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.

[FireStarterRN, BSN, RN]

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.

I would never put all that. Just say "BP now xx/xx, this information was given to Witchwithab RN in report. Pt continues A&O, denies CP, HR xx, no other distress noted."

[elizabells, BSN, RN]

I would never put all that. Just say "BP now xx/xx, this information was given to Witchwithab RN in report. Pt continues A&O, denies CP, HR xx, no other distress noted."

Bwahahaha!

And yeah, I just put " [whatever data] endorsed to RN Evilpants"

[northshore08]

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

I agree with the above posters; it is wrong for you to document it in that way. You were right to report the changes to her. She was wrong to try to belittle your concerns. Explain in the notes that you reported pt status and changes through the shift to A. Meany, RN. What she chooses to follow up on is her deal. But you can bet if the doc noted the changes and said something to her she would be all over it, telling the doc how you reported it to her.

[Woodenpug, BSN]

Blowing off another nurse's concerns is a bit scary. The numbers are less important than the fact that you, the nurse at bedside, thought it was significant. I would want to know, so please tell me, no matter who snickers. The trend you reported certainly was no fire, but it is interesting and far from reassuring.

[FireStarterRN, BSN, RN]

Bwahahaha!

And yeah, I just put " [whatever data] endorsed to RN Evilpants"

Heh heh, I think that was Nurse Youngeating

[november17, ASN, RN]

Even though it may have been insignificant, I would have been happy that it was shared. Every bit of info shared in report is vital. I'm not sure of the situation you are describing, so I won't say anything about that, but personally if you gave me that info in report I wouldn't have been a jerk about it, whether I thought it was important or unimportant. The seemingly inane details shared in report will often end up being a huge part of a bigger puzzle.

[Tait, MSN, RN]

I got an eyeroll this evening from a nurse I get along with really well. I was talking to her new grad. We were discussing the need to call when a patient has a new onset change in tele rhythm. In this case pt had a short burst of VTach, asymptomatic (none documented prior to this). The NG didn't call it in, so I mentioned that had it been me I would have called. I mean in my opinion it is easier to say "hey VTach on your GI patient, just an FYI" then to wait until 3am when pt had a nice run of SVT.

Would the doc have done much? Prolly not, but possibly a quick Mg/Potassium level would have been ordered for the morning.

I basically just looked at her, looked at the NG and said "everyone has thier way, that is just what I would have done."

Blow off the idiots and lazy folk, do what your heart tells you to do. Will you look back one day and think "yeah I suppose maybe he just gets low when he sleeps, or maybe the tech took it on the arm that was up on his side? (that can have mild effects on BP)" But you know what? That will be your realization, not someone's lack of empathy for your learning.

:icon_hug:

Tait

PS. I read further, and I agree. Don't ever put personal conflict in a legal medical record. Lawyers love to find that stuff when they have you in deposition.

[2shihtzus]

Theres one in every crowd I guess.

Had you given me report on the BP, I would have just nodded and been thankful for the heads up. To your credit, new grads are usually much more intuned to changes in VS and stuff.....while a more seasoned nurse may blow such things off, its better safe than sorry. There was no reason for her to be such a cow about it. Next time she acts that way, I would just smile and say, "Just thought you would want to know" and leave it at that.

[Tweety, BSN, RN]

I think you handled it just fine. You gave the information and it's up to her what she does with it. But since you felt that she was rude and demeaning you probably want to do something about it because you just gave her permission to do it.

I don't recommend you saying ""are you trying to be rude or is this just how you are?" because that will escalate the situation. Back and forth bickering will get you no where. Take the high road and don't sink to her level.

You might find more constructive things to say such as "if you don't mind, can we talk about how report just went (or how it went yesterday when we talked about the BP issue). You sounded very degrading and even rude, do you mean to make me feel belittled, because that's how you're appearing." Then when she does it again, say "you're still coming across as demeaning and rude to me, what can we do about that?" Over and over again with consistency.

[elizabells, BSN, RN]

Thinking on it more, you just KNOW that if the OP hadn't mentioned it and it turned out to be significant, Miss Meanybritches would have been on her so freakin' fast...

[iluvivt, BSN, RN]

Yes sometimes you have to take the high rode but sometimes you have to draw the line in the sand or these type of people will keep up the bad behavior. Of course, that BP needed to be watched especially if you were administering packed red cells and platlets. The patient could have been having a hemolytic reaction or a reaction related to HLA. First I get them with knowledge and if I can not use that tactic I just call them on the behavior. I would say "you are being very rude and I do not appreciate it" It does not matter what she thinks about the BP and if she throws that at you again just repeat yourself. Most people will back down and if they do not you will feel so much better. Another trick of mine is to find a nursing article about the significance of BP changes and leave the article in her mailbox.....do not sign your name...a little sneaky but it makes me feel better especially when I know I am right

[Morettia2, BSN, RN]

I just recently found out that Benadryl has a interaction with plts, I never knew that. So maybe when you were giving the plts. the benadryl had and pharmacologic interaction. But that's just a guess. But I know what it is like dealing with these type of people at work. You did a great job assessing s/s!!! That makes you a better nurse for keeping a keen eye on your pt!