Suggestions needed for New Nurse and MD Rounds

[clhankin67]

I am a manager for a Medicare HMO. I have 20 Nurses that are direct reports and they perform daily onsite reviews at hospitals and Skilled Nursing Facilities. They gather clinical and psychosocial information on the member's, and then give a brief telephonic report daily to a medical director. They have all been trained to give the basics of what brought the member in, symptoms, treatment and discharge plan. They all do well, except for one.

Although "Suzy" is very competent and knowledgeable, her reports are painful. She will go on and on about the most inconsequential discussion she had with the member's daughter about her poodle, but fails to mention that the member is on a vent, with 3 drips, NG tube, and + MI. You want to bang your head against a hard object when listening. She has only been with us 5 months, but has been an RN for 15 years, and has extensive UR and CM experience. I have had her precept with a seasoned Field Case Manager, I have worked with her one on one. I have had her listen to everyone else give report. I have had her highlight the most pertinent part of her review so that she can focus on what to deliver, all to no avail.

She does amazing documentation, and can tell you everything clinically, etc regarding her member, but cannot regurgitate it during report. I can't blame the medical director as he is extremely kind and gentle during his interactions with all of the Nurses, and will even try to redirect her during her stories by saying "OK, now in reference to the respiratory status" to which yesterday he got a response of "well I guess he was breathing OK, but you know he doesn't speak english like I said, and the wife does, but she wasn't there, so I had to find an interpreter, but if the wife had been there it would have been easier... for 5 minutes" Our reports are recorded, so I listened to the playback.

All of our staff work at home through out a large geographical area, and this nurse is located 2 hours from me. I try to make regular visits to work with all of my direct reports, but typically manage only once a month working 1 on 1 with them after they have completed their 6 week training.

I am at a loss and am open to any suggestions that anyone has to help redirect and focus "Suzy".

[Mijourney]

In my opinion, sounds like this nurse has storytelling imbedded in her personality. Can you formally script her? If she has a form to fill out, maybe that will once and for all get her to focus on the main facts. Once, she becomes scripted, maybe you can ease off on the formal requirements.

[JerseyLilly]

Could your worker possibly have adult attention deficit disorder or an underlying anxiety disorder? Perhaps, a one on one, softly spoken dialogue would help along with a template given on providing "just the facts"? There may be ways around this "chatty-ness" while utilizing and engaging her strong qualities. :sstrs:

[coast2coast]

In my opinion, sounds like this nurse has storytelling imbedded in her personality. Can you formally script her? If she has a form to fill out, maybe that will once and for all get her to focus on the main facts. Once, she becomes scripted, maybe you can ease off on the formal requirements.

Exactly what I was thinking. Some people just don't know when to shut their mouths - I have a wonderful cousin with a chronic case "verbal diarrhea."

Have (another?) conversation with her about staying on point, and then give her a script or checklist to follow. Make her fill it out and check off each part as she passes it on. You could also try giving her a set time to complete this in - with a little practice pacing herself, she might start to realize how much she rambles.