Abandonment???

[Happeetxn]

Howdy All,

I have a question concerning abandonment. I am a new nurse who passed boards earlier this year. At the hospital that I work for we don't give each other a verbal report, instead there is a phone system that the nurse leaves a recorded message on at the end of their shift. This is usually not a big deal for 7a - 7p and vise versa because we see each other and can ask questions if we have any. The problem is when we have 7a - 3p nurses and they leave. The remaining nurses have to take on the leaving nurses pt's. No big deal so far except, we are not always told when a nurse is leaving.

So the other day I am at the nurses station it is 1800 and the unit secretary asks me if Mr. Smith (not real name) in room 1234 can have something for pain? I replied by saying that I didn't have that pt. to which she replied, "your name is by his on the assignment board." Sure enough there it is. To make matters worse, the family member is standing next to the unit secretary while all of this is being said. I get an MAR, the pain meds and go to the pt's room. I apologize to the family and say there was a miscommunication but I am here for you yada yada yada, and assess the pt. The wife of the pt. informs me that the off going nurse told them that I would be their nurse, but that nurse NEVER mentioned that to me. To make matters worse the pt. had come up from ICU (post CABG x 5) around 1300 and was on a dobutamine drip. I was furious that I knew nothing about him. I spoke to my manager / charge about this and the response I received was "Well you need to check the assignment at 1500 to see if you are picking up any patients." Funny this was left out of the orientation I was given.

Now we don't have someone leave everyday at 1500, but I don't know who is working what schedule from day to day. Isn't it the nurses responsibility to let me know that I am picking up one or more of their pts.? As for checking the assignment board at 1500 everyday, at 1500 I may be in a pt's room giving meds, leave there to do a dressing change, then on to answer a call light and so on....... It could be 1600 or later before I am back at the nurses station.

I have spoken with my manager / charge about this and the best answer that I have received to date is "Well, I will try to let you know when you are picking one up." My co-workers just say "yeah I hate that, but that's just how it works here." I am nuts??? Is this really an acceptable attitude to have? I now just work my 3 - 12 hour shifts and pick up my over time on a different unit. I can't transfer off of the floor because I have a contract to fulfill.

When these nurses leave without saying anything does it constitute abandonment? Friday was the most recent time this happened, I had 5 pt's. Of those 5, 1 had a trach, 1 was bradying down to the low 40's and a 4.0 second pause, one was getting blood. Going to check the assignment board was not on the top of my list of priorities.

Please understand I am not upset about picking up a, we take up to 6, nor do I want to come across as complaining about the workload. If I have 5 and ICU or recovery calls report at 1800 with a transfer I know that is part of my job and get ready for the new patient and move along. It is the not knowing that gets me upset. And yes, I do keep a closer eye on the assignment board.

I have been on this floor for a few months now, half of that was w/ a preceptor, since I have been on my own I wonder how many patients I have been assigned that I never saw because I didn't know about them.

Anyways all thoughts and / or comments will be greatly appreciated.

[SuesquatchRN, BSN, RN]

That's just really sloppy. Someone should let you know as common freakin' courtesy, let alone for obvious safety reasons.

[mom4josh]

First of all, 5 or 6 patients on a tele floor is way too many, esp if you have trachs and drips and such. I think even an experienced nurse would have trouble with this. Our tele nurses gripe when they have more than 4! It is absolutely not unreasonable for you to expect the courtesy of at least the prior nurse giving you verbal report or the charge nurse letting you know you will be picking up a patient. Keep documentation on all of this. Doesn't sound like a good situation.

[Tweety, BSN, RN]

It sounds like the system is in place and has been in place before you arrived. So the nurses aren't abandoning the assignment if they followed the established procedure by giving report by phone and the assignment was on the assignment sheet prior to them leaving.

It doesn't sound like a good system, in fact downright dangerous with those types of patients. You might just have to chalk it up as a lesson learned to check your assignment every day at 3pm.

Did you do an incident report so risk management is aware of this system. Can you come up with a better system and try to institute so this type of situation doesn't happen again?

[Celia M, ASN, RN]

If you're a JCAHO accredited hospital check the regs because I believe that if you don't give a face to face report there has to be the opportunity for the oncoming shift to ask questions of the off going shift. Celia

[Tweety, BSN, RN]

Good point Celia. JACHO's newest "big thing" is "hand off". They are nitpicking about how we handoff to radiology, to transfer patients from one unit to the next, etc. They probably wouldn't approve of a system of taped report without nurse to nurse handoff.

However, nurses have taped report for decades and it really isn't abandonment.

[rags]

I would have thought a simple, "I'm leaving now, I last gave pain meds at blah blah time and have left report for you on the recorder".

I DO believe this is pt abandonment and very poor practice by the charge nurse. I don't care how long the system has been in place. It obviously isn't a good one.

On my unit we give verbal report but we still know ahead of time if we will be picking up another nurses pt's. On the other units in our hospital they do record their report, but!... NO ONE leaves until report has been heard and the new nurse has an opportunity to ask questions. After all, someone has to be there for that pt. Until that report is listened to (which is the same as reporting off), the patient still belongs to the first nurse NOT the one taking over.

I feel for you and hope you can find a way to fix a broken system or at least are able to go elsewhere when your contract is up. I also agree with the other poster. An incident report should be filed for risk management be informed of this so they too can maybe do something to fix it. Families don't like to be ignored or to feel their loved one is not being cared for. If they feel the situation was bad enough they might even take it to court. The hospital and risk management are fully aware of that I'm sure!

rags

[santhony44, MSN, RN, NP]

I don't see why you can't be given the whole assignment at the beginning of the shift: you'll have rooms 1, 2, and 3 from 7A-3P and then pick up room 4 from Nurse Nancy at 3 PM. It seems to me that when I worked in the hospital, this is how it was done. No surprises that way. And, if things changed during the shift, the charge nurses made sure that everyone knew what was up. If I were the charge nurse, I'd be sure that all staff were fully aware of their assignments. The way it's being done is just asking for patients to get overlooked.

They probably won't change it, though, so you're stuck until you're free to leave. Just make a habit of checking the darned thing!

[walk6miles]

This p'o' me. You are NOT at fault. First of all, when you are as busy as your assignment says you are, it is up to the offgoing nurse to find her replacement and inform her that she is leaving and at the very least, answer any questions. I am not a fan of taped reports - this is just one of the things that can happen with taped reports.

I also think you have a lousy charge nurse - I loose my cool when I find out I am getting another patient or something else happens because my LAZY charge nurse cannot get up off her butt and tell me I am getting another patient - I NEVER give her a hard time about assignments, etc. so she has no excuse.

You are being treated most unfairly!

[Dolce, RN]

I think it is quite bizarre that the nurse going home didn't pass off to you that she was leaving and inform you that you were going to be taking over her patients. It would be one thing if she was leaving at a regular time, like 1500 or 1900, but to leave early and not let nurse taking over know...that is just bad practice. I agree with the idea of an incident report. Incident reports get things done! If your manager doesn't address this issue, go up the food chain!

[Happeetxn]

It would be one thing if she was leaving at a regular time, like 1500 or 1900, but to leave early and not let nurse taking over know...that is just bad practice.

The off-going nurse did leave at a regular time that day (1500) she normally works 12's with me. I didn't know she was leaving much less that I was getting one of her patients.

We are a JCAHO hospital and are expecting them at anytime.

I don't plan to go higher up the chain, this is obviously the way things have been done on this floor for who knows how long, and I don't care to bang my head on the wall. Might sound self-centered but you have to pick and choose your battles, it is easier for me try and remember to go check the board daily than to go above my managers' head. I just hate being surprised like this.

I only do my shifts I am obligated to do on this floor now, my overtime I pick up elsewhere in the hospital. I plan to finish my contract and move on. I will keep a positive attitude as I find this profession to be the most rewarding thing I have ever done. I don't mind having difficult patients (trach's, drips, blood transfusions, etc.....) as I feel I am gaining invaluable experience. I must also mention that there are some really outstanding nurses that are on my shift. I can ask them anything and they will tell me, show me, or point me in the right direction to find out what I need to know.

I appreciate all of the feed back on this topic.

[dazey71]

sounds like you work where i do. that's happened to me quite a few times.