Change of shift calls to MD. Who should take the call? - page 3

I had a patient yesterday, a sweet LOL had gotten back from pacemaker, doing fine, but elevated BP systolic in 190s. She had come from a smaller facility with bradycardia and had gone straight to... Read More

  1. by   Vito Andolini
    Quote from FireStarterRN
    Are you really 94 years old?
    umpiron:
  2. by   Vito Andolini
    Quote from FireStarterRN
    Most of our patients have their cellphones at the bedside. On my unit all the nurses carry cellphone issued by the hospital so the tele tech or others can call us at any time.

    Many Moms will carry their cellphones at work so their children can have easy access. Unfortunately, some use poor judgement in using them. Officially we are not permitted personal cellphones, but that's only enforced with those caught abusing their use.


    It would be up to the Charge Nurse to enforce it where I work. And they are not about to enforce it. Our facility is way too laid back for CN's to enforce it against those who run the place anyway (aides). There'd be so many complaints, it seems a small enough offense compared to the fact that the offenders are still doing their jobs pretty well, etc.
  3. by   Virgo_RN
    Coming in late here, but I agree that if it's end of shift and you paged, you should take the call. Reason being that the oncoming nurse has not assessed the patient.
  4. by   caliotter3
    If she had immediately started working on another important situation, I would have helped her. However, to stay and do her work for her while she talks to her boyfriend? No. A professional talk with her should clear up the situation. If it happens again, then turn over the patient care situation to the charge nurse and go home.
  5. by   Ahhphoey
    I would have taken the call (as the offgoing nurse) even if it was a minor issue. Like someone else mentioned, what if the doc had other questions that the oncoming nurse who hadn't yet even seen the patient would know the anwer to? I have been in situations where I've called the doc for one thing, and he asks about everything else under the sun that has nothing to do with what I call for in the first place. It would be unfair to expect the oncoming nurse who hasn't yet seen the patient to answer those questions.

    Now, if its a doc who notoriously takes forever to call back, than yeah, I'll stay until the minute my shift ends (i.e. 1530, 1930, 2330, etc.), but after that, I'm going to have to pass it on.
  6. by   Keysnurse2008
    Quote from firestarterrn
    i had a patient yesterday, a sweet lol had gotten back from pacemaker, doing fine, but elevated bp systolic in 190s. she had come from a smaller facility with bradycardia and had gone straight to cath lab after briefly arriving to my unit, and had returned from that procedure in fine shape except for elevated bp.

    my first course of action was to give her her lisinopril which she obviously had not had, then i did a follow up bp after giving that time to work and systolic was still in 180s. i gave all info to oncoming nurse regarding when i had given the bp med, etc and so forth, and paged the md.

    oncoming nurse didn't want to take the call (she was in an empty room making a personal call to her boyfriend ) so, i took the call, even though it was past time for me to leave, wrote out the order, scanned it down to pharmacy, and accrued some more unwanted overtime.

    our hospital, like many, has been pleading with us to try to reduce overtime, and i'm all for it! i hate to stay even 5 minutes over.

    so, what would you all have done in a case like this? i don't like to leave things undone, but i was annoyed at oncoming nurse for her being on her cellphone with boyfriend and wanting me to take this shift change call for a simple matter such as an elevated bp.

    yet, in some cases it definitely would be appropriate to stay and follow through on issues from your shift. where do you draw the line?
    you had already given report and given the oncoming nurse the information about what transitioned on your shift, the time the med was given, ...which i am sure she even had on the mar, or emar. so...it isnt rocket science....gave lisinopril...ineffective...pt is currently in "x" rhythm. doc- what do you want to do?
    that....is all she had to ask the md. it isnt like the lady is clasping her chest gasping for air as a code is being called. this call...should have been the oncoming nurses. that ...is why they have 2 shifts. now if the lady was crumping...i'd have stayed ...but this is just a routine call that should have been taken by the oncoming nurse. that...is why they have 2 shifts. it isnt like this lady was crumping...and in the time she took that personal phone call ...she could have used that time to actually go lay eyes on her patient. just imo
  7. by   bill4745
    I would have stayed and taken the call, since I was familiar with the situation.
  8. by   cardiacRN2006
    Quote from keysnurse2008
    that....is all she had to ask the md. it isnt like the lady is clasping her chest gasping for air as a code is being called. this call...should have been the oncoming nurses. that ...is why they have 2 shifts. now if the lady was crumping...i'd have stayed ...but this is just a routine call that should have been taken by the oncoming nurse. that...is why they have 2 shifts. it isnt like this lady was crumping...and in the time she took that personal phone call ...she could have used that time to actually go lay eyes on her patient. just imo

    yet...

    what if the pt does have crushing chest pain? remember, this is a lazy nurse caring for this pt. what if she does crump just after you leave? what if she does develop chest pain?

    who do you think is gonna get blamed? she will be the first person to say that you didn't follow through.

    remember the state expects us to monitor the effects of all of all medications that we administer. the pt was still hypertensive on her shift after her administration of an anti-hypertensive medication. it was the right thing to do to take the 3 minute call and do right by the pt.
  9. by   Straydandelion
    Not knowing when the doctor would call back, if I am still on the floor and he calls, I would take the call having a better idea of why I called then the oncoming nurse. However I would not have waited past my shift time for him to call giving as much information to the oncoming nurse as possible before leaving.
  10. by   FireStarterRN
    Quote from keysnurse2008
    you had already given report and given the oncoming nurse the information about what transitioned on your shift, the time the med was given, ...which i am sure she even had on the mar, or emar. so...it isnt rocket science....gave lisinopril...ineffective...pt is currently in "x" rhythm. doc- what do you want to do?
    that....is all she had to ask the md. it isnt like the lady is clasping her chest gasping for air as a code is being called. this call...should have been the oncoming nurses. that ...is why they have 2 shifts. now if the lady was crumping...i'd have stayed ...but this is just a routine call that should have been taken by the oncoming nurse. that...is why they have 2 shifts. it isnt like this lady was crumping...and in the time she took that personal phone call ...she could have used that time to actually go lay eyes on her patient. just imo
    in this particular case i agree with you.
  11. by   litbitblack
    I would have taken the call IF it wasn't time for me to leave. Thats why we have two shifts and the nurse could have taken it. Thats also why we have report. I would not wait as some docs take forever to call back
  12. by   Keysnurse2008
    Quote from cardiacrn2006
    yet...

    what if the pt does have crushing chest pain? remember, this is a lazy nurse caring for this pt. what if she does crump just after you leave? what if she does develop chest pain?

    who do you think is gonna get blamed? she will be the first person to say that you didn't follow through.

    remember the state expects us to monitor the effects of all of all medications that we administer. the pt was still hypertensive on her shift after her administration of an anti-hypertensive medication. it was the right thing to do to take the 3 minute call and do right by the pt.
    ok...i know the state expects you to monitor the effects of the medication you administer...but child....you cant stay 24-7. what about the insulin you gave at 6 pm. it doesnt take effect for another hour or two...should you stay? their bg was 228....should you stay? no...no you shouldnt. that is why they have 2 shifts.
    i mean...that is why you give and get shift report and do walking rounds. that way...they have laid their eyes on the patient...they have gotten report..you have given the information for that nurse to be able to take that call...so ....time to go. you cant stay 24-7 to make sure every disease process gets "taken care of"....bc some are going to be uncontrollable. you give report to the nurse that your facility has deemed proficient enough to care for that patient.

    now that being said....i am a firm believer in timely calls. i dont like getting report from a nurse that says their b/p has been up to the 180's and that the last med they gave was 5 hours ago and they just paged the doc. but...even in that situation...if i were the oncoming nurse i would have still taken the call. i would have laid my eyes on the patient bc we are suppost to do walking rounds. i would have gotten the information i needed during report like
    1. pt has a h/o htn, and chf
    2. lisinopril x mg given at 1600 when b/p was 190/100. now
    b/p is still in the 180/90 range and is asymptomatic otherwise. (i would have known this bc i do ...i do walking rounds). there are no prn antihypertensives on the emar....so "doc...what do you want to do?'.
    3. now....if i had seen jvd, and my patient was symptomatic with cp, jvd, decrease in sats etc etc i'd have stayed and taken the call. but this is just an elevated b/p and teh nurse had received all the information needed to take the call. you cant stay and make sure every disease process is monitored. the only exception to that is if the nurse seems impaired...laziness...is not an impairment. if it were a pt that was exhibiting s/s distress...id have taken it........but for a asymptomatic htn ,....no. gave report, pertinent information relayed to oncoming nurse, pt now in capable hands of another...clock out.
    Last edit by Keysnurse2008 on Jun 14, '09
  13. by   RNKPCE
    Yes we need to assess the effects of meds we give but the term "we" means which ever nurse is assigned to the patient. If you give a PO pain med 30 minutes before your shift ends you aren't going to stick around to see if pain relieved, the next nurse has the duty to do that.

    Nursing is a 24/7 job, not all situations are wrapped up when the nurses shift ends. That is why report is so important. This situation, high blood pressure is a no brainer, a nurse should be able to take over care and speak to the doctor. Tell the doctors what other meds she may have received and what latest vitals are. If my shift ends at 7:30p and it is 7:20 I will take the call I put out if not, I will document that oncoming nurse informed of call out to md for continued high blood pressure.

    If I were a manager I would not want OT for this reason, a complex situation such as a rapid response yes but at some point even the care of that pt has to be transferred to the oncoming nurse . As a nurse I wouldn't donate my time to stay over either. If I stay over I charge the time.

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