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.

[holdensjane]

what bothered me most was that even after I said "i'm just letting you know, if you don't think thats a problem then thats fine" she kept saying it "i don't know what you think its an issue, its not an issue, the bp did not drop". Like she made a point to purposefully make me feel dumb by harping on it. I took the blood pressures myself manually. I was concerned because I was giving blood products one after another. Hypotension is a reaction, no? I wasn't so much concerned with the actual bp than the trend.

[heron, ASN, 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 just want to back up several of the above posters to say please, please don't get into a p------g match in the chart. I was on the receiving end of such comments a while back. The nurse happens to be one of the best and was under tremendous stress at the time. The issue was clinically insignificant, but she made a big deal of it in her charting as well as our unit communication book, while never once saying anything to me in person.

This kind of horizontal hostility can crop up without warning from roots that have nothing to do with you. (In my case, the nurse was angry at the company that owns our hospice ... a few months later, she moved to a different hospice and is much happier now, which is great 'cause she's one of the best.)

My point - and I do have one - is that recording the conflict in the chart for all to see - for all time - is not the way to resolve it. It's hostile, unprofessional and possibly legally actionable. It also guarantees that you will never have a decent working relationship with this nurse.

I wish I had a sure-fire method for dealing with your co-worker's arrogance. Unfortunately, any action can bite you in the butt if she takes it the wrong way. Just keep it professional and stick to your guns.

YOU were at the bedside, YOU were responsible for safe monitoring of your patient, YOU did the right thing Heron

[mpccrn, 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.

yeah, i'm afraid that little quote has no place in your nurses notes.....but, what i do when i'm turfing off an ify patient to an oncoming nurse is write a quickie head to toe assessment as my last note......remains oriented, ST on monitor. SBP 92%, BS + urine outs borderline..........it takes just a minute, documents the patient's condition at shift change and there's no mistaking her condition at shift change, it's documented.

as for handling the rudeness of the situation.....you really shouldn't care how the information is received.....that's her deal, not yours......you reported it, your job here is done. i'd much rather follow someone that checked too frequently than follow a nurse that blew things off. sometimes i think it was warrented, sometimes i don't, but there is never a situation when too cautious is a bad thing......not when someone's life is in your hands!:heartbeat

[UM Review RN, ASN, RN]

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

Believe me, if you didn't report it, she would've c/o that! Sounds like she's that type.

[northwestwind]

Never, ever chart how another nurse questioned you. If an adverse or sentinel event occurs on a patient like this one, the lawyers representing the harmed patient will zero in on those notes and conclude that both of you are incompetent. Legal charting is vitally important. Chart only patient facts, and how you responded to a change in status, using best practice that either comes from your training or help from a more experienced RN. Keep emotion entirely out of your charting. In fact, keep negative emotion at bay in all that you do. Your job is to build your skills, focus on learning from your patients, and building strong relationships with your charge nurses.

What you are experiencing in report is horizontal hostility, a sadly huge issue among even experienced nurses. It is almost impossible as a new grad to adequately respond to hostile comments, first because it is a new experience for you, and second, because you are put on the defensive without experience to draw from. This behavior is unethical, and don't get pulled into it. Get good at asking nurses like this clinical questions regarding their comments. For example, you may have said "what would you consider to be a drop in BP?" or "I'm interested in learning from you what you are saying about a drop in BP" - but this will require you to begin these questions the second you feel the hostility. Your questions stop the hostility in their tracks, because you are taking the lead in a much more productive manner. In the case you cite, this nurse was allowed to keep on going, and she pulled out of the air the comment about not paying attention to diastolic - a completely ridiculous statement based on zero fact. At that point, she was only interested in testing you some more, since she realized she was "getting away with it". And, you never know, you might learn something valuable from this experienced nurse when you direct the dialog more appropriately. It's the behavior you have to manage. Always take it back to clinical facts. And learn how to move on to the next patient more quickly - you are in charge in report, and use that to your advantage.

The last thing you want to do is report this person. That is engaging in horizontal hostility, too. And, you hold no "position power" as a new grad, BUT you do have an active license, and you are on exactly the same playing field as all RNs legally. You did what is required of you, namely documenting in the chart changes in patient status.

Mismanaging or ignoring altogether horizontal hostility is leadership failure on your manager's behalf. No doubt this person has been engaging in this hostility for years, without proper limit setting from the manager.

Many posts here are correct when they say that the best units are those that are managed well, have adequate staffing, support services, and supplies. They are harder and harder to find, but they do exist. Don't let a rogue nurse get you down. And most of all, do not become one of them! Keep your ideals and values important to you, and close by in whatever you do.

There is no harder job on earth than the first couple of years of nursing these days. So much to learn, so much responsibility, constant shortages of experienced nurses, and, a constant fear of doing harm. Find supportive nurses around you, and work toward minimizing horizontal hostility in your own work.

You can do it - and good luck!

[jjjoy, LPN]

This behavior is unethical, and don't get pulled into it. Get good at asking nurses like this clinical questions regarding their comments. For example, you may have said "what would you consider to be a drop in BP?" or "I'm interested in learning from you what you are saying about a drop in BP"

Awesome advice! That sounds like a great way to redirect this kind of obnoxious behavior!

I'm imaging the rude on-coming nurse being faced with a direct clinical question like that, unable to articulate an answer, trying to yet again turn the exchange "Why are you asking me that? You're supposed to know this!" or "Yeah, asking ME for advice? now you're trying to butter me up." Both are responses that would irk me, but seem to me easier to deal with that the previous responses that seemed to be refusing to accept the information being passed on. I'd be better able to let those comments slide and to move on with report because for them to NOT answer such a direct question tells me that they may not be confident enough in their own knowledge to give a direct answer. And if the person instead gives a clear answer... great! They can feel good for teaching and you learn!

[holdensjane]

Thanks for all your responses. I'm greatful to have this place where i can seek the advice of experienced nurses since I hate to bring these things up in the workplace and became part of the gossip i've witnessed before. I have another question.

Would it be unwise of me to bring this situation up with the manager and not name names specifically. I'm just so disturbed by this one experience. Also because I feel this nurse has something against me. I had an experienced where I took care of a patient once who was on pca dilaudid and ativan and was very lethargic one night. a week later I was called into the manager office and she told me she recieved a complaint about me going into a patients bedroom in the middle of the night sat down in the corner on the floor and read a book. She thought it was ridiculous and i wouldn't do such a thing but had to ask me because the nurse that took over my shift came to her with the concern. at the time the manager couldn't remember the name of the patient and i didn't press for the name of the nurse. but i only had one patient all week that was a man (i only get three patients) that was that lethargic and possibly hallucination (we all know what dilaudid on a pca pump and ativan can do). well the nurse i happened to give report was the same nurse that gave me a hard time in report recently. I thought nothing of it at first but everyone said that it was ridiculous of whatever nurse it was who brought it to the manager. and even then i thought, well no big deal she didn't mean it in harm. well after this experience, i think she might be harping on me and trying to get me because i'm new.

Next time, if i have to give report to her again, I will tell her (if she continues to be rude) that she was rude to me once before in report and i won't have it to please not interrupt me until i am finished. I feel like she will keep doing this until i stand up for myself (I also look like i'm 18 which may make it easier for her). Though i have a feeling that she will only go to the manager and complain about my attitude. and since i'm new it will look bad. I want my manager to understand the situation from me first. btw, I want to ask my manager for a letter of rec for going to grad school. do you think this will ruin her image of me? or should I not bring this to the manager? is this too petty and insignifcant of an incident? thoughts are appreciated.

[mpccrn, BSN, RN]

kaeky,

you are obviously bugged big time by this particular nurse. perhaps it's time to approach the manager to clear the air. take the high road however. present the situation without emotion or raising your voice. a good manager will suggest a conference between the 3 of you, her as mediator. if she doesn't, you suggest it. emphasize the fact that you only wish to do a good job and the best for your patients and you see the behavior of this nurse towards you a detriment and that you hope only good things to result from this meeting. good luck. there is enough hardships in this career, you don't need this on top of it!

:loveya: