You see Docs come in to Round about 1515. You do not see which patient they see first.
You go in to Report Room a moment later, come out at 1528, sit down to chart (first chance all day to do so). You have had no break that day except a quick potty run, including no lunch. You have about 1/2 hour's worth of charting to do and you will be on overtime, which is highly discouraged.
3-11 RN comes to you at 1540, tells you that Room 3 has a mess in it and you have to clean it up. She is loud and angry and speaks none too calmly.
Docs had done some procedure on Rounds while you were in Report and had left the aftermath (trash, sharps, bloody stuff - this was a long time ago when blood and sharps were left wherever).
On the one hand, you did not know there was a mess because you did know the docs were on the unit, but you did not know what they were doing because you were in Report. Also, you still had to chart and were already on OT.
On the other hand, is it right for the 3-11 nurse to walk into a mess which, she argued, happened before she was on duty? She was on duty, technically, at 1500, came out of Report about 1528.
I guess that's not the right word maybe. It does need done. But, I'm going to say this, and I'm fully aware this will raise the hair on the necks of more than a few readers: If we're talking about the nurses, the answer in neither. If we're talking about the CNA's, the answer is both.
I've been part of a committee that was dealing with poorly executed hand-off reports. The crux of the problem was shift to shift aggression.
We implemented a number of interventions and they were effective:
1. Stagger CNA and nurse schedules so they aren't changing shifts at exactly the same time.
To further things, we also educated the CNA's on what was an emergency and justified interrupting report and what was not.
We also put a stop to CNA's doing any sort of "report off" to one another at all. They fought more than the nurses did, and would take two hours figuring out the new shift's assignments if you let them. We started with a new system where CNA's went to the nurses for report.
2. Be more clear on when one can refuse to take report and not. Too many "I'm not taking the assignment until bed five is cleaned" types on the unit.
Nurses can refuse an assignment for it being unsafe. They can not refuse it because a patient needs something they don't wish to do.
We also initiated an anonymous system to report problems that were found after shift hand off. While shift hand off report time was not the place to be complaining about linen drawers not being stalked, there had to by a way to respond to those who were not doing their part.
You'd be surprised how many of the shift hand off complaints were things the person found almost two hours into the shift. They started at 0700 and were mad about a patient being "messed".................when it was close to 0900. First rounds anyone? How about not taking the first 45min. of your shift to finish your Starbucks?
Those were the big ones.
Point is, for nurses to give an effective hand off report and for shift change to happen smoothly, everyone has to "know their place" and have an outlet to vent if they think something is unfair.
So, my answer to this question is: Where are the aids?
If this place is one of those places that likes to go with one aid for thirty patients, I can understand this falling on the nurses. If the aids are staffed more appropriately though, it's time for delegation.
Hmm, I don't remember if we had aides. It was ICU and I don't really remember there being any aides. But I like your ideas. Thanks.
Enough complaints to the boss from people who had to get home to get their kids off to school or give the car to the spouse so he or she could get to work finally got this rule changed. It was set back to a half hour before shift end, then to the more reasonable 1 hour before shift end.
Does your job have a cutoff?
If you look at our policies, it says that within 2 hours of end of shift we only have to do the admission vitals and a physical exam and the oncoming shift has to finish the rest. I can't tell you how many times the ED has called us with 30 mins till end of shift telling us we have an admit.. I finally got to the point where I tell them, "You either need to wait, or you can call my supervisor and get another RN in to do the admit". Still to this day they haven't pressed to admit the patient within the 30 min time frame when I do that, and I still haven't gotten talked to about it. Makes me feel as though they know they are in the wrong.
I've had a few day shift nurses give me crap about it, and the simple line I give them is "per the policy I did the physical exam and got the vitals..." and that usually shuts them up really quickly. I don't have the time within the last 2 hours to get patients up, get them toileted, get the last vitals, pass the pre-AM shift meds, tally I's/O's, do my careplanning ect... The last 2 hours of night shift are a nightmare.
Didn't read through the entire thread, but I have to say that as night shift I'm often times the one who gets to clean up after day shift. It drives me nuts too because its simple things like linen piles in corners, cords, lines, and cables that are a tangled mess, commodes in the middle of the room, ect.. When I do come in the day shift nurses are all on their phones texting and whatnot so its not like they didn't have the time to do so, but they just don't. I don't say anything, because I know that should I need the ammunition against a complaint against night shift (which happens all the darn time because we get the "easy shift" - pfft yeah right). When day shift complains that I didn't get a patient, who isn't a fresh post op or who is trying to sleep after being woken up every hour by us all throughout the night, up out of bed and into a chair, I can remind them that I was too busy cleaning up after their shift yesterday.
I should also add: If you are day shift, leave the room how you want to find it in the morning. If I'm busy, and the patient is trying to sleep, I simply don't have the time to tidy up and its not like I'm going to be doing a lot of things that will mess up the room. So often times I have no contribution to the mess, its just how I found it when I came on shift.
What do your boss and Night coworkers say about this?
If you look at our policies, it says that within 2 hours of end of shift we only have to do the admission vitals and a physical exam and the oncoming shift has to finish the rest. I can't tell you how many times the ED has called us with 30 mins till end of shift telling us we have an admit.. I finally got to the point where I tell them, "You either need to wait, or you can call my supervisor and get another RN in to do the admit". Still to this day they haven't pressed to admit the patient within the 30 min time frame when I do that, and I still haven't gotten talked to about it. Makes me feel as though they know they are in the wrong.
I was trying to Like this, but I don't see the button. Anyway, I Like this.
Jeez, KK, you are a bit of a control freak. This is a stupid situation. A) The doc shouldn't have made a mess, B) if the off-going nurse was just then charting, then the oncoming nurse didn't need to be a jerk about it, and finally, C) what is presented in this vignette is a simplified slice of what was probably a hugely complicated pie.
This is a stylized example of disrespect and incivility.
Why do you think I'm a control freak?
What do you think were the other parts of a hugely complicated pie?
Outgoing shift should clean up. I expect the same when I return in 12 hrs. I might let you get away with it once but that depends on the pt's acuity. Do it again and I see it as habit forming, I take you in my office and deal with it right there.
Why do you think the offgoing nurse should clean up?
Because you are trying to dictate how people respond to this weird thread.
What do you think were the other parts of a hugely complicated pie?
Where were the other nurses? Why is this nurse just now getting to chart? Was it a bad shift and no one is leaving on time? Was this nurse left to drown? Was no one available to cover this nurse's lunch? Where is the teamwork? Is there an aide? What did the doctor do that made a mess? Is it that doctor's habit to fly in, make a mess, and leave, or was this a special situation? Where is the charge nurse? Where is management? Who else is available to help this nurse? What is the unit culture? What is the unit's expectation - teamwork or individualism, paternalism or equal respect for docor's and nurses? Etc., etc., etc...
Why do you think the situation is stupid?
How is this not stupid?
Stylized? What does that mean to you?
This is a very abbreviated vignette with almost no detail.
Here is a definition for you: "stylize - depict or treat in a mannered and nonrealistic style"
What does stylized mean to you?
Who was incivil and disrespectful?
Quoted from the OP - "3-11 RN comes to you at 1540, tells you that Room 3 has a mess in it and you have to clean it up. She is loud and angry and speaks none too calmly."
Who in this vignette is not incivil and disrespectful?
No need for anger. I just wanted to understand who you thought was rude, why and what you thought was/were stupid, and what other questions you had.
Sorry I didn't give more details in the OP. You raised good questions. I don't see that "stylized" applies, but thank you for defining the word.
Was the Day shift nurse incivil and disrespectful?
All I asked was that responders reply to the question I asked (Who should clean up, given the circumstances I gave). If that is weird or indicative of excessive wish for control, I don't see it. But you can certainly have your opinion.
No need for anger. I just wanted to understand who you thought was rude, why and what you thought was/were stupid, and what other questions you had.
Sorry I didn't give more details in the OP. You raised good questions. I don't see that "stylized" applies, but thank you for defining the word.
Was the Day shift nurse incivil and disrespectful?
All I asked was that responders reply to the question I asked (Who should clean up, given the circumstances I gave). If that is weird or indicative of excessive wish for control, I don't see it. But you can certainly have your opinion.
Peace.
You haven't answered why you're dragging up a "back in the day" story to poll who was in the wrong. What's your goal here?
By way of answer, an outgoing nurse is not responsible for a new mess that they did not create, did not know about, and could not have foreseen. I'd gladly help an oncoming nurse who asked for help in a civilized manner, though, and I agree with the poster who said that if techs are present, they are responsible for assisting with patient care during nurse report.
Why do you think the offgoing nurse should clean up?
Why not? How critically busy are your shifts? On my 12 hr shifts, if there was a mess, I clean it up. Every unit I worked, has been this way. If the pt coded and the whole 5 pound bag of _____ (you fill in the blank) hit the fan and is like an IED went off right where you are standing before the end of your shift... that to me is understandable and I still will clean up a bit unless my coworker told to go home.
Even when I was in the sandbox after 12-14 hrs of caring for casualties, we clean up for the next shift.
What is your thinking? I work 12 hrs, let's say I was a sloppy/messy RN...yes, there are some that fit that title... YOU come in and you are ok with cleaning my mess? Just curious...:)
The docs in my facility know damn well that if they make a mess, they will clean it. They cannot make a mess because they do not have access to the supply room. They find us and let us know that they need to do such procedure and will need such and such...
If they came in without me noticing, they would be lucky to get away with it. My facility is a teaching facility and the white coats (baby docs) are trained from the first day to do it right.
Now, if the coworker came to me all out of control like the OP states, I know that they are a lunatic for not being civil. I could pull many cards on them like call security and say that I felt threatened by their behavior... I seen this once and the outcome was not pretty.
I do not tolerate such behavior. That is all I will say on that.
And where do you work? ICU, MEDSURG, OR, L&D, PICU, ER, Pain Clinic????
What do your boss and Night coworkers say about this?
Unfortunately the day shifters are, and will forever be, the golden children. They are the ones that "have it so bad" and doctors "hover over them unlike night shift"... Yeah right.. All the night co-workers feel the same, but we have very little say. If I find my rooms are messy and the day didn't seem that terrible (I can look at the intervention lists and the orders and know that it was a low maintenance day) I might "accidentally" forget to stock things such as needles, syringes, flushes, ect.. in the med room. I've also been known, when day shift has really crapped on me, to wait to give my 40mg lasix right before end of shift (doc likes to round at 0600 and orders it as IVP Now x1 at 0630, giving me a 30 min window).
Never do I do things that would remotely harm patients, but I find a little satisfaction knowing that I might have inconvienced them a little bit.
No need for anger. I just wanted to understand who you thought was rude, why and what you thought was/were stupid, and what other questions you had.
Sorry I didn't give more details in the OP. You raised good questions. I don't see that "stylized" applies, but thank you for defining the word.
Was the Day shift nurse incivil and disrespectful?
All I asked was that responders reply to the question I asked (Who should clean up, given the circumstances I gave). If that is weird or indicative of excessive wish for control, I don't see it. But you can certainly have your opinion.
Peace.
There was no anger in my post. It was merely a reflection of yours. I mirrored your own questions back to you. If that makes you angry, perhaps you should rethink your communication style.
You aren't giving any of your own opinions, just picking apart other's posts.
Here is some more fodder for the grist:
I thought the doc was rude for leaving a mess and expecting others to clean it up. I thought the oncoming nurse was rude for being loud and angry, which is unprofessional, to boot. I thought the offgoing nurse was uncivil due to the passive aggressiveness displayed by not dealing directly with either the doc or the oncoming nurse.
They were all disrespectful of each other.
What a toxic environment! Which is stupid, because respect, civility, and fostering teamwork makes for a less stressful environment.
Kooky Korky, BSN, RN
5,216 Posts
Hmm, I don't remember if we had aides. It was ICU and I don't really remember there being any aides. But I like your ideas. Thanks.