be passed over.

will_power27 · May 23, 2020

1 hour ago, Sour Lemon said:
Were you out of line? That's a hard question to answer without observing the actual interaction. If she got up and walked out, then someone else said you were being "mean", maybe there was a better approach you could have taken

Fair point. The nurse saying I was mean wasn't working that day, and didn't seem aware of the interaction. I was more taken back that she saw me asking a question in report as mean, as people frequently clarify or ask questions during report on our floor. The new nurse didn't seem upset when she left, she just seemed to think she was done giving report. I was trying to help her out cause some of the nurses we work with would be very upset with the report she gave. What would you have done differently?

will_power27 · May 23, 2020

41 minutes ago, CalicoKitty said:
I tend to ask questions, and sometimes people don't know. With working on the Covid unit, I find that more stuff is being "slipped by". I had report on 2 patients, both transferred from the ICU (she did mention that).. But, not much info. Looking into the chart, I found both had been septic within the last week and had MRSA (one lung, one blood). I asked the nurse about the MRSA history (listed on my printout with no details) and she didn't know... I realize it happens, but in these cases, both were thankfully testing Covid negative.. So, knowing they still required contact precautions is kinda important, especially when choosing which rooms to go to.

It happens. As a more experienced nurse, I kinda ask questions related to what's going on. I don't care where their IV is. But, I do wanna know why they're getting anticoagulants and antibiotics.

I don't wanna be the jerk to new nurses, so if they don't know the answers, I'll find out/fix it. Nursing is 24h, and I usually work nights so somewhat more time to look stuff up and dig through notes.

Definitely! I was happy to figure it out myself, and didn't say anything negative to her in regards to her not knowing. The interaction went "why is surgery following?", when she said she didn't know we moved on. I know other nurses on my floor would not be happy with the lack of knowledge and that she missed out on 1/2 the report. I was taken back any one would find that mean and was trying to figure out if anyone else had a problem with maybe 3 questions in report and what I could have done differently.

Sour Lemon · May 23, 2020

4 minutes ago, will_power27 said:
Fair point. The nurse saying I was mean wasn't working that day, and didn't seem aware of the interaction. I was more taken back that she saw me asking a question in report as mean, as people frequently clarify or ask questions during report on our floor. The new nurse didn't seem upset when she left, she just seemed to think she was done giving report. I was trying to help her out cause some of the nurses we work with would be very upset with the report she gave. What would you have done differently?

With new nurses, I tend to be casual and go into teaching mode if I feel like something's off. I'm also very reassuring, probably because I had quite the rough start as a new graduate. I can't say what I might have done differently without seeing the actual interaction. Post a video? ?

I will say ...that if you had an issue with her report and her walking off, it might have been better to talk to her instead of someone who "wasn't working that day". That sort of makes it sound like there's some mean gossiping going on.

will_power27 · May 23, 2020

2 hours ago, Sour Lemon said:
With new nurses, I tend to be casual and go into teaching mode if I feel like something's off. I'm also very reassuring, probably because I had quite the rough start as a new graduate. I can't say what I might have done differently without seeing the actual interaction. Post a video? ?
I will say ...that if you had an issue with her report and her walking off, it might have been better to talk to her instead of someone who "wasn't working that day". That sort of makes it sound like there's some mean gossiping going on.

I too had some bad experiences when I first graduated, so I try not to be judgy. My thought process was rather than outright teach how to give report, I would subtly "guide" by asking questions. No video is coming unfortunately haha.

I was planning on talking to her the next day, but I haven't seen her since the one interaction. I can see how it would be interpreted as us gossiping, but it wasn't intended that way. The subject came up in a discussion on how the new staff (10 RNs) were doing and what we could do to support them. No names were mentioned, just the odd report. Me and the other nurse are frequently asked to teach new staff, supposedly because we are good at it ?, and I mentioned the interaction because she was mentioning things missed in reports she had received.

TriciaJ, RN · May 24, 2020

Your floor should have a report protocol and this should be included in every new person's orientation.

Is there any possibility that you were peppering her with questions in a way that made her feel grilled?

Otherwise it was her responsibility to provide a complete report per your unit protocol. Any chance of speaking with her directly to find out what the problem was?

will_power27 · May 24, 2020

1 hour ago, TriciaJ said:
Your floor should have a report protocol and this should be included in every new person's orientation.
Is there any possibility that you were peppering her with questions in a way that made her feel grilled?
Otherwise it was her responsibility to provide a complete report per your unit protocol. Any chance of speaking with her directly to find out what the problem was?

We do have a protocol that is expressed during orientation, and she should have seen and done a quite a few reports while she was shadowing and buddying with other staff. I recall asking 3 questions: why surgery was following, why endo was following (we rarely have pts followed by endo) and what the pts resp support history was (intubated/hfo/jet). I guess she could have misconstrued the intent behind the questions. I easily found the information in my own after she left, my reasoning behind asking her was to help her in providing report the way unit expects. I have a shift with her next week, and have debated on approaching her about it, but didn't her to think I was picking on her.