Who orders a PRBC transfusion at 0659, I ask you? Who does that?
Oh wait, the NP for my patient last night, that's who. After I'd told the fellow at 0600 that the Hct was 30. And the baby has no peripheral access. And now, at 0659, I must make at least an attempt to start one. Me, who is the most hopeless IV starter on the floor. But still, in order to avoid the wrath of day shift, I must try. Because the blood was ordered on my time. At six. Fifty. NINE.
Specializes in Acute Care Cardiac, Education, Prof Practice.
We have a "golden hour" on admits, 645-745 so that we don't have this issue, however lots of orders get written late, and we often support each other by tidying up small tasks each day. I expect each of my three shifts to be a 13-14 hour day, and there are many day nurses who do the same for me, and the ones that don't often leave much more than just that last order or two.
I do agree with you though that this situation can be very frustrating, especially if you have children to come home to and a very tight schedule (we don't have kids just yet, so I have more time to lag about).
I think honesty is always the best policy, so I would have handed off the transfusion, with my apologies. I am sure most nurses understand. However it was a tiny baby in need of a transfusion I might just stay and help out of sympathy for the patient, but then again I work with fussy adults, so babies would be a breath of fresh air. :heartbeat
Unless this baby were actively crashing, this should have been handed off to the next shift. I would have gone so far as to take off the order, perhaps send the blood order to the lab (if they already had a current T&S), but the more time consuming part should be done by those who will be there for the next 8-12 hours.
An exception would be if you were particularly skilled at the ordered task - the IV whiz for example and could save the baby a lot of trauma of multiple sticks.
Our telemetry unit is notorious for transferring patients up at shift change. Never mind that we've had word and voice care for half of the shift. Outgoing shift will do the settling and vitals, which is great if you're coming on, but stinks if you're the one having to stay over after you've done 12 and you're dead on your feet.
My favorite is the crash c/s at 0700 or the time when the MD kept saying the pt needed a c/s but just let her labor, with lates!, all night long and then took her for c/s at 0658. And I was NOT happy! She decided so suddenly that I didn't have time to chart anything. I had to stay way late to catch up. And we always seem to have change of shift deliveries too. They aren't too bad though, you just chart the delivery, make sure baby is ok and hand off. At least you don't have to do the recovery.
For some reason, things tend to happen at change of shift!
For some reason, things tend to happen at change of shift!
-N
We got 28wk QUADS delivered at change of shift a couple of weeks ago. Thank goodness most of our nurses show up a little early to loiter in the breakroom, or the poor girl from day shift assigned to deliveries might have jumped out the window.
I had my first taste of this yesterday. I was told at 18:15 that report was on the phone for my new admit (this was the first I had heard I was getting one.) So I took report on this pt, who was coming from a satellite ER 30 minutes away. Like clockwork, the pt showed up at 18:50, while I was trying to get my other pts wrapped up (prn meds, a scheduled med I always forget till the last minute, making sure everyone was clean and happy).
So I went in the room, introduced myself, helped him change into a gown, oriented him to the room and call light, made sure he was safe and left the room. I found out who the pct was and informed her we had a new admit, so she got his vitals. I gathered as much admission paperwork as I could find (our unit is being remodeled and nothing is where it's supposed to be), and printed a monitor strip.
But that's all I did. I gave the oncoming nurse as much info as I knew, but everytime he asked "did you do X?" I had to say no. I offered to stay and help but he just kind of dismissed me. Everyone says I didn't need to do more than that, but I still felt bad. I don't like leaving things for the next nurse, but at the same time, I didn't want to neglect my other 3 patients and leave stuff for those 3 nurses to do too!
My favorite is the 0705 transfer from a neighboring hospital so they can go to heart cath. Umm, I have to give bedside report to at least 3 different nurses in 10 minutes. I can tuck you in, get your vitals and change your IV tubing to ours. And don't you DARE have chest pain.
Also this morning I got an order for a Foley at 0709. Six minutes? And the SA wanted it done THAT SECOND, even though I had just bladder scanned the man for something like 134 mls and the pt had no distress and a huge prostate to wrestle with.
I don't want the off-going nurse staying after her/his shift to take care of something that wasn't done before the begninng of my shift - it interferes my ability to start my day.
When an off-going nurse tells me that she/he wasn't able to get something done I will almost always say, "Don't worry about it, I'll take care of it."
I expect the same when I wasn't able to get something done.
knew of a day nurse who told a night nurse (who was to clock out at 6 am) that she had to stay in the building until 7:30 am to call the doc on her resident who had fallen during the night. Doc wouldn't answer the phone after 3am. He wanted all calls made to his office at 7:30am.
Sad day when nurses can't hand off simple tasks to another shift. I have in the past, with a brand new admit, had a night nurse come in and tell me to go home, she'd take care of it. She was a nurse truly from heaven.
Tait, MSN, RN
2,142 Posts
We have a "golden hour" on admits, 645-745 so that we don't have this issue, however lots of orders get written late, and we often support each other by tidying up small tasks each day. I expect each of my three shifts to be a 13-14 hour day, and there are many day nurses who do the same for me, and the ones that don't often leave much more than just that last order or two.
I do agree with you though that this situation can be very frustrating, especially if you have children to come home to and a very tight schedule (we don't have kids just yet, so I have more time to lag about).
I think honesty is always the best policy, so I would have handed off the transfusion, with my apologies. I am sure most nurses understand. However it was a tiny baby in need of a transfusion I might just stay and help out of sympathy for the patient, but then again I work with fussy adults, so babies would be a breath of fresh air. :heartbeat
:icon_hug:
Tait