Report vent turned mega vent

[loveoutloud]

I have become increasingly frustrated during bedside report at change of shift. Ignorant nurses wanting to know ridiculous details or why I didn't do certain things. I'm not telling the Dr. To switch my patient from their current anti-depressant to citalopram because YOU think it's Indictated. There is a reason why PSYCH decided on the particular medication and we need to give it a fair chance. I'm not advocating for an increase dose in flomax because it was started yesterday.....these things take time. I did however ask for an order for a temporary foley until the medication takes effect so the poor patient doesn't need to be straight cath'd q shift (and put it in of course). I'm sorry I didn't change the OD drsg either, my patient in another room passed away and I was comforting her husband. Nursing is a 24 hour job, not everything needs to be done between 7-3. All my patients are clean, comfortable, turned, and all the orders/tasks for my shift have been completed when I pass my patient off to you. I did not read social works last note, but I also didn't take a lunch break or pee. That's because I was helping a more junior nurse with a difficult IV stick and showering my patients because that has not been done for a week and I know you will be too busy texting to bother with it yourself.

You were the last straw- the reason why I accepted a position on another unit. We often work understaffed with high acuity patients that also require complete care. It's not safe. I cannot provide the quality care I would want my loved ones to receive and therefor feel like a crappy, inadequate nurse. I truly hope the staffing and other rough areas on the unit improve for you- surely working there is taking a toll on everybody.

the above vent is NOT the main reason why I left, but was the catalyst for being fed up with years of an unsafe environment and apathetic manager. The finger-pointing and witch-hunting when people make an error needs to stop. Mistakes don't need to be advertised during a staff meeting for everybody to know. I'm getting out before I become the subject of the aforementioned witch hunts.

thanks for reading my vent. Now I must put my game face back on and get back to work.

[jadelpn, LPN, EMT-B]

With the initiation of SBAR reporting at bedside....I would stick to it. Otherwise, that is what the chart and one's own assessment is for.

"Why did you not do XYZ?"......"Why, are you unable to complete that task?"

Sigh.

[WoosahRN, MSN, RN]

I forgot my major annoyance of the week (and a question I initially intended to ask in this thread): would it be rude to say "please wait until I'm done report before asking questions- I will probably get there" in response to constant interruptions? I cannot stand when people interrupt report with CONSTANT questions that 1) I will get to if you give me a chance 2) are stupid and irrelevant

I have absolutely told specific people that I would go through report and if they had questions they can ask at the end. These are the same people who are trying to organize their colored pens and read the computer while listening to report. Which means they aren't listening to report and they ask questions about things I just went over. There was one that I make her turn off the computer screen when we give report because she can't multi-task and somehow, when she was a new grad someone told her it would save time but she's not a good candidate for that (no one is really...feel free to look up anything you want once I leave. Report is meant to listen and get clarification. I also have a pet peeve with people who aren't focusing/listening/making some eye contact during the communication of important information).

[WoosahRN, MSN, RN]

If I get a terrible or scattered report I usually just sit back, get it over with and look stuff up. I make sure I know the important details of each system but usually it's less painful just to try and get in there and gather info.

I'm in PICU and we exaggerate about the type of nurses who need to know every detail..."Were they full term?" Asked on a 17 year old previously healthy child.

[canigraduate]

Eh, this quote sounds like a newerish nurse replying. Honestlyn if it's THAT important to you to find out if "the patient" is on tele, feel free to look up the order in the computer. I agree with the OP. I personally hate it when nurses try to use my report to gather their complete assessment. I am not there to do your patients assessment, do it yourself, dear.

Nope, dear. I don't appreciate the condescension, either. I'm not that new and I have worked in enough places to know a little about unit culture.

I expect nurses to know the basics about their patient. If they don't say "this patient is not on tele" or "this patient is not a fingerstick," then I'm going to ask them. Just the same way I ask how the patients ambulate, if that dressing has orders to be changed, etc.

If they get attitude with me and say, "Did I say tele? Then no, no tele!" then we have a problem. It's unprofessional and rude. A lot like your comment. I definitely don't expect you to do my assessment, because if you don't know whether or not your patient is tele or needs a fingerstick, I bet your assessment isn't worth much.

[canigraduate]

In those particular cases - accuchecks and telemetry - the solution is simple. (1) look at the monitor. (2) look at the orders for accuchecks and/or insulin and telemetry.

Problem solved w/o management.

It's not that I can't look it up. I actually prefer to look things up. It's that the nurse is being rude. If you tell me "Did I say they were on tele? No? Okay, then that means they aren't on tele!" then I will tell you to grow up. I don't put up with that. Attitude problems are above my pay grade and are definitely the province of management.

[canigraduate]

Eh, this quote sounds like a newerish nurse replying. Honestlyn if it's THAT important to you to find out if "the patient" is on tele, feel free to look up the order in the computer. I agree with the OP. I personally hate it when nurses try to use my report to gather their complete assessment. I am not there to do your patients assessment, do it yourself, dear.

I find this post to be condescending. I am not a new nurse. I expect you to know the basics about your patient. If it was hospital policy to look everything up, why would I need to talk to you in the first place?

[traumaRUs, MSN, APRN]

Lets TRY to be polite with each other.

We all have pet peeves that can push us over the edge. However...this was meant as a vent thread.

Thanks...

[THELIVINGWORST, ASN, RN]

I find this post to be condescending. I am not a new nurse. I expect you to know the basics about your patient. If it was hospital policy to look everything up, why would I need to talk to you in the first place?

It's not that the off going nurse doesn't know, it's that it's wasting time. I'm not spoon feeding report to anybody. I don't advocate being rude but some nurses will ask the silliest questions sometimes.

I show up 30 min early everyday so I can look over orders and labs and things so that I am ready for report and can have ACTUAL important "can't find the information anywhere else" questions ready after listening carefully to report.

All I ask in return is for the next nurse to be ready for report when it's time to go home.

[smf0903]

Posts/responses like this are part of the reason I love how we give report on our floor. We have a 5-10 minutes report on every patient on the floor (granted, we are a small community hospital so we can do this) from the charge nurse. Every nurse and aide gets a sheet tht lists every patient and pertinent info (admit date and dx, important hx, tele and rhythm, if they are accucheck, if on O2 and if so at what rate, activity order, diet order, code status, foley/attends, if they are a daily weight, if they have any procedures coming up--also things like if we still need a sputum, IV fluids and rates, HIPAA password, and where they are being discharged). This sheet of info is fantastic to have because we have a go-to of basic information for each and every patient. Then we can get the nitty gritty from the RN going off duty. It seriously cuts down on having to scour through the computer for this info, especially if answering a call light on another RN's patient. The sheet is updated as needed and redone every 24 hours by us night shifters. It makes beside report smoother, in my little ol' opinion anyhow LOL :) Personally I make a notation if I have questions and save it for the end of report...9 times out of 10 the question is eventually answered at some point during report.

Good luck in your new spot!! I hope you love it!

[Horseshoe, BSN, RN]

If you did that to me, I would report you. There is no reason to be rude to the oncoming nurse when YOU didn't address a question.

If they get attitude with me and say, "Did I say tele? Then no, no tele!" then we have a problem. It's unprofessional and rude. A lot like your comment. I definitely don't expect you to do my assessment, because if you don't know whether or not your patient is tele or needs a fingerstick, I bet your assessment isn't worth much.

But why would you report them? That just sounds really juvenile. Why wouldn't you address this adult to adult instead of running off to tattle? If you have a chronic problem with a coworker, you've addressed it yourself with various tactics, and it continues, then yeah, time to take it higher.But your previous post said you would report this person. If I were the manager, my first question would be "What have you done to try to address this situation?" If the answer was "I am addressing it-I'm coming to you," I would not be impressed.

[CountryMomma, ASN, RN]

Look, I know if my patients are on tele. How do I know? Because I LOOKED AT THE CHART. I don't expect the off shift to read me the kardex. If you need the off shift to tell you whether or not your patient is on tele, I'm thinking you didn't bother to look up the patient.

Actually, this is all moot - I most often report what rhthym they've been in t/o my shift.

I'm not the kardex. Want to know everything about the patient? There's the EHR, I have 3-4 other nurses to report off to and charting to finish.

[canigraduate]

Look, I know if my patients are on tele. How do I know? Because I LOOKED AT THE CHART. I don't expect the off shift to read me the kardex. If you need the off shift to tell you whether or not your patient is on tele, I'm thinking you didn't bother to look up the patient.

Actually, this is all moot - I most often report what rhthym they've been in t/o my shift.

I'm not the kardex. Want to know everything about the patient? There's the EHR, I have 3-4 other nurses to report off to and charting to finish.

I don't know why you're so upset about the tele. I don't want you to tell me everything about the patient. I just expect you to know the basics. A good report with the major info should take less than five minutes per patient. Two minutes, if you're really good.

On a fast-paced unit like mine, the expectation is that you give good report based on an SBAR sheet because the oncoming nurse doesn't have the time to do a full chart check. Half the patients I get report on I will be discharging or transferring within the next hour or so, to be replaced soon after.

I check labs and read the latest progress notes, and that's about it (unless I have crappy report). Night shift does the chart checks if the patient stays that long.

On the SBAR we have, we're even supposed to report the tele box number. I usually skip that part, because that's a little too detailed for me.

I didn't know that kardexes were still in use, LOL!

As far as reporting a nurse, I don't usually jump straight to that step unless the nurse in question is flat out rude and unprofessional. Like I said, I don't put up with that. I've been around long enough to know when someone is salvageable with assertive communication, and when they're not. I don't like to waste time on those people.

A large part of management's function is to manage interpersonal disputes and problem employees. I am not afraid to go to them.