I feel out of the loop.

CoffeeRTC, BSN, RN · Nov 11, 2010

I'm confused...what exactly do you do on what shift?

Do you have a report sheet that they write down all new orders, abn labs or calls out to doc and family?

anonymous1919, LPN · Nov 11, 2010

I'm confused...what exactly do you do on what shift?
Do you have a report sheet that they write down all new orders, abn labs or calls out to doc and family?

I work 2nd shift. I pass medications/do treatments/chart. On second shift there is a Charge Nurse who handles phone calls, families, admits/discharges, labs, etc. When I get report, I get report from the 1st shift cart nurse.. not the first shift charge nurse... the charge nurses give each other report.... except on 3rd where there is no charge nurse the nurse who gets report is also the nurse on the cart.

TakeOne · Nov 11, 2010

I work 2nd shift. I pass medications/do treatments/chart. On second shift there is a Charge Nurse who handles phone calls, families, admits/discharges, labs, etc. When I get report, I get report from the 1st shift cart nurse.. not the first shift charge nurse... the charge nurses give each other report.... except on 3rd where there is no charge nurse the nurse who gets report is also the nurse on the cart.

So why don't you ask your charge nurse for relevant information about your patients? I have never worked in a setting where the "cart nurse" (?) was kept in the dark and only the charge nurse was aware of what was happening on a unit. Ever! I've never heard such nonsense!

Midwest4me · Nov 11, 2010

There should NOT be two separate reports. Makes no sense.Why hasn't someone suggested an intershift report wherein all staff on the oncoming shift sit down with the CNAs, the charge nurse and "cart nurse"(never heard such a term before in 25+ yrs of nursing) of the prior shift? That's how it's always been at the facilities for which I worked.

TakeOne · Nov 11, 2010

There should NOT be two separate reports. Makes no sense.Why hasn't someone suggested an intershift report wherein all staff on the oncoming shift sit down with the CNAs, the charge nurse and "cart nurse"(never heard such a term before in 25+ yrs of nursing) of the prior shift? That's how it's always been at the facilities for which I worked.

Because it sounds to me like the old scenario wherein the nurses on the units would give report to each other and to the charge nurses, then the charge nurses for each unit--who seem to act more like shift supervisors than unit staff nowadays--gave report to the supervisor, then the supervisors gave report to each other. But even then, the unit nurses would know what was going on as they were the ones who passed the information to the supervisor to begin with. In the primary model, nurses would hear report only on their own section of patients but the UNIT charge heard report on everybody and passed facts and concerns onto the supervisor, but everybody got full reports on their own patient load. In the team model, every team member got report on every patient on their assignment, with the team leader hearing report on everybody and communicating with the supervisor, etc., etc.

I cannot understand this "cart nurse" approach or even the terminology, in which the poor schlub who's doing the leg work isn't apprised of simple things like pending labs, appointments, diet changes or treatment changes. It doesn't make any sense. Where is the continuity of care if only one nurse sitting at a desk has all the information while the nurses who are actually giving care go about their day without pertinent knowledge. Why are the "charge nurse" and the "cart nurse" not talking to each other?

anonymous1919, LPN · Nov 11, 2010

So why don't you ask your charge nurse for relevant information about your patients? I have never worked in a setting where the "cart nurse" (?) was kept in the dark and only the charge nurse was aware of what was happening on a unit. Ever! I've never heard such nonsense!

He comes to me and tells me certain things... like when a med changes and I thought he was telling me everything I needed to know, until I overheard his report and he said like 6 different things I had no clue about. This is also my like 9th time on the floor for the first time (I'm brand new).. maybe he..? I don't know, doesnt think I need to know since he is handling it all? Who knows.

anonymous1919, LPN · Nov 11, 2010

I cannot understand this "cart nurse" approach or even the terminology, in which the poor schlub who's doing the leg work isn't apprised of simple things like pending labs, appointments, diet changes or treatment changes. It doesn't make any sense. Where is the continuity of care if only one nurse sitting at a desk has all the information while the nurses who are actually giving care go about their day without pertinent knowledge. Why are the "charge nurse" and the "cart nurse" not talking to each other?

I agree with you, it doesn't make sense. Honestly- I am brand new. I sort of think that the charge nurse doesn't tell me a lot because "it doesn't make a difference" (it does, I feel like he doesnt think so). Why tell me Dr. so and so is being called? He is handling the call, why do I need to know? Well I need to know because if I need to be watching for signs of something in a patient... I should know... but I feel like he doesnt see things that way.

I honestly don't find him to be that great of a nurse, his judgment is off. Like a patient was having chest pain and he gave her nitro and after 3 she was still in pain. He did a full assessment on her except listen to her lungs. She kept pointing to where the pain was and it wasn't pain in her chest, it was more near the bottom of her R lung... after standing behind him watching him take care of the situation I finally stepped in to figure it all out. I listened to her lungs, and heard wheezing. He sent her to the hospital (which I'm not even sure was necessary- he sends people out for everything and anything) and we found out she has pneumonia. So basically he gave her nitro and dropped her BP to 80/50 for no damn reason (BP might be why he sent her out- he never told me exactly why she needed to be sent out)

So yeah, I am going to ask him in the future whats going on. I didn't know he wasn't telling me until last night.

anonymous1919, LPN · Nov 11, 2010

There should NOT be two separate reports. Makes no sense.Why hasn't someone suggested an intershift report wherein all staff on the oncoming shift sit down with the CNAs, the charge nurse and "cart nurse"(never heard such a term before in 25+ yrs of nursing) of the prior shift? That's how it's always been at the facilities for which I worked.

I think he made the term "cart nurse" up tbh... that's what he calls me and the other nurse who both are on the carts. My name tag says Anonymous1919, LPN Unit Supervisor just like his but hes the "charge nurse" and I'm the "cart nurse"

mazy · Nov 11, 2010

What about the first shift nurse? Is that nurse as out of the loop as you feel? Because it is definitely weird that you are not being told what's going on with your patients. In most settings I have worked in the incoming and outgoing nurses provide all that info to each other so I'm wondering if the problem is that you are not getting a good report from the outgoing nurse....

Where I work, which I admit is a new set up for me, we have a "charge nurse" who comes and asks those of us working the carts to give her report on what's going on...the idea being that we're with the patients all day so we know better than anyone.

By the same token, they have a better "big picture" view of the patient's issues and care and can add other info to the picture.

Then we work collaboratively with that nurse on how to provide appropriate follow up, but we are usually the ones who do that follow up.

I work in a similar manner with the CNAs -- they have a unique and very "up close and personal" view of what's going on with the patients so I try to work collaboratively with them to get a full picture of what's going on throughout the shift. I always tell them to feel free to drag me away from what I'm doing if they are concerned about something.

But whatever is going on that seems like a very weird situation. The charge nurses sound removed from the hands-on patient issues, and then they are passing info on without your input, so there is no feedback on if that info is correct...the system seems to have you set up to be working against each other.

Something is wrong there. If you feel comfortable discussing this with the first shift nurse you might start there, or put out some feelers to the other nurses.

anonymous1919, LPN · Nov 11, 2010

What about the first shift nurse? Is that nurse as out of the loop as you feel? Because it is definitely weird that you are not being told what's going on with your patients. In most settings I have worked in the incoming and outgoing nurses provide all that info to each other so I'm wondering if the problem is that you are not getting a good report from the outgoing nurse....
Where I work, which I admit is a new set up for me, we have a "charge nurse" who comes and asks those of us working the carts to give her report on what's going on...the idea being that we're with the patients all day so we know better than anyone.
By the same token, they have a better "big picture" view of the patient's issues and care and can add other info to the picture.
Then we work collaboratively with that nurse on how to provide appropriate follow up, but we are usually the ones who do that follow up.
I work in a similar manner with the CNAs -- they have a unique and very "up close and personal" view of what's going on with the patients so I try to work collaboratively with them to get a full picture of what's going on throughout the shift. I always tell them to feel free to drag me away from what I'm doing if they are concerned about something.
But whatever is going on that seems like a very weird situation. The charge nurses sound removed from the hands-on patient issues, and then they are passing info on without your input, so there is no feedback on if that info is correct...the system seems to have you set up to be working against each other.
Something is wrong there. If you feel comfortable discussing this with the first shift nurse you might start there, or put out some feelers to the other nurses.

It could be 1st shift nurse I guess. Like one of my patients family members wants dementia added to her diagnosis and wants her on a medication for it. I found this out when the family member asked me if there were any updates on that... I had no clue she even wanted that... I had to ask the charge nurse about it and he told me about it and then called the family member and handled it. I would have only found out about it once a med was being added because I would see the new med in the mar. Oh and I still dont know if they are getting her on anything when/why/etcetc.

CloudySue · Nov 12, 2010

When I first started, all they wanted me to focus on at the start was the med pass and treatments. Everything was taken care of for me and I was so oblivious that first month or two that I didn't even know that I had other responsibilities, like PT/INR results and new coumadin orders, wound measurements, med reorders, Braden scales etc. The desk nurse quietly did them. In retrospect I realize that they didn't not want to overwhelm me. If you are only on your ninth day, you have a long way to go before you are efficient and comfortable in your job. You may even sink and hit rock bottom before you start to perk up and hit your stride. I remember by my sixth week, the enormity of my job hit me and I internally freaked for a while, especially when I first observed a code from beginning to end. Things will be placed on you, all in good time. Enjoy the ignorant bliss. Don't rush it or you WILL get spooked! (BTW, good job on the pneumonia catch. Newbies tend to make some good catches, with all that med/surg info still fresh in the brain!)