What would you do....?

jmgrn65, RN · Feb 4, 2009

What would you do if its 1830, the shift ends 1930. You have an IV to restart, have loads of charting to do...have to hang a new bag of TPN....have a patient in pain....and have a few IV anibiotics to give....and have just received an new admit, who needs to be assessed, documented, med reconciliation done, IV access gained, orders to be carried out if there is any yet...and the nurses on the next shift all ways gives the day nurse crap if the new admit hasnt had everything done yet or if there is any task that hasn't been done on the day shift that they have to do or are left with. Remember its 1830 and the shift ends at 1930.
What would you do?

First of all, ask if anyone is available to help you do something. Then give the pain medications. Hang the TPN. Don't know if the iv restart is a priority or not. I certainly wouldn't assess the new patient, because the night shift should be doing that anyways. There is no way you could get all that done by 1930. THe next shift will have to get over it. Thats why there are nurses 24 hours.

bagladyrn, RN · Feb 5, 2009

I would: Give the pain med, hang the TPN and the IV antibiotics, do a quick set of vitals on the new admit (make them feel attended to and let them know that the oncoming nurse will be doing an assessment in a short time). Then I would sit down and catch up on my charting until time to give report.

If the oncoming nurse complains, remind her that nursing is a 24 hour job and realize that she will get over it (or not - it's not your problem)

athena55, BSN, RN · Feb 5, 2009

Ditto what bagladyrn and jmgrn65 said!

Delegate. Prioritize. Did I mention...Delegate?

Give pain meds, obtain vitals on new admit, go back and re-evaluate pain level on patient(s) that you gave pain meds to, hang antibiotics and start charting.

When giving report state what time new admission actually came to the floor and say: I did the vitals for you.

If you feel pressure to finish EVERYTHING you will never, ever get off the floor at a reasonable hour. Your children/friends/family will forget what you look like and your spouse/honey/SO will start to cuddle with the dog and/or the cat!

athena "been there, done that" and yes my SO says the dog doesn't snore as much as me!! the nerve!

catshowlady · Feb 5, 2009

I also agree w/ above posters - ask for help, pain meds first, hang TPN if the bag is dry, check out the new admit - just to make sure they are not in distress (delegate the VS), then hang atbx and change that TPN bag that wasn't dry. IV restart would only be a priority if the pt has no access in an acute care situation - if it's a routine change, too bad, the next shift will have to do it. Next shift can do the rest of the new admission, too. You are only one person, you cannot do it all and this is a 24-hr job.

I do find that it helps to have a history of being a good worker (i.e. you don't constantly leave things undone for the next shift to clean up), and I am also honest when I am in this situation. "Hey, I had a really bad afternoon and got behind. I'm sorry, but I just wasn't able to get to X, Y & Z" in a polite, matter-of-fact tone. That way the catch-up work isn't a surprise to the next person. If they kvetch, just say, "I did the best I could," (matter-of-fact, not groveling) and go on about report. If they are still peeved, too bad. Sometimes, you just can't do it all.

Whispera, MSN, RN · Feb 5, 2009

I agree with everyone else and feel the need to add: you have to get a thick skin to the next shift's attitude if they act like they're ticked off.

CoachBarbara · Feb 5, 2009

I agree with everyone else. And I would establish a good rapport with the oncoming nurses--it always helps to have an ally and someone who understands you are not a slack. Good relationships with others always paves the way to better working conditions.

dorimar, BSN, RN · Feb 5, 2009

What I hate most about nursing, is that you could probably do all of it within the hour you speak, if documentation was not the issue. We are constantly assessing our patients. When your patient arrived you looked at him... In ICU we look at EVERYTHING (no focusesed assessment about it). We listen too... We just don't want to be the one that has to document all of that at 6:45 at night because it takes time to doucment. Documentation is not considered enough in our care hours, and it takes a great deal of our time

eriksoln, BSN, RN · Feb 5, 2009

Yeah. I agree.

First the pain meds. Then the "non-paperwork" tasks like TPN, IV starts and antibiotics. I'd get the admission done "if" it is a person that you can get it done quickly with.......AOx3, not to talkative. Save the paperwork stuff other than the admission for after you give report.

If the tasks are all caught up and the admission is done, after report you can hide and do documentation for awhile then you are done.

diane227, LPN, RN · Feb 5, 2009

Tell the charge nurse and ask for help. Get your medications done. Greet your new patient, make sure they are stable. Get your IV started or ask another nurse do to this for you. The next shift will have to admit the patient. If they don't like it, tell them to report you and leave it at that. Unfortunately, you will have to leave your charting until last.

garciadiego · Feb 5, 2009

Thank you all knowledgeable insights

Only one point will not usually work, asking for help. It would seem that every one else is to busy to help because they want to get out at 1930

eriksoln, BSN, RN · Feb 5, 2009

That is true, some nurses will walk out at the right time every single day regardless of what is going on.

There is something that can be taken from that though. Dont become bitter at those who do it. Just remember not to be that way yourself. Any help you give will be returned in the long run. I've found this to be true anyway.