Change of shift calls to MD. Who should take the call?

Nurses General Nursing

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I had a patient yesterday, a sweet LOL had gotten back from pacemaker, doing fine, but elevated BP systolic in 190s. She had come from a smaller facility with bradycardia and had gone straight to cath lab after briefly arriving to my unit, and had returned from that procedure in fine shape except for elevated BP.

My first course of action was to give her her lisinopril which she obviously had not had, then I did a follow up BP after giving that time to work and systolic was still in 180s. I gave all info to oncoming nurse regarding when I had given the BP med, etc and so forth, and paged the MD.

Oncoming nurse didn't want to take the call (she was in an empty room making a personal call to her boyfriend :rolleyes: ) So, I took the call, even though it was past time for me to leave, wrote out the order, scanned it down to pharmacy, and accrued some more unwanted overtime.

Our hospital, like many, has been pleading with us to try to reduce overtime, and I'm all for it! I hate to stay even 5 minutes over.

So, what would you all have done in a case like this? I don't like to leave things undone, but I was annoyed at oncoming nurse for her being on her cellphone with boyfriend and wanting me to take this shift change call for a simple matter such as an elevated BP.

Yet, in some cases it definitely WOULD be appropriate to stay and follow through on issues from your shift. Where do you draw the line?

Specializes in Med/Surg, Home Health.
The other thing is, especially with a lazy nurse like this, is that she may take credit for the call to the MD, and blame you for not doing anything about it.

You gave the lisinopril, and it didn't really work as well as you'd liked, but then it just looks like you let it be and went home.

Take the call, your telephone order is on record, you did your job following up on the pt and you can rest easy knowing that you did right by your pt.

Can you imagine if she had some kind of hypertensive emergency or stroke, and they looked back and said, "what did you do Firestarter, about this BP when you noticed that your med didnt' work. Did you call the MD?"

You did the right thing. THe other RN is just lazy and immature.

Exactly!! You did the right thing by staying. You not only helped the "lazy" nurse, you protected yourself and the patient.

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Specializes in ER.

If you paged the MD you take his call. But you can leave the written orders for her to act on.

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.

That's a good point Cardiac! In fact, this very same nurse did sit on a patient all night once, giving morphine for his "SOB" that I had suggested at shift change might be him blowing off some metabolic acidosis. The hospitalist was not our best one, but in fact our worst one, and had tried diuresing the pt. I was discussing the symptoms at shift change with her and speculating that perhaps an ABG would be in order, especially in light of his other labs that the hospitalist didn't seem to be paying much attention to.

She wholeheartedly agreed with me, but then just medicated him all night with morphine, in the AM the same hospitalist came in, ignored the pertinent labs again, but I was able to get ABGs another hospitalist and get the patient sent to the ICU.

Yes, good idea to CYA by following through on your own, although I did chart that I had paged the doctor and handed off the patient to her...

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If you already gave report, and she had taken over care of the patient, the call is hers. It's not clear if that happened here. Yeah, it's nice to help out, but if you have reported off, you should draw the line and leave. If she were busy with another patient, I might have taken the call, but since she was on a personal phone call, she needs to cut it and get to work. 12 hours shifts get longer when we don't draw the line.

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.
If you already gave report, and she had taken over care of the patient, the call is hers. It's not clear if that happened here. Yeah, it's nice to help out, but if you have reported off, you should draw the line and leave. If she were busy with another patient, I might have taken the call, but since she was on a personal phone call, she needs to cut it and get to work. 12 hours shifts get longer when we don't draw the line.

I do agree with this sentiment. If she had actually been in a room assessing one of her patients though, I would have had more sympathy for her.

At the previous hospital where I worked, there was more of a culture of getting out on time. Overtime all had to be signed off by someone. At that hospital I felt like people DID leave things to the next shift that they really should have followed through on themselves. Once I came on to a patient who had been crashing in the ICU where I worked and was about to be transfered to another facility. The other nurse left on the dot and I had to handle the entire transfer of an unstable patient with whom I was not well acquainted. I had another demanding patient with immediate needs and had to also transfer the unstable patient and give report to the other facility within the 1/2 hr transit time. I didn't sound too intelligent when I gave report. :rolleyes:

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Specializes in Med-Surg, LTC, Rehab, HH.

If you were packed up and walking to the elevator or door, she should have taken it. If it was after report, she should have taken it. But you did good:) You are professional, SHE is NOT.

I bet she is one nurse that gets her pee breaks, 15 minute breaks and lunch breaks, and "just does not understand" why others complain that they dont....

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Specializes in psych, addictions, hospice, education.

How is it that people can use cellphones, period, while at work? Everywhere I've worked, they've been forbidden and signs are posted that visitors and patients can't use theirs either.

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Specializes in Telemetry, CCU.
I do agree with this sentiment. If she had actually been in a room assessing one of her patients though, I would have had more sympathy for her.

At the previous hospital where I worked, there was more of a culture of getting out on time. Overtime all had to be signed off by someone. At that hospital I felt like people DID leave things to the next shift that they really should have followed through on themselves. Once I came on to a patient who had been crashing in the ICU where I worked and was about to be transfered to another facility. The other nurse left on the dot and I had to handle the entire transfer of an unstable patient with whom I was not well acquainted. I had another demanding patient with immediate needs and had to also transfer the unstable patient and give report to the other facility within the 1/2 hr transit time. I didn't sound too intelligent when I gave report. :rolleyes:

Yes, the hospital where I'm currently working has a culture of "you have to get out on time" and "overtime has to be approved by the supervisor"; its all part of this economy thing, and BS to me. If something comes up with your patient right at 6:30, I doubt you will want to waste time trying to page the house super to get OT approved. There are even people that encourage you to clock out even if you aren't done with your work, its just stupid. Patient care and safety always come first and sometimes this job takes longer than the allotted 12 hours. I'd rather stay late and know that my patients are okay than worry about ******* my supervisor off.

Looking at what other people have said here, I think you did the right thing taking the call; at least you know the patient got treatment for her BP, instead of going home and wondering about it. I can just picture the type of nurse you handed off to, I worked with a few like her on the tele floor. I suppose I'd feel better if I'd just taken the call and covered my butt too!

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Specializes in Telemetry, CCU.
How is it that people can use cellphones, period, while at work? Everywhere I've worked, they've been forbidden and signs are posted that visitors and patients can't use theirs either.

I guess if it doesn't affect pt care its okay; but now I'm seeing more and more people using headphones to listen to music while at work. That's a whole other thread!!!

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.
How is it that people can use cellphones, period, while at work? Everywhere I've worked, they've been forbidden and signs are posted that visitors and patients can't use theirs either.

Most of our patients have their cellphones at the bedside. On my unit all the nurses carry cellphone issued by the hospital so the tele tech or others can call us at any time.

Many Moms will carry their cellphones at work so their children can have easy access. Unfortunately, some use poor judgement in using them. Officially we are not permitted personal cellphones, but that's only enforced with those caught abusing their use.

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.
I guess if it doesn't affect pt care its okay; but now I'm seeing more and more people using headphones to listen to music while at work. That's a whole other thread!!!

I picked up a nightshift the other night and a nurse I really respect was watching a movie with a small device and an earphone. I was surprised. She said that it helps her concentrate on her charting.

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the nurse giving report should take the call. the oncoming nurse has no idea what's going on (usually).

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