1. I would have called the MD and informed of the 591 and the time other nurse gave the insulin. Also- I'd let him know the pt was non-compliant with her diet.
2. Document the non-compliance and that MD was made aware.
3. You can ALWAYS call MD at any hour. It's a 24 hour nursing facility. Cover yourself and protect your patient! If you think something's broken- it can't wait until morning. I've never been yelled at for calling at night for a real reason like this. (Plus, who cares if they yell- they don't really KNOW you and they get into this business knowing it involves late night phone calls
4. Is the DON aware of the business going on at the nurse's station at night? That would NEVER fly in my LTC and you shouldn't have to work amongst such slackers. Horrible! We are wayyy too busy even at night to be hiding in rooms or thinking of doing out hair at the NS!
5. Even though the other nurse failed to initiate neuro checks, you're responsible for the pt now. You should have initated them. Two wrongs don't make a right. You are responsible for evaulating your patients and to keep an eye on the ones with potential for a change in condition. Post fall assessments are integral and neuro's are included to monitor for a change in condition. Of course, let your unit manager know in the morning that they were initiated late so she can follow up with the prior nurse and understand what happened. CYA, CYA, CYA!
I worked nights for 3 years in a rehab/LTC. I've followed more than one nurse who were slack on documentation and who have had falls and did not notify MD. When the pt begins to c/o pain on my shift, I have to call the MD in the middle of the night to request an Xray. There have been two instances where fractures have actually been the result of these falls and I'm SO glad I called. Don't let it wait until morning when it shouldn't. We night shifters are nurse's too! Not everything needs to be passed on to day shift
Trust me, as a day shifter now, we appreciate it!