I worked 7a to 7p yesterday and three of my five patients are discharged. The ED usually hold their patients till shift change time so they don't need to get new patients, it happens all the time. Two of my three new admissions all came in at 7:15pm during the shift report and the night shift nurse was upset that she has to do the admission stuff. I tried to give her report and help with the new admission as much as possible.
The night shift nurse has a foul mood and is so nasty. She questions every single thing I said in report. She starts to assess her pt during the report so I have to stay. I asked her that she seems upset, did I do something wrong. She said "oh no, it's not your fault. They give me so many damn admissions at the same time". I don't understand why she is giving me hard time.
I know maybe the best way is to ignore this type of passive aggressive nurse. They make the work place like hell.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
our ED does this all the time! They get travel orders to the floor by 9 pm and then send EVERYONE up at 10:30 pm. Then the nurses that have these patients send them to the floor (2 and 3 at a time - its not uncommon to get 4-5 admissions at shift change) and then the ED nurses walk out at 11 pm without having to assess or report off.
I think you don't understand the process. I wish that we as nurses would just stop laying blame and come up with solutions or try to understand the process may be out of the ED nurses control.
I have done many process research projects on this very subject. The solutions are simple but require cooperation. The process begins with the physicians and making them behave...to work up and disposition the patient as quickly as possible. I have worked with many physicians who have perfected the process of extended work ups and delayed dispositions on the patients to an art form. They process these patients with agonizing precision only to officially dispo them at the end of THEIR shift. Once dispositioned the bed can be called for, the bed them needs to be assigned.
New "regulations" and watchdog time keepers don't time the physicians timing delaying the process but they do measure the nurses...the clock begins to tick and these patients have a specific time frame now to reach their destination. Hence the mass exodus...the nurses have little control over this.
Any good ER nurse KNOWS which of his/her patients are going to be admitted and so does the MD who painstakingly, agonizingly, works up a hang nail for it might change the orders. They KNOW that at the end of their shift these patients need dispo and final evaluations or the oncoming MD starst essentially from scratch (not really) by ER "regulations" and this NEVER makes the oncoming MD happy. The on coming MD also has to deal with the angry patients that have been kept waiting so suddenly the present MD gets a fire under tier behind and dispos a group all at once that everyone knew, including the MD that the patient will be admitted.
Now you need to get the cooperation from the hospitalist who will only come and evaluate the "group" at one time because they are "busy and not going to keep running down to the ED" to admit patients.
The cycle begins again...and in the end nurses are blamed once again, even by their fellow nurses, for being responsible for it all...when in fact it the physician driven.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
So I may perceive the reasons wrong but it is true that a lot of our admissions on med-surg come on shift change time.
Second, med-surg floor is such a fast paced floor where patient turn over is one or two days. I do not understand why it is justified to be upset that you get two admissions when you come on shifts. The charge nurse have helped her with one admission already. No one intentionally does it to her, it is just the nature of the work.
Do you want to work with someone who is upset and hostile?
I think it could be an expectation issue. so Just curious, your coworker is supposed to leave at 730 and the admissions come at 715, do you expect the coworker to stay and do the admission stuff?
Med-surg is a tough floor to work under any conditions. I openly admit my admiration of the medsurg nurse. It is helpful to remember that if you are busy so is the ED. Depending on your ED those nurses may be seeing 80 to 100 +++ (on average for a community hospital) per shift.
[h=2]Hospital emergency department care[/h]
Number of emergency department visits: 129.8 million
Emergency department visits per 100 persons: 42.8
Number of emergency department visits resulting in hospital admission: 17.2 million
Number of emergency department visits resulting in admission to critical care unit: 2.1 million
The ED statistically sees far more patients in a day than the floor and they are busy as well. Your facility has a bad policy that needs improvement. Start a committee to see how you can improve this process. It can be done.
I think the nurses on the floors, actually everywhere, are maxed out at the demands placed upon them by the administration. I wouldn't take your co-workers agitation personally work towards a solution. Ask her how you can improve the process for her as she seems angry and upset. Ask what I can do to improve this for her. As you bring the behavior to her attention maybe you can work out a solution...together and therefore helping you both instead of assuming that she is a passive aggressive bully that needs to be avoided.
It is almost impossible to always equally distribute new admissions among nurses. Suppose the hall way is 200 ft, is it reasonable to expect a nurse at the end of the hall to admit a new patient in room 1 just to equally divide the new admissions? Again, there is no reason to be upset when you get two admissions at the same time. It happens this time to you, it can happen next time to another nurse.
Maybe I am not clear, but I think I can tell the difference between asking questions and being hostile. ok, she went to verify the IV site and fluids, that's fine, but she starts to lift the pt's gown and listen to her lung sounds, bowel sounds, to empty the 30cc from pt's colostomy and to have a five minutes conversation with the pt when I am waiting to finish my report, that is rude.
That depends. Does every nurse on her shift have at least one admission when they come on shift? If so, someone needs to talk to the ED about their patient flow. If not, and she is getting two admissions while other nurses have none, she needs to talk to your shift's charge about more equitable patient assignments.
Again, you haven't said anything to show this nurse is hostile. You've just said she asks questions during your report. She is upset about the admissions, but you haven't given a bigger picture about admission assignment on your floor.
Oh, absolutely not. At 7:15 is during report time! If I knew the patient was coming prior to the other shift clocking in, the only thing I would do is put toiletries in the room, grab a VS machine, and move furniture so that the patient can get settled. Question to you: does she ask you to stay and do the admission or do you do it because you feel you "have to" because she's annoyed? I had to learn to put my foot down on very late-in-shift orders that take considerable time to do, although I usually try to gather supplies and educate the patient on them.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I worked 7a to 7p yesterday and three of my five patients are discharged. The ED usually hold their patients till shift change time so they don't need to get new patients, it happens all the time. Two of my three new admissions all came in at 7:15pm during the shift report and the night shift nurse was upset that she has to do the admission stuff. I tried to give her report and help with the new admission as much as possible.
The night shift nurse has a foul mood and is so nasty. She questions every single thing I said in report. She starts to assess her pt during the report so I have to stay. I asked her that she seems upset, did I do something wrong. She said "oh no, it's not your fault. They give me so many damn admissions at the same time". I don't understand why she is giving me hard time.
I know maybe the best way is to ignore this type of passive aggressive nurse. They make the work place like hell.
The night shift nurse told you her foul mood had nothing to do with you, that it was because she had too many admissions at the same time. She wasn't giving YOU a hard time, she was just cranky. YOU personalized it when it had nothing to do with you.
Questioning you during report isn't passive-aggressive, either. It's what nurses do to ensure they understand what is going on with the patient. Everyone looks at the information in a slightly different framework -- the way I understand it best probably isn't the way you understand it best. If you were -- as most of us do -- giving the information the way you'd want it given to you, she probably had to ask for clarification so it was meaningful to her. That's annoying, I know, but hardly foul or nasty.
Ignoring that nurse isn't going to accomplish anything good. She wasn't being passive agressive, passive or aggressive. She was just a justifiably ticked off nurse who wasn't covering it sufficiently well for your comfort level. The best thing YOU can do is to adjust your attitude, since you aren't going to be able to adjust anyone else's behavior.
It is almost impossible to always equally distribute new admissions among nurses. Suppose the hall way is 200 ft, is it reasonable to expect a nurse at the end of the hall to admit a new patient in room 1 just to equally divide the new admissions? Again, there is no reason to be upset when you get two admissions at the same time. It happens this time to you, it can happen next time to another nurse.
Maybe I am not clear, but I think I can tell the difference between asking questions and being hostile. ok, she went to verify the IV site and fluids, that's fine, but she starts to lift the pt's gown and listen to her lung sounds, bowel sounds, to empty the 30cc from pt's colostomy and to have a five minutes conversation with the pt when I am waiting to finish my report, that is rude.
You haven't answered my questions, but that is your prerogative. I just can't say in reply to the information given, "Yeah, she's rude and hostile, and how dare she!" I can however encourage you to politely put an end to the assessments during report, as I suggested in a previous post.
A lot of people complain about the ED holding patients so the individual nurses will not have to get a new one. In my experience it is often a combination of MD not completing the chart, Housekeeping not thru with cleaning room, receiving nurse not available for report from ED nurse---the list goes on and on
As for PA nurse- you have nothing to feel guilty about, unless you are making assignments and decided to load her down. Otherwise, it is what it is.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
It is almost impossible to always equally distribute new admissions among nurses. Suppose the hall way is 200 ft, is it reasonable to expect a nurse at the end of the hall to admit a new patient in room 1 just to equally divide the new admissions? Again, there is no reason to be upset when you get two admissions at the same time. It happens this time to you, it can happen next time to another nurse.
Maybe I am not clear, but I think I can tell the difference between asking questions and being hostile. ok, she went to verify the IV site and fluids, that's fine, but she starts to lift the pt's gown and listen to her lung sounds, bowel sounds, to empty the 30cc from pt's colostomy and to have a five minutes conversation with the pt when I am waiting to finish my report, that is rude.
If you facility was doing bedside rounds this would be the hand-off report. You need to be careful not to over think the situation. The nurse told you it wasn't you maybe she really meant it. Don't look for things that might not be there.
So I may perceive the reasons wrong but it is true that a lot of our admissions on med-surg come on shift change time.
Second, med-surg floor is such a fast paced floor where patient turn over is one or two days. I do not understand why it is justified to be upset that you get two admissions when you come on shifts. The charge nurse have helped her with one admission already. No one intentionally does it to her, it is just the nature of the work.
Do you want to work with someone who is upset and hostile?
I think it could be an expectation issue. so Just curious, your coworker is supposed to leave at 730 and the admissions come at 715, do you expect the coworker to stay and do the admission stuff?
I do expect my coworker to stay over. The patient technically was reported to this coworker, and she should at least start the database. This is my opinion & it may not reflect the general views of other nurses.
But, if you have a more thorough report of the patient & I am to pass meds, do assessments, etc. I believe the nurse who received primary report should at least pitch in to assist.
It is almost impossible to always equally distribute new admissions among nurses. Suppose the hall way is 200 ft, is it reasonable to expect a nurse at the end of the hall to admit a new patient in room 1 just to equally divide the new admissions? Again, there is no reason to be upset when you get two admissions at the same time. It happens this time to you, it can happen next time to another nurse.
Maybe I am not clear, but I think I can tell the difference between asking questions and being hostile. ok, she went to verify the IV site and fluids, that's fine, but she starts to lift the pt's gown and listen to her lung sounds, bowel sounds, to empty the 30cc from pt's colostomy and to have a five minutes conversation with the pt when I am waiting to finish my report, that is rude.
She, like many, when having the overwhelming responsibility of completing two admissions upon arrival was attempting to reduce her work load...possibly. If you feel as though she was being "Passive", I wouldn't consider this any form of aggressiveness, you should address it with her the next shift.
I would suggest, going home & leaving work at work. You did what you were there to do, you gave the report she was looking for, and you attempted to rectify the situation by volunteering to stay beyond shift.
Too many people attempt to look for fire where there is none. If she said she wasn't upset, take her for her word & keep it moving.
She said "oh no, it's not your fault. They give me so many damn admissions at the same time..
When I read the above I imagined the other nurse emphasizing the YOUR.
Only the OP knows the tone that was given her and she may have taken it as rude. I don't think Any of us can argue that since we weren't there. I used to be a secretary on a busy hospital floor for a few years and I used to work 7p-7a. Sometime 7a-7p. When I worked nights coming on? I used to have charts upon charts of admissions that needed to be done. Seems like the ED always called up for an admission around 6:30 or so. Until I worked day shift. The ED Kept calling wanting to give report. Finding the nurse was impossible. I had to tell the ED they would call back or the nurse would say I'll call them back in a minute. A minute turned into Alan hour and they tried to prolong getting report until it was close the the 7p crew came in. Because what nurse at 6:30 is going to so an admission! Lol the. The 7p shift would be all PO'd etc. the shifts used to do it to each other. It was crazy!
There is also the factor that staffing numbers change with the shifts; sometimes we don't get room numbers until the number of nurses or ratios change with the shift. Then we will get multiple room numbers all at once, (because more beds have "opened up") and the oncoming shift expects us to get all the pts moved since we the offgoing shift have been doing all the care and can better answer the questions.
Why were you not done giving report by 7:15, your shift was over for 15 mins already. Maybe your not giving a good enough report so she needs to ask lots of questions. She said she wasn't mad at you, it doesn't seem aggressive to me.
Esme12, ASN, BSN, RN
20,908 Posts
I think you don't understand the process. I wish that we as nurses would just stop laying blame and come up with solutions or try to understand the process may be out of the ED nurses control.
I have done many process research projects on this very subject. The solutions are simple but require cooperation. The process begins with the physicians and making them behave...to work up and disposition the patient as quickly as possible. I have worked with many physicians who have perfected the process of extended work ups and delayed dispositions on the patients to an art form. They process these patients with agonizing precision only to officially dispo them at the end of THEIR shift. Once dispositioned the bed can be called for, the bed them needs to be assigned.
New "regulations" and watchdog time keepers don't time the physicians timing delaying the process but they do measure the nurses...the clock begins to tick and these patients have a specific time frame now to reach their destination. Hence the mass exodus...the nurses have little control over this.
Any good ER nurse KNOWS which of his/her patients are going to be admitted and so does the MD who painstakingly, agonizingly, works up a hang nail for it might change the orders. They KNOW that at the end of their shift these patients need dispo and final evaluations or the oncoming MD starst essentially from scratch (not really) by ER "regulations" and this NEVER makes the oncoming MD happy. The on coming MD also has to deal with the angry patients that have been kept waiting so suddenly the present MD gets a fire under tier behind and dispos a group all at once that everyone knew, including the MD that the patient will be admitted.
Now you need to get the cooperation from the hospitalist who will only come and evaluate the "group" at one time because they are "busy and not going to keep running down to the ED" to admit patients.
The cycle begins again...and in the end nurses are blamed once again, even by their fellow nurses, for being responsible for it all...when in fact it the physician driven.