VENT: You mean I still have to work when I'm on the clock?

[Penelope_Pitstop, BSN, RN]

]I used to work on an extremely busy Med-Surg floor at my current hospital's "little sister." This is my fifth week on a much slower (but still busy) medical floor. I'm not a new nurse, but I'm new to the hospital and the floor. I must confess that I want my coworkers to like me, and this is causing me to bite my tongue concerning "Ramona." I don't know, though, how much longer "get thee behind me, Satan!" will work for me.

]

]The first night Ramona reported off to me, I gave the benefit of the doubt. We all have terrible nights, we all have given bad reports, we've all come to work feeling like crap, whatever. I know I've done it myself, and I know I'll do it again.

]

]I knew all of the patients in the group except for one, so report went pretty quickly. I didn't mind that at all, as I like jumping in and getting a start on everything. However, we're not allowed to clock out before 2330 (or whatever time) in my department, and our report was finished at 2310.

]

]During report, I had been told "the only thing I didn't get to do was verify the meds because pharmacy hadn't profiled them, and I'm still waiting on the PCA pump to arrive." Then a minute or so later (we were still giving report) escort arrived with said PCA pump.

]

]Since Ramona couldn't clock out for twenty more minutes and two nurses are needed to verify PCA settings, I asked if she could please do that with me before leaving.

]

]"No, I don't think the pharmacy's profiled the meds, have a good night!"

]

]I checked the computer and they were profiled, so I offered to sign off the order if she would get the tubing setup. She agreed, and came back with the necessary stuff.

]

]Then she looked at me and said, "do you even know how to set up a PCA?"

]

]I replied that yes, I did, as my old floor saw a lot of surgeries and I was a tech in the PACU before that, so I was rather familiar with them.

]

]The reply? "Well, sounds like you're the expert here, I'll let you do it," and I was handed the stuff.

]

]After I was finished, we set up the pump and then she left, but not before rolling her eyes and saying, "bed 35A wants pain meds, do you want me to do that, too, or can you handle it on your own?" I told her it was 2328, and it was entirely her choice if she wished to medicate the patient, but I didn't need her to.

]

]I wasn't exactly happy but shrugged it off to a bad night. The next night, report took up the entire half an hour and I did receive some weird information in report (I don't feel like going into details here), so I ended up not being happy then but for different reasons. (If a patient is nonverbal, he or she can still hear, goodness...now back to the topic at hand.)

]

]On the third night, I knew all of the patients so report took no time. There wasn't really anything new to tell me on the patients, either. We were finished yet again at 2310. This time, she didn't even ask if I needed anything. She said goodbye and retreated to the breakroom, where she remained until time to clock out.

]

]I think I've perhaps been spoiled by the rest of the evening shift nurses, who don't leave unless they feel that they've done everything they can, and wouldn't just chill by the time clock for twenty minutes. I know that I wouldn't do that. If I finished before 0730, I make sure the nurse following me is okay, and if so, I check with the other midnight shift people to help them get out on time, and also check with the day shift techs to see if they need help. During shift change, there is always someone who needs help!

]

]There are other reasons that following Ramona is difficult, but I'm not going to get into them. I'm going to focus on the issue of leaving ASAP even though one is still on the clock. Does anyone know what I'm talking about here?

]

]Thanks for listening.

[patwil73]

I can hear the frustration in your post and wish I could say something that would make it better. I honestly don't know if I have ever experienced that problem, as most of the reports I've been a part of have gone on way too long with way too much information (I actually like looking a lot up myself as it gets me more familiar and saves me from piercing together the scattered info I get).

However, back to you - I would probably concentrate more on the tasks not completed here. If things are routinely not getting done then you have a very valid and potentially serious complaint and I would not hesitate to let her know that if she has time at the end of her shift she can certainly finish some of her tasks. If it continues it should move to a write up.

However, if it is a rare occurence that tasks are not done then I see no problem with 20 minutes of downtime at the end of the shift. (:chair: Quickly ducks against the protests I know are coming).

I do think it would be nice if she helped out others that are behind, but maybe she is just a very efficient nurse and has grown tired of always having to help others on her floor who aren't so efficient (one possible scenario). Of course if someone asks for help and she is still on the clock she is ethically obligated to help here as she is getting paid for the work.

So without knowing anything else that is my . Talk with her about tasks not being completed (if that is the case) and try to let the 20 minutes of downtime slide off your back. Trying to change people's behavior in the sense that they should be - working hard up to the last minutes - rarely if ever is successful.

Hope this helps

Pat

[Penelope_Pitstop, BSN, RN]

However, back to you - I would probably concentrate more on the tasks not completed here. If things are routinely not getting done then you have a very valid and potentially serious complaint and I would not hesitate to let her know that if she has time at the end of her shift she can certainly finish some of her tasks. If it continues it should move to a write up.

]That's just it...during report, she lists off things she "didn't get to" during her shift...she did it every time she reported to me. And if most of the time report is quick, why can't she finish one of those things? Or check to make sure the paper work on her admission is complete (I haven't seen this happen yet, and the admissions were often around 1800).

]

]So yes, you hit the nail right on the head that this is the problem and not the down time. I know there are sometimes you can't do anything but twiddle yoru thumbs...it's a rarity but not anyone's fault, just like when things are going so crazy you don't know what day it is anymore.

]

]Thanks.

[eriksoln, BSN, RN]

I hear you Bluehen.

I was once given a pt. with a heparin drip that was "shut off" because the rate that it should be running at was "in question". That was the nurses way of dealing with it, just shut it off and report off that it needs dealt with.

I left report with this, obviously, as my top priority. I started calling pharmacy, looking at policies and paged the physician. While doing this, the charge nurse for evenings started telling me "this and that pt. wants bathed, and so and so wants more tissue." Yeah, after I got done with her, lets just say the next day I got pulled in the office for another "assertiveness not aggressiveness" speech.

I was a traveler then, and the whole situation blew over. Actually became good friends with the nurse who left that to me, she was actually just having a bad day.

Still, there are some things in my mind that just trump leaving on time.

[blondy2061h, MSN, RN]

I hate when people do that. Mornings are our busiest time, so I'm almost always working right up until I leave, checking blood with people, hanging electrolytes, etc, etc, etc.

My last shift when I left, I got report from a nurse not typically on our floor. Her shift was suppose to go until 1930, and she left at 1900, having not hung some of the 1800 doses of meds because "the 1200 dose wasn't hung til 1300."

Okee, then.

[patwil73]

If she keeps listing things she didn't get done each day - I would start keeping a list on my report sheet (since you will have to get the done) and write down the time report is finished. Then, without being too confrontational I would say, "It looks like it is going to be a busy day, since we still have 20 minutes can you get x, y and z done?" Try to make those task something she can get done quickly - say in 10 minutes or so. If she refuses try "you know all these things are going to put me way behind, we have 20 minutes left in the shift and it would be a big help".

Now if she still doesn't, or only does 1 thing and slides out, know that you have tried and report it to your charge or manager. Show her your list and let her know that you have asked this nurse to help finish a few tasks before she leaves and that you are concerned that this practice is impacting care since it puts you much further behind. Now it is the managers responsibility to fix the problem.

Of course none of this might help (a sad commentary on hospital politics but there you go), so you might just have to become used to feeling put on. If it truly is dangerous for the patient then you need to report it higher, but otherwise keep giving written reports to your manager - at our hospital those reports first go to Risk Management and then back to the manager so if they start getting a lot they will look into why it is not being fixed.

Wish I could be more help, but here is hoping

Pat

[Christie RN2006]

Holy cow, Becky has a twin!?! There is a certain nurse where I work that is exactly like what you are describing. It doesn't seem to matter how often I complain about things, nothing is ever done about it and somehow I always end up being the bad guy. Normally when I follow her I have to double check everything really well because almost always every patient has something wrong... whether it is an order never checked from 4-12 hours before I came in, to a question never dealt with to something such as a wrong drip rate! She rarely completes her admission info even if the pt has been there for the majority of her shift. Then if I have to give her report in the morning, she always gets mad at me if I didn't complete a dressing or tubing change that isn't due until that afternoon/evening or if I didn't check an order that was written during report! I am getting irritated just thinking about it...

The thing that really set me off the other day was something she should have been reprimanded for. She ignores pt care/safety in order to give report and get out the door. We had a pt code during shift change and I was the first into the room and initiated cpr. She was never to be found during the code and then after we had the pt back, I was explaining to the nurse who was getting the pt what I found/did and Becky came up to me and stood there with her arms crossed and said "are you finished yet?" (complete with the little head bob and sarcasm in the voice) I wanted to yell at her right then and there, but I held myself back and calmly told her that I would be with her in a few minutes.

How I have been dealing with it is that I am not letting her see or know that she is getting to me and I don't let her go on and on complaining about things. I am just hoping that she retires soon :)

[eriksoln, BSN, RN]

Holy cow, Becky has a twin!?! There is a certain nurse where I work that is exactly like what you are describing. It doesn't seem to matter how often I complain about things, nothing is ever done about it and somehow I always end up being the bad guy. Normally when I follow her I have to double check everything really well because almost always every patient has something wrong... whether it is an order never checked from 4-12 hours before I came in, to a question never dealt with to something such as a wrong drip rate! She rarely completes her admission info even if the pt has been there for the majority of her shift. Then if I have to give her report in the morning, she always gets mad at me if I didn't complete a dressing or tubing change that isn't due until that afternoon/evening or if I didn't check an order that was written during report! I am getting irritated just thinking about it...

The thing that really set me off the other day was something she should have been reprimanded for. She ignores pt care/safety in order to give report and get out the door. We had a pt code during shift change and I was the first into the room and initiated cpr. She was never to be found during the code and then after we had the pt back, I was explaining to the nurse who was getting the pt what I found/did and Becky came up to me and stood there with her arms crossed and said "are you finished yet?" (complete with the little head bob and sarcasm in the voice) I wanted to yell at her right then and there, but I held myself back and calmly told her that I would be with her in a few minutes.

How I have been dealing with it is that I am not letting her see or know that she is getting to me and I don't let her go on and on complaining about things. I am just hoping that she retires soon :)

Like I said, some things just trump getting out on time. A nice right cross to the jaw is what people like this need. Nothing else works. Shame, I miss my landscapeing days when you could do that and keep your job.

[Christie RN2006]

Like I said, some things just trump getting out on time. A nice right cross to the jaw is what people like this need. Nothing else works. Shame, I miss my landscapeing days when you could do that and keep your job.

Sometimes I have been tempted... I'm surprised I haven't had to get stitches in my tongue from biting it so much

[kellykelly]

Address the problem head-on. I would simply say (and I've had to, more than once) "you're still here until 11:30 so I would like you to be sure this is done before you leave. It's not my job to start off my shift finishing this" unless, of course, there is a very good reason for not getting things done.

The nurse who simply shut off the heparin rather than clarifying? That would be the LAST time she ever tried that. She'd be calling the doctor herself within two minutes or she'd be written up and lectured soundly AND the manager would be made aware. I don't make a habit of writing people up or making unnecessary fusses, but there are some things you simply can't let slide. Shutting heparin off instead of dealing with the order is one of them. Good god--do people actually let other nurses get away with things like this on a routine basis? It's not just inconvenient for the next nurse, it's dangerous for the patient!

[classicdame, MSN, EdD]

I believe this is the main reason people may resent the previous shift, day or night. Someone who chronically leaves things dangling should be reported to the manager. That is not team work. Nursing is a 24 hour job in the hospital, but not 22 or 23.5

[HappyBunnyNurse]

What I hate even more is when people don't do things but don't feel the need to share this information. Then you find little surprises when you check the chart (or the patient!). I think it is not really a nursing issue so much as a manners issue. I want to say "didn't your mama teach you any better?". Lol.