No report; disrespected

[ABQLNDRN]

Hi everyone--I am troubled about something and would like to have your feedback. I am a postpartum/newborn/high-risk OB nurse. Yesterday I was charge in the nursery. An L&D nurse that I normally get along very well with brought me a baby without calling report first. She just dropped the baby off, saying (as she was heading out of the door) that she would call report "in a little while." I was checking on another patient and my tech was holding down the fort when this occurred. The second I walked back into the nursery and my tech gave me the rundown, I grabbed a report sheet and headed right to L&D to find this nurse and TAKE report. I told the nurse that I was not comfortable taking a patient without getting report first. Maybe I should have said "how dare you," or "are you crazy?," or "this is against hospital policy," or something a little more blunt, but I was trying to be non-offensive. As soon as she told me that the baby's temp was 35.2, I called the nursery and asked what the kid's blood sugar was. (They were working on getting it.) The L&D nurse stated that she "put the baby on mom's chest and the baby's temp dropped" after that. That does not make sense. Unless the mother no longer had a pulse, that should've warmed baby up. She should not have transported a hypothermic patient to a stable-baby nursery. If she had called report, I wouldn't have accepted the baby. I would have told her to call the NBICU. I have gotten hypothermic kids before and they often go to the NBICU anyway. (The day before all of this happened, the SAME nurse brought a tachypneic, tachycardic, hypothermic baby to us. The blood sugar was 12. The kid needed a D5W IV; we don't do IVs in the regular nursery. It's not that we CAN'T; for some reason our hospital has decided that we aren't to do IVs in the regular nursery. The NBICU team was scrambling to get the kid into their unit. We were gavage-feeding that kid every 20 minutes or so until it was transported. It should have been in the NBICU in the first place, but she [the L&D nurse] wanted to get the baby off of her hands.) So, anyway, later on in the day, this L&D nurse got wind of the fact that I wasn't very pleased with her no-report, patient-drop-off tactic. She called me and said that she thought that I'd "get it" from report that the reason she brought the baby down without report was because of the temp. She said, "I wouldn't just drop a baby off without report because I just wanted to." However, when I originally got (read: made her give me) report, she stated that she "just wanted to get the baby to me," without citing the reason of hypothermia. (The mother is an OB/GYN fellow and the L&D nurse was busy attending to her every need.)

I thought that was very disrespectful of her to talk to me that way. She didn't so much as give a "heads-up" that a patient was coming. We at least always do that. For example, if we have a critical baby like we did the other day, our charge calls the NBICU charge to tell them what's going on and to make sure there's a bed. We don't just show up and say "We thought you'd get it...".

I try very hard to promote harmony between my unit and L&D. I have been asked several times by several L&D nurses "when" I am going to work for them. That is very flattering to me. That tells me that they view me as a team member, or at least I think they do. I don't know what they'll think of me now, because their nurse was written up for what she did (editted to mention that she was written up for compromising patient safety, not for personal reasons).

Her calling me and speaking rudely on the phone to me really offended me. It's bad enough that postpartum nurses aren't regarded as "real nurses." We put up with a lot of disrespect. We went to the same nursing schools, learned the same skills, and can do everything that other nurses do. Most of us just love our jobs, and that's why we do what we do. L&D nurses usually understand that postpartum nurses have an important job, too. In a lot of ways, they are my professional "sisters." But this time, she treated me like I was a stupid, second-rate nurse.

I want to confront this nurse. How should I do it?

[TrudyRN]

First, let a little time go by so you can calm down and not speak angrily when you do speak. Then, just say what you said to her in the first place - not legal or acceptable to just bring a pt without report, as you have the legal right to accept or not accept a pt.

Leave all the other out - it dilutes your message that you have a right to accept or not, based on whether or not you believe you can properly care for the pt, in view of the patient's condition, your work load, and so on.

Cite hospital policy, not any personality issues. Yes, it's ok to mention that you have always, up until now, enjoyed a very good working relationship with your peers in all departments and you fervently hope that relationship can be preserved but that you must insist that protocol and legal procedures of transfer be followed, to protect everyone, including the transferring nurse.

Say this formally, in writing, to your boss and let her take it from there.

[NurseCard, ADN]

Wow... firstly, I'm sorry that all of this happened. It was very unprofessional behavior on the part of the L&D nurse to just drop off a baby without giving report; no less a baby that has something critical going on.

I don't really think there is any need for you to confront this nurse any further though. You did everything right, and she already knows that you were displeased with her actions. She's been written up for what she did. I know you are miffed for the way that she spoke to you on the phone; I certainly would be too. But if you are just interested in keeping things smooth between your department and L&D, then you are better off just letting this go. I mean, the nurse knows you were displeased about what happened. She did wrong, she got wrote up for it. What else is there? If she hasn't already learned her lesson by being written up, that isn't your fault. I would think that dragging this controversy out any further by confronting her because she was rude... I mean no, you shouldn't have to put up with rude behavior, but.... the event is in the past now, no? From now on if she is rude to you, tell her right then and there that you don't appreciate her tone of speaking and it isn't helping the two of you accomplish anything.

This is totally off the subject but... I'm confused as to what you do? You said you are a post-partum nurse but you work in the nursery? I've always though of post-partum=taking care of the MOM after delivery. Then again, it depends on the hospital I guess? Like, in your hospital a post partum nurse is defined as one who takes care of moms OR babies after delivery. You don't ever take care of BOTH in one shift, do you?

[Mulan]

I would write her up for every time she has done this.

She didn't call you report first because she knew you wouldn't accept the baby if she did.

She's just passing her problem off onto you, inappropriately.

It's a matter of patient safety.

[ABQLNDRN]

Thank you so much for your advice, RealWitch--I appreciate it. In my hospital , we do take care of both the moms and the babies after delivery; we do couplet care. It's really cool. I love it. We see a lot of major social issues: addicted moms, babies conceived post-rape, incest, many young, teenaged moms...cops are occasionally on our unit to aid CYFD in taking custody of babies. It gets dramatic! Aside from all of that, I love what I do because I want to give those moms and babies the best chance at a good start. I want help the moms to feel empowered--especially the first-time moms--to feel competent, so as to give those babies the best start possible. I can actually say that most days when I go to work, I am happy.

[llg, PhD, RN]

I think you are focusing on the wrong problem. Put your personal feelings of being disrespected aside. That's not the most important issue. Nor is it the way to address the problem.

Focus on safe patient care. Since there seems to be a pattern of poor communication beteen nurses going on here, you need to address that with your management team. Bring it to their attention that information necessary for safe patient care is not being communicated appropriately. Point out the dangers to the patient caused by that poor communication. Don't say that you are personally offended by the disrespect. Focus on safety and the need to improve communication -- and then let them institute the changes that need to be made in your setting to assure better communication and safe practice.

It's not that your feelings aren't important to you. It's just that the best way to get the changes in behavior that you seek will be to focus on patient safety.

[ABQLNDRN]

I would write her up for every time she has done this.

She didn't call you report first because she knew you wouldn't accept the baby if she did.

She's just passing her problem off onto you, inappropriately.

Thank you for your advice. I am going to start consistently writing her up for these sorts of events from now on.

[ABQLNDRN]

I think you are focusing on the wrong problem. Put your personal feelings of being disrespected aside. That's not the most important issue. Nor is it the way to address the problem.

Focus on safe patient care. Since there seems to be a pattern of poor communication beteen nurses going on here, you need to address that with your management team. Bring it to their attention that information necessary for safe patient care is not being communicated appropriately. Point out the dangers to the patient caused by that poor communication. Don't say that you are personally offended by the disrespect. Focus on safety and the need to improve communication -- and then let them institute the changes that need to be made in your setting to assure better communication and safe practice.

It's not that your feelings aren't important to you. It's just that the best way to get the changes in behavior that you seek will be to focus on patient safety.

I embarrassed myself in my OP--I must have come across as though my feelings were more important than patient care. I apologize. My primary concern is for my patients. I am kind of like a Momma Bear when it comes to them. The unsafe patient care issue was the reason the nurse was written up. I did immediately notify management about the issue. I should have stated that in my OP.

[Artemis2]

Ditto what llg & mulan said. This cannot be tolerated. When these things happen I hope your first action (after stabalizing the patient of course) is to call your shift supervisor. It will help as you take further action to know that they are involved. As far as what the L&D nurses will think of you for writing her up...don't worry about that. I will bet that she has a pattern of sloppy care and that they will be happy that something happened to cause her to be formally written up.

[ebear, BSN, RN]

deleted per ebear

[ABQLNDRN]

I would write her up again only if patient safety/care continues to be jeopardized. This particular incident has been reviewed with her, I can assure you. To write her up for your personal feelings of disrespect will not accomplish much IMHO. You need to continue to approach this on a very professional level.

ebear

I do not write up other nurses for personal issues, and would not unless the issue created a hostile working environment which affects patient care. I did not state that she was written up for personal reasons. She was written up for compromising patient care, and I will continue to approach this professionally.

[nursemike, ASN, RN]

I embarrassed myself in my OP--I must have come across as though my feelings were more important than patient care. I apologize. My primary concern is for my patients. I am kind of like a Momma Bear when it comes to them. The unsafe patient care issue was the reason the nurse was written up. I did immediately notify management about the issue. I should have stated that in my OP.

I don't think you have any reason to be embarrassed. While I agree pt safety is likely to be a bigger issue to mgt, professional courtesy ought to be a concern, as well. A collegial environment helps with retention and also helps promote teamwork. Teamwork=better pt outcomes, so horizontal violence seems to me as much a pt safety issue as it is an employee satisfaction issue.