That gray timing, what to do to please everybody.

Specialties Emergency

Published

Hey readers, first time post so bear with me on this one.

I graduate nursing school this December but I have been in the ED since before I started my program and I love it. I hope I can have my whole career be in the ED (unrealistic, I know). So with graduating soon and wanting to not only be the best ED nurse I can be, I also want to have a good rapport with the floor/critical care/CVICU/every department nursing staffs (again, unrealistic, I know). With all of that being said, I walked into a patient room recently that was ready to be transported to their room on the floor, this patient had acute confusion and had to be educated again on why he was being admitted, there was not an ID band or an allergy band on his wrists, and his IV fluids had been done long enough for the blood to back track almost halfway up the tubing. This occurred right at shift change, so the night nurse had gotten this patient "ready" and just had not called report that way we were not transporting this patient right before/at/during floor shift change. But after the bed was assigned the night nurse never laid eyes on the patient again, which I understand (not that it's right). Day shift comes on and the nurse that took this patient was told they were ready and so the day nurse called report and said they were ready without laying eyes on the patient, which again I understand (not that it's right).

Who would essentially be in the wrong?

And what steps should be taken to ensure that we don't become jaded and even after a night that just beats us to a pulp (I work rotating shift so I get the worst of both day and night shifts) we just jet off?

I understand both sides but I also wants to be able to be the best I can be to alleviate unnecessary things being done to the patient such as starting a new IV since the current one wasn't flushed and had clotted off, and alleviate unnecessary headaches such as the patient having no ID/allergy band on.

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Sure, change of shift, confused patient being transported to another unit, s**t happens. Doesn't make if right.

I'm not sure if you're asking how to make other nurses or a nursing unit function better so this doesn't happen again?

Or how you can be sure not to become this type of nurse?

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Specializes in NICU, ICU, PICU, Academia.

I think you're trying to make everyone involved happy- and that is just not realistic.

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Essentially what I'm asking is who should take responsibility for the patient?

Such as, the patient was "ready" at 6:20am, is that that current nurse's responsibility that the patient is ready to ship off after shift change

or

Is it the responsibility of the nurse who took over at 6:30am to make sure they are ready after they call report?

As well as how to cut down on fragmentation during change of shift.

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I understand that for sure! Haha

I just know had that patient been taken to the floor with no bands on and an empty bag of fluid and blood in the line, I would've gotten my a$$ chewed as transport, and then that nurse would've called straight down to the ER and chewed some more.

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Essentially what I'm asking is who should take responsibility for the patient?

Such as, the patient was "ready" at 6:20am, is that that current nurse's responsibility that the patient is ready to ship off after shift change

or

Is it the responsibility of the nurse who took over at 6:30am to make sure they are ready after they call report?

As well as how to cut down on fragmentation during change of shift.

In a perfect, smoothly running, 8 hour shift, the nurse who had the patient all night, left at 6:30 am, was responsible for sufficient IV fluid and the name band. With no other information than what you presented.

I'm sure you, we, all know, there is no such thing as a perfect, smoothly running, shift.

If you follow a co-worker who always leaves a mess like this it is appropriate to say something to them.

If this is a one time occurence, nursing is a hard, 24 hour, job, we all need to help each other.

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As someone else said, "we cannot please everyone", but when HIPPA is violated and the patient's safety is at risk, everyone involved here is at fault. Too bad we didn't get the facility name so we can all avoid this place.

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Both are responsible to make sure their patients have an ID band and don't have a clotted IV site.

Beyond that, what is going to happen around hospital shift changes needs to be worked out between departments, with the result being an agreement that people stick to.

Personally I favor, where at all possible, the oncoming day RN calling report to get ED report from the off-going night RN, either before the day RN gets report on the rest of the patients or directly after (so at 0700 or 0725ish). This cuts out "middle reporters" who never cared for the patient and aren't going to be caring for the patient.

The days of needing to get everything under the sun done before an admit can be accepted onto the floor are gone. So says CMS. It is a quality measure that, when it is decided that a patient will be admitted, the patient gets to their admit bed ASAP. A very slight delay to accommodate for shift report is reasonable.

The floor calls and gets report during the 30 minute shift transition, and the patient is transported upstairs without further delay. The night ED RN remains responsible to make sure the patient is ready to go.

This whole topic is one for unit-based councils and process improvement committees. It just causes such angst (and sometimes actual patient difficulty) when it isn't ironed out.

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Specializes in Peds ED.

Most places I've worked at do not have nurse to nurse report from the ED to the med surg floors anymore. The room is ready and transport is triggered so transport might arrive with the patient not completely ready to go upstairs. Our process here is for the transported to ask the nurse if they can take the patient while picking up the patient's chart and will give us a minute to flush a line or print out a bracelet.

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Most places I've worked at do not have nurse to nurse report from the ED to the med surg floors anymore.

I'm familiar with this trend, too, but for the life of me I have no idea how it's acceptable.

I strongly suspect it's one of those things where facilities change their usual practices because they are incentivized to do so (in this case due to CMS quality measures) - but the individual acts themselves include things any BON would not look highly upon. If there isn't a proper hand-off, there isn't a proper hand-off. Patient abandonment definitions in many places (states) directly incorporate the idea of a proper hand-off having been (or having not been) given. As far as I'm concerned the fact that various tidbits of information can be found "somewhere" in a chart is no substitute for proper report.

I really don't think a facility's change in usual practice is going to be proper defense for an RN caught up in a tragic scenario that coincidentally (even if not causally) involves "no report." What's more - since these types of practices are constantly being tweaked and changed, they don't always actually make it to official policy and even if they did there would probably be some disclaimer that the RN should always use "nursing judgment" about whether or not report should be called.

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