So I am having an issue with giving a particular nurse report. The problem is that she expects the reporting nurse to "spoon feed" her every minute detail beginning with circumstances surrounding reason for admission up to the current time. She's expects this from everyone, not only me and it's well known throughout our unit that if you see that you're giving report to this person, you know you will not be leaving on time.
Some of our patients have quite lengthy stays and are very complex, depending on their circumstances and you can imagine where it then becomes tedious to review every single thing/test/lab/etc that has occurred.
Recently, as one example, she was receiving three patients and another nurse had started giving her report on two of those patients. I also had to give report on three patients; I gave report on two of mine to another nurse in fifteen minutes. I go over to where the nurse who takes forever is getting report and wait for about ten minutes. Finally, I say something like, "all done?" or "You ready for me?" and I am told they have just finished report on ONE patient. So it's now 25 minutes into the half hour we have to give report and I am expected to wait likely another 20 minutes to even begin. The nurse giving her report kind of rolled their eyes as they know how it is.
I know that the charge nurses and manager are aware of this but everyone accommodates her repeatedly.
My question is....how can I put my foot down and refuse to stay over every time I give her report, based solely on the fact that she asks a million nonpertinent questions, interrupts constantly and wants to be informed of every little detail? I would like to say to her, when it's time for me to leave and it's obvious I'm not going to get done anytime soon (or haven't even begun yet), "I have updated the report sheet....any further questions can be directed to the charge nurse as I have obligations at home and I must leave on time today." Of course I would notifiy the charge nurse also. I don't want to to be accused of patient abandonment.
Is going to be a bit difficult to backtrack because this nurse has been appeased and has grown accustomed to being spoon fed her patient information. Your coworkers must all be on the same page and I agree that management needs to be involved. Most shifts overlap by 30 min so if you divide the number of patients you have by 30 you will get the time allotment that can be used for report. So if you have 6 patients you get 5 minutes per patient. You can start the time limit on your own but everyone will have to do this as well because if you have a split report you will just be waiting to give your report while she is sucking all the info from the other nurses giving report.
I would also tell the nurse that each patient report will not go over 5 min. You give her a 2.5 minute report..she gets 2.5 minutes to ask any questions and then the rest she can look up on her own. Make sure that you can give a succinct and well rounded report in that time allotment. She will not change unless you lead her into the new way of doing things. She will not like it but the reality is that part or the job is getting tasks completed in the time allotted. She is being very insensitive to fact that most employes do want to leave on time after a long shift and incidental overtime often is reported in yearly evaluations as a negative and reflects as poor time management. Out of curiosity I wonder if she gets out on time or if her report goes on and on to the oncoming nurse. If it too is long winded it may reflect on her inability to select the pertinent information and then she will need to be give a cheat sheet or an outline to follow.
The problem is definitely worse when the report is split between two nurses as one has to wait for the other to finish up. However, I have stayed over 20 min before, giving her report on TWO patients. So that is 25 min per patient!!! She tends to go off on tangents when you're speaking and jumps ahead to things you haven't gotten to yet, so it makes it difficult for the reporting nurse to stay on track. And she likes to write down every word that comes out of your mouth:
Me: pt had a recent abdominal aortogram with right femoral artery balloon angioplasty
Her: abd..om...in....al aor..to...gram (sounding the words out to herself while writing)
so it's difficult to keep the flow of report moving smoothly as you must wait for her to write everything down.
The problem is definitely worse when the report is split between two nurses as one has to wait for the other to finish up. However, I have stayed over 20 min before, giving her report on TWO patients. So that is 25 min per patient!!! She tends to go off on tangents when you're speaking and jumps ahead to things you haven't gotten to yet, so it makes it difficult for the reporting nurse to stay on track. And she likes to write down every word that comes out of your mouth:
Me: pt had a recent abdominal aortogram with right femoral artery balloon angioplasty
Her: abd..om...in....al aor..to...gram (sounding the words out to herself while writing)
so it's difficult to keep the flow of report moving smoothly as you must wait for her to write everything down.
I think I know this person LOL. Does she have ADHD? I would grab her when she walks in and say good morning now I need to get out of here on time today so lets get started. Keep it brief and focused. If she tries to ask a lot of tangential extraneous questions say I'll get to that. You have to train her to be efficient and get the next nurse lined up to do the same thing. You and your colleagues can handle this yourselves.
Yes, I'm also curious, when she gives YOU report, is report as lengthy and meticulous as she requires from other nurses?
I try to keep her moving along because I want to get my shift started and get in to assess my patients. When I have the info I need, I try to politely wrap it up.
I just want the basics and pertinent info, I can look up the details myself. I'd rather the nurse reporting to me give me info that wouldn't be in the chart or helpful info related to the patient such as, the pt wears glasses but they were left at home; the pt prefers her water without ice; the pt's husband recently passed. She definitely does not give as many details as she wants others to provide to her.
Every patient should ideally have a running Kardex type sheet detailing their history as a quick reference, so you can skim these parts in report without her having to dig through the chart to find information she wants. And three ICU patients? Wow.
Yes, three ICU patients due to staffing issues. That's a whole other topic
I wonder if this is an issue of lack of experience rather than micromanaging. How long has the nurse been on your unit or working in a similar environment? Is it possible that she asks for all this information because she doesn't yet have the experience to know what information will be relevant for her shift? My thought would be to have her immediately at the end of each shift determine how much of report was relevant to her clinically that shift and how much was not, but this might be a better task for someone in management to take on.
Many PPs have made good comments but I have another suggestion possibility. Because of the overtime issue, I would guess that mgt would be desirous to avoid it. So I suggest requesting a supervisor or staff educator (if poss) to be physically present for the shift change report and to observe & monitor that nurse's needy report.
I realize it would be a deviation from supervisors' shift change report, but it's only to be a one (maybe two) time occurrence. Since it's your shift that preceeds needy nurse, I would further suggest that it be your supervisor to see the problem. (Wanna bet that the nurse will be on her best behavior as she knows she's being watched!) Supervisor recommendations for needy nurse would then appropriate.
And I like that suggestion re getting the union involved. Yep! It is HER style of report that is causing you (and others) overtime. That subjects you to mgt review. That is distressing to you as it potentially sets YOU up for disciplinary action. Yep! Negative work environment. I like that.
Any hint that Miss Thing could have had an unsuspected/unreported head injury? Learning disability? Prescription medication change? I'd look at this lack of executive functioning (prioritizing, filtering, organization) as evidence of something like that.
Perhaps your manager could ask as part of her annual review/counseling (which she IS gonna do, right?), because she notices Miss Thing's having a hard time with this sort of thing. She can say it's illegal to ask about personal medical conditions, so she isn't, but that she is concerned because it seems like Miss Thing is having an increasingly difficult time keeping up, and would she like to have an eval scheduled via employee health? Because if things don't improve, Miss Thing isn't going to meet performance criteria for remaining on this critical care staff (there are objectives for, like, passing orientation and being independently functional, right?), and will have to put in for a transfer. Then sit back and see what Miss Thing says.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
The problem is definitely worse when the report is split between two nurses as one has to wait for the other to finish up. However, I have stayed over 20 min before, giving her report on TWO patients. So that is 25 min per patient!!! She tends to go off on tangents when you're speaking and jumps ahead to things you haven't gotten to yet, so it makes it difficult for the reporting nurse to stay on track. And she likes to write down every word that comes out of your mouth:
Me: pt had a recent abdominal aortogram with right femoral artery balloon angioplasty
Her: abd..om...in....al aor..to...gram (sounding the words out to herself while writing)
so it's difficult to keep the flow of report moving smoothly as you must wait for her to write everything down.
ab...dom..in..al... Can't even abbreviate the usual diagnoses? This speaks to level of functioning and could be a huge performance issue. If her thinking is that cumbersome and methodical, how can she make timely judgements and interventions? Scary. And if she keeps derailing report with tangents and premature questions, she needs to learn to just shut up and listen. She is more than an annoyance, she is dangerous and management needs to intervene before she kills someone.
It is really simple. She starts to ask questions, tell her that if she just listens her questions will probably be answered. Give just the facts of dx, any RECENT labs that may have been ABNORMAL. Any RECENT test results. And any oertinantningobthat may have happened on your shift and any info she may need for her shift like upcoming tests. If she demands more, tell her to read the chart. Cthen say your done. If she complains then tell her she has received report and you are leaving now. You control the report you give. Not her.
you may be closer to the truth then you want to be....
Any hint that Miss Thing could have had an unsuspected/unreported head injury? Learning disability? Prescription medication change? I'd look at this lack of executive functioning (prioritizing, filtering, organization) as evidence of something like that.
Perhaps your manager could ask as part of her annual review/counseling (which she IS gonna do, right?), because she notices Miss Thing's having a hard time with this sort of thing. She can say it's illegal to ask about personal medical conditions, so she isn't, but that she is concerned because it seems like Miss Thing is having an increasingly difficult time keeping up, and would she like to have an eval scheduled via employee health? Because if things don't improve, Miss Thing isn't going to meet performance criteria for remaining on this critical care staff (there are objectives for, like, passing orientation and being independently functional, right?), and will have to put in for a transfer. Then sit back and see what Miss Thing says.
ICURN3020
392 Posts
The problem is definitely worse when the report is split between two nurses as one has to wait for the other to finish up. However, I have stayed over 20 min before, giving her report on TWO patients. So that is 25 min per patient!!! She tends to go off on tangents when you're speaking and jumps ahead to things you haven't gotten to yet, so it makes it difficult for the reporting nurse to stay on track. And she likes to write down every word that comes out of your mouth:
Me: pt had a recent abdominal aortogram with right femoral artery balloon angioplasty
Her: abd..om...in....al aor..to...gram (sounding the words out to herself while writing)
so it's difficult to keep the flow of report moving smoothly as you must wait for her to write everything down.