Dazed and Confused: Blurred Lines

Night__Owl, BSN, RN · Jun 30, 2018

Complete the responsibilities that you had before report started. If possible, I try to check on all my pain patients and check all my incontinent patients once after 5am.

Our report starts at 6 45. If the MD writes orders at 6 59, tough luck. Sometimes I'll stay 5-10 mins and help, but it is strictly out of the goodness of my heart, NOT because I think it's my responsibility.

After you give report, those are not "your" patients anymore. Legally and morally, they are now under the care of the oncoming nurse. If it is too hard for you to say no to these people, I suggest you go to another unit after you give report to finish up your charting.

bugya90, ASN, BSN, LVN, RN · Jun 30, 2018

Anything that is ordered before report start time is the previous nurses responsibility. If there are orders for meds to be given at 0300, night nurse needs to take care of those before you leave. If a patient asks for pain meds in the middle of report that is the next shifts responsibility. Our standard cut off time is 0645/1845 (we work 7-7).

JKL33 · Jun 30, 2018

The issue too is that, I am not really sure where my responsibility ends as a night nurse and where the day nurses responsibility starts. Being that I am new, I try not to ruffle feathers but I am beginning to feel like some day shift nurses are taking advantage of me.

Oh my. Yes, you are correct and you need to pleasantly put your foot down ASAP.

This is mostly simple. Your routine tasks need to be done and accounted for, meaning that abnormalities uncovered at the most recent rounds should have been addressed or be in the process of such. Meds due within the 30' before and after the hour of shift change (say 07/1900) should have been given if at all feasible.

With few exceptions, beyond ^ that, this is a 24-hour operation for a reason. You are being taken advantage of if someone is referring to what "we" need to do 2 hours after your shift has ended.

I don't care if that's the culture of this unit, it's the kind of thing that wears nurses out prematurely. It is not acceptable.

Your bedside report needs to be brief and organized and delivered without long pauses in which you entertain all of this malarkey. Deliver it briskly and with purpose and be ready to move to your next room. Don't make any little task list of what they want you to do when you're done with report. If they bring up unreasonable things, turf them ("Can you let the tech know? We need to move on with report"). Don't get suckered into watching them do their assessment or pretending that the entire assessment needs to be done together. Head for the door and say, "I'll wait for you in the next room."

I could go on but generally, you probably need to pick up the pace and assert yourself a little; report isn't where you passively await their further instruction about what you need to do before you can leave.

Keep it pleasant and upbeat. You can do it.

JKL33 · Jun 30, 2018

Anything that is ordered before report start time is the previous nurses responsibility.

I beg to differ. Especially with the turnarounds for pharmacy verification or equipment delivery, for example, that is entirely unreasonable.

brownbook · Jun 30, 2018

Check with your charge nurse or supervisor befor this happens again. Tell her you are staying overtime is that okay. I hope, assume, she will say no unless it's pre-approved or an emergency, you need to clock out on time.

Smile at the on coming nurse and politely say, " sorry I can't do that I don't have overtime approval," and go on to the next patient.

bugya90, ASN, BSN, LVN, RN · Jun 30, 2018

I beg to differ. Especially with the turnarounds for pharmacy verification or equipment delivery, for example, that is entirely unreasonable.

I was referring to things that are ordered at 0500ish. I've had multiple times that I float to other units and the night nurse tries to not give meds that were ordered several hours before I even got there. I don't expect the previous nurse to stay there 1-2 hours late trying to take care of tasks or requests that happen after 0700 but I'm also not going to spend the first 2 hours if my shift giving meds that should've been given hours ago either. I don't dump things on the next shift and don't allow them to dump things on me either. Like I said in my original post 0645/1845 is when report starts and when new orders become the next shifts responsibility.

JKL33 · Jun 30, 2018

I gotcha, but there is a HUGE difference in something being ordered at 0500 and 0644 or even 0630. At some point the off-going person should be able to wrap up what they reasonably can and make sure to be prepared for report.

Personally I think the best policy is to not watch the clock too much unless there is an obvious problem. I've actually enjoyed staying a bit to help the next person get off on a good foot, and the goodwill/camaraderie/cooperation it has earned me has been worth it. I'm also understanding when people sometimes don't have everything done perfectly and look like they've been run over by a truck at the end of the shift. It works out well since it can and does happen to any/all of us. So this really only gets my attention when others have separate standards for themselves and everyone else.

:)

WestCoastSunRN, MSN, CNS · Jun 30, 2018

Where I work, the unit culture is "go home!" -- nursing is a 24/7 job. What you are doing.... staying that late -- totally unacceptable. I agree with keep that report moving, crisp and to the point. I would also have NO problem saying, "yeah, I've got my work-life boundaries figured out now -- I gotta get out of here" -- Providing, of course, you have done all that was supposed to be done on YOUR shift.

And yeah, I also do try to have everyone's pain under control -- make sure everyone's stable before report starts. This makes for a better hand off and sets the next nurse up for a better start to his/her shift.

I'll stay late for some stuff like helping with a new admit or code or someone circling the drain.

Been there,done that, ASN, RN · Jun 30, 2018

"I am not really sure where my responsibility ends as a night nurse and where the day nurses responsibility starts." There should be a policy regarding this issue. In most facilities I have worked, there was a one hour time frame from an order written to start of report, that the off-going shift was responsible for. Same with completing an admission.

You need to bring this to you manager's attention, there is NO way they want to pay you overtime to perform routine duties that the oncoming shift can handle.

verene, MSN · Jul 1, 2018

Check your unit policy and check with management and nip the staying late in the bud. I can pretty much guarantee that management is not going to be okay with you staying 2-3 hours late for day shift on a regular basis. Where I work there is a 15 minute grace period beyond normal end of report, because sometimes stuff happens and it can take a little longer to get through report. Anything beyond that 15 minutes you don't necessarily need to seek prior approval for, but better be able to justify why you stayed late. And acceptable reasons are more on the order of "**** hit the fan and I stayed to get everyone through the crisis" or "I needed to complete a critical incident report before I left" rather than "oh I was administering PRN Tums and checking vitals for the on-coming shift"

Don't let day shift's laziness become your write up for incremental overtime and/or poor time management skills.

cleback · Jul 1, 2018

Just make sure pain is well managed and meds are given that were scheduled before report. If the med isn't available, kindly explain that to the oncoming nurse. You do not need to stay latell to wait until it's there, give it, etc. Also if the patient was sleeping comfortably and only requests that prn for pain once awoken by bedside handoff, that is for the oncoming nurse too, not you, to give. Also long as you've been diligently monitoring an unstable patients vitals during your shift, there is absolutely no reason you should have to recheck them after your shift (the caveat is if it's a rapid response situation, then it is nice to stay and help a bit). Someone needs a bathroom? Kindly explain the nurse aide will be in in a few minutes. Also don't leave with fluid bags nearly dry.

It also seems to me like you could shorten your report overall. Keep it short and simple. If the oncoming nurse could plainly read it in your note, no need to include it in bedside, unless you want to emphasize the point.

Keep going--you've got this!