Leaving tasks for the next shift

  1. On my unit it's policy that we need to have at least 2 peripheral IVs.

    During my shift last night, I had a pt with a dialysis fistula thus only 1 arm. He originally had 2 IVs at the beginning of my shift but during my initial assessment, one of them was leaking when I tried to flush it so I took it out and tried to put in another one. I wasn't confident in my ability to put another in because his veins looked really beat up so I brought another nurse in. We both tried with no success. The doctor came in to attempt to put an IV in with an ultrasound and the pt responded by yelling at the doctor and refusing any more sticks. The pt was not receiving anything IV so the doctor verbally informed me he was ok with only 1 IV.

    Later during my shift, I get an admission who also had a left arm fistula. The ED only was able to put one IV in. Once again, I had another nurse look with me and we both tried and didn't succeed. This patient also started yelling at us for our failed attempts. I told the doctor about the access issues and she said as long as we don't need to give anything IV she was ok with it as well.

    When day shift arrived, I let the oncoming nurse know that I wasn't able to get a second IV in both my pt's but there were no plans for infusions and the doctors were okay with only one.

    Despite these tasks, all my labs were drawn, electrolytes repleted, baths done, and all that other good stuff. I normally never leave these kinds of tasks for other people, but both patients were to the point of verbally abusing out staff and refusing our care. I felt bad and kind of a push over for not continuing to attempt to put in an IV despite the patient's complaints.

    How do you overcome patients like this? Is it okay to leave things for the next shift?
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    About dergs, BSN, RN

    Joined: May '18; Posts: 4; Likes: 3

    23 Comments

  3. by   Newgradnurse17
    There's no reason why you can't leave things for the next shift, some times it happens. Either you can't do it like in this case, or you simply ran out of time.

    If it's urgent and needs to be done ASAP, or there's no reason why you didn't do it, or your constantly passing on work that's when there's an issue.

    If the pt declines something, there's nothing more you can do. You can't force them. Just document it well, and move on. In this case I would apologise for all the attempts, and cont with whatever else I had for the pt as normal. If they are abusive just give them time to cool off.
  4. by   brownbook
    It is against the law, assult and battery, to do anything to a patient when they say no. No means no.

    You inform the doctor that the patient refused and chart the doctor was notified.


    And where in the heck do you work? What type of unit? I've never heard of two IV's being a standard of care?

    And you did nothing wrong. Absolutely yes, it's okay to leave things for the next shift.
    Last edit by brownbook on Jul 17
  5. by   JKL33
    Neither of these scenarios leave something for the next shift.

    If the patient has been given the rationales for the proposed care and refuses anyway, it's done.

    If the physician approves of maintaining only one IV site, this should be formally noted (i.e. it should become an order).
  6. by   cleback
    I put it as an order if the doc ok'd the one iv. Then the next shift is clear no more attempts are needed.
  7. by   dergs
    I work in a medical intensive care unit.

    My first patient actually had continuous hemodialysis central line going so he technically did have another site, but it's really only meant to be used as access if theres an absolute emergency.
  8. by   brownbook
    Quote from dergs
    I work in a medical intensive care unit.

    My first patient actually had continuous hemodialysis central line going so he technically did have another site, but it's really only meant to be used as access if theres an absolute emergency.
    It can't understand the logic of this policy. Two IV's...that according to most policies and standards have to be changed every 72 hours...so less sites available every time they are changed, so they go bad, leak, so have to be changed again. All for "possible" emergencies? Even in ACLS is has never been hinted at that two IV's is recommended.

    I am assuming you mean two peripheral IV's.

    A critically ill patient needs a triple lumen central line, or VAP, or PICC, right from the get go. And maybe one peripheral IV

    A moderately ill patient needs one IV. Maybe two IF both sites are being used, needed for multiple infusions or incompatible IV solutions or such.

    But a routine blanket policy that every patient have two IV's irregardless of their condition doesn't make sense to me.
    Last edit by brownbook on Jul 17
  9. by   NuGuyNurse2b
    Quote from brownbook

    But a routine blanket policy that every patient have two IV's irregardless of their condition doesn't make sense to me.
    That's what stood out for me, too. Why 2 IV's? Most of my patients have one and most of the time it's a saline lock, nothing infusing. the usual "in case something happens" type of IV. Doesn't make sense to torture someone for a 2nd line, especially a dialysis pt, cause they rarely have good veins.
  10. by   cleback
    I've seen the order on IMC floors where the patient is at risk for bleeding and needing blood products quickly. Just another scenario where a second line is requested "in case." But yes, if the patient has been there a few days we will ask to have it dcd as one of the lines will inevitably fail.
    Last edit by cleback on Jul 17
  11. by   Hoosier_RN
    Quote from dergs
    I work in a medical intensive care unit.

    My first patient actually had continuous hemodialysis central line going so he technically did have another site, but it's really only meant to be used as access if theres an absolute emergency.
    I work in dialysis, and the local hospitals do not touch any dialysis access, whether its a central line or their fistula/graft (yes, we've seen attempted IV sticks in those because they look "easy to access"). This is a big no-no! If they have a central line then something is wrong with their fistula and if that central line fails, they are SOL for dialysis. Make sure to get clearance from IR/vascular prior to use. Once the Dr said ok to the 1 site, you weren't leaving anything for next shift, so you have no worries anyway
  12. by   FurBabyMom
    Um - between your patient refusal and the MD being notified re: access issues, you should be fine. Document both. No big deal.

    I work in the OR, and we require 2 access points during surgery, for big cases. For smaller cases or those where anesthesia will have an arm or leg, it's negotiable. During some of our situations, especially in big or emergent cases, and with some of our positioning considerations, quickly obtaining alternate access is not possible. Most of our emergencies get a central line - trauma bay, in the ICU during a watch and wait period, or in the OR (on arrival if bypassing the ED and/or direct admit to the OR from outside hospital). I work in neurosurgery, we often have two 18g PIVs or a 20g and 18g (or 16g) PIV. If there is a high likelihood we'll end up on mass transfusion protocol (MTP) - elective or emergent case, anesthesia or the surgery team will place a central line. Patients we know will be admitted >several days with limited peripheral options get a central line (easier to put in while in the OR and the patient under general anesthesia and the floors seem to appreciate having a central line).

    When I worked neuro stepdown we often had 2 or more PIVs, but they came from NSICU. We tended to d/c and reduce lines as patients did better. We never "had to have" more than 1 working PIV.

    Health care is a 24/7 job. There will be days your coworkers will pass things off on you. There are days you will just not be able to get everything done. It doesn't mean you are a bad nurse either. Just means that sometimes you have to adjust priorities and put out figurative fires.

    We are supposed to restock our rooms (supplies). On days I walk into an already running emergency case, or situations where I get an emergency (or several - I've had days with 3+ emergency cases in a day - back to back to back...we did no scheduled cases in our room), times where we code a patient, times when a patient dies in the OR - we are probably not getting all of our busywork/chores done. I've been "out" of my room before, and "could have" restocked my room, but I was pulled/reassigned to help in another room (usually an emergency case) or something like that. It just happens sometimes - evenings and nights don't always get all of their stuff done.
  13. by   LovingLife123
    Quote from brownbook
    It can't understand the logic of this policy. Two IV's...that according to most policies and standards have to be changed every 72 hours...so less sites available every time they are changed, so they go bad, leak, so have to be changed again. All for "possible" emergencies? Even in ACLS is has never been hinted at that two IV's is recommended.

    I am assuming you mean two peripheral IV's.

    A critically ill patient needs a triple lumen central line, or VAP, or PICC, right from the get go. And maybe one peripheral IV

    A moderately ill patient needs one IV. Maybe two IF both sites are being used, needed for multiple infusions or incompatible IV solutions or such.

    But a routine blanket policy that every patient have two IV's irregardless of their condition doesn't make sense to me.

    It is also my unit standard in the ICU to have two access points. We do not change IV sites every 72 hours. And not every patient gets a line. Too much risk for infection with a central line so we see less and less of them these days. We only really get PICCs and line people if the are on vesicsnts. We are actually starting to do more and more midlines to reduce infection rates.

    I personally wish every icu patient received a PICC. I love them.

    But sometimes they only end up with one peripheral. You can't help it. Nursing is a 24 hour job and don't feel bad when you can't get it all done.
  14. by   GaryRay
    I would consult leadership/risk management. A policy is not a law or a hard stop in most cases. They are there for a reason, but mot meant to replace critical thinking. All you did in trying to abide by your policy is shred the few vessels this patient had left that radiology could have used later for better access. Sometimes it makes sense to just work with one and save the other veins for when that one goes...

    I came from pedi icu where best practice is 2 IVs but we can also stick 4 limbs and sometimes a scalp, we also kept IVs in for weeks if they were still working. Even then, if the patient wasn't on drips, and stablish, I wouldn't risk wasting a vein I might need later just to have a "just in case" IV.

    If pt on pressers, insulin drip, triple abx, or ppn with incompatible meds, yes you need that IV and maybe a cvc.

    Back to the point if you choose not to follow policy, document the indication for why. Generally by addressing the policy you've covered yourself.

    As for leaving work for the next shift... nursing is a 24 hour job for a reason. The only thing you should be staying for is a rapid response or code. Beyond That, it's their patient now... in 12 hours they'll be handing them back along with anything they didn't get done. Nature of the beast.

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