Lack of communication....This is NOT RIGHT!!!!

[cute_cabbage2005]

I work 7p-7a. Last night I got a patient from a nurse who was leaving at 11pm. He didnt bother to tell me I was getting a patient from him and didnt bother to give me a shift report. The charge nurse who assigned this patient to me didnt bother to tell me that I was getting this patient either. I find out that the patient was mine at 130am by the PCT who was reporting a sky high blood sugar. I was LIVID!!!! Nurses on that floor tell me that its my responsibility to check the shift assignments at 11pm and that is my responsibility. At that time I was running around like a chicken trying to keep up with my patient care.

This is NOT RIGHT. I feel the charge nurse and the exiting nurse could at least tell me that I was getting this patient. The exiting nurse just left a telephone shift report and then took off. What makes it more aggravating was this patient was in DKA and suicidal and I find out about it 2 1/2 hrs later from the PCT?????

This is a large floor in which I work in the back area and the charge nurse works up in the front area. The charge nurse could have called my cell phone to tell me I was getting this patient (if she didnt feel like walking all the way to the back area where I was) and the exiting nurse could have told me I was getting a pt from him with a face to face shift report.

Im still fuming about it. Am I right to be angry? If something had happened to the patient it would be my behind that would of got nailed.

[blondy2061h, MSN, RN]

Why wasn't the patient in the ICU if they were in DKA?

[Vito Andolini]

In my state, it is a law that the offgoing nurse must give the receiving nurse a report.

Furthermore, if you are unaware that you are supposed to receive a patient, how does that give the opportunity to decide whether or not to accept the patient? You do have a RIGHT to say yea or nay to accepting a patient. For instance, if you believe you cannot safely care for a patient (you're a general Peds nurse and you're assigned a NICU patient or your specialty is OR and you're pulled to Recovery room without proper orientation, or you get a patient who is your ex-spouse's relative and you never got along with this person; This stuff does happen.) In each instance, you would be perfectly justified in not establishing a nurse-patient relationship, in declining to care for the patient, or in accepting the assignment only under protest and under duress.

You must make it known, in writing, to your Manager, your Charge Nurse, to the DON, to HR, to Risk Management, to the hospital attorney, to Administration, to anyone and everyone you need to involve that the way patient assignments are currently done is dangerous to both you and to the patients, therefore, is not unacceptable and that you cannot and will not take responsibility for any patient without a full report, in person, from the offgoing nurse. Let it be known that the employer is at risk if they continue to allow nurses to "give" report the way this one did and if they allow nurses like yourself to have a "secret" assignment.

I hope you can take this stand without losing your job. But better to lose the job than your license.

Since you know the sloppy way they do the assignment, double check it often. But mostly demand that they do it properly. I'm surprised that no patient has ever suffered harm if they have been doing this a lot. Has it always been this way?

[Vito Andolini]

It was very wrong for the nurse before you not to say anything to you before leaving but isn't it your responsbility to find out who your patients are? Maybe I'm wrong, I don't know how it is done in your department. Since you were there at 7p you could have check the assisgnment chart and the if by 11p the nurse that was leaving had not spoke to you, maybe you could have spoke to that person before they left and all of this could have been avoided. I'm not trying to ruffle any feathers but just another way of looking at the situation if this is the norm for your department.

By law, at least in my state, it is required that the offgoing nurse give report to the receiving nurse. It is not the responsibility of a nurse to find out who is going to take the patients of an offgoing nurse.

[Vito Andolini]

You had a patient for 2 1/2 hours that you didn't know about? You've just described one of my recurring nightmares!

You have every right to be angry. However wrong the practice, it sounds like this is the norm for your place of work. You can either try to change how things are done or change the way you do things and just make it a point to recheck your assignment at 11PM.

Suppose a nurse you work with gets sick or has an emergency and has to leave at midnight or 2 a.m. or 6 p.m. but you don't know about it. Now whose responsibility is it to clearly communicate the assignment to each nurse?

The time isn't the issue. The issue is what I said above.

[gonzo1, ASN, RN]

It is a JACHO rule that even if a report is in voice care there must be a chance for the accepting nurse to question the nurse giving up the patient. There fore since you did not have a chance to question the outgoing nurse there was a major violation.

You seriously need to do an incident report in order to cover your bum.

I believe that when a nurse is given another pt it is the charge nurse job to let said nurse know.

We do not have the time to keep running to see if we have a new pt.

When a situation like this happens also start charting with the line--assumed pt care at this time---

so you are not held responsible for anything that happened prior.

[WingsEarned21, LPN, RN]

Luckily when I was in the hospital setting my charge nurse and the leaving nurse always reported to me that I was getting another pt. and I got a face to face report.It does happen at times though or you have one pt. on the other side of the floor and have to keep reminding yourself you have that person because the rest of your pt.'s are all grouped together and you don't want to forget that one on the other side of the floor.You definetly need to make your NM aware and say something to the nurse that left also.If you do make an incident report or ever write someone up for something (anything) you should make a copy of it and keep it for your records.I have had too many writeups and incident reports make it to the circular file and nothing ever be done about it.

[pagandeva2000, LPN]

horrible. i see things like this happen often...patients transferred from clinics, er, other floors and the nurses have no idea that the client had been there for 6 hours-even more. i would at the very least speak to the nurse manager to alert them of this practice and ask for her intervention and solution. if nothing comes out of this-then, it shows the type of management you work under and may have to consider seeking greener (and safer) pastures...

[weesyanne]

Someone mentioned the fact that one of the National Patient Safety Goals is to improve the effectiveness of communication between caregivers by implementing a standardized approach to "hand off" communications, including an opportunity to ask and to respond to questions.

What happened to you violated this principle. Yes, you probably should have checked the board for any changes. Yes, your charge nurse should have notified you.

It sounds like a system problem for your hospital. I would suggest that you approach you manager and discuss your concerns with him or her, making note that this is something that JCAHO addresses and that you are concerned about patient safety in this type of situation.

[oramar]

You have to report this to manager. This is the kind of system problem that can lead to harm. I hope your manager is the type of person that will see the danger here. Totally unacceptable, is not enough just to push the blame on to you and walk away. Sooner or later someone will get hurt. That business about you checking the assignment again is baloney. They could add patients all night long to that list, what are you supposed to do check every five minutes.

[jadu1106]

:angryfire :angryfire :angryfire

hell yea, you have every right to be furious! as the posters state, you need need need to report this to the nurse manager, and if still nothing happens, then report to the next person on your chain of command. you are 100% right, it is your license and the patient's life on the line and if anything were to happen, you would be the one responsible, so yes absolutely, do something about it!!! that nurse who failed to give you report, write his ass up!!!!

jadu1106

[TangoLima]

I'm a new nurse, and a similar situation has happened to me on 2 occasions in the last 2 months.

I get my assignment and I'll have 4 or 5 patients with 1 or 2 empty rooms. I know to expect a patient to be sent to the floor, but somewhere between shift change and taking care of my other patients, I'm never notified that my patient is on the floor. We carry pagers, and we are supposed to receive a page that 1) our room has been assigned 2) a faxed report has been received and 3) the patient has arrived on the floor. However, on 2 separate occasions, I didn't receive the pages.

I never thought of filing an incident report, but if this happens again, I most certainly will.

[Bluehair]

I totally agree with the OP's regarding the JCAHO thing. Of course, this is assuming your facility is JCAHO accredited - not all are.

I also agree with the OP's who mentioned patient abandonment issues. I don't know how you could be considered legally responsible for the patient when you were never given report, never notified of your assignment or responsibilities to that patient.

There is likely some sort of policy in your facility that shows what the accepted procedure is for receiving an assignment/report on a patient, etc. Any deviation from that policy leaves those who deviated open for potential legal action if anything goes wrong.

DO point this out via incident report and email to your chain of command in whatever your policy manual says you must do for chain of command issues. Put it in writing and keep a copy. If anything happens in the future, you are more likely to be the one protected instead of disciplined. And, I am assuming, you are religious about giving report to others, making sure they know their patient is in the room, etc., right?! Lol!

ps - Whenever I transfer a patient to the floor from ICU, I chart in their record that a)the patient was made comf. in his/her new room, oriented to the environment and has the call bell, and b) was introduced to staff member X. (Or staff member X was in room with patient at time of transfer if patient has altered mental status). If I absolutely can't wait for someone to come into the room, I take the chart and hand it to the receiving nurse and let them know the patient is comf. in room xxx.

I like my butt just the way it is, and don't want anyone chewing on it.