How to deal with change of shift admits

[CatieK, BSN, RN]

*Long post ahead*

Hi, I am a new grad nurse on a very busy peds med/surg unit. I just finished up my preceptorship and have been on my own for a few weeks now. It's going pretty well overall, but the other day I found myself in an awkward situation at shift change. 

So I had an admit come to the floor at 6 pm, an hour before we changed shifts. Immediately I had orders to give Versed, drop an NG tube, start an IV, start fluids, give an enema, and start Golytely via NG tube. I tried to complete all of the tasks before change of shift, but I just couldn't get everything done. I gave the Versed, put in the NG tube and called for X-ray to come verify it, and started the IV and fluids. On top of that I had to go through the whole admit process, do a head to toe, orient the family to the unit, and chart chart chart. 

Now it is 730 and I am giving report to the night nurse. She knows that the patient just came up to the unit an hour ago. She asks why I haven't given the enema or started the Golytely yet. I tell her that the meds were still being verified by pharmacy and that x ray has not come to verify the tube placement yet. She tells me that I should call pharmacy and ask them to verify the meds, pick them up from pharmacy, and give them before I leave. I call pharmacy and they said it will be at least another 10 minutes. Long story short, I ended up leaving with those couple of tasks left for the night nurse because she told me to go ahead and go. 

So now I am just having those typical new grad thoughts and doubting my ability to be a nurse. Should I have waited another 10, 20, 30 minutes for the meds and the NG tube to be verified? Am I in the wrong here? I know that it is very frowned upon to leave tasks that were supposed to be done on your shift for the oncoming nurse. It was just very awkward timing because I had already given report on my other kiddos so all I would be doing is sitting around and waiting. I didn't know what to do, and now I am afraid that the other nurse will think I am lazy and unreliable. Please give me your honest thoughts on the situation so that I can be better prepared for what to do next time something like this happens. 

Thank you!

[amoLucia]

Welcome to the club!   Late change of shift admissions have long been the bane of many nurses. Off-going nurses do just as much as they realistically can, but on-coming nurses feel it's NOT enough.

Whatever happened to the 24/7 concept???

Personally, I think you did just fine. In fact, I'm impressed that you did as much as you did in an hour. The other nurse should get over it!

JMHO

[caliotter3]

You certainly did more than many could or would do, in that amount of time.  I think the oncoming nurse was being harsh with you.  I would have made more of an effort to step in to help and make the transition as seamless as possible.  But that is how I interact with coworkers, particularly at shift change.  Don't fret over this.

[RuralMOSchoolRN, ADN, RN]

I would have done the same thing as you.  You did the admissions plus as much as possible prior to shift change.  I worked ER and had similar issues-a patient getting brought back with about 20 orders just a little before shift change.  Just be clear on what you got done and what is left--there isn't any reason you should have to wait beyond your shift for xray or pharm unless there is something crazy going on on the unit to where the incoming nurse is swamped (like one of your handoff patients coded)--then I would spend the extra time to finish it all.  But on a normal handoff--you're good.

I know nurses eat their young-but hopefully that isn't true on your unit.  You sound like a conscientious new nurse that got a lot done in a short amount of time!  Don't beat yourself up over it!

[chare]

On 4/24/2021 at 12:32 PM, CatieK said:

[...]

... I gave the Versed, put in the NG tube and called for X-ray to come verify it, and started the IV and fluids. On top of that I had to go through the whole admit process, do a head to toe, orient the family to the unit, and chart chart chart. 

You did all of this in one hour.  How many of your coworkers do you think would have done this much?

On 4/24/2021 at 12:32 PM, CatieK said:

[...]

... I ended up leaving with those couple of tasks left for the night nurse because she told me to go ahead and go. 

[...]

No, you left because you shift was over, not because she so graciously allowed you to do so.  And don't let her tell you otherwise.

Best wishes.

[Friendlyelse41]

Don't beat yourself up. For future reference find out when is the cut off for admissions. On my unit it is 6am. Work nights and shift ends at 7:30am. If I am busy giving meds, I will do a quick assessment when the patient arrives especially vital signs. If the patient has respiratory problems, I will ensure the that any respiratory medication is given once ordered.  The admission is handed to the incoming shift. The key is to ask what time is the cut off. Keep in mind nursing is 24hrs, at some point it has to be handed over.  Don't allow anyone to bully you, regardless of how long they are working there. I remember when I started; I pushed back very fast from the start. Best wishes

[sergel02, BSN]

Nursing is 24 hour care, especially in the hospital. The fact that you did all that was more than most would have done or been able to. The beginning of the shift is super busy but unless something major is happening to the nurse who got that patient, you did plenty. I wouldn’t wait and honestly you set everything up for the other nurse to be able to do easily. Not like she has to put in the NG tube or IV in or do the admission even.

[Mcjohns09]

From the sounds of it you did a great job. You did as much as the time would allow and genuinely were trying to get it all done. That’s all you can do and it’s not right to expect someone to sit around waiting on an x-ray. You were right for leaving and it’s a 24/7 job, she was perfectly capable of finishing those few tasks.