Nurse refuses to give me report!!!

[Longleggedstar]

So as I embark on my journey to pursue my masters and specialize in geriatrics I find myself in LTC. Some of you who have worked in a hospital vs LTC can clearly see the culture/rule shocks. But when does it go too far?? A few weeks ago the 7-3 nurse questioned me as to why I didn't give our patient his 8am IV abts meds (I come in at 3). She began to state how she told me he missed it because he was at dialysis. And I should have given it. I then immediately explained to her that, that would be a med error and she was not a doctor, she cannot tell me to just "give a medication". Now keep in mind he receives that same dose of IV abts on my shift at 8pm. So she wanted me to give at 4 which is around the time she finished to give me report and then again at 8pm. Apparantly I pushed a hot button because she immediately began to get loud and insult me at the nurses station. Then stated, "just for that I refuse to give you report or count with you." I immediately went to the unit manager and ADON, and DON. 3 weeks later I am still having trouble getting report and being able to count correctly (ie if the count is off she will say something like, well someone else forgot to sign or if she can't find the book, she will say something like, somebody playing games up in here, I'm fixing to leave :|. I am SICK of this!!!! No one is doing anything, and I can't talk to her because then she begins to throw insults and go completely off topic about all the other things that are wrong on the unit! What do I do!!!!!

[Nascar nurse, ASN, RN]

Start documenting - in detail - every day and keeping turning it into the DON (and keep a copy for yourself). If they won't listen, take it to the administrator. I would have another nurse doing the narc count with me when she won't. At least you'd have a witness to exactly what you found when you took over the cart.

As a last resort, start looking for a new job.

[Emergent, RN]

She sounds like she's diverting. I knew a gal who was, and boy was she moody!

[JKL33]

Aside from everything elses, if "abt" is antibiotic, then missed doses should be given as soon as possible, not waiting around for the next time they would have been due. However, IMO she is the one who should have either given the med at 4 before she left and then re-timed the subsequent doses or rescheduled the dose for an appropriate time following dialysis and then re-timed the subsequent doses or proceeded as instructed by provider.

But no, it is not an "error" to give antibiotics ASAP when they are missed for whatever reason. It is far more an error to not give ordered antibiotics at the time they can be given.

She might be crazy or she might be fed up with nonsense.

[bluegeegoo2, LPN]

First, I would address the antibiotic issue with the MD and see how he/she would like to proceed.

Second, if the off-going nurse refuses to give report and count appropriately then she keeps the keys. I would not, under any circumstance, accept the cart and assignment otherwise.

As stated above, diverters can act "funny" around count time. Not saying she IS a diverter, mind you, but I have witnessed similar behaviors in people who were eventually caught diverting. Be careful there.

Lastly, if management is aware and will not addressed the issue, another job may be your only recourse.

Best of luck.

[Hoosier_RN, MSN]

If counts are off, do not accept the cart until you notify supervisor (DON) and the problem is fixed. If state walked into the building, her excuses would end her up in very hot water. Narc counts are very serious business. Missing count logs, same. Refusal to give report, look her directly in the eye and state that you are happy to go home because you will not accept assignment without report. As suggested, keep log of this childish behavior and keep a copy for yourself.