Deciding which orders can wait

[311ltc]

It is understandable in this time of economic crisis, the push to elimate overtime, but where do you safely, ethically, morally, legally..... do this.

I work second shift in ALF (with 30+ residents with a mixed population of AAO to moderated Alzheimer), there is no third shift nurse. Doctor comes in after 6PM leaving you with 11 orders to take off. Most of which involved some type of med change, none of them being critical, i.e. increase in slept medication.

Your told to do only the orders that needed to be done immediately. Directly related to the avoid OT.

I have a problem leaving things unfinished even if I was passing it on directly to the next shift nurse, but more so, especially since it would not be handed off directly to the next nurse.

So I pushed myself to do it all, which isn't the best thing to do either.

How would one decide which should be done and which could wait until the first shift nurse came in the next day. Protecting themself and the residents.

Thanks!:)

[elprup, BSN, RN]

I'd love to know the answer to this question as well.

But with no third shift, won't the next am shift get a ton of orders that were not done plus new ones? That does not seem right either.

Thanks

[CathyLew]

do anything that says Stat.

think about the other shift...if a Dr comes in early (we do 7-7 shifts) so the Dr rounds early, at 6am.... should the night crew stay and take off all of his day round orders? or assume they are meant as morning rounds. (usually happen at 7-8am) when I worked nights, and a dr came in at 6am and did rounds, we did the stat orders.

you can't rush thrugh a stack of orders, and do them half @ssed. rounds are meant to be done with the shift having ample time to give them the neccisary time to look them over and take them off.

the on comming shift may be ticked off, but you have to think of patient safety.

[CapeCodMermaid, RN]

I'm guessing you work in assisted living? It's not really good practice to leave orders left over, but do the crucial ones...new coumadin orders, new pain meds, diuretics....

[sweetlass]

Sort out important orders that needs to be carry out immediately.You dont have to carry out all the orders as much as you wanted if you are not able specially if you are busy with other patients.Prioritize and endorsed nicely to the next shift the remaining., its better to be safe and slow than carrying it out in a hurry to prevent fatal mistake.If you are alone in your shift, ask the supervisor for floater.While you are carrying out other important orders the floater can make errands-labs, pharmacy,etc.The next time the doctor will make rounds, tell him in a nice way to write orders that can be carry out within your shift. ^_^ Happy Duty!

[Mr Ian]

If you can DTO the MMCs under a FI1AA then I don't see why they shouldn't PPHM the CUD.

What's an ALF?

[311ltc]

ALF Assisted Living Facility.

What is DTO? Delagate to others? How about MMC, FI1AA, PPHM, CUD?

[Mr Ian]

ALF Assisted Living Facility.

Thanks.

What is DTO? Delagate to others? How about MMC, FI1AA, PPHM, CUD?

Irony.

I would raise it with administration. Since they are saying no OT and only do what is strictly necessary - then I'd want in writing:

1. What is 'strictly' necessary?

2. That they assume liability for anything not done that they said wasn't 'strictly necessary'

Otherwise you're leaving yourself open to being culpable for anything not done.