Lets be hypothetical

[ohbet]

Take this here hypothetical situation:

Lets say your on a unit,your shift is 8 hours,and there is so much to do that after your 8 hour shift,you dont have time to do the treatments or very few . Some treatment are BID and some are QD Not getting the treatments done happens to all the nurses who work on this unit and it happens everyday and there is no one to call during the shift to help you with the treatments.Remember ,we are just being theoretical here.

And you have been staying overtime to finish them everyday but now your tired and dont want to stay over time.You want to see your family or what ever.

Would it be OK to say to the oncoming nurse you didnt have time to do the treatments and ask her to please try to do them,or are you responsible to stay and do them?

I know that negligence is the failure to perform a duty and as a consequence,harm was done

So if you didnt do the treatments and passed them on to the next shift and no harm was done then I guess you wouldnt be negligent.

Whats the right thing to do?

Some might say ask management to hire a treatment nurse,but lets say hypothetically,there is no money for that.

[oldgirl, RN]

I believe you can be setting yourself up for legal troubles if you clock out and then continue working. God forbid, if anything happened, to you or a patient, the facility could say--WHAT??She wasn't even working-already clocked out! Just nother point to consider. I don't think workmens comp or facility malpractice ins will cover you if you are "not there" Anyone else have any knowledge of how this all goes down?

[Aussienurse2]

I'm not complaining about my workload any-more!(Cause I quit!! YAY!!) But here the R.N.s give out the meds, do the charts etc. The E.N.'s do the dressings, showers, BSLs, insulin, meds if the RNs don't get aroung to it(depends on if the RN is good or not) Bed making, charting(wound) , pressure care, feeds, in conjuntion with an aide. Of course we only have about sixteen patients as a general rule, unless someone calls in sick.

I guess I made it plain I'm an EN didn't I ? Sorry, most of the RNs we have are great, but then you get the ones who think aged care is a holiday camp and spend all day reading charts.... I hate that!!

[ohbet]

I love the replies and the dialoge,and welcome more. All are helpful. My feeling is this hypothetical situation may not be so hypothetical and its interesting that there is a diversity of solutions for a probable common problem.

[caliotter3]

There was not a LTC facility that I worked in where I did not observe that nurses routinely just signed off on treatments. Overburdening was not always the reason. I once stayed over to do a med pass when someone called in (just trying to be helpful). A few days later, the medical records supvr came to me and requested that I sign off on all the txs for that shift. She didn't care that I had not done them and got angry when I refused. I also learned that I had better keep my mouth shut about what should and should not be done (this was when I was really new) as there were serious repercussions for nurses who did not fit into the "flock". I was glad to leave those places of employment.

My thoughts are that nothing will change as long as the general consensus remains to cover up what is not done at all or is done half-way. When the majority of the workers act in this manner and are supported and led by their first line supervisors in this behavior, then the individual has limited recourse. And yes, in many places, there really are no other available jobs. Been there, done that.

[dawngloves, BSN, RN]

Originally posted by sharann

Why don't we hypothetically say there is a continueum of care in nursing. Then hypothetically say , oh why not, why don't we just have one shift do everything. Then the next shift can just stay at home

ITA!!!! Why is it up to one shift to do everything? Why does QD mean, "Do it on day shift" or BID day and evening?

Some institutions expect all interventions to be done between 7a and 3p!Meds, treatments, dressing changes, test.

And why does night shift have to give all the baths? Would it kill someone to get a bath at say 9pm? Or to have a lab drawn at 8 pm instead of 3 am?

[JailRN]

well, as the "next shift", I would have to wonder, If this nurse is just poor with time management, or truly overworked.

If they can pay time and a half every day, they can affotd to hire another person, if you're doing this off hte clock, DON'T. liability, liablilty, liability.

I agree with daawngloves, night shift shouldn't have to do ALl the baths, not all pts want to be woken at 0400 to get clean.

But that's just another reason why I don't do hospital nursing any more.

[Jenny P]

There are so many hypotheticals here; but, to play the devil's advocate, let's throw in a few more. Let's say that YOU are the patient and that this IS a LTC facility. Now, I don't work LTC, but I always wonder how it would feel to be awoken at 04:00 for lab draws and bathing; or have treatments done to me at 06:00 or even be forced to eat breakfast at 08:00! I am NOT a day person!

DH's Aunt had to spend some time in a rehab/LTC facility this past spring, and she was FORCED to take naps after breakfast and again in the afternoon; and would not be allowed up on the commode or to go to the BR at night-- she was forced to wear diapers because the night staff insisted on it. This is an 83 yr old lady who lives independently (again) and suffered from delerium during part of this time. She never was incontinent EVER; she never naps at home, and she gets up early and goes to bed early.

If a doctor orders treatments as QD or BID, can't these things be done within a certain period of time (not necessarily a shift) that would be agreeable to the patient, the nurses and the policies of the facility?

Even in acute care, some people are so compulsive about things that they insist on all baths being done by 08:00 or whatever. Is this in the patients' best interest, or is it for the convenience of the nurse?

[Rustyhammer]

A couple of possible suggestions.

1) Bring it up at your next nurses meeting. Just state the hypothetical situation like you did here and see how many other staff are having simular dificulties and how your DON chooses to handle it.

2) See if you can change some of those tx's to QD instead of BID or more. If they aren't getting done maybe some other tx plan is needed.

-Russell