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

[nursefrances]

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?

[1fastRN]

I work in the ER so my discharges are quick. I also like to.discharge a patient ive had all shift since ive already established a relationship with them. I am able to answer their questions a bit easier since I followed them from start to finish. It also lightens the load for the oncoming nurse.... this way when I get report from them later on down the line, he or she is.more.likely to return the favor. But ive gotten assignments from nurses who leave me with a.million loose ends and I end up playing catch up for a couple hours... it sucks and.I hate to do it to someone else. Like the CP patient who sat for an hour prior to end if shift and the nurse never even lined and patient... really!? I'll be less likely to go out of my way to help you out during shift change if you're that kind of nurse.

Generally I find what goes around comes around, so you know which nurses are team players and plan your"favors" accordingly

[CodeteamB]

I work in the ER so my discharges are quick. I also like to.discharge a patient ive had all shift since ive already established a relationship with them. I am able to answer their questions a bit easier since I followed them from start to finish. It also lightens the load for the oncoming nurse.... this way when I get report from them later on down the line he or she is.more.likely to return the favor. But ive gotten assignments from nurses who leave me with a.million loose ends and I end up playing catch up for a couple hours... it sucks and.I hate to do it to someone else. Like the CP patient who sat for an hour prior to end if shift and the nurse never even lined and patient... really!? I'll be less likely to go out of my way to help you out during shift change if you're that kind of nurse. Generally I find what goes around comes around, so you know which nurses are team players and plan your"favors" accordingly[/quote']

I also work in the ER, and it sounds like we have different workplace cultures as I mentioned in my other post. Basically everyone where I work expects to be coming into a room full of work.

That being said a patient would never sit in a room for an hour without having the basics done. The expectation is that within 10 minutes of their butt hitting the bed someone has done the checkin and started interventions, and there would be hell to pay if someone wasn't doing it.

Basically I'll start what I can, and what's reasonable, But, in the last five minutes if my shift to start a bunch of non-stat orders will delay report, cause me to leave late and annoy my co-workers who want to hear what's up and get on with their day.

As to discharges, I will often take care of a patient all day and then have them discharged by another nurse. This is a task that can be easily done by any of our nursing staff so the floats will often do it for us.

[OlivetheRN, ADN, BSN, RN]

Day starts out crazy, but by 5 it's leveled off some. Discharge two pts at 5:30 and miraculously, no one in the waiting room. My other two are stable and just waiting on beds on the floor, all orders complete. Awesome. Get nervous, because two empty beds and no one waiting means it's gonna be a doozy. 6:50 rolls around and two EMS encode, and you guessed it, I had the only two rooms open. I get one going, while my charge takes the other. Start to give report to the oncoming nurse when charge sticks his head out of the other room and asks me to get a RIK and intubation roll. Walk into room to see 5 people holding pt down with doc at the head of the bed looking dumbfounded for a second, because apparently the pt had been darn near unresponsive 10 seconds ago. Long story short, I didn't get out till 7:55 and had my first delightful experience with the effects of bath salts.

[1fastRN]

I also woand yeark in the ER, and it sounds like we have different workplace cultures as I mentioned in my other post. Basically everyone where I work expects to be coming into a room full of work.

That being said a patient would never sit in a room for an hour without having the basics done. The expectation is that within 10 minutes of their butt hitting the bed someone has done the checkin and started interventions, and there would be hell to pay if someone wasn't doing it.

Basically I'll start what I can, and what's reasonable, But, in the last five minutes if my shift to start a bunch of non-stat orders will delay report, cause me to leave late and annoy my co-workers who want to hear what's up and get on with their day.

As to discharges, I will often take care of a patient all day and then have them discharged by another nurse. This is a task that can be easily done by any of our nursing staff so the floats will often do it for us.

Agree with most of what you said, and yeah might be a little different work culture. Just saying I'm scheduled until 730 so if im done with report by 715/720 I don't mind staying to wrap things up. Other nurses run out the door right after report but if I'm getting paid....why not? Plus I never want to give my superiors a reason to hassle me ie leaving early. On that note I TRY not to stay late either, for the same reason.

[CodeteamB]

Paid until 7:15, so another difference there.

[HikingEDRN, BSN, RN]

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.

Oh I'm sorry but I'm laughing. I think I'm laughing in relief that I am not the only person this happens to. It's especially annoying when your relief is late because they had to meet with someone or is just running late and you wouldn't have even seen the patient if they had gotten out to take report at the normal time!

I had such a hideous day in the ED today (isn't Valentine's Day supposed to be fun and romantic - HA!) that I can't think of where to begin...

Change of shift.....

I think all the nursing supervisors across the country gather together and assign beds at 6:50 pm (or am).

My fit for confinement suddenly started hyperventilating and said he was going to pass out and his face was tingling. He said he has a family history of anxiety ("my aunt, my grandma") and that he was about to have a "major" panic attack. I told him not to breathe so fast and the tingling would go away, and that if he passed out, it was no big deal because he was in a stretcher in the ED....

Don't you dare walk into the room with the LP kit, doc. We have to do a timeout, a consent hasn't even been signed, like it or not there is required documentation and you are not going to do this in the middle of shift change (patient was very stable) - grr!

Please stop chatting - I need to give you report and you have 12 more hours to talk to your buddy. I really really want to go home (not a normal occurrence - I work with great people on all shifts).

"Oh, you are going home? Okay, thanks for taking care of me. By the way, is this medicine supposed to make me itch all over and, oh, look at this rash..."

My trauma room was empty or underutilized all day (unheard of). 6:50 triage nurse running back with a blue, unresponsive man slumped in a wheelchair not breathing (that actually didn't delay me too much - a little narcan pinked him up nicely and he started talking to us).

Ugh, hope I'm not being too negative - very rough day!

[HyperSaurus, RN, BSN]

"Oh, you are going home? Okay, thanks for taking care of me. By the way, is this medicine supposed to make me itch all over and, oh, look at this rash…"

*facepalm*

[1fastRN]

Haha I can definitely relate to all of these! And yup love when they wait until shift change to assign beds. I love when my ICU patient gets a bed at 6am and the nurse in the unit won't take report... giving me the run around. All I want to do is bring my patient up so the next shift doesn't get stuck holding them. Plus I know the patient well enough to give report...and I don't really want to have to endorse them to the oncoming shift. I can see it from both ends but come on! Wouldn't it be best to get this critical patient to the ICU ASAP so they can get the care they need?! Sometimes I want to just bring the patient up and give report face to face but I'm sure that'd warrant a write up!

I had a rough night the other evening as well... shift change and all of a sudden my patients are angry and uncooperative when they've been fine for 12 hours. Really!

How about when your patient suddenly becomes lethargic... hypoglycemic or hypotensive? It's like shift change is the perfect time to crap out.

Oh I'm sorry but I'm laughing. I think I'm laughing in relief that I am not the only person this happens to. It's especially annoying when your relief is late because they had to meet with someone or is just running late and you wouldn't have even seen the patient if they had gotten out to take report at the normal time!

I had such a hideous day in the ED today (isn't Valentine's Day supposed to be fun and romantic - HA!) that I can't think of where to begin...

Change of shift.....

I think all the nursing supervisors across the country gather together and assign beds at 6:50 pm (or am).

My fit for confinement suddenly started hyperventilating and said he was going to pass out and his face was tingling. He said he has a family history of anxiety ("my aunt, my grandma") and that he was about to have a "major" panic attack. I told him not to breathe so fast and the tingling would go away, and that if he passed out, it was no big deal because he was in a stretcher in the ED....

Don't you dare walk into the room with the LP kit, doc. We have to do a timeout, a consent hasn't even been signed, like it or not there is required documentation and you are not going to do this in the middle of shift change (patient was very stable) - grr!

Please stop chatting - I need to give you report and you have 12 more hours to talk to your buddy. I really really want to go home (not a normal occurrence - I work with great people on all shifts).

"Oh, you are going home? Okay, thanks for taking care of me. By the way, is this medicine supposed to make me itch all over and, oh, look at this rash..."

My trauma room was empty or underutilized all day (unheard of). 6:50 triage nurse running back with a blue, unresponsive man slumped in a wheelchair not breathing (that actually didn't delay me too much - a little narcan pinked him up nicely and he started talking to us).

Ugh, hope I'm not being too negative - very rough day!

[Twinmom06, ASN, APN]

or when there is only one bed on the unit (we were fully staffed so not a big deal to get an admit) but the nurse that is getting the admit just had her patient fall while squatting over a hat to pee (not sure why the nice big bedside commode wasn't good enough for her, or even the bathroom that was 5 steps from her bed...) and you ask the ED to wait 5 minutes before putting the SBAR in so said nurse (not me) can get patient into bed, assessed and call the doc and family completed, and no lie, the patient rolled up the hallway within 2 minutes - which means the ED sent the pt with transport BEFORE they even called us....

[1fastRN]

or when there is only one bed on the unit (we were fully staffed so not a big deal to get an admit) but the nurse that is getting the admit just had her patient fall while squatting over a hat to pee (not sure why the nice big bedside commode wasn't good enough for her, or even the bathroom that was 5 steps from her bed...) and you ask the ED to wait 5 minutes before putting the SBAR in so said nurse (not me) can get patient into bed, assessed and call the doc and family completed, and no lie, the patient rolled up the hallway within 2 minutes - which means the ED sent the pt with transport BEFORE they even called us....

This happens from time to time, especially when the clerk gets so tied up and they "thought" they called to confirm the bed. The nurses used to be the ones to call and confirm but they've now delegated that to the clerk (they expect the nurses to do EVERYTHING!).

I also got a call from an angry ICU nurse after transport sent my patient to the unit without my knowledge. I hadn't even given report on the patient yet, and the patient was in the stretcher hooked up to the overhead monitor and the life pack monitor which was sitting on the bed. Our transporters usually KNOW when a patient is on a portable monitor that they need to go with a nurse. Typically, the transporters will ask us if the patient is ready to go to the floor even if it's a standard med-surg patient. I was ****** at the transporter because I got the brunt of it. I wasn't mad at her, I'd be ****** too if a patient just showed up without a nurse and without getting report.

Oh yeah, and the time my hypoglycemic patient "disappeared" to the floor without anyone mentioning this to me. I had treated the hypoglycemia as per policy, but did not follow up with a repeat finger stick because the patient was already gone. Yup, the nurse from the floor called me screaming. The patient was fine, but dang I hate when the transporters just take the patient without verifying with the RN that they're ready to roll.

[annie.rn]

I've had some real end of shift doozies but HyperSaurus' post takes the cake...yikes!

My big pet peeve is when I've busted butt to get everything done on time and then while I'm waiting to give report the critical labs start coming in as the AM labs are being run.

The other night I had two critical labs on two different patients. Spent 45 minutes getting call backs from doctors and processing a half a page of orders. Didn't get out until 0800.

Which leads to another peeve.... calling the primary doc to tell him of a critical value and him giving you orders to call all the consult docs and let them know about the critical value, too.

He can't let the consult docs know?

[pinkiepieRN]

I had one this morning. I'm normally the house supervisor but I got pulled to the floor due to a last minute call out. I know the general details of these residents, but am not necessarily 100% on their histories and what's happened over the course of the week, unless they're unstable or have changes in orders or status.

Transportation comes to pick up this lady for dialysis at 0530. She's in NAD albeit a bit hypertension (but she says she's always that way when she wakes up, especially before dialysis), has a breakfast and the EMTs tell me that they'll hook her up to O2 in the ambo because we couldn't find a wheelchair with an O2 caddy. Well, she missed her Thursday treatment due to the snow and they didn't get her in there on Friday so she was fluid overloaded. I'm in the middle of getting report when the incoming PT nurse who doesn't know this resident says, "Do we have patient XYZ? It's the ER." Yeah, it turns out she coded on them and has been admitted to ICU and they have no information on her because dialysis couldn't even give her a face sheet and the hospital was confused as to why she didn't have an ID band (we're a LTC facility, so that doesn't happen). The following then transpired:

Hospitalist: Why is she with you guys?

Me: Umm...lemme check the chart.

H: Why was she in the hospital before.

M: Again, the chart.

H: Why didn't she get her session on Thursday?

M: Ambo couldn't get here for transportation and the center was closed anyway.

H: Why didn't you guys reschedule for Friday?

M: First, I don't know because I wasn't here during the day on Friday. Second, I assume it's likely because they were trying to get back on schedule so their Wednesday patients who didn't receive treatments on Wednesday didn't miss treatment. Either way, she seriously was in no distress for me, no complaints, no SOB, headache, dizziness or pain.

H: You know she was in cardiac arrest. Arrived at the dialysis center with SOB, was weak and c/o pain.

M: I do now. I assumed they started her treatment. No one told me anything until you just called.

Longer story short, I ended up copying everything from her previous hospital admission, advanced directives, med orders, Kardexes (76 pages total) AND wrote an extensive transfer note. I didn't leave until 8:30 (an hour late) and even then I was worried about leaving in case the hospital called back, because she was technically my resident when she went to the ER.