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Discussion

Coworker problem

Hello all!

Sorry if this post is long, I just really need outsiders opinions on this.

I work on a general internal medicine unit. I had a patient a few days ago that wasn't doing too well. Long story short over my night shift I knew he probably needed ICU care, but he was in that in between stage where he was still stable enough for interventions that could be done on my floor so the MICU would not accept a transfer.

That day, he became more unstable so as I entered work at 1830 that evening he was set to be transferred.

Heres where the problem begins...

I was getting this patient from a nurse I work with that is notoriously lazy. She told me the that "they" I'm assuming she meant the doctors and possibly MICU staff asked her to not transfer the patient until after 2000-2100 so that the patient didnt come until shift change was over

now I'm all for helping others nurses by trying to not call or anything during that time, however I think this calls for some judgement in the fact that it was an icu transfer?

i got very bad report (basically nothing) about what had happened that day, and she tells me to call report at 2000. I'm kind of uncomfortable but as she is my senior nurse I don't really know how to complain that SHE should be calling report since this all occurred on her shift not mine.

So I try to start my shift, check on all my other patients, get them settled and then start to work on getting my transfer patient ready to go as nothing has been done. He needs cleaned up, his stuff pulled together, medicated, to finish a bolus etc. I do all this and call report as quickly as possible.

By this time it is 2000, and she asks me if I want her to stay to help me take the patient to the ICU. of course I do??

So I say let's get him hooked up to the monitor as we always do this for icu transfers.

She makes a comment like maybe we don't need to but I insist and I get him hooked up.

Then I ask if we need to call the physician to escort, which I thought was policy but wasn't sure in this situation since it wasn't a normal emergent transfer like I had in the past.

She says no and I trust her since again, she is my senior. (I have worked a year, and she 10).

We take the patient over, he is stable and get him settled. I go back to my unit and this other senior nurse tells us that we really

should have had the physician to escort. Now I am upset. I asked the other nurse directly about this. I also performed all the tasks of the transfer myself, walking into my shift that way, and she didn't do anything to help. All of the tasks could and should have been completed the moment she got notification that he had a bed in the ICU not an hour later by me, the next shift.

I have thought about going to my manager about this, but I don't want to 1) get myself into trouble for not following the rule of taking the physician with us and 2) my manager and this nurse are close. This isn't the first time this nurse has done things that I would consider negligent, and now she has pulled me into it.

I realize that I also contributed to this mistake by not following up on my intuition about calling the physician. I am okay with taking repercussions on this, I just don't trust my coworker to do the same and not talk her way out of it and place all blame on me.

Thoughts on any of this?

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    • Featured Replies

    Sounds like you need to learn to stick up for yourself and trust your gut. Good luck!

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    Some people are not going to do anything that you don't ask them to do. You cannot change their behavior, but you can ask them to do things in a polite and professional way. In my opinion, she should have given report at 1900 and told the ICU you'd bring the patient at 2000. She should have helped prepare the patient for transport. But you should have empowered yourself to ask her to do these things. Maybe she says she can't because she has to leave, but maybe she stays and helps.

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    • Expert

    It is dangerous to have the oncoming shift give report for a transfer to a higher level of care. The nurse who took care of this patient for 12 hours should be the one to do it, and it does not matter if you had him in the previous 12 hours. She should have done everything to prepare the patient for transfer, except for the physical transfer itself.

    In my former workplace, it was also policy to have a provider escort the patient to a higher level of care, along with the primary nurse.

    She was wrong and lazy, and you are right to not trust her.

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    Also, good documentation is important here! Never place blame on a co-worker in your documentation, but be specific about what time you assumed care and what you did for them. If there are problems in the future, management (if they care enough) can look back and find trends on this "lazy" nurse.

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    Wow, I've never heard of this physician escort. Is this a huge hospital?

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    Wow, I've never heard of this physician escort. Is this a huge hospital?

    I was going to say the same thing. I work in a large facility. But I have also worked in a rural setting. We have a transport team who transport pts. I usually do also go with them but it is not required.

    I so agree it is not good practice & dangerous to have the oncoming shift give a report on the patient going to a higher level of care.

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    Wow, I've never heard of this physician escort. Is this a huge hospital?

    Same- never heard of this practice. I did have a couple patients so unstable that my manager came on the transport, but normally it was me and an aide taking the patient.

    ETA: unless the patient was going to icu as a rapid response- if that was the case there might be a whole slew of people depending on the issue (critical care nurse, nursing supervisor, respiratory therapist, provider, etc).

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    • Guides

    Never heard of a physician escort here either. We would be waiting for.ev.er. to transfer and would, frankly, give them motivation to resist transferring patients if they have to escort. That is just...strange. What is the rationale?

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    I was going to say the same thing. I work in a large facility. But I have also worked in a rural setting. We have a transport team who transport pts. I usually do also go with them but it is not required.

    I so agree it is not good practice & dangerous to have the oncoming shift give a report on the patient going to a higher level of care.

    Yes, the off-going nurse should have called up to ICU and requested that the nurse who would be receiving the patient call for report once they've gotten report on their other patient. The nurse could get quickly squared away with their first patient and then be ready to receive the new transfer. There is a reason a patient is going to icu and it shouldn't be delayed.

    I've held an icu patient going to the floor, but that's totally different. I've had a patient ready to go to the floor with 30-60 minutes or so left in a shift. I've prepped the patient and called report to the next shift right at shift change (called before shift change to alert the new unit of the plan) and my unit will keep the patient for an hour or so as a courtesy.

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    • Author

    Yes it is a large hospital. I believe the rational is that if the patient should code on the way, that patients physician is already present for orders and other assistance.

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    Even when I take the patients I have rapid responsed we do not have a doc go with us. It is me (rapid nurse), patient nurse, and RT, or a nurse assistant. Does your facility have a dedicated rapid response team OP?

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    • Author

    We do. They already knew about this patient and such. They just weren't on the unit anymore by the time I got there.

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