What is with this angry nurse?

quazar · Jul 16, 2016

Last night I had a nurse act rudely to me and she had literally JUST MET me. It gave me a visceral reaction towards her from way back when I was a new grad, and worked with this horrible nurse (she really was...on so many levels) who was rude and nasty to me, and I found myself immediately equating this nurse with that older one. In my head, though, I was able to stop myself dead in my tracks and think. There are days when I am, quite frankly, a you-know-what. I have been. I am not at the top of my manners game (although I really do bend over backwards to try to be), and I have been snippy with my coworkers. Once I was downright mean (I apologized to her about 20 minutes later after I collected myself). When that happens, it's usually because something peripherally is going on that is getting under my skin (we're human, sometimes the extraneous stuff affects our mood, professionals or not). When I started to think along these lines, I decided that this nurse probably had something else going on that I wasn't aware of, and that was the reason for her behavior. Sure enough, not 2 minutes later, she said apologized and said she was having some health problems.

It doesn't excuse rudeness, no, but it does help to temper your reaction and maybe help you to step back a bit and kind of reign in your own emotional response. I know that inside, I can flare up like gasoline thrown on a fire when someone is rude to me, and have had to make a conscious effort to work with myself inside my head to remember that it's not always personal and that most of the time, someone behaving rudely is about something I don't even know about and can't control. When I am able to remember that, it helps me to soften my own reaction and calm myself, which is really important not only for communication, but for my OWN stress levels.

Now, don't get me wrong, I do realize that yeah, some people are just jerks. Either way, though, if you can remain calm and not take their behavior personally, it really will help your own stress levels. I still internalize a lot of people's negative behavior towards me, and have to really WORK at getting to the point where I am able to realize that their nastiness is not a commentary on my own worth as a person or a nurse, and let it go. It's so hard, and I'm not great at it, but I'm getting there. It does help, though.

FolksBtrippin, BSN, RN · Jul 16, 2016

In this situation, I would just give a history. When I was done with the history, I would say "Any questions about the history?"

She may not have been trying to be rude. She may have been trying to be polite. She did say please. Her tone was probably off-putting. But it probably had nothing to do with you.

itsybitsy · Jul 16, 2016

Okay.
You're not the crazy one.

Thanks. :lol2:

itsybitsy · Jul 16, 2016

I have been a NICU nurse for over 20 years. And still am. I taylor my reports to whoever is taking. I might give all the details to s newer nurse. We have kardex's for all our babies from which we give report from. I read what I think is important to the oncoming nurse. Other wise they can read it themselves for more details. Personally I would rather just have the recent important details.

Well I can say you're better than me. I usually just report what was given to me/what changes today. I do look in the chart if I feel like something is missing or the previous nurse wasn't quite sure of something, but I don't tailor anything nurse by nurse.

Those kardex's interest me. We don't have anything that fancy, but you mentioning them makes me wish we had. It would be nice to look at instead of going to a million different places in the chart to find one thing.

I'm with you, I like knowing what is going on now/recently.

itsybitsy · Jul 16, 2016

We have a nurse like that. It is an ongoing joke between me and my coworkers that this nurse will want to know in report how many hairs are
On the left butt cheek and what is the scrotal circumference! I once gave her report and told her the gentleman had fallen at home and was a left hip repair. She asked
Me how long he laid at home before he was found? To which I replied I don't know I wasn't there lol

Yea, I don't see how it's relevant unless there is like some PTSD that is affecting his life now.

I usually try to answer all questions, over the top or not (if it's possible). Luckily, I don't think we have any nurses that are THAT in-depth with their assessment or report. At least you only have one :)

itsybitsy · Jul 16, 2016

That's why SBAR is important, and why the parts of SBAR are in the order they're in. It's hard to put current situation into context without background. Background could be as simple as "previous 28-week delivery 2/2 preterm labor." But that needs to come at the beginning of the report, not after all the minutia of vent settings, I&O, etc. And it doesn't have to be long and detailed with pregnancy hx and all the resuscitation efforts. Short and sweet, such as what I said above.
And yes, you are making a mountain out of a molehill. If you let THAT one comment ruin or shadow a previously great day, well....you shouldn't.

I agree with you. A format for report should be used such as SBAR. Which I usually run right down the line, but missed in this instance. But my problem wasn't that she interrupted me to get the history, it was the way it was conveyed.

I do want to ask since you brought up SBAR. I know it is a communication tool and some might even say "report" tool but do you think SBAR is an efficient handoff tool? I have heard before that the format of a SBAR doesn't quite equal a nurse to nurse handoff. It is more of a tool of communication between physician and nurse.

Likewise, you, like myself put the history of the patient in the "background" category of the SBAR format. In about 50% of SBAR's, history is in the background. In the other 50%, history or admitting dx is in the "situation" part. So following the SBAR format, situation before background, right? Then in the situation of SBAR, you have recent changes to condition/treatment plan, etc etc. Which you would say if you were calling the doctor; "Hey, I'm calling because of this change that just happened in the patient status." But in nurse reports, the recent changes, in my situation is that they did just switch respiratory support. Which following format again, I should say before the history of the patient, according to SBAR.

I get what you're saying, a history before you really get into it, which again, is what I usually do, but this one got away from me. I am just curious if you think SBAR is really a tool for nurse handoff and not just a communication tool between physician and nurse.

Coffee Nurse, BSN, RN · Jul 16, 2016

Have to say I disagree with your take on the situation. Maybe the oncoming nurse could have been nicer about it, but I definitely want some sort of history to give context to a baby I'm getting report on, and definitely something more than "preterm labor" (I assume that's what PTL stands for, haven't heard that particular abbreviation before). Name and parents' names are nice, but they don't tell me whether I'm getting a 25-weeker with a PDA whose sats swing all over the place, versus a 33-weeker who should be more stable and lots of FiO2 changes indicates a potential issue (so you see how history is useful to know before you jump into the ventilatory settings).

NursesRmofun, ASN, RN · Jul 16, 2016

I know!! I have deduced that different nurses seem to put more of an emphasis on certain things as being important in report. My NM said hx is something you can look up and, therefore, not important in the scheme of things as far as *she was concerned...but yet- some nurses will act as your nurse did if they don't get it.

Kitiger, RN · Jul 16, 2016

I definitely want some sort of history to give context to a baby I'm getting report on, and definitely something more than "preterm labor" (I assume that's what PTL stands for, haven't heard that particular abbreviation before).

I also think she means preterm labor. I googled it, and got:

Praise The Lord

Pedro the Lion (band)

Pass The Loo

Part Time Lover

Pay the Lady (National Thoroughbred Racing Association)

Pushing the Limits (gaming team)

Post Tenebras Lux (Latin: Light After Darkness)

Push-The-Limit

Passion Tea Lemonade (beverage)

... You did say that you wanted general nurses to chime in, but it's hard when I can't decipher your meaning ...

gonzo1, ASN, RN · Jul 16, 2016

So many different personalities in nursing, it boggles the mind. I have worked with nurses that want a "butt hair" count and I have worked with nurses that come in, read the chart and say they don't want or need report from me. I too, have learned to tailor my report to who is getting the patient.

It took me a long time to be comfortable with both types of nurses, but in the end I decided that I can only care about what happens on my shift and when I turn the pt over my job is done.

Nursing is a very hard job on so MANY levels, but is enormously rewarding too.

Conqueror+, BSN, RN · Jul 17, 2016

I used to work with a nurse and I could tell if she and her bedmate of the week were getting along by the way she put her bag down. Working with her taught me to let people keep their crazy to themselves. I do my job and ignore the rest.

itsybitsy · Jul 17, 2016

Have to say I disagree with your take on the situation. Maybe the oncoming nurse could have been nicer about it, but I definitely want some sort of history to give context to a baby I'm getting report on, and definitely something more than "preterm labor" (I assume that's what PTL stands for, haven't heard that particular abbreviation before). Name and parents' names are nice, but they don't tell me whether I'm getting a 25-weeker with a PDA whose sats swing all over the place, versus a 33-weeker who should be more stable and lots of FiO2 changes indicates a potential issue (so you see how history is useful to know before you jump into the ventilatory settings).

And as I have said, I ALWAYS give a history, whether it be brief or quite extensive - depending on what I feel adequately prepares the nurse to take care of the patient.

My problem was mainly the snarky attitude and wanting it right then and there.

PTL = Preterm labor. Sorry, I get so use to abbreviating it I forget some people have no idea what it means. :)

And as for the age of the patient, just like a nurse would do for adults, at the point when I am reporting name and parents, I am giving age, what bed, weight. Hence the "etc" in my OP. For example, I would say "This is Baby Girl, parents Jane and John, was a 30 weeker, corrected to 33 and 4, in incubator on air temp of 28, weight was 2000 which was up 20 grams." Basic patient information.

At this point I usually move on to history, as I said I accidentally skipped the small preterm labor bit and got my head chopped off. There was nothing besides PTL in the history. I feel like yours and my reports look grossly different because my history is why they are in the NICU and any immediate social problems. I only start to address FiO2 changes when I actually am addressing FiO2. I don't skip around in my report because it makes it difficult for anyone to follow something when you talk about one subject, switch subjects, and then come back to the 1st subject again. I talk about FiO2 when I am talking about respiratory, when I am addressing my titrations of O2, not in the history of the patient. Same with a PDA, when I am talking assessment of the patient, "the kid has a murmur due to a large PDA seen on echo on 7/16". Sure when I am addressing FiO2 and say the patient dips frequently on their sats and is back up by self, I mention because the patient has a large PDA.

It wasn't like I just said, oh PTL, there you go, bye. There are other parts to a report that I did not initially post about because they were none issues. The nurse had a cow about the history. I was venting. Not trying to solve a mystery.