Going on shift to previous shift's mess

[chenoaspirit, ASN, RN]

Do you ever get blamed for what happened/didnt happen on the shift before you?

When I hit the floor yesterday, my first assessment worried me. Her pulses were not palpable, bp was only by doppler, HR 156, distended abdomen, pale and clammy/diaphoretic, severe abdominal pain, RR 30. Her ABG resulted CO2 of 8! pH was 7.11! (I would assume that the hyperventilation was blowing off the CO2, but unsure of why the pH was low). I of course called the doc immediately after checking her glucose (101). I had only been on the floor a few minutes and the doc was mad at me! The only thing the previous shift had told me in report was that she had c/o N/V and she had given her Phenergan and Darvocet for abdominal pain. Needless to say, patient was transferred to ICU, but I hate being blamed for stuff like this. I dont know what happened on the previous shift, I dont know why the doc was not notified of her condition sooner, but I DID contact him and I DID do as I was ordered. Apparently an ABG was ordered at 6:56 and RT didnt do it, again I got blamed for that even though I wasnt there. I still got the blame for her deteriorating condition. I cant help what did/didnt get done on the shift before I got there. He should have been GLAD I assessed her and contacted him, but noooooooo. It made me feel bad and made me feel like I was the one to blame, even though I knew I wasnt. It set the mood for the rest of my day.

[kellykelly]

I'm sorry this happened but I sure hope you set him straight. It's not in your job description to take the heat for someone else, and you could let him know that you were just coming on and finding this out yourself without placing blame on the nurse before you. You have a right to stand up for yourself and you can do it without making it into a big confrontation! When this has happened to me I simply stated "I don't know what went on before my shift, if it just happened or what. I haven't had time to investigate that. I just got here and I'm telling you what is happening right now, per my assessment. What do you want me to do for this lady?" Sometimes they are just venting but no reason you have to grin and bear it and have the rest of your day ruined. I get riled when I hear about doctors treating nurses like this and also I feel bad when they aren't set straight, because they feel free to walk all over ALL nurses.

((hugs))

[kellykelly]

((not that we don't all get walked on a time or two...sometimes it's hard in the heat of the moment to stay calm enough to set them straight!!))

[chenoaspirit, ASN, RN]

I tried to set him straight, but he didnt want to hear it, which made me feel worse. He was just upset, which I dont blame him, I would be too. But he is notorious for doing this to ALL nurses. He gets frustrated over anything and whoever is standing in front of him is the brunt of his wrath. He is an excellent doctor, but terrible with nurses. We all DREAD seeing him come to the floor, we all DREAD taking care of his patients. Oh, and when I was on the phone with him, I was only able to tell him PART of her conditon before he started blurting orders, I was trying to tell him about her bp and her RR and stuff, he cut me short. The sad thing also is that he is MY doctor and I dont feel comfortable going to him anymore because of how he treats us on the floor.

[Vito Andolini]

He's your doctor, too? Oh, brother!

Well, I think you should get rid of him as your own doctor and set him straight at work PRN.

Try calling him by his first name. "John, you don't want to get sued, do you?" (or something equally attention-grabbing) "You're making me extremely nervous. Quit yelling at me. I just got on duty. And before you start giving orders, you need to know blah blah blah". Hearing his first name from someone from whom he's not expecting it might grab his attention enough to shut him up long enough to get out what you have to say. If not, tell him you can't take his orders. That should floor him enough for you to add that such and such condition also exists and now you are able to take his orders and what does he want done.

I tell you, these doctors can be really difficult to deal with. You might have to get your Manager to deal with him, or get the Chief of his service to talk to him about his foul temper, impatience, and general jerkiness.

Some doctors are very stuck up, some are so mean, some are chronically tired, some are just I don't know what.

[pricklypear]

Hospital nursing is a 24/7 job. You can't always expect to walk on to the floor and find all your patients in great condition. This patient's condition could have deteriorated significantly since the last time the previous nurse saw her. It doesn't do any good to "blame" the previous shift, or anybody else for that matter. The problem here is a patient who is circling the drain, a doctor with an attitude problem, and you taking it personally.

[Purple_Scrubs, BSN, RN]

When I worked on a cardiac step-down unit, I came on shift at 7pm, took report then printed tele strips on my pts. Immediately saw that one patient who was supposed to be NSR had slipped into a-fib at 4pm and no one noticed. I called the doc by 7:30. Guess who got yelled at. Yep, that would be me :) I sweetly told the doc that I apologized that I had not arrived at work 3 hours early for my shift to have caught it any earlier. He was quiet for a long time, gave me orders for the patient, and apologized to me the next time I saw him in person.

[tigger2sassy1]

hugs to u my friend as others have said it is not unusual to walk into something previous shift failed to pick up on remember you are a good nurse you did the right thing

[reisling]

You must be a new nurse. Cause none of us old timers would have put up with that doctors gruff. Sounds like you did everything right. Good job!!! You saved a life.

[wooh, BSN, RN]

Easier said than done, I know, but it's all about having the attitude that "I will not be walked on." They start going off, just take a breath, and tell them what they need to know. And if it's an MD nobody likes, all the more reason to stand up for yourself. I tend to get along just fine with the biggest pains, because I set limits, and they learn to respect me or at the very least, act like they do. (Often true for PIA patients too.:))

[dorimar, BSN, RN]

Hey Chenospirit,

Sounds like your patient had a hot belly -most likely either perffed or ischemic bowel. Patient's CO2 was low because she was compensating for her metabolic acidosis related to poor tissue perfusion by hyperventilating- as you stated.. Her lactic acid was probably at least 8 (probably much higher)!

Now, I am not one to pass the buck or try to lay blame on someone else. However, there are times I've come onto big messes and when acting on those messes, gotten chewed out. The minute that happens I come back with, "Excuse me Dr., but I can't speak for what happened with the prior nurse's shift. I just walked into this--just like you. Can we deal with the issues and information we have to take care of this very sick patient"? This works every time, especially if you have your ducks in a row and have all the pertinent information you did!!! Now, after it was all said and done, I would definitely report this to your immediate supervisor, because that nurse missed some really big signs and let that patient deteriorate to a point she may not be able to return from. This is exactly what I mean when I say some nurses do not understand teh impact their care (or lack there of) can have on patient outcomes. It is very likely that patient is going to die. Would this outcome change if the problem was acted on sooner? No one can say, but her chances would have been greatly improved! IF you're interested in learning, research sepsis and specifically "early goal directed therapy" to see how early intervention can influence mortality rates!