Change of shift- acute patient issues?

[Trubie, LPN]

New grad.... got another question! :)

Whose responsibility is it when a patient reports a change in condition during shift changeover?? Last night, I was getting off work at 6p, and in the middle of report, a CNA comes to us and says a patient is having chest pain. My preceptor and I went to see the patient, and she told us she had been having upper body (shoulder/arm) pain with occasional stabbing chest pain for the past 2 HOURS!! (wth, why is it taking you 2 hours to report this?! anyway...) Her blood pressure was slightly elevated. My precepter decided to give her PRN pain medication, and told me that "if it was truely a cardiac issue, her BP would be higher". Is that true? I thought chest pain should at least warrant a call to the doctor and perhaps some nitro? Pt did not have standing orders for nitro, as chest pain had not been a previous concern.

So I guess this is a 2 part question.

1.) Since it was shift change, is the oncoming shift responsible for treating/documenting... or should the outgoing shift stay late to provide care?

2.) In the LTC setting, would you automatically call the doctor for chest pain (on patient with no history) or give a PRN and see if it goes away?

[MelEpiRN]

A) Always report chest pain to the MD, ESPECIALLY if the patient has no history!! I never worked in LTC but seems to me that's considered a reportable change in status.

B) I hate to say don't trust your coworkers, but if my patient was doing poorly I always stayed late to handle the situation or waited until the patient was stable. You don't know what your coworker would prioritize or document, or come back to say "she never told me the patient was having chest pain in report". Would y'all reading this agree? I think many of us have been burned in this situation before.

[lkwashington]

If you are in the middle of shift change, both nurses can work on the patient. One you can be calling the doc and the other with patient for continue monitoring. You both can document what you have done. It is a team effort. It does make the job easier for everyone. Now, I know this is not always the case on every unit but it work smoothly when it does happen. DOCUMENT!!!DOCUMENT!!!DOCUMENT!!!

[nicenurselpn, LPN]

I agree with the above post!! Always Always report chest pain!! If the doc says to send them out, get them outta there!! Better safe then sorry!! It is your license on the line. And document document!! I have been in this situtation before at my very first nursing job in LTC. This lady (who wasnt even my patient, I was on another unit) had been complaining for hours of chest pain. One of the cnas called me over, and I assessed her, found her bp up and she was c/o severe chest pain. I called the doc, called ems and sent her out. I then proceeded to write up her nurse, that had been ignoring her complaints most of the shift. Turns out, this woman was having an MI. She spent a little over 2 weeks in the hospital.

Wendy LPN

[ebear, BSN, RN]

BOTH nurses handle the patient. Your preceptor is misinformed RE: BP. Call MD without delay,get EKG, and start O2. Rather MD scream that he didn't want it than scream because you delayed! He/she will probably order ASA and NTG anyway along with cardiac enzymes,etc. ALWAYS call the doc with new onset of chest pain...period. Time is muscle.

[SuesquatchRN, BSN, RN]

Call the MD. Stay.

[nicenurselpn, LPN]

I have the philosphy that all of the kids in my building are "all of our kids" I dont want to hear someone say "that is not my patient". Burns my rump everytime!!! Teamwork is the key!!!

Wendy LPN

[AprilRNurse]

Chest pain is ALWAYS cardiac until rulled out by a doctor.

Did patient have an order for nitro? There is no corrolation between BP and chest pain. I've had cardiac patients with low BP, and with high BP.

[Kooky Korky, BSN, RN]

I have the philosphy that all of the kids in my building are "all of our kids" I dont want to hear someone say "that is not my patient". Burns my rump everytime!!! Teamwork is the key!!!

Wendy LPN

But that's not what she asked. She's not denying that the patient is hers. She's asking at what point the patient becomes the patient of the next shift. She's giving offgoing report, for God's sake, and is asking if she has to delay going off duty to care for a patient who, I think, should pretty quickly become the responsibility of the next shift.

[steelydanfan]

But that's not what she asked. She's not denying that the patient is hers. She's asking at what point the patient becomes the patient of the next shift. She's giving offgoing report, for God's sake, and is asking if she has to delay going off duty to care for a patient who, I think, should pretty quickly become the responsibility of the next shift.

If you are in the middle of giving report and get a message that one of your pt's is c/o chest pain, you and the oncoming nurse both get up, go to see the pt., (so that you can communicate the different appearance, understand the pt.s complaint clearly, and decide who will do what. Obviously, the offgoing nurse won't stay hours, but she COULD and should, make the call to the MD as she has been with the pt. for 12 hours and has the background to explain the pt.'s changed status clearly. Your manager might beg to disagree and cite OT concerns, but the pt's well being come first.