i feel bad- leaving things to do for day shift

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so i am a new grad..about a month and a half off orientation on a Bone Marrow Transplant Unit..our ratio is 1:3..I have been doing pretty well so far at managing my patients and getting everything done..until last night.

one of my patient's is having a stem cell transplant tomorrow..he was up walking and talking and fine. my second patient slept most of the shift, was on TPN and several IVFs with antibiotics, insulin, etc. and my third patient is 6 days following a stem cell transplant with IVFs, a PCA pump, pain and nausea and vomiting, and a fever of 103.9 as well as neutropenic and on a lot of antibiotics.

the majority of the night went as planned..i was all caught up but when my sickest patient's AM labs came back around 5 AM he needed 2 units of blood, platelets, potassium replacement, and Mag replacement..the day before his Hgb was 8.4, today it was 6.8..I never thought to question the Hgb level but knew he needed blood so I drew a current clot for crossmatch and while waiting for the results of that I hung up blood tubing, pre-medicated for platelets, did vitals for platelets, and started platelets, all while giving meds and charting..his PICC line was slow so the platelets were not running as fast as I had hoped but after flushing twice and a pressure bag, that's all I could really do. I had all my meds given and everything else done but yet felt guilty when I left work that I left too much stuff undone. The nurse taking him asked if I rechecked Hgb and I said no, even after telling my coworkers his Hgb in comparison to the day before they didn't say anything..they just said to draw the clot and set up the tubing and start the platelets first. So I did all this..so why did the nurse I give report to give me the death stare when I told her what I couldn't get to?? clearly I was running my a** off all morning doing the rest of the stuff..in that 2 hour window from the time I got results to the end of shift, there is only so much that can be done.

sorry for the venting..i just need some insight..should I have stayed past my shift and helped? Or should I accept what I could do and let the rest go?

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Specializes in Hospice, corrections, psychiatry, rehab, LTC.

A former supervisor once said that we have more than one shift for a reason. Unfortunately it is inevitable that some things are endorsed to the next shift. From what you described, it was unavoidable. I prefer not to pass things on either, but sometimes you have to.

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Specializes in Neuro ICU and Med Surg.

Nursing is a 24/7 job. I have had to leave blood and/or other thing for the opposite shift too. Even after being a nurse for 11 years.

A few weeks ago I had a pt with clotting issues, and I transfused him all night. I gave 12 untis platelets, 2 FFP, 10 units Cryo, and I think 2 Units PRBC's. He needed more pre op platelets ordered at 0600. Day staff had to hang them because Blood bank was not wanting to release them due to his platlet count being 89.

Point being in all that is that no matter what you do sometimes you will have to leave something for the next shift.

I only get mad when I know the previous nurse leaves lots all the time.

Don't be too hard on yourself.

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Specializes in Med/Surg, Rehab.

It sounds like you did your best. It would be one thing if you didn't even start the transfusion and just left the day shift nurse with the lab work to follow up on, but it sounds like you did as much as you could. There are some things that just get passed on.

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Do not fall for the "death stare" routine. Some nurses use this--especially on newbies--to intimidate, even when the other nurse did her best.

As previous posters have said, nursing is a 24/7 job. There will be times when you got a late order or the night blew up on you and you simply could not have gotten to everything, even on roller skates. What you do then is prioritize. Get the most crucial items accomplished, and keep chipping away at the rest. You'll get more efficient with experience, but you are where you are in development, and that's all there is too it.

Be open to constructive criticism, but don't look to someone who gives the death stare for affirmation and approval. That just teaches them how to push your buttons and sets you up to feel inadequate. Don't fall all over yourself apologizing for only having two hands. You can offer a simple, "Sorry," if you mean that you're sorry they have to start the day running. But if you did your best (and I'm talking a reasonable best, not perfection), you don't have to fall on your sword or open yourself up to their snarky attitude.

Think about what happens when you are the oncoming nurse. I'm sure things get left for you, too. How do the off-going nurses conduct themselves? Are they straightforward and calm, or do they cave in on themselves and act like they've committed serious wrong by passing some tasks on to you?

Keep in mind, too, that you are working in an area with heavy responsibilities. Sounds like you're doing just fine as a newbie nurse.

The more matter-of-fact you are about what you're passing on, the less exploitable you'll be.

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Specializes in Med-Surg Nursing.

Ditto to what everyone else said! You got the platelets in...sometimes, things are going to be left for day shift to finish. I myself will NOT start a unit of blood during report time, from 6:45-7:15..I can't be at the bedside monitoring the blood AND watching the monitors for the rest of the patients at the same time(ICU). It sounds like you're pretty well organized to me...not too shabby for a new grad. Don't beat yourself up and don't let anyone else TRY to intimidate you. Occasionally, you're going to be left things to do from the previous shift as well....nursing is a 24-7 job!

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seems to me, as a new grad just off orientation, you did a GREAT job......keep on doing what you are doing......even those of us with tons of expierence leave stuff for the next shift

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Specializes in ER/ICU/STICU.

I'm confused as to why they asked about a repeat hgb if the patient had not received the blood. I think it's probably just something with this nurse. I personally could care less if there is a mess when I come on if the nurse the night before had been running around. It's probably why I don't feel bad when I leave stuff for night shift when I'm done. It's a 24/7 job and it seems like more often than not these things happen just prior to change of shift.

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Specializes in Med/Surg, Rehab.

I agree with ckh23 that I wouldn't have questioned the Hgb. It seems like you have a standing order that you follow that if the Hgb is below a certain level, the person gets a transfusion. I think if you had taken the time to repeat the lab values the MD may have questioned why the transfusion hadn't started yet. And then you would have left even more for day shift to complete!

The only time I question lab values is when there is a drastic difference between days. 8.4 and 6.8 is significant but not so drastic that it bears repeating.

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Specializes in MS, ED.

Agree with the others - I think you did a great job. There will always be those few eye-rollers and heavy sighers who can't be left anything, even a message to pass along; don't worry about them. As already mentioned, nursing is 24/7 and there will always be more to do. The big things for me are that (1) I'm told about any orders you couldn't get to or anything otherwise outstanding and (2) that you weren't sitting, talking and laughing while 5/7 patients all have outstanding labs, PRBCs, consents, etc left over from the am/early afternoon.

I'll second the suggestion to just say 'sorry, I couldn't get to it. This ( ____ ) is what still needs to be completed' and that's it.

Good luck OP - you're off to a good start on your unit!

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I guess the reason I might want a redraw on that lab is that if it was a line draw and not enough was wasted, the results would come back diluted, which would explain why the sudden drop in all the values. To do all those interventions for a diluted sample would seem a little wasteful, and potentially risky for the patient.

Other than that, I think you did just fine, and no, I would not let the oncoming nurse make you feel badly. Now, if you're leaving a hot mess for the next shift every single time, then I can understand them getting an attitude. But everyone has one of those shifts every once in a while, and it sounds like the oncoming nurse was just mad that she had a lot of work to do right out of the gates.

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Specializes in ICU.

Nursing is a 24/7 job. Not everything can be done in one shift.

A good deal of errors are made trying to rush things and some of the things that should never be rushed are blood transfusions. You did alot of 5am. I know some nurses who would have left everything for the dayshift after receiving the labs, even calling the doctor.

I also don't see any reason to question that hemoglobin. That is a sick patient s/p bone marrow transplant.

I worked nights and there was this dayshift nurse who was so sweet and so thorough. She always felt so bad leaving anything for me. I knew she was a hard worker and if she was leaving something from her shift, it was because she was very busy. I would always tell her to finish up, go home and not to worry about it, I'll take it from here.

Then there was the nurse who sat on her butt until the last minute and I would get upset when the abx ordered at 12 pm was not hung at 7pm because "oh, the pharmacy never brought it" I would make her atleast get it from the pharmacy.

You did good. Don't be intimidated. There is only so much you can do in one shift.

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