report from a sloppy nurse

[edbed25]

Hi,

I was wondering how others deal with receiving report from a sloppy nurse? I always dread getting report from one nurse on my unit. She always leaves me with a mess which usually makes my night pretty awful.

Some examples.. 6 of our patients were supposed to have IV fluids hanging and none were when I came on shift. (she eventually helped me out and hung 3 before she left)

that same night someone came back from dialysis an hour before my shift started and she didn't check the vitals.. the tech checked them as I was getting report and he was hypotensive which started my night off hectic.

Another night, vitals were checked before I came on, and the tech came to the day nurse with a low BP. she said she would recheck it and never did. After the nurse left and I checked the vitals in the computer, I asked the tech why the BP was not entered. She told me how the day RN was going to recheck it manually because it was low using the machine. She never rechecked it and sure enough, the patient was hypotensive.

Another night, I made rounds before getting report, and a patient was screaming at me saying that she was promised pain medication. I asked the nurse if she promised her pain meds, and her response was "well she asked me for pain meds, I never said I was going to get it for her, it's the end of my shift."

I can go into a million other examples. How would you deal with this situation? I don't want to be a tattle tale, and others have reported her to management before.

[Altra, BSN, RN]

that same night someone came back from dialysis an hour before my shift started and she didn't check the vitals.. the tech checked them as I was getting report and he was hypotensive which started my night off hectic.

It may well be that this particular nurse has a time management issue or simply substandard performance. But the part of your post I quoted above stands out to me.

IMO and in my experience, 90% of shift-to-shift tension comes from a probably unrealistic expectation of having patients all packaged nicely and tied up with a bow before handoff ... and acute care simply does not work that way. Patient conditions evolve continuously 24/7 without regard for the clock, without regard for shift change, and without regard for whether or not the oncoming nurse has had time to "get situated".

Acute care nurses can continue to maintain the expectation of there being a predictable rhythm to their workday ... but it is not a realistic one, and they will find themselves repeatedly frustrated and disappointed.

[doho_rn, ADN, RN]

When I come on shift I get report from the previous nurse and that nurse and I round together going into each room to introduce/say bye to each pt. This is the standard on my floor and the other floors are looking to start doing it as well. At first I didnt like it and thought it was dumb, but it has really helped with issues like you are experiencing.

[ukjenn231]

Does your institution do any sort of bedside report?

It's usually unliked by many, but it sounds like it could help with this person. Maybe before she leaves, you could say "let's go meet the patients together" and go in each room. This way, you can quickly check - are IVFs up? Is the patient requesting medication? She will be accountable.

Good luck, I know this is a bad situation.

[jadelpn, LPN, EMT-B]

Yikes. I am not sure what else to add to the above pp's other than if you know that you are following a less than stellar nurse, and bedside reporting is not an option, make sure you get new full assessments on everyone right when you come on. Just reviewing your medications beforehand to see who may be due for pain medications as well.

What strikes me as odd is the "I assessed for pain but I never told patient I was going to medicate them, it is the end of my shift" SERIOUSLY?!

I would only go to the powers that be if you are consistently noticing that patients have dry IV bags that have been hanging for hours when they are on continuous fluids, that there's a medication (or 2) that have not been given that should have been--outward neglecting of what is supposed to be happening with these patients--as in that is why they are on the unit.

Best of luck with this!