Nurse was so RUDE to me in report, what should I say next time)

[holdensjane]

I work the night shift, I had a patient that was admitted at 5, the nurse on days noted all the orders and told me he needed blood and plts. I look at the mar and noticed no premeds for plts. I asked the nurse about it and she said "yeah no pre-meds, I called pharmacy and they said no pre-meds too". after report I look at the original order, the premeds for plts were specifically crossed out and said "no premeds". but i noticed that the prbcs were right above the plt order. I concluded that the physician most likely meant no premeds for prbcs (usually theres no premeds anyway for prbcs) and accidentally crossed off the ones for plts. i asked the pt if he usually had premeds, he said yes and the one time he didn't, he had a reaction. well i called the oncall for premeds benadryl tylenol. bp was 119/62 on days and 121/67 for the beginning of my shift. I give him the benadryl and about half an hour later bp 98/60. that night he continued to be 92/50, 110/60, 90/55, 90/47. I asked the pt if he has ever had a bp drop with benadryl before, he said no. end of shift he was 105/55.

well i give report to the day nurse and she says "what? thats no a drop in bp, I don't know why you're worried about that." I said "I didn't say it was a huge, prob i'm just saying its something that happened last night and its maybe something you should keep in mind" She said "his bp didn't go down! its fine". I said " at one point it was a 47 diastolic, so i kept an eye on it". Then responded "well, we don't look at that here, we only look at systolic". Its a bone marrow transplant floor. I finally said "you know i'm just letting you know, if you don't think its a problem then thats fine" and she rolled her eyes at me and said "so then his bp didn't really drop". I was soo mad, how rude! and this nurse interrupted my report with another nurse before her saying "are you guys giving report or fooling around, I hear giggling in here". I was telling the other nurse about my morphine cadd pump patient whose starting to get confused and saying weird things. the other nurse said "we're giving report about a confused patient, giggling doesn't mean anything". I'm a ng just off orientation about three months and this nurse knows i'm new. When I reviewed her noted orders, I had to fix so many things and you know, i understand things happen and its not a big deal, I fix it, I don't give her a hard time about it. I even gave HER blood that morning. How do you handle a situation when a nurse belittles you or trivializes your judgement in report? I came home and thought of all the things I could have said. Next time I will just ask her "are you trying to be rude or is this just how you are?" i'm not afraid of her! but then again, i'm new so i feel like its hard to stand up for myself because there is so much i don't know yet.

[Laughs-a-lot, RN]

That is horrible. First of all why would you not be looking at the diastolic? If it wasn't important we would only use 1 number and save time. When a pt starts to go septic it may not be a drastic change. Maybe a slightly elevated temp, a little tachy, a little drop in BP. You should have confidence in yourself that you did the right thing by keeping closer tabs on this pt and if she continues to give you a hard time tell her that your concern is for the well-being of your pt and maybe you will need to speak with a supervisor regarding her poor attitude.

[leslie :-D]

every now and then, my concerns about a pt, are blown off too.

i always tell the patronizing nurse that "i've written these trends in my nsg notes, along w/noting my report to oncoming nurse. just know that it's on you if something happens to the pt."

and then i curtly continue w/my report.

i refuse to get in a peeing contest w/anyone.

keep your emotions out of it.

share your concerns w/oncoming nurse, also communicating you've written thorough nn's and let it go.

at least you've covered yourself.

sometimes you just can't fix ignorant.

leslie

[ann945n, RN]

Theres nothing to say to people like this. Saying some "smart" remark back will only add fuel to the fire. I would stay professional, communicate your concerns verbally, and then document document document what you told that nurse and go home. I think stories like these as well are a good reason to never take a verbal order from another nurse or anyone, best to look at it for yourself like you did and make your own judgement.

[meandragonbrett]

Give report, be professional, and ignore the idiots.

[FireStarterRN, BSN, RN]

I'm sure everyone here has encountered rude people during report. Some people just like to use that opportunity to be confrontational and critical. Try not to let them push your buttons, those types are bullies.

[holdensjane]

do you think my concern was valid, or am i just being paranoid?

[mat25:40]

I'm a new grad as well and have found myself in similar situations. I think some veteran nurses are threatened by our enthusiasm. Her reaction and response to you are reflective of her insecurites. You keep doing what is right for your patients, which includes precise documentation and an accurate report. When I am treated rudely I remember my new mantra: INAM, It's Not About Me. This is her issue. As for how you shoud respond, there are several approaches: Humble Novice Nurse is usually best in these situations; "Listen, I respect the fact that you've been a nurse for ?, and I am not questioning your nursing judgement, but I want to do what I believe is best for my patient and, that includes giving you an accurate report, please respect my effort". Good luck to you!!

mat25:40

[canoehead, BSN, RN]

Something like "this is the data, interpret it whatever way you want to" would work, and if she continues to argue just move on to the next point or say "can we move on now?"

Be aware that her standards are different from yours, so you need to be cautious when receiving patients from her.

I would not report verbal pecking in a report room, but I would notify your charge, and make incident reports, if her judgement put a patient in danger and you caught it as the receiving nurse. Get a good solid reputation for excellent care before even thinking about challenging her. Until then run all situations by your charge, and you can say "I spoke to Jane about it, and we both felt we needed to xxx, " if you notice an incident.

The situation you describe is so petty (on her side) that it's like a fart in the wind- just let it blow away. If you are challenged just say OK, and move on, and if you have questions go to someone you trust later and get another opinion. If the entire unit is like that I would seriously consider moving on before they blow your confidence to hell. Unfortunately there's one in every crowd, and sometimes you get to be her target.

[holdensjane]

its not so much the fact that she questioned my judgement but the way she said it was degrading as though it was SO outrageous that I was at all concerned about the bp. Next time will be out of line for me to document "informed oncoming day nurse of bp changes. Nurse aware, states "thats not a drop at all, we don't look at diastolic here". Pt stable no acute distress noted".

I mean she said it, let her take responsibility for it right? haha. ok honest question, is it wrong for me to document that.

[JBudd, MSN]

do you think my concern was valid, or am i just being paranoid?

Paranoia is what keeps patients alive.

Maybe this time the change in BP wasn't significant, but next time it could be a precursor to disaster. Is it possible the BP was down because it was night time and he was sleepy both from time and drug? Or was it the onset of a reaction? Your job to watch and note changes, every time, every patient. If she blows if off, eventually she'll regret the habit, and unfortunately her patient will too.

Don't get into tit-for-tat verbals, just say "those were my findings" and go on. Keep giving report whether she listens or not. Then find a mentor you trust on the floor to explore those kind of findings with later, so you learn from their experience; and not feel isolated about not being able to explore things with other nurses you work with.

[JBudd, MSN]

its not so much the fact that she questioned my judgement but the way she said it was degrading as though it was SO outrageous that I was at all concerned about the bp. Next time will be out of line for me to document "informed oncoming day nurse of bp changes. Nurse aware, states "thats not a drop at all, we don't look at diastolic here". Pt stable no acute distress noted".

I mean she said it, let her take responsibility for it right? haha. ok honest question, is it wrong for me to document that.

Yes it is. Your notes are just about your findings and actions, not hers. The time you chart you notified changes is when you called the doctor because you were concerned, that the doctor may need to come evaluate or give new orders. If you get new orders, say so "orders recieved", or "no new orders". If the changes were significant enough to concern you, you'd have called the doc. If you just wanted her to keep an eye on the patient, report is enough (plus your notes about your findings).

Charting is not about your interactions with the next shift, only the patient. I think you're doing fine! Don't let her get your goat. Stay the professional you've shown yourself to be.