Oncoming nurse refuses report and leaves the room...

sevensonnets · Sep 6, 2016

I think I'd approach the charge nurse with this issue and ask her to send a couple of techs to clean the patient so I could give report.

AutumnApple · Sep 6, 2016

I would have gone to the charge nurse and told him/her that the oncoming nurse was refusing report and let the CN deal with it. I have no tolerance for stupid behavior.

Ok so, to start with, I'm generally someone who will stay over and help if needed with no qualms and no complaints... that being said, I experienced what I feel is an extreme reaction by an oncoming nurse to a pretty small thing and he was downright rude and unprofessional...
So to set the stage, I had a crazy night... very busy with a transfer out, a new admit that was somewhat unstable, a post op with pain management issues, heparin drip and PCA pump, as well as an external fixation to right tibia with a freshly dc'd Foley, as well as a behavioral problem patient in restraints...
In my last 2 hours I was running ragged trying to get everything settled for next shift when unstable patient has a BP of 85/55, and post op patient retaining urine... by the time day shift arrives, BP is under control in the one room and I've done all I can for the lady retaining urine because the night intern finally said (at 630) "well we can let the team decide when they get here in a half hour"
So when shift change comes on, I tell the oncoming nurse to meet me in unstable patients room because I'm gonna clean him up before I leave...
Said nurse comes into the room, sees what I am doing, goes to bed 2 (behavioral problem patient) and states " I refuse to accept handoff until bed 2 has been cleaned" and this said in not a nice way at all!!!
I respond with "I'm cleaning bed 1 right now and still need to give you report... you guys have 4 techs today...." I don't even get to finish when he says, " I will not accept him like this" and leaves the room!!!
I finish what I'm doing, track down the nurse and give report amongst sighs and eye rolls as I outline a couple issues for the day team to make decisions about on post op patient, etc.
After report, I do a rudimentary cleaning of behavioral issues patient and walk back saying "okay, he is clean" as I wash my hands at the nurses station... his response is a grumble and I merely say "your welcome" in as light a tone as I can manage at this point...
To make matters worse, I leave then backtrack when I find the PCA key in my pocket and catch him complaining to another nurse about me!!!!
To say the least, I am peeved.... Any advice on how to best handle this in the future as well as dealing with unprofessional behavior both in front of patients and to coworkers???
I have never had a problem with this nurse before and I'm very upset at the whole thing....

NicuGal has the right of it. The parts I highlighted above are where I believe you made a mistake.

Your mistake was that you validated him. You validated his assuming authority over you that he does not have. Bullies do this. You must nip that behavior in the bud and be very assertive with it as you do.

Bullies love to make camp just across that line in the sand (your boundaries) and dare you to make them move. If you don't, they've successfully redefined where the line is and eventually will stand up and cross it again, a little closer this time. On and on the process repeats until...........you explode and make yourself the bad guy.

He is refusing to receive report, so at that point, he is no longer a part of the solution or care team. He's removed himself from it all. It's not your responsibility to convince him to come back.

At that point, you can only go to the Charge Nurse or Manager and ask who you can give report to. It's their call, their decision to make on how to proceed.

You see, he has a right to complain if he feels accepting the assignment is unsafe. He even has a right to refuse an assignment if it's unsafe. He does not have the authority though to make up his own policies about how to refuse an assignment and what you need to do to make it right. That is between him and those higher up on the chain of command.

He is either willing to accept the assignment, or he is refusing it as unsafe. There is no "I'll not take it until................". Again, he is not in a position of authority to generate day to day policies on what must be done before he'll get report.

You humored his "false authority" a bit much, from my point of view. When he refuses and assignment, he must mean it. Let him be accountable for explaining himself. Don't stress yourself appeasing false authority.

While it may seem easier/nicer to humor him, you will one day regret it. You said you were stressed but not angry. Well, guess what? The day will come when you are in no mood for his false authority and impromptu policy making. He'll repeat this behavior, you will respond in kind and..........you become the bad guy. Thats how bullies work, very good at making you the bad guy for not putting up with them.

So nip it in the bud, refuse to validate his false authority.

Kooky Korky, BSN, RN · Sep 6, 2016

Oh, I'm so glad I found this post today. I just signed up to Allnurses today a few minutes ago for the first time because I have this EXACT issue going on and I'm hitting a brick wall with what to do. I've been an RN for ten years, all in the ED, and I'm also a CEN and halfway through my FNP program. I say this only to give you an idea of who I am, my background and unit I work.
I work days in a 15 bed ED. The hospital has been open for only three years and we are already seeing over 60 patients on day shift alone. (Yes, I worked in larger EDs but keep in mind the scope of this unit and hospital). The night shift is so used to walking into an empty department and not having to hit the floor running. Lately, as the census has increased significantly, we still have a full house at 1900 and all the "tasks" have not been completed by day shift. Obviously, this irritates the night shift RNs to no end. Report usually consists of "what time was that ordered and why has it not been done?" I'm so sick and tired of this attitude. Management is involved (great!). But I'm just over their attitude. And yes, I had to go back to the nurse's station after I left and turn something in that was in my pocket, and they were just going on and on about me....
Management needs to be involved. But, then what??? I've done some pretty intense self-reflection...what can I do better, prioritize better/faster, but in the end I ask myself "What the heck do you expect?"
I've made a conscious effort to run like crazy during that magical "witching hour" 1800-1900. But, now I'm exhausted. All my nursing "tasks" are done, I have maybe two discharges that are still up, and an hour of charting to do, but is that right? (I've been told that those are 'my discharges' to get out) Now, the next shift is complaining that I'm sitting at "their" computer while I finish my charting. Every day is unique, I get it, and there is no fixed formula. But I need help with too.

I guess we have to strike a balance between trying to keep the oncoming shift happy and setting correct priorities about tasks, safety for patients, and getting your unpaid rest/meal break. It seems somehow wrong to put your own well-being on a part with the other things, but it is not really unreasonable at all.

Sometimes orders are not done despite having been written a while ago and it isn't due to laziness or disorganization or intentional avoidance by the nurse. Sometimes there are higher priorities.

Some staff can't be pleased no matter how hard you try.

The problem comes when your manager sides with the complainers without asking you for your side of the story.

Try keeping a little log of what you do all shift. Just enough verbiage to help you remember. It might explain why this or that order wasn't carried out if you were on a code or the pt was out of the department having tests or other procedures. Of course, no explanation will ever really be good enough for coworkers who come in with an attitude.

Just do your best, do not overdo, do not sacrifice yourself to try to please others. It will get you nowhere except burned out, used up, bitter, and old before your time. Buddy up to the boss. :roflmao:

If you are shirking, quit it. :eek:

sevensonnets · Sep 6, 2016

I needed a good laugh, Korky. If you're shirking just quit it!

CoffeeRTC, BSN, RN · Sep 9, 2016

This is universal to nursing. I work LTC and have days like this. 3-11 and 11-7 run on much less staff, no support staff either. Accidents happen close to shift change too. Nurses need to give and get report.

We tried to solve some of these issues by staggering report and having the CNAs get their assignments as soon as they walk in the door and get them moving.

AutumnApple · Sep 9, 2016

This is universal to nursing. I work LTC and have days like this. 3-11 and 11-7 run on much less staff, no support staff either. Accidents happen close to shift change too. Nurses need to give and get report.
We tried to solve some of these issues by staggering report and having the CNAs get their assignments as soon as they walk in the door and get them moving.

I've had to face this problem from both ends: involved in it as a nurse and being tasked with solving it as a supervisor.

To solve it, you must first make your objective. What end result are you looking for?This sounds trite, unnecessary, as though I am stating the obvious. But this is the step too many skip and hence they make little progress.

Many facilities approach the problem with a myriad of delightful, general goals in mind: Improve moral, make a more efficient hand off process for the staff, foster better care so that there are less unaddressed issues come time for hand off report..............

Fantastic goals but it's a tall order. Very tall. No one is going to achieve that with a few policy changes and "sit downs" with problematic workers. It's better to approach it with one, specific goal in mind. Said goal should be more of the short term variety, not a head in the sky altruistic one.

Ours was to make the hand off process itself more efficient, nothing more. We did a few different things to achieve the goal:

1. Like your facility, we staggered the UAP and nurses schedules so not everyone was coming and going at the same time.

When everyone is doing hand off report at the same time, the patients are left neglected for that half hour. We choose to put this in the back of our minds, but it is a fact. Every time a shift change occurs, the patients experience a stop in care. Unless they are coding, pretty much every request they make is going to be put on hold until after hand off is done.

At least with the UAP still available, requests to be toileted or for water and things of that nature are taken care of.

2. For shift hand off to be more efficient, the culture of the facility needed improving. We had a handful of people just like the one described in the OP.

People who like to assume authority and make demands of others that they are not in a position to make drag down efficiency. To stop this, I had to have a talk with those specific problematic individuals. But we couldn't make them feel singled out. So we did a mandatory workshop where everyone was addressed at the same time, problematic and non problematic workers alike.

The message in said workshop is reflected in the post I made earlier pointing out how these people were assuming authority they don't have.

We went through the guidelines of how one can refuse an assignment if they consider it "unsafe". We also discussed what is and is not "unsafe", because someone who needing their bed changed is not unsafe. We stressed what conduct is expected while refusing an assignment as well.

3. We changed our policies on reporting deficiencies that were repetitive when relieving someone. We developed an anonymous way to report issues that are unsafe but still not ideal practice.

We also started using peer reviews for quarterly (but not annual) employee reviews. We felt workers who made a habit if letting things fall onto the next shift would be exposed here.

4. We changed the tardy/late clock out policies. Hand off report was to take place at very specific times. The facility used a point system for attendance. If you delayed hand off and got out of report late, it was the same as arriving and punching in late. So, people who did things like what the OP described, walking around giving people attitude and refusing report, were at risk for write ups.

The culture did change quite a bit. Yes, it lead to one person being let go and some quit. Most felt the new attendance policies were too restrictive. But I must say, the culture changes took us in a positive direction. It seemed the new policies affected the individuals who were the problem, for the most part.

The guy who the OP described would not have lasted with us is all I'm saying. And that, to me, is the real problem. The facility he is working at is generating a culture in which his behavior is promoted and accommodated. Change that culture, he'll hang himself.