Do you follow orders??

  1. Of course you do!! I was just wondering though, how common is it for you to come on to a shift and find orders not carried out and lots of excuses. Is it just me or is this really a theme. Im not trying to play the blame game here, I really want to understand the rationale behind this ever increasing problem.

    I work nights and come on at 1900. For instance tonight there was a discharge that was to leave after 1500. Orders were to remove ivs, etc.,standard stuff.

    Another order on another pt. was to start a PCA written at 1400.

    Neither of these were done. The pt. leaving had her whole family there and had been told that the subclavian line triple lumen picc would be pulled last before they left. She also had a peripheral IV in. The family was just standing around waiting. I wasnt told at report either. I walked in and found them all there waiting to take mama home. . I got the NTL to pull the SC line and dress it, pulled the periph,unhooked her continous pulse ox, gave them the med list and instructions and sent them out. Helloo!!!! What is the problem.

    I was told there was no PCA machine available on the floor for the other pt. so it had never been started. In five minutes I had a machine and got him hooked up.

    I am always finding at least one or two things like this to do. Is it just that they figure night shift can clean up the mess at the pts. expense??? I dunno. I am going to eve shift in December and I want to know how to avoid becoming one who passes on to the next shift.

    Lets hear it from the experienced and frustrated.
    Last edit by Fairlythere on Oct 18, '06
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  2. 10 Comments

  3. by   RGN1
    Most nurses, I'm sure, do their best to fill orders. I think sometimes you can get caught up in other things going on & genuinly are not able to do everything but when that happens - which should be once in a blue moon - then you should tell the nurse taking over what you haven't been able to do & why.

    Unfortunately it sounds to me like this wasn't the case this time & that you weren't even given the courtesy of being told in one case! If it was a "once off" from the nurse involved a quiet chat might be all that's needed. If it's a recurrent theme from the same person/people then you might need to take things further. Afterall how would they like it if everytime they came on shift they had a heap of stuff still to do from the previous one?

    It boils down to the need for good team work & good communication as usual!
  4. by   NurseyBaby'05
    Quote from Fairlythere
    Of course you do!! I was just wondering though, how common is it for you to come on to a shift and find orders not carried out and lots of excuses. Is it just me or is this really a theme. Im not trying to play the blame game here, I really want to understand the rationale behind this ever increasing problem.

    I work nights and come on at 1900. For instance tonight there was a discharge that was to leave after 1500. Orders were to remove ivs, etc.,standard stuff.

    Another order on another pt. was to start a PCA written at 1400.

    Neither of these were done. The pt. leaving had her whole family there and had been told that the subclavian line triple lumen picc would be pulled last before they left. She also had a peripheral IV in. The family was just standing around waiting. I wasnt told at report either. I walked in and found them all there waiting to take mama home. . I got the NTL to pull the SC line and dress it, pulled the periph,unhooked her continous pulse ox, gave them the med list and instructions and sent them out. Helloo!!!! What is the problem.

    I was told there was no PCA machine available on the floor for the other pt. so it had never been started. In five minutes I had a machine and got him hooked up.

    I am always finding at least one or two things like this to do. Is it just that they figure night shift can clean up the mess at the pts. expense??? I dunno. I am going to eve shift in December and I want to know how to avoid becoming one who passes on to the next shift.

    Lets hear it from the experienced and frustrated.
    It sounds like someone left you a mess. That being said, I have found it harder to get equipment, meds, etc. on the afternoon shift. Like any other area of the hospital, it depends on who is working in the department that day. Some people are good and some are not (and don't care to be.) The people in central may have switched shifts just like you nurses and someone more reliable came on when you did. Also, like another poster said, the person you took over for could have at least told you what still needed to be done rather than let you walk in blind. It sounds like he/she never checked the orders at all.
  5. by   NurseyBaby'05
    Also, better to have found them not completed when you came on than @ 02:00 when you're redlining. I usually find something about once a week. If it's bowel regimen or something that another 2-3 hours won't make a difference, I'll do it right before I leave. One time it was a STAT blood transfusion. Another it was a STAT CT TAP. Obviously, those didn't wait.
  6. by   angel337
    when i was a new grad i used to trip all over myself trying to get every little thing done so i wouldn't look like a slacker to my fellow coworkers. i learned quickly that sometimes you just can't do it all. i try to do things based on priority and if i do have to endorse something to the next nurse it is usually something easy. but then again there are times when you won't be able to get to everything and the next nurse won't be happy...but hey, nursing care is a 24/7 job which is why you give report. i work with a couple of nurses who are notrious for having MAJOR attitude if something is left over. i ignore it. like someone said before most nurses don't do it intentionally. i work ED only now, but when i worked the floor i found this more prevalent. one more reason not work on the floor:wink2:
  7. by   NurseyBaby'05
    Yes, but you would have at least told the oncoming nurse what still needed to be addressed. The OP walked blindly into a mess. The outgoing nurse gave her no warning whatsoever. It sounds like she may not have even known the pt was suppossed to be dishcarged to tell the next nurse.
  8. by   SharonH, RN
    I don't follow orders but I do implement them.


    As for passing on work, I have worked every shift and trust me every shift passes on work. Every shift. I was shocked that the same night-shift nurses who used to sigh and gripe when I worked 3-11, had no problem passing on work that they just didn't get around to. Same thing when I worked evenings, the same nurses from day shift who used to roll their work during report had so much difficulty getting to their discharges or always seemed to have an admission who just got there. And let's not talk about the work I wasn't told about.


    You cannot avoid passing on work. That's why the care is 24 hours. And the work does not belong to a specific shift. The order may have been written for the patient to leave after 1500 but the unit secretary may not have gotten to it until 1700. The order may not have gotten to the nurse until 1800. And at 1800, he or she is preparing to end the shift. It happens. And 3-7p are the 4 busiest hours of the day.
  9. by   Tweety
    Night shift almost never leaves us orders to fulfill. They frequently ask us to clarify something with the MD, or report a non-critical event to the MD. Or leave something minor "because I didn't want to wake them." No problem with me whatsoever.

    Here's the big "however". However, night shift rarely gets orders. I get several orders on alll of my patients during my shift. My ratio is one or two patients less than night shift. Sometimes, there just isn't enough hours in the day and I need a little help and understanding from the next shift. It's hard to understand how an order written hours prior can't be carried out, but it's amazing how quickly those hours pass.

    Of course you're going to find at least one or two things to do. If that's all you find then count yourself lucky. Some of the things you describe are off the chain, and should be dealt with the person directly and the charge nurses, because that sounds rediculous.

    I worked nights for many years and was a charge nurse, and yes I did consider us the "clean up crew". We cleaned up the mess for dayshift to start all over again and mess it up again.

    Thanks for keeping up that tradition.

    When I went to day shift after 13 years of nights a couple of years ago, I used to feel guilty and apologize profusely over and over if I had to leave something. Now I make sure to tell them exactly what I'm going to have to pass on, and I thank them for helping me out, but I don't feel the least bit guilty if I've been working hard all day, which is 100% of the time. I definately tell the next shift what I didn't do, because having them walk into a mess and finding things on their own is crazy.
    Last edit by Tweety on Oct 18, '06
  10. by   NurseyBaby'05
    Quote from Tweety
    Now I make sure to tell them exactly what I'm going to have to pass on,
    That's all I ask. I mean, if things were written @ 09:00 and the nurse had 4-5 smoke breaks, plus lunch, plus was having long, frequent discussions with staff about union activities, and the above mentioned orders haven't even been started when I come on @ 19:00, I'll be ticked. I know hospitals are run 24 hours a day and don't have a problem doing things that were ordered on previous shifts, but I don't like finding about them via angry phone calls, chart checks @ 03:00, etc. several hours later. Just tell me. Please give me that courtesy.
  11. by   scribblerpnp
    I was used to the occassional pass-on when I worked as a night shift nurse, especially if the unit was busy (and you could always tell if it had been busy when you came on). And not once did I care to help out. We were lucky in that we had AWESOME pt to staff ratios and usually every shift had a fair amount of downtime. However, there was one particular nurse who gave a quick report and would leave 20 minutes before the shift. AND she always left at least 2-3 tasks for the nurse coming-on. Stupid stuff thatshe had plenty of time to do during her shift. At first I thought she just was a slow worker, but soon I got wise to this problem and found out she did it to every nurse at the end of every shift.

    So, every time I got report from her and she tried to pass something one, I would pass it right back by saying something like, "It looks like I've got to call Dr. X to get ____________" or "Wow, I've got a lot of meds/blood draws due in the next 30 minutes. Would you care to finish that since there is still some time left in your shift? It would REALLY keep me from falling behind." This took about 4 shifts, and by the fifth time she never tried to pass anything on to me again, unless it really was a busy shift for her, and in that case I didn't mind a bit!
    Last edit by scribblerpnp on Oct 18, '06
  12. by   Antikigirl
    For me I typically find this to be a probelm when there are a bunch of admits at change of shift, or so many newer MD orders that you can't get to the chart at all!

    One night..it was so bad that I had three total admits...I got the paperwork done because it was change of shift and the nurse before me couldn't get any of the paperwork during her shift. That I can understand, been there too. However...none of the new orders taken from 3 hours before my shift were written or on a MAR. I had to stop everything and write orders for all my patients so I could pass meds and do treatments in an orderly fashion (and not forget something). Hard shift, but we all had this probelm...and noc seemed to understand once they arrived and saw all the charts on the desk and none in the rounder!

    That is about the only thing that gets me, not typically the RN, but a overflow of orders not being done because we only had one cleric to work on them...so they get them done on my shift and I am playing catch up for the entire day during my 8 hour shift!

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