Endorsing to the next shift.

[dudette10]

I know we've talked about this before, but a situation came up recently where I wasn't quite sure what was "right."

I'm pretty easy-going when it comes to stuff endorsed to me on day shift. The night shift nurses usually are apologetic or feeling overwhelmed (mostly new nurses) when they have to endorse stuff. I've gotten my work flow and efficiency pretty much air-tight so I rarely have to stay late for anything, which I think is the reason having stuff endorsed to me doesn't bother me. That is, I know it won't put me behind too much.

What does bother me, however, is when a nurse expects me to pick up their slack and is particularly ungrateful and downright annoyed by my reluctance to do a few things.

The other day, a newer nurse (new to acute care, limited experienced in extended care) didn't endorse anything to me, but a quick look at the chart indicated there were quite a few things she missed, specifically admission flowsheet charting, blood draw off a central line, 0600 EKG, notifying an MD of a UOP problem. I tracked her down in a central charting room to discuss the missed orders/notifications. She endorsed a "busy night" with two admissions and she hadn't done any charting...when it was busy really because of her inefficiency. Not unusual, I know.

What got me, though, was when I suggested to split the tasks that she missed. I told her I could delegate the EKG immediately and do the admission flowsheet charting (history questions that don't require an assessment), but she would need to do the blood draw and notify the MD.

My ire quickly ignited when she sighed and said, "I'm tired, and I had a busy night. I want to go home. Why can't you do them?" I'll admit that it was pretty apparent I was royally ticked through my tone of voice and facial expression: "Because these were duties for your shift, you failed to properly endorse them to me, and I'm still offering to do half of them because I can do fairly quickly."

I had decided to split the tasks in this situation. I could have done them all without a real drain on my time (paging doc about the previous UOP as I'm walking from room to room and doing the blood draw during first rounds), and I could have saved the working relationship. The nurse has yet to speak to me--even after greeting her casually during subsequent shift changes--but that could just be me making up stuff in my head, I acknowledge. I feel like my decision to put my foot down on splitting tasks was because I was bothered by her attitude, rather than by how far doing the stuff would put me behind. That is to say, if she had approached me with a different attitude, I might have done them all. That's why I'm not sure if I was "right." My emotional reaction directed my actions, which is why this still bothers me.

So, I have two questions: 1) what is your opinion on the situation described above and 2) what are your "rules" for receiving or giving endorsement for nursing tasks?

[Been there,done that, ASN, RN]

She is definitely acting childish by not speaking to you and whining "I'm tired, and I had a busy night. I want to go home." Not surprised you bristled at that, you are human. As far as saving the work relationship... you shouldn't have to bend over backward, smile and do her work to maintain it.

Sounds like she is overwhelmed , leaving that much undone. I would discuss it with management, only to identify and help her with her issues.

[jadelpn, LPN, EMT-B]

If it was an 0600 lab as a cardiac rule out, along with an EKG....time is a HUGE thing!! For all anyone knows, this patient could be in the midst of an MI.

And that would be an issue.

If it were medications that are extremely time specific, that again is an issue.

Charting...we also have 24 hours to complete admissions. If it is questions of a history nature, no reason you can't just fill them in. What I won't do is chart someone else's assessment. That would be something they need to accomplish. As well as critical labs--they need to finish that, as they received the critical.

I would do an incident report each time. Not as a "get some one in trouble" thing but as a adequate staffing issue. If the nurse did not complete tasks on hand due to multiple admissions, a full unit.....there's only so many hours in a shift. And the burden is on the manager to see that shifts are staffed appropriately.

And do take emotion out of this. The time spent negotiating who does what on principle, you could have had the labs drawn and the EKG done.

[amandakayern]

I think there are certain things that are ok to hand off and others that aren't. Orders scheduled for your shift should be completed unless it's something that needs to be carried over or was delayed for reasons beyond your control (like pharmacy not getting a med to you soon enough or lab not coming soon enough to draw labs needed etc) .

I was floated to a surgical ortho floor one night where 5 of my 7 patients needed dressing changes. Everyone I had was on round the clock pain and anti emetics. The dressing changes were Qday and I guess they always left them for nights. I got around to 4 of 5 patients and left my am nurse with the last one and she acted miffed bc she had to do one dressing change. I had literally been running around all night, trying to acclimate to a new floor and get all my tasks done while managing all the stuff that inevitably pops up and she was angry about one simple dressing change. There are some things that just can't get done in the time allotted to you.

[SleeepyRN]

What bothers me in this case is not that she had to endorse work to you, but the way she did it. She neglected to give you an accurate report, and you found out on your own that stuff was missed.

As far as endorsing, I agree with above post that nursing is 24/7. At my job they are cracking down on leaving on time. I'm new at this place, and HAVE to endorse. I'm not as quick as the other nurses yet, so of course I have to endorse some things. But there are a few nurses who basically don't allow me to leave. They start to throw a fit saying they don't have time to do whatever it is I need to endorse. But our supervisors are saying we HAVE to get out on time.

Here's an example: Last night on my 3-11 shift, my patient asked for tramadol at around 10:50. I go to the narc box to pull it only to see he doesn't have any yet. (New admit patient from the day before.) Yet documentation on the EMR showed that day shift had administered a pill. If we pull from the convenience box, we have to have an authorization form from the pharmacy that states how many we are allowed to pull. Then we pull that many and put it in the narc box until pharmacy delivers the med. This requires a complete narc count to be completed by 2 nurses from the convenience box. So this is a process.

Anyway, there was no paper showing authorization to pull this med, leaving me baffled as to how how the nurse before me gave the pill. So this was going to require a call to the pharmacy emergency line with a bit of investigative work. I understand that the oncoming night nurse doesn't have time to deal with this. But neither do I. It's now 11 and time for me to go home. But I'm a pushover and allow the oncoming nurses to bully me into staying past my shift. But like I said, my supervisors are cracking down on staying past our shift.

So I don't know what to do. Heck, I hate endorsing more than the nurse hates getting the endorsement. I feel bad about it being new.

[Assclown]

Your talking about a new nurse. You expect a new nurse to have experience. Your expecting a New nurse to hand off their assignment to you like a seasoned experienced nurse... and then you wrote about it

You, the seasoned nurse, should have helped the new nurse. Lead by example. You did not mention if someone dumped a couple patients in that person's lap at the beginning of shift or at the end of shift. What did the nurse get done? Were the big parts completed? Was that nurse working on all of it for an hour or 6 hours? You sound like a day shifter, I am sure you think nothing of it but when night shift calls the MD's service and has left half a dozen messages because the MD wanted to sleep, dayshift always harps on night shift because of it. I've been on both sides and it sounds like you are sticking the new nurse  on things that mean next to nothing to you to do.

When the nurse said she was really tired, we have all been there, sounded like any one of us had a tough shift. Then at the end of it, there you were going to teach a lesson. Stick that nurse. 

Have empathy for your coworkers. Help one another. Learn from each other.  

God bless.

[canoehead, BSN, RN]

Im an old nurse, and I don't mind if someone is overwhelmed and has to hand off undone tasks. I DO mind if they try to hand off twenty minutes before shift change instead of just doing them on their time. I arrive before shift change to organize myself looking at charts, so some people figure they can use that to go home early. 

If something is undone I expect the offgoing nurse to say "I needed to do a, b, c, and didn't get a chance" so I know where to start. If I find at midnight that tasks from suppertime were missed, it's not a good look for either of us.

[Nurse Pompom]

On 8/6/2015 at 3:32 PM, dudette10 said:

So, I have two questions: 1) what is your opinion on the situation described above and 2) what are your "rules" for receiving or giving endorsement for nursing tasks?

She's new. She's overwhelmed, unit probably understaffed, and you tracked her down and probably came off as aggressive,  even if it wast your intention. I wouldnt like you either, but I also get why you did it. Even though nursing is a 24 hour job, she has to learn how to organize her time.