It's end of shift and I'm leaving on time. Not!

[nursefrances, BSN, RN]

I was thinking about those shifts when everything seems to be going smooth, shift is almost over and you think "Yes! I might ACTUALLY leave on time today." You are mentally doing a happy dance, THEN something happens. It always does, right? Here are a few of those lovely little events:

I was closing up my charting, fifteen minutes left...woo hoo! Then I hear a little commotion down the hall. I am praying to the the end of shift gods, "Pleeease don't be my patient...." Yep. It's my patient. She tried to get to her bedside commode (she usually could) but lost her footing and slow motion like, slid to her butt. Another nurse witnessed it while helping his patient in another room. I see myself at the computer filling out an incident report in my near future. As I am walking to the patient's room I hear "Hey, nursefrances your ER admit is here." Really?!?

Then there is the patient who pulled out their___________ fill in the blank. For me it has been an NG tube and an IV that of course looked like a murder scene when I walked in.

Ooh, don't forget the patient who wants to go AMA "now" because they want a cigarette.

Once (or twice) realized the CNA forgot to empty the foleys and put the I&Os in the computer and went home already. On a side note our CNAs were awesome and this didn't happen often.

Also, the doctor who called 5 minutes before end of shift and wanted me to take down 2 pages of orders.

I am sure I have more but can't remember right now.

Anyone want to share?

[weirdscience]

Oh yeah...new admit at 0200, orders to transfuse, pt with some sort of dementia+anxiety combo, family leaves bedside. First unit finally ready at 0500, sit with pt for the requisite 15 minutes, vitals stable, pt reports no change in baseline. Leave the bedside, at 0600 while I'm calling report pt starts calling out, "my chest hurts! I'm nauseous!" Nooooooo.

[1fastRN]

Patient is stable his whole ER stay, came in for opiate "overdose". But he was aaox3 and ralking for hours. Im giving report and i decide to do it bedside for this patient. Whelp, now hes unresponsive even to a sternal rub. Give him several rounds of narcan with no response. Time to intubate.... Now i feel like i just look like a ****** nurse to the oncoming nurse. Come to find out he took a bunch of methadone and marcan pretty much has no effect on methadone. Why did he have to crap out right at change of shift?!

I work 7p-7a. Finally it is time to go home and im waiting for my relief. Well, in rolls the hypotensive septic hypoxic nursing home special! Now im busting my hump to get a blood pressure and regulate their temperature. So much fun!

I swear so many people crap out at change of shift.

Meanwhile 659am rolls around and the ER doc finally decides to discharge a handful of my patients and put in orders so they can give report and go home. Now i have to scramble and get all this stuff done so i dont leave a ton of work for the oncoming nurse. Really doc!?

[WoosahRN, MSN, RN]

This is the start of a shift but I swear our neurosurgeon ALWAYS calls at 1930 which means I have just finished report and haven't seen the patient yet. I always tell them so and repeat what I just got in report. Sigh.

[Morainey, BSN, RN]

Get my post-op, get them settled and assessed and washed, "how's your pain?" "I can't believe it! ZERO out of 10!" All dressings clean, dry, and intact; here, have a sandwich.

Continue to round on patient hourly, pain continues to be 0. "I LOVE this hospital!" No nausea. Lovely clean dressings.

Bring around next shift nurse for bedside rounding and the patient is puking/ominously bleeding through dressing/in 10/10 "oh Jesus" pain. WTH

[Here.I.Stand, BSN, RN]

Grr, I was chastised for this at my last review. They're really trying to contain OT, and I'm frequently 10 min. or so over. (I have stayed longer, but that's not an everyday thing.) I work in a safety-net hospital and 1/4 hour per nurse adds up really fast... and this nurse doesn't work for free. I'm not clocking out until I'm leaving.

Anyway, once a couple months ago where my entire shift was fine. Slow, even--I was asking my colleagues if they needed help w/ anything. 6:55 comes, and the hyperbaric RN calls and says she's going to come get my pt for his dive at 7:15. (His chart had said his appt was 8:00.) Instead of starting report at 7:00, I'm getting my pt packed up to travel--IV pumps minimized, tubefeeding stopped, a.m. meds gotten ready to send, pain med given b/c she doesn't have way of securing controlled substances... Then she gets there, we have to get him onto her cart and out the door. It was close to 7:30 before we even started report.

Yeah I was a little annoyed. It was a Saturday a.m. so not like it was a big deal that I got home a little late, but I really hated having 1/2 hour of OT something like two wks after being told I need to get out on time for the budget's sake.

[Momtomykiddos]

Had one of those last week. There are the days when you know you aren't getting out on time, then there are the ones where it looks good. I work LTC, per diem so I work days or evenings, with little consistency as to which of the four "neighborhoods" I'm on. I was working evening, so 2-10:30. Had all of my meds done, treatments done, charting done. Night shift nurse arrives at about 10, starts getting report/counting since she's taking over all 4 carts. I would normally be third in line, but told her to go ahead with the other nurse since I had to take off a patch (confused, falls risk, likes to self transfer so she goes to bed late so we can keep an eye on her longer. She's sitting in her wheelchair, and the patch is on her back. I can't get to it, so I wait until she's in bed, so I can just go in and pull it while she's in bed). It's 10:25. I'm walking down the hall. Going to pull this patch, count and report off, then I'm out the door. I'm glancing in rooms as I walk down the hall. Look into one, and sure enough, LOL is sitting on the floor by her bed. She was fine, but fall out of bed=incident report, of course. And of course, she's still mine. Why couldn't she wait ten more minutes to want her shoes? And why did she want her shoes? Never could figure that out.

[HyperSaurus, RN, BSN]

It's 0400 and it's been a sloow night for me. I've seen all of my very easy patients, finished charting on them by 0200, everyone had been sleeping comfortably. I go in to Mr Observation Bowel Obstruction and in C-diff precaution's room to hang the one antibiotic I had that shift.

"I need to use to commode"

"Oh, sure, Let me help you with that."

Mumbles to self, "I need to check my sugar, I think it's low."

I grab the glucometer, and sure enough, it's 37. OK, call the noc hospitalist, no diabetic protocol had already been ordered.

Give the D50, change the fluids to D5W, start BG checks q hr.

It's 0500. I go to due another BG check, see how he responded to the D50. He's sitting on the side of the bed, having already vomitted 750mL of something that smells like C-diff (I have a very poor sense of smell, it took me until that moment to realise that C-diff does infact have a distinct smell). Hmm, and his belly is somehow more distended now than an hour ago. Ok, call noc hospitalist again for order for NG and x-ray. Sink the NG no problem. Oh hey, this isn't a portable x-ray, he actually needs to go down to the bowels of the facility for this, it's 0545 and logistics is at the airport, and I have no idea where he needs to go.

I talk to my awesome manager, who volunteers to take him herself, since she knows report is coming soon-ish.

I spend the next hour he's gone charting and finishing up loose ends. It looks like I'll still be able to go home on time.

It's 0730, I've just finished report, and I see Mr. Obs Bowel Obstruction being wheeled back in. I figure, "Eh, I'll help get him settled, it'll help out day shift."

I get him in bed and see that he's looking around for something, without success.

"Can I help you find something?"

"I need my nitro pills, do you think they're in my pocket?"

"Are you having chest pain?"

"I think so."

[nursefrances, BSN, RN]

Oh yes, I forgot about the "5 minutes left in shift" chest pain.

Or the ostomy bag that wants to leak and not reseal at the end of shift. Those are fun too.

Another that made me almost laugh was the cardiologist who wanted to see me at the nurses station. It was 1815, less than one hour left.....home stretch.

Doc says "Mr X says he is a little constipated so lets go ahead and do an enema. Also I want to start him on a heparin drip, and he needs tests xyz that you need to prep him for....(have a nice day)." Exit stage left. All I could say was uhhh, ok. Now I did pass some things off to the night shift as the meds were not in and the pump was not received but it still made my last hour very interesting. Can't we tell these doctors not to come within an hour window of before/after shift change?

[WoosahRN, MSN, RN]

As far as my time management I always try to have all maintenance stuff done by my second to last assessments (Q2 assessments) because I figure if something is gonna go wrong it's going to be my 0600 assessment. I swear the patient's and their families seem to know when it is shift change and when the worst time is to "misbehave". ?

[CodeteamB]

Meanwhile 659am rolls around and the ER doc finally decides to discharge a handful of my patients and put in orders so they can give report and go home. Now i have to scramble and get all this stuff done so i dont leave a ton of work for the oncoming nurse. Really doc!?

Either you are very kind to your co-workers, or you have a very different workplace culture than me, lol.

Orders I would take responsibility for at 0659 would be:

"Shock at 200"

"Prepare to intubate"

"Start CPR"

For everything else, well, It's a 24 hour game, and I played my half. Toodles!

[CodeteamB]

It never fails. If the code room is empty all night at 0645 you will hear "code team to resus 1, ETA 5 minutes" and it'll always be a doozy.