Problems close to/during shift change.

[babysteps25]

I would like to hear other peoples thoughts on the expectations of who will take care of problems that occur close to or even during shift change. It seems to happen to me all the time.

I had a patient develop a fever and chills. I called the doctor and followed his orders. I was expecting to see the patient get better but his condition didn't seem to change at all. An little over an hour later it is shift change. I had checked on the patient 10 mins prior and he was the same, but then duirng our report we see he is now pale and diaphoretic. I assure the person I was giving report to he was not like that earlier. She is upset that I didn't take care of it despite having plenty of time left in my shift.. For reference I work on a medsurge floor.

Did I commit a no-no by passing the torch?

Also once had a patient's visitor sneak in alcohol for him during a shift change (and he had already drank of course) and I stayed then to do the incident report and everything. I have many more examples but then this post would be too long.

[anotherone, BSN, RN]

Depends on what the scenerio is, what the other patients are like, and who is picking up after me. I have stayed up to 1.5 hours because of something that happened at the end of the shift. Some times the pt was ordered to be transfered to another floor right at shift change, or decompensated etc. I try to do as much as possible before the very end. 0730. Residents come and write orders starting at 0545-0600. sometimes all of your patients get a ton of orders changed and I can not and will not stay to do them all. i will remove/insert foleys, dc pcas, fluids, change them etc. I will do what I can , that is the most time consuming for the next shift. I wouldn't want to leave a decompensating pt, that occured still techincally on my shift and hope that the next coworker paged md, dealt with it. i would want to be the one to actually page and make sure the co worker knew it was a change etc. I might stay a few more minutes to help out and wait for MD's return phone call.

[RNJill]

For me, it really depends on the situation. If it is just a matter of a few annoying loose ends that have come up (new order for a bolus, pt suddenly wants x/y/z/, new pt has just come up with meds that need to be given), I usually try to give report on pts and tell the oncoming nurse that I'll take care of whatever before I leave. That way the pt gets what they need, the next nurse can get started with their shift efficiently, and I don't feel guilty about leaving "a mess."

If something major is happening, I often feel like I'm sort of stuck until it is resolved. Obviously I can't leave a rapid response, pt that is going downhill, etc. HOWEVER, it is soooo annoying when an oncoming nurse is nitpicking over the fact that you haven't done some inconsequential thing for a pt who has just.come to the floor. Umm hello, when I've completed a lg amount of admission paperwork, started an IV, done labs, and given all meds, I'm not going to beat myself up for not getting a PRN sleeping pill for a pt who won't need one for several hours. I really feel that nursing IS a 24 hr job and that we should be gracious to each other about not having every.loose.end tied with for every pt at shift change. (Obviously, chronic patterns of poor time mgmt are something else).

[BeenThereDoneThat74, MSN, RN]

I know this sounds cliche, but nursing is a 24 hour job. I understand following through on an issue to an extent. Knowing who your relief is getting (like if the rest of the district is heavy) should make a difference too (if there are many issues to be passed on, yes it would be nice to help out by stomping out a fire or two).

What I hate is that oncoming nurses like to guilt the reporting nurse into feeling like every issue needs to be completely solved. It is a very subjective issue, and unfortunately there is no correct answer.