Who Takes Care of Things that Happen at Shift Change? (long and chatty)

ktwlpn, LPN · Sep 9, 2007

We've been having a lot of issues with things happening just before or just after shift change and neither of the nurses feeling like they should be responsible for taking care of paperwork, calling families, etc.
Some examples...shift change is at 1400 on weekends...technically, the 0600-1400 nurse is supposed to stay until 1415 (the shift is actually 0545-1415). So if a resident resident returns from the hospital at 1330, it seems to me that the day shift nurse should handle the assessment and re-admit paperwork...I guess that only applies when either I or one ofthe other nurses is the day shift nurse...every other nurse somehow manages to pass the paperwork off to the evening shift.
Another example...during the week, shifts run from 0545-1815 and 1745-0615. A nurse was walking out the door at 1830 when she saw one of the residents (a very confused resident with MULTIPLE elopment attempts) walking across the parking lot. So...she brought the resident back inside and told the charge nurse what happened. The charge nurse informed her that since she found her it was her responsibility to handle the paperwork. (The extensive 10 pages of paperwork, mandated by corporate policy).
In the first case, the administrator thinks the oncoming nurse should have taken care of the readmit...in the second she agrees that the nurse who found the resident should have taken care of it. Doesn't seem right to me.
We don't have a DON right now and the responsibility for her duties are being shared by me and the most experienced charge nurse. We have agency RNs who take care of out RN coverage.
The charge nurse and I are meeting with the administrator tomorrow to work this out (along with a few other bugs in our system) and I want to have a good logical plan. She says it doesn't make sense that I would take care of the paperwork for a resident coming back at the end of my shift but I won't take care of an elopement at the end of my shift. It seems like two different things to me.

Our policy states that if a hospital return or new admission arrives a half hour before the end of the shift then the next shift takes care of it.(it does NOT matter who you are-the policy applies to everyone) The receiving nurse gets a set of vital signs and settles the resident in and that's it.....30mins is not enough time to complete all of our mandatory assessments,body check and orders along with any thing else that may still need to be done. You can't rush through that stuff.... Our administration believes any nurse on any shift is as capable as any other and since it is a 24 hour facility the oncoming shift needs to be ready to pick up the ball.We are not going to get OT for something like an elopement or a fall.We all have lives of our own to get to after shift.The charge nurse was wrong-she had the day shift nurse clock back in and do the paperwork on the elopement? And rack up OT? No way... The nurse was off the clock-no different then a housekeeper or a visitor as far as the paperwork goes. IMHO Seems that neither the charge nurse nor the administrator are considering the 2 most important factors involved here -resident safety and money....

CapeCodMermaid, RN · Sep 10, 2007

Did the resident leave the building on the day shift? The nurse who found her should at least have written a statement, but I don't think she should be responsible for the report....don't forget you'll probably have to report it to the DPH depending on your facility's definition of elopement. We are all there to work our 8 or 12 hour shifts so just do what you can and pass the left overs on to the next shift. If an admission rolls in at 2:30, there is no way the day nurse will be able to finish the admission....have that shift get a set of vitals and write a brief nurse's note and the next shift will have to finish the assessments. Most things don't have to be done immediately and all at once.....just make sure you do the skin assessment right away.

flashpoint · Sep 10, 2007

I know that the first couple hours and the last couple hours of our shifts are the most hectic...if I can get an admission done and only end up staying an extra 45 minutes or so, it seems to make more sense that putting the evening shift nurse 45 minutes behind. An admission at the beginning of the shift can totally throw the routine off. I can also work pretty much uninterrupted, so that saves time too. And...at the risk of sounding like a total *itch...the evening nurse is slower than molasses and always messes up the paperwork...the extra time I took then would probably save me all kinds of time the next day.

As far as the case with the elopement...I was the nurse who was leaving...I heard the front door alarm go off as I swiped my time card to punch out. A part of me considered going to check the alarm, but it was turned off pretty quickly, so I left. Another resident with a Wander Guard was sitting near the door and a visitor was leaving the building, so the CNA who turned the alarm off assumed that is what set off the alarm. It was a total fluke that I drove through the front parking lot at all...they were cutting down a tree across the street and the route I usually take was blocked with branches. I was off the clock, so it seemed pretty unreasonable to punch back in to do the elopement paperwork...I kind of thought the evening nurse was lucky that I had found her at all. I know that the paperwork will throw her off if she completes everything right then, but it only takes a few minutes to call the doctor and family, and make a few notes...the paperwork can be done later...its just a corporate tool that reviews what happened and what could have been done differently. If I had still been on the clock, I probably would have stayed, but I was actually in my car and almost off facility property.

FrustratedLPN · Sep 10, 2007

Do you make walking rounds with the oncoming shifts? This possibly would have assured you that patients were either in their rooms or not. Insist on nurses coming on shift, and nurses going off shift check each patient briefly prior to clocking out.

As for admissions, hospitals want to keep them until after lunch so they can bill for another day, thus you'll have lots of admissions coming in for the 3-11 shift to admit. During the week, it's not that bad since some of the management nurses or tx nurse is usually available to help with paperwork and assessments. On weekends if there is an admission, it's all yours to handle. They'll arrive on our hall (sometimes we don't even know they're coming,) they'll have paperwork in hand.

Our medications are ordered from a pharmacy that is 80 miles away... so patients arrive post ORIF, and they have no pain medications, Luvenox, etc. available for at least 6-8 hours for a special delivery to be made.

Why doesn't admissions, the DON, ADON, SOMEONE... have the paperwork, meds ordered, physician orders verified, O2 concentrators in the room (if needed) HHN available (if ordered), PRIOR to the patient arriving?

They can preach "teamwork" all they want.. rarely do you see it in action. Just as with treatments for residents. Seems administration may think they need tx during the week (when the tx nurse is there on day shift) but apparently the patients don't need it on weekends??? They expect us to do our own tx's on weekend shift. Would you not think that either the manager on call, or someone from management would be delegated to do this? Floor nurses are overwhelmed now with the mountain of paperwork, incidents, observations, and med passes now.

The number one reason new hires won't stay is the "paperwork" involved, AND being lied to from the beginning of the hiring process. One new nurse was told she wouldn't be on the med cart alone for at least two weeks (they had her on the hall by herself the 3rd day), One RN supervisor was told she would never be on the hall, she was only there to "supervise" (she had 50 patients under her care on 11-7 shift the 2nd weekend she worked). We've also had several nurses leave, which puts the rest of us working overtime, days off, etc. Sure the money is great, but at what price to your physical health? You've finished your 8 hour shift, and the oncoming nurse doesn't show up for work.... you're required to stay. This happened to me only last week AND scheduling was very unflexible when it came to me asking for some time off.

You'll see things time and again that aren't done, no one wants to assume responsibility. Think about 10 minutes into shift change, the other two nurses are outside smoking.. talking about an upcoming "Keg" party, while you're left alone with 100 residents. You suddenly feel as if the entire building is your responsibility. CNA's pushing the residents up to the nursing station getting them ready for their evening meal and leaving them alone with no supervision *do they think the nurses are just going to sit at the desk??* One resident stood up behind his geri-chair, one pushed the footrest down and almost toppled out, one was flashing everyone by pulling her shirt up. I just went down the hall got all the CNA's and told them, do NOT put the residents up there with no one to watch them... you keep them on your hall UNTIL it's time for the meal to be served, THEN bring them up to the dining room. The newer, younger, inexperienced nurses WILL NOT say anything to the CNA's, they don't want anyone mad at them... PUHLEAZE

santhony44, MSN, RN, NP · Sep 10, 2007

I think for admissions setting a time limit (more than 30 minutes before end of shift, it's yours, less than that, it's the next shift's) plus specifying what your shift does if you don't do the whole admission, makes sense.

I don't think you should have done the elopement paperwork. I think the second shift nurse should have been darned grateful that you found the resident before something bad happened. If you had not, how long would it have taken for the resident to be missed???

ktwlpn, LPN · Sep 10, 2007

I know that the first couple hours and the last couple hours of our shifts are the most hectic...if I can get an admission done and only end up staying an extra 45 minutes or so, it seems to make more sense that putting the evening shift nurse 45 minutes behind. An admission at the beginning of the shift can totally throw the routine off. I can also work pretty much uninterrupted, so that saves time too. And...at the risk of sounding like a total *itch...the evening nurse is slower than molasses and always messes up the paperwork...the extra time I took then would probably save me all kinds of time the next day.
As far as the case with the elopement...I was the nurse who was leaving...I heard the front door alarm go off as I swiped my time card to punch out. A part of me considered going to check the alarm, but it was turned off pretty quickly, so I left. Another resident with a Wander Guard was sitting near the door and a visitor was leaving the building, so the CNA who turned the alarm off assumed that is what set off the alarm. It was a total fluke that I drove through the front parking lot at all...they were cutting down a tree across the street and the route I usually take was blocked with branches. I was off the clock, so it seemed pretty unreasonable to punch back in to do the elopement paperwork...I kind of thought the evening nurse was lucky that I had found her at all. I know that the paperwork will throw her off if she completes everything right then, but it only takes a few minutes to call the doctor and family, and make a few notes...the paperwork can be done later...its just a corporate tool that reviews what happened and what could have been done differently. If I had still been on the clock, I probably would have stayed, but I was actually in my car and almost off facility property.

I don't understand how paying you OT is a good idea.And-what happens when you or some other nurse just can not stay? So the evening nurse is slow and always screws up ..If she has to do it she'll eventually learn-especially if she comes in to work her next shift and has to fix anything she did wrong.

And we all have a routine but the nature of our jobs almost gaurentee that something will throw us of track.So what? It's the next shift's responsibility to pick up where you left off....Don't take what I am going to say personally but nurses like you make the rest of us look like we don't give a crap-by that I mean if you want to be a martyr and stay late to get something done "the right way" since only you are capable of doing so you make those of us who have obligations after work look and feel like crap..And administration may be more then happy to pay you because they don't want to hear any bitching from others (like the evening shift) but that does not solve the problem...Not enough staff and staff on evenings and nights not as familiar with P and P...Both scenarios are the same-give a report to the nurse on duty and go about your business.... Lucky for the eloping resident and the facility that you went through the parking lot and saw the resident eloping...Good Lord that could have ended so badly-sends chills down the spine when you consider the negative outcomes that could have resulted...

flashpoint · Sep 12, 2007

I am so frustrated with this...I don't even work on the floor anymore (except for an occasional shift) and I am seeing more and more passing the buck. Last night, I stayed late to finish some paperwork. Around 1830 (shift ends at 1815), the day nurse was finishing charting and was getting ready to leave. A resident had a HUGE emesis...one evening CNA was charting in the dining room, another CNA was busy answering a light, and the night nurse was pre-signing her meds sheets. The day nurse was the first to get up to take care of the resident! I was walking out the doorto leave and told the CNA in the dining room to put the diet record down and help the resident. Then...I told the night nurse that her resident needed her and that the day nurse needed to go home...not take care of something that happened after her shift was over. The evening nurse told me that she was too busy and that the resident would have to wait. I got the CNA a warm wash cloth and a pair of gloves and told her charting could wait. I took the med books that the nurse was not using and moved them to another part of the desk and told her again that a resident needed her. The nurse looked me straight in the eye and said, "No! I won't do it! Linda can do it, she is almost done with her charting." The CNA looked shocked...the other CNA finished what she was doing and helped get the resident cleaned up, helped get her to bed, and they got a set of vitals. I handed the vitals to the charge nurse and called the administrator. The administrator came in and I asked her if she wanted me to stay...she told me that I had been there too long already and to go a ahead and go home. I'm not sure what happened after that. This nurse is also having issues with refusing to answer call lights, refusing to help on rounds, and refusing to give PRN pain and psych meds. We have a HUGE dementia population and she won't give pain meds unless they can tell her they are in pain and rate it according to the pain scale (we use the "faces" pain scale, so I have no idea what her issue is there). She let a new admit who took Tylenol #3 every 4 hours at home go over 12 hours without pain meds...she didn't ASK for it, so she didn't get it...poor lady was so nervous and scared, she didn't say anything.

Overall this really is a good place to work...we have some corporate nurses coming in to work with some of the "problem" staff and they say they are going to terminate them and replace them with agency staff if they won't step into place. Too bad they didn't let the DON take care of things like that...she would probably still be there.

CapeCodMermaid, RN · Sep 12, 2007

Okay so this is a bit off the main topic, but nurses who refuse to medicate people for pain really fry my nose(thank you Mumbles Menino). I worked at a place where the alzheimers program director told the nurses that people with dementia don't feel pain like we do. There was one woman who grimaced with every step she took. They told me it was a facial tic. I told them I wanted her medicated for pain....what do you know??The "tic" went away and some of her behaviors did too. When will these nurses learn?

CoffeeRTC, BSN, RN · Sep 13, 2007

As far as the admit at shift change. Days would normally start pulling the paper work from the hospital to set up the chart, get the orders and try to verify them or at least make the call and get a set of vitals. That is all that would be expected.

As far as the elopement situation. I might ask them to write a really quick statement before they leave. The next shift would be responsible for the incident and calls, etc.

When you are off the clock, you are off the clock. Period. If the previous nurse is staying it is normally to finish charting. That is all they should be doing. Unless there is an emergency and I need an extra set of hands...they are just in my way;)

morte, LPN, LVN · Sep 13, 2007

Okay so this is a bit off the main topic, but nurses who refuse to medicate people for pain really fry my nose(thank you Mumbles Menino). I worked at a place where the alzheimers program director told the nurses that people with dementia don't feel pain like we do. There was one woman who grimaced with every step she took. They told me it was a facial tic. I told them I wanted her medicated for pain....what do you know??The "tic" went away and some of her behaviors did too. When will these nurses learn?

mumbles Menino, i love it. you think if we pitched in we could pay for elocution lessons?....then there are the folk from leominster....

marjoriemac, LPN · Sep 14, 2007

I guess at handover, the nurse doing the next shift will usually end up dealing with any incident unless the nurse going home is feeling really nice that day. It sounds terrible but I have known nurses to walk out on time because they 'don't get paid to stay on'. Personally I take it as the norm to never be out on time!